The National Institutes of Health (NIH) defines deep vein thrombosis or DVT as “a blood clot that forms in a vein deep in the body. Blood clots occur when blood thickens and clumps together.” Why is this hazardous to our health and potentially fatal? Because it is the job of our veins to return blood and fluid back to our heart via the lungs. If part of a DVT mobilizes into the circulation, it can land someplace harmful like the lungs and cause a pulmonary embolus or PE which can lead to respiratory distress or even death. DVTs may occur in any extremity but are most common in the legs.
The American College of Chest Physicians (ACCP) is the leading authority on the management of blood clots. They published guidelines for the diagnosis and treatment of deep vein thrombosis (DVT) and other blood clots in February 2012, which are considered the standard of care. The following information is courtesy of the patient information on their website: http://www.chestnet.org/Foundation/Patient-Education-Resources/DVT-Blood-Clots
Signs and Symptoms of Deep Vein Thrombosis (DVT)
- Swelling of the affected leg
- Pain or tenderness in the leg, may be worse with walking or standing
- Warmth in the area of the leg with the blood clot
- Red or discolored skin on the leg
- May also have no symptoms
Signs and Symptoms of Pulmonary Embolism (PE)
- Symptoms of PE:
- Difficulty breathing
- Sharp chest pain, worse on inspiration
- Coughing blood
- Light-headedness, fainting
- Symptoms of PE can be sudden and without warning
Common Causes or Risk Factors
- Surgery, injury – orthopedic procedures, falls, abdominal surgery
- Prolonged sitting during travel or prolonged bed rest during illness- blood is likely to pool and clot
- Genetic clotting disorder – abnormal clotting deficiencies can run in the family
- Pregnancy – hormones and fluid retention or leg swelling during can make you prone to clotting
- Estrogen use – birth control pills, hormone replacement therapy
- Cancer – certain cancers like lymphoma or leukemia
- Advanced age
- Obesity, sedentary lifestyle – risk of abnormal clotting increases two fold
- Prior history of DVT or PE
- Physical exam and history – reporting swelling and pain to your doctor is crucial, especially if you have had recent surgery or injury to a leg or arm.
- Ultrasound – a quick, non-invasive picture test of the blood vessels (veins) is the most common diagnostic tool
- MR or CT angiogram – radiologic picture tests that visualize blood vessels and surrounding organs. Non-invasive but both are more expensive than ultrasound with exposure to contrast dye and radiation for CT scan.
- Lung Scan/ VQ scan – a non-invasive nuclear med study that evaluates for PE
- Blood tests – D-dimer test is a highly sensitive test for the detection of a blood clot. Hypercoagulability tests may be performed to assess for clotting factors or deficiencies that may make you prone to developing blood clots
The primary goal of treatment is to prevent or minimize the complications of the clot.
- Anticoagulation is the mainstay of treatment. Blood thinning medications such a warfarin or xarelto keep the blood thin to prevent the clot from worsening while your body works to break down the blood. May be contraindicated if there is a bleeding history or fall risk.
- Inferior vena cava filter or IVC filter placement – mechanical protection in the form of a small mesh “umbrella” that is placed in the inferior vena cava to catch clots that may break from a leg DVT and be carried upstream. May be used in conjunction with anticoagulation medication or by itself, if blood thinners cannot be taken
- Venous thrombolysis and thrombectomy for large blood clots, depending on their location and severity of symptoms – a catheter procedure may be performed to break down the blood clot with injection of a potent blood thinner followed by extraction or removal of the clot.
- Serial monitoring with ultrasound
- Hematology consultation – expert evaluation to uncover the cause of the clot
Lifestyle/ Home Remedies
You can help decrease your risk of developing DVTs. If your health-care provider suspects you are at increased risk of a DVT or blood clot for any reason—genetics, upcoming surgery, limited movement—he or she may recommend:
• Preventive treatment with blood-thinning medication such as a daily aspirin
• Elastic compression stockings. These stockings, worn on the legs, provide gentle, graduated pressure to keep blood from pooling in the legs.
• Movement breaks on long trips. The overall risk of developing a DVT while traveling is low, although it increases on trips over 4 hours long, especially in long airplane or car trips. You can decrease this risk by moving and flexing your legs and periodically walking around. If you're at high risk of developing a DVT or blood clot, your health-care provider may recommend that you wear compression stockings while traveling.