Deep Vein Thrombosis (DVT)

Deep vein thrombosis occurs when blood clots form, typically, in a deep vein in the leg. Besides leg veins, the condition can affect veins in the pelvis.

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are two parts of the disease known as venous thromboembolism.

DVT is a medical urgency. The Centers for Disease Control and Prevention (CDC) say that 10–30% of patients who develop DVT in the leg experience fatal complications within a month of diagnosis.

Deep vein thrombosis (DVT) is blood clotting that develops with deep veins, often in the leg or pelvis.

If the thrombus, or clot, breaks off, doctors call this an embolus. Emboli can make their way to the lung, causing a Pulmonary embolism (PE).

Clots may also form in the veins of the arm, such as in patients with Paget-Schroetter syndrome.

According to a 2017 review, DVT is the most common cause of maternal death in the developed world.

DVT is extremely rare in children. According to a 2016 article, the most recent figures suggest that 0.30 in every 100,000 children under 9 years of age, and 0.64 in every 100,000 children aged between 10 and 19 years develop DVT.

Signs and Symptoms of Deep Vein Thrombosis

Some patients may develop DVT without noticing any symptoms. However, if symptoms develop, they may resemble the following:

A warm feeling in the swollen, painful region of the leg
Pain in the affected limb that begins in the calf
Swelling in the affected limb
Red or discolored skin

In most patients, deep vein thrombosis only develops in one leg. However, on rare occasions, both legs may have DVT.

If a clot dislodges and travels to the lung, the following symptoms may indicate pulmonary embolism:

A faster heart rate
Chest pain, usually more severe while breathing deeply
Rapid breaths
Slow breathing or sudden breathlessness

Complications of Deep Vein Thrombosis (DVT)

Following are the two possible complications of DVT:

Pulmonary Embolism

PE is the most common complication of deep vein thrombosis (DVT) and can be life threatening. It develops when a piece of a blood clot becomes dislodged and makes its way through the bloodstream into the lungs.

The clot becomes stuck and disrupts the flow of blood in one of the blood vessels in the lung. In mild PE, an individual may not be aware.

A medium sized clot may cause breathing problems and chest pain. In more severe cases, the lung might collapse. PE can lead to heart failure and can be fatal.

Post-Thrombotic Syndrome

This is more common among people with recurrent DVT. According to a 2016 review, a patient with post-thrombotic syndrome might experience the following symptom:

A persistent swelling in the calf
Feeling of heaviness in the leg
A pulling sensation in the leg
An excessively tired leg
Fluid buildup in the affected leg
Leg ulcers for patients with severe post-thrombotic syndrome
New varicose veins
Redness of the skin
Thickening skin around the area of the DVT

Causes of Deep Vein Thrombosis (DVT)

An individual may develop DVT when there is no clear cause. However, according to the National Heart, Lung, and Blood Institute (NHLBI), most patients with DVT develop the condition due to one or several risk factors and underlying conditions.

Age

Even though DVT may develop at any age, the risk increases as a person’s age advances.

According to the NHLBI, the risk of DVT doubles every 10 years after people reach 40 years of age.

Cancer

Some cancers have links to a higher risk of developing deep vein thrombosis (DVT), including late stage colorectal cancer, pancreatic cancer, and breast cancers.

Cancer therapies and procedures can also increase a patients risk of developing deep vein thrombosis (DVT), including chemotherapy, a central venous catheter, and certain cancer surgeries.

Genetics

A person may have an inherited disorder that makes blood clots more likely, such as Factor V Leiden thrombophilia.

However, even though having this condition increases the risk, only around 10% of people with it go on to develop unusual blood clots, according to Genetics Home Reference.

Heart Problems

Any condition that affects how well the heart moves blood around the body can cause problems with clots and bleeds.

Conditions such as heart attacks or congestive heart failure may increase a person’s risk of developing a blood clot.

Hormone-Based Medications

Females who take hormone-based birth control or are on a course of hormone replacement therapy (HRT) for menopause have a higher risk of DVT than those who do not take these medications.

Inactivity

If the human body is inactive for long periods, blood can build up in the lower limbs and pelvic area.

This situation is not a problem for most people. As soon as physical activity levels return to normal, blood flow speeds up. The vein and arteries redistribute blood around the body.

However, prolong inactivity means that blood in the legs may slow a person’s blood flow, increasing the risk of clots forming.

A person might be inactive for long periods due to a range of causes, including:

A disability that restricts movement
An extended hospital stay
Being immobile at home
Remaining seated during a long journey, such as a long flight

Injury or Surgery

An injury or surgery that damages veins can slow the flow of blood. This increases the risk of blood clots. General anesthetics can also widen the veins, making it more likely that blood pools and clots may form.

While this risk may affect anyone having major surgery, the NHLBI suggest that people receiving knee and hip surgery, particularly, have a high risk of developing DVT.

Irritable Bowel Disease

Patients with Irritable bowel syndrome (IBS) have a higher risk of DVT. A 2018 study found that the risk may be three to four times higher than that of a person without IBD.

Obesity

People with obesity experience more pressure on their blood vessels, especially those in the pelvis and legs.

For this reason, they may have an increased risk of DVT.

Pregnancy

As a fetus develops inside the uterus, pressure against a woman’s veins in the legs and pelvis increases. A woman has an increased risk of DVT during pregnancy until six weeks after delivering their baby.

Females with some inherited blood disorders, such as hereditary antithrombin disorder, have a higher risk of DVT during pregnancy compared with other women.

Sex

A person’s sex can affect their DVT risk.

Females are more likely than males to experience DVT around childbearing age. However, females have a lower risk after menopause than men do at the same age.

Smoking

Individuals who smoke tobacco regularly are more likely to develop DVT than people who have never smoked or have stopped.

Varicose Veins

Varicose veins are enlarged and misshapen veins. While they often do not cause health problems, particularly overgrown varicose veins may lead to DVT unless a person receives treatment for them.

Diagnosis of Deep Vein Thrombosis (DVT)

If an individual suspects that they may have DVT, they should seek immediate medical attention. The doctor will ask questions about symptoms and medical history before carrying out a physical examination.

A doctor will usually not be able to diagnose DVT through symptoms alone and may recommend the following tests:

D-dimer test: D-dimer is a protein fragment that is present in blood after a blood clot fibrinolysis degrades a blood clot. A test result revealing more than a certain amount of D-dimer indicates a possible blood clot. However, this test may not be reliable in individuals with certain inflammatory conditions and after surgery.
Ultrasound: This type of scan can detect clots in veins, alterations in blood flow, and whether the clot is acute or chronic.
Venogram: A doctor may request this scan if the ultrasound and D-dimer tests do not provide enough information. The doctor injects a dye into a vein in the foot, knee, or groin. X-ray images can track the dye as it moves to reveal the location of a blood clot.
Other imaging scans: Magnetic resonance imaging (MRI) and computerized tomography (CT) scans may highlight the presence of a clot. These scans may identify blood clots while testing for other health conditions.

Treatment of Deep Vein Thrombosis (DVT)

The treatment of deep vein thrombosis (DVT) aims to do the following:

Minimize the risk of other complications
Prevent a clot from becoming an embolism and moving into the lung
Reduce the risk that DVT might come back after treatment
Stop the growth of a clot

A doctor may recommend the following several methods to manage deep vein thrombosis (DVT):

Anticoagulant Medications

These are drugs that prevent the clot from growing, as well as reducing the risk of embolism. Two types of anticoagulants support the treatment of DVT: Heparin and warfarin.

Heparin has an immediate effect. For this reason, doctors usually administer it first through a brief course of injections lasting less than a week.

With warfarin, the doctor is likely to recommend a 3–6-month course of oral tablets to prevent recurrence of DVT.

Patients with recurrent DVT may need to take anticoagulant medication for the rest of their lives.

Compression Stocking

People wear these to help reduce pain, limit swelling, and prevent ulcers from developing. Stockings can also protect the individual from post-thrombotic syndrome.

Someone with deep vein thrombosis (DVT) will have to wear stockings at all times for at least 24 months.

Inferior Vena Cava Filter

A surgeon inserts a very small device, resembling an umbrella, into the vena cava, which is a large vein. The device catches blood clots and stops them moving into the lungs while allowing blood flow to continue.

Thrombolysis

Patients with more severe deep vein thrombosis (DVT) or pulmonary embolism (PE) require immediate medical attention. The doctor or emergency team administers drugs called thrombolytics, or clot busters, that break down clots.

Tissue plasminogen activator (TPA) is an example of a thrombolytic drug.

Excessive bleeding is a side effect of these drugs. As a result, medical teams only administer TPA or similar interventions in emergency situations.

Healthcare professionals administer TPA through a small catheter, or tube, directly into the site of the clot. Patients undergoing catheter-directed thrombolysis will be in the hospital for several days and have intermittent “lysis checks” to make sure the clot is breaking down appropriately.

Mechanical Thrombectomy

This is a relatively new technique that surgeons may use to treat a blood clot that occurs with deep vein thrombosis (DVT) or pulmonary embolism (PE).

The procedure involves using a catheter and a clot-removing device, which may be an aspiration catheter, a retrieval stent, or a pump.

Using imaging techniques for guidance, the surgeon:

inserts the catheter toward the area where the clot is
directs the clot-removing device through the catheter
removes the clot, using aspiration or a stent, and reestablishes blood flow

The authors of a 2019 review conclude that mechanical thrombectomy is safe and effective at treating DVT and reducing the risk of recurrence.

Prevention of Deep Vein Thrombosis (DVT)

There is no available method for screening patients for deep vein thrombosis (DVT). However, doctors recommend three ways for patients with one or several risk factors, such as recent surgery, to prevent the first occurrence of DVT.

These are:

Anticoagulant medication: A doctor may prescribe blood-thinning medication to reduce the risk of clotting before or after surgery.
Maintaining pressure on the at-risk area: This can prevent blood pooling and clotting. Medical professionals may recommend wearing compression stockings or a boot that fills with air to increase pressure.
Regular movement: A doctor might recommend staying highly mobile after surgery to stimulate blood flow and reduce the risk of a clot.

As smoking and obesity are also key risk factors, it may be advisable to quit smoking and engage in regular physical activity.

According to the American Heart Association (AHA), 150 minutes of moderate-to-high intensity exercise every week is the amount they recommend.

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Deep Vein Thrombosis (DVT)