Deep Vein Thrombosis or DVT, is a condition in which blood clots from in the deep veins of the body. DVT usually forms in the veins of the legs, but this can also occur in other veins of the body. If a blood clot (thrombus) dislodges and travels in your blood stream, it may get stuck in lungs, causing pulmonary embolism, or it may get stuck in an artery in the brain, causing a stroke rarely through a hole in the heart when there is Shunt. The deep veins differ from the superficial veins in that they are located deep in the body and cannot be seen, and more importantly, they have a direct connection to the heart and lungs.
WHAT ARE THE SYMPTOMS OF DEEP VEIN THROMBOSIS?
Approximately 50% of patients with DVT have no symptoms. When symptoms are present they include
- Swelling of the leg.
- Pain or tenderness in the leg, which is usually present in one leg and may only be present when standing or walking.
- Feeling of increased warmth in the area of the leg that is swollen or painful.
Red or discolored skin in the area of swelling or pain.
WHAT ARE THE RISKS FACTORS FOR DEVELOPING DEEP VEIN THROMBOSIS?
There are several factors that could increase the risk of DVT. The risk increases if several of the risk factors are present at the same time.
These risks include:
- Low blood flow in deep veins due to surgery, injury or lack of movement.(stasis)
- Other medical conditions, such as varicose veins or past history of blood clots, lungs, bowel disorder, cancers.
- Long periods of inactivity, such as bed rest, travel on long trips 8hrs.
- Pregnancy an especially delivery the first weeks after delivery of baby.
- Obesity, oral contraceptor pills (OCPs)
- Birth control pills or hormone therapy.
- A central venous cathters.
- Age above 60yrs (DVT can occur at any age)
How is DVT treated?
Medical therapy consists of:
- Leg elevation
- Compression stockings
Anticoagulation involves taking medicine that thins the blood. Thinning of the blood prevents further growth of the blood clot.
Acute DVT (leading to dschemia)
Your body also has natural substances in the blood which will dissolve the clot slowly over period of time, usually within 3months.
- Acenocoumerol, Warfarin are the oral blood thinning tablets.
- Heparin is the blood thinning agent, needs to be given intravenously / subcutaneously.
LMWH is a blood thinning agent which can be given in outpatient clinic and over long period of time.
CAN DVT BE PREVENTED WITH
- Regular exercise
- Smoking Cessasion
- Early activity after surgery, Low dose blood thinners,
- Elastic stocking, and compression pumps.
- Regular stretching and walking exercises for people who are Sedentary.
- While travelling long distances by car / by plane, stretch leg movements avoids DVT.
- Drinking lots of water adequately.
- If you feel you are at high risk, talk to your doctor about other ways to reduce your risk of DVT
How is Deep Vein Thrombosis diagnosed?
A suspicion of DVT is raised by physician after evaluating patient’s history and physical examination, and associated risk factors. The most important test performed to detect DVT is venous Doppler ultrasound. This test is quick, painless, and accurate in making the diagnosis. It can identify thrombus within the deep veins, and is also used to follow the patient’s response to therapy. Usually, this test is very helpful. Occasionally, for more complex cases, a contrast venography may be needed. This test involves injecting dye into the veins to visualize thrombus Some other tests also can be performed by physician depending up the condition and need.
- Magnetic Resonance Imaging (MRI):
- CAT scan
- D-Dimer Test.
WHAT SHOULD I DO WHEN DVT IS DIAGNOSED?
- Injection Heparin or LMWH should be taken (according to the body weight dose should be adjusted)
- Compression bandage or stocking for leg for 1 or 2 yrs.
- After 5 to 7 days when the pain or discomfort swelling started to come down, oral anticoagulant tablets should be started.
- Blood thinning tablets (Warfain or Acitrom ) affect should be monitored at weekly intervals with INR test.
- The INR test value should be maintained between 2.0 to 2.5
- If there is any suspicion of bleeding the tablet should be stopped and INR should be checked, the nearest doctor can be consulted and appropriate advice should be taken.
- Some patients will be asked undergo special tests to find out the cause for the thrombosis.
- If any time breathlessness or chest pain is noted, you contact the cardiologist as this could be due to clot in lungs.
- (Pulmonary embolism) and inform him about the blood clots in the leg.