|Preventing Deep Vein Thrombosis |
Preventing Deep Vein Thrombosis
What is Deep Vein Thrombosis?
Deep Vein Thrombosis (DVT) is a blood clot that forms in a vein deep in the body. Most develop in the lower leg or thigh, but they can also occur in your arm, chest and other locations.
Why is DVT a problem?
What causes DVT?
The danger of DVT is the possibility that the blood clot will break loose, travel through the blood stream and lodge itself in one of the smaller blood vessels of the lungs. This is called a pulmonary embolism (PE), a very serious condition. (Pulmonary=of the lung, Embolism=obstruction of a blood vessel by a blood clot that has broken loose.) The lodged blood clot then blocks blood flow to that area of the lung, causing serious life-threatening consequences and, potentially, death.
Poor blood flow (circulation) in your veins increases the risk for DVT. Poor blood flow can develop when you are not able to move for long periods of time. As a result, blood pools in your veins, and clots are more likely to form. Some causes include:
- Major surgery on your hip, leg, abdomen or chest
- A broken hip or leg
- Long-term bed rest
- Prolonged travel
- Inherited blood disorders that make your blood more likely to clot
- Cancer or cancer treatments
You have a greater chance for developing DVT if you:
- Have had DVT previously
- Are over the age of 40
- Are obese
- Have a history of circulatory or heart problems, stroke, varicose veins, or sickle cell anemia
- Are pregnant
- Take birth control pills or hormone replacement medication
- Have inflammatory bowel disease
A pacemaker, an implantable cardioverter defibrillator (ICD) or a catheter in an arm vein can increase your chances of developing DVT in the upper body, as these can irritate your vein walls and cause a clot to form. Having cancer near a vein is also a risk factor for DVT.
What are the signs and symptoms of DVT?
About half of all people who have DVT do not show symptoms. Symptoms depend on the location and the size of the blood clot and can include:
How is DVT diagnosed?
- Pain that is worse when walking or standing, typically in the calf region
- Swelling of the affected leg
- Warmth in the area that is swollen or painful
- Red or discolored skin in the affected area
If the physician suspects you have DVT, he or she will request a Duplex ultrasound
. This test uses high-frequency waves that allow the doctor to measure the rate of blood flow and see the structure of the veins and, sometimes, the clot. If the ultrasound does not provide enough information, a venogram
may be performed. A venogram is an X-ray with a dye injection that shows the veins and, sometimes, the clot.
If a PE is suspected, additional tests will be needed for diagnosis.
How is DVT treated?
Your physician can usually treat DVT with anticoagulation (blood thinning) medications, minimally invasive procedures or, rarely, surgery. The main goals when treating DVT are to stop the clot from getting larger, reduce the chance of developing another clot and prevent the clot from breaking off and moving to the lungs. Treatments may include:
- Bedrest for a few days
- Heat to relieve pain and reduce swelling
- Elastic compression stockings to reduce swelling and prevent blood form pooling in your legs
- Medications (anticoagulants/blood thinners), such as heparin, low molecular weight heparin (LMWH), warfarin (Coumadin)
- Minimally invasive procedure, such as:
Thrombolysis – a procedure that dissolves the clot. In this procedure, your doctor injects clot-dissolving drugs through a catheter directly into the clot. Your doctor may use thrombolysis if you are likely to develop a pulmonary embolism or if you have DVT in your arm.
Trellis Peripheral Infusion System – a procedure that isolates the clot and prepares the area for targeted treatment. It is designed to remove clots from the veins quickly in order to help restore normal blood flow and reduce symptoms.
Venous Thrombectomy – for people who have a severe form of DVT called phlegmasia cerulea dolens, which does not respond to non-surgical treatment. This surgery removes the clots from the veins. If not adequately treated, phlegmasia cerulea dolens can cause gangrene (death of tissue in the body that does not receive enough oxygen and blood), which can lead to amputation.
Vena Cava Filter – for people who are not candidates for blood thinning medication or if the medication did not reduce the clots. A vena cava filter is a device inserted into a major vein to prevent a blood clot that breaks away from entering the lungs. For very high risk patients, a filter may be used in addition to blood thinning medications.
Image reproduced by permission from the Society for Vascular Surgery. For more information, visit www.VascularWeb.org.
Nine Ways to Avoid
Deep Vein Thrombosis (DVT)
- Talk to a doctor about your risk factors.
- Elevate your legs while you are sitting.
- Avoid sitting or standing for long periods of time.
- Get out of bed and move around as soon as possible after having surgery or being ill.
- Avoid crossing legs.
- Keep hydrated by drinking at least six glasses of water a day
- If you have varicose veins, wear support stockings.
- Do not wear constricting garments on the legs.
- If you are on an airplane for a long period of time, get up and walk the aisles or exercise in your seat by rotating your ankles, lifting your knees and stretching your feet and leg muscles.