Deep venous thrombosis

A blood clot in a deep vein, predominantly in the lower extremity, but may include the pelvis or upper extremity characterized by pain, swelling, warmth, and redness in the affected area, also called DVT.

Doppler ultrasound in long-axis view of axillary and subclavian vein thrombosis

DVT and PE

• Deep Vein Thrombosis and Pulmonary Embolism (DVT/PE) are often underdiagnosed and serious, but preventable medical conditions.
• Deep vein thrombosis (DVT) is a medical condition that occurs when a blood clot forms in a deep vein. These clots usually develop in the lower leg, thigh, or pelvis, but they can also occur in the arm.
• It is important to know about DVT because it can happen to anybody and can cause serious illness, disability, and in some cases, death. The good news is that DVT is preventable and treatable if discovered early.

Deep Vein Thrombosis of the leg.

Clinical Practice Guidelines for Venous Thromboembolism

• Venous thromboembolism (VTE), a term referring to blood clots in the veins, is an underdiagnosed and serious, yet preventable medical condition that can cause disability and death.
• The American Society of Hematologyexternal icon (ASH) recognizes the need for a comprehensive set of guidelines on the treatment of VTE to help the medical community better manage this serious condition. In partnership with the McMaster University GRADE Centreexternal icon, ASH brought together experts to address this challenge, including hematologists, other clinicians, guideline development specialists, and patient representatives. In November 2018, ASH announced the results of their collective efforts – the 2018 ASH Clinical Practice Guidelines on Venous Thromboembolism. Access the new guidelinesexternal icon.

Ultrasonography of thrombosis of the fibular veins, coronal plane, annotated

Complications of DVT

• The most serious complication of DVT happens when a part of the clot breaks off and travels through the bloodstream to the lungs, causing a blockage called pulmonary embolism (PE). If the clot is small, and with appropriate treatment, people can recover from PE. However, there could be some damage to the lungs. If the clot is large, it can stop blood from reaching the lungs and is fatal.
• In addition, one-third to one-half of people who have a DVT will have long-term complications caused by the damage the clot does to the valves in the vein called post-thrombotic syndrome (PTS). People with PTS have symptoms such as swelling, pain, discoloration, and in severe cases, scaling or ulcers in the affected part of the body. In some cases, the symptoms can be so severe that a person becomes disabled.
• For some people, DVT and PE can become a chronic illness; about 30% of people who have had a DVT or PE are at risk for another episode.

Risk Factors for DVT

Almost anyone can have a DVT. However, certain factors can increase the chance of having this condition. The chance increases even more for someone who has more than one of these factors at the same time.

Swedish algorithm of deep vein thrombosis

• Everyone Is at Risk. Some Factors Can Increase This Risk.
• View the full infographic
• Following is a list of factors that increase the risk of developing DVT:
• Injury to a vein, often caused by:
• Fractures,
• Severe muscle injury, or
• Major surgery (particularly involving the abdomen, pelvis, hip, or legs).
• Slow blood flow, often caused by:
• Confinement to bed (e.g., due to a medical condition or after surgery);
• Limited movement (e.g., a cast on a leg to help heal an injured bone);
• Sitting for a long time, especially with crossed legs; or
• Paralysis.
• Increased estrogen, often caused by:
• Birth control pills
• Hormone replacement therapy, sometimes used after menopause
• Pregnancy, for up to 3 months after giving birth
• Certain chronic medical illnesses, such as:
• Heart disease
• Lung disease
• Cancer and its treatment
• Inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
• Other factors that increase the risk of DVT include:
• Previous DVT or PE
• Family history of DVT or PE
• Age (risk increases as age increases)
• Obesity
• A catheter located in a central vein
• Inherited clotting disorders
• Preventing DVT
• female running

Prevention

Tips for prevention of DVT and PE:

• Move around as soon as possible after having been confined to bed, such as after surgery, illness, or injury.
• If you’re at risk for DVT, talk to your doctor about:
• Graduated compression stockings (sometimes called “medical compression stockings”)
• Medication (anticoagulants) to prevent DVT.
• When sitting for long periods of time, such as when traveling for more than four hours:
• Get up and walk around every 2 to 3 hours.
• Exercise your legs while you’re sitting by:
• Raising and lowering your heels while keeping your toes on the floor
• Raising and lowering your toes while keeping your heels on the floor
• Tightening and releasing your leg muscles
• Wear loose-fitting clothes.
• You can reduce your risk by maintaining a healthy weight, avoiding a sedentary lifestyle, and following your doctor’s recommendations based on your individual risk factors.

Signs and Symptoms DVT

• Know the Signs. Know your Risk. Seek Care.
• Everybody should know the signs and symptoms of DVT/PE, their risk for DVT/PE, to talk to their health care provider about their risk, and to seek care immediately if they have any sign or symptom of DVT/PE.
• About half of people with DVT have no symptoms at all. The following are the most common symptoms of DVT that occur in the affected part of the body:
• Swelling
• Pain
• Tenderness
• Redness of the skin

If you have any of these symptoms, you should see your doctor as soon as possible.

Pulmonary embolism

Signs and symptoms of pulmonary embolism

• Shortness of breath or difficulty breathing
• Faster than normal or irregular heart beat
• Chest pain or discomfort, which usually worsens with a deep breath or coughing
• Coughing up blood
• Very low blood pressure, lightheadedness, or fainting
• If you have any of these symptoms, you should seek medical help immediately.

Diagnosis of DVT and PE

• The diagnosis of DVT include the following:

A D-dimer test can also be used to assist with excluding the diagnosis or to signal a need for further testing. Diagnosis is most commonly confirmed by ultrasound of the suspected veins For diagnosing PE, a CT of the chest with and without contrast, C-XR, EKG, D-dimers, etc are used.

Treatment of DVT

• Medication is used to prevent and treat DVT. Compression stockings (also called graduated compression stockings) are sometimes recommended to prevent DVT and relieve pain and swelling. These might need to be worn for 2 years or more after having DVT. In severe cases, the clot might need to be removed surgically.

Treatment of PE

• Immediate medical attention is necessary to treat PE. In cases of severe, life-threatening PE, there are medicines called thrombolytics that can dissolve the clot. Other medicines, called anticoagulants, may be prescribed to prevent more clots from forming. Some people may need to be on medication long-term to prevent future blood clots.

Deep venous thrombosis Resources
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