Deep Vein Thrombosis

DEEP VEIN THROMBOSIS (DVT) –Veis carry blood back to the heart. There are two sets of veins .Superficial veins and deep veins. Majority of the blood is carried by the deep veins. DVT is a condition when blood clots develop in the deep veins blocking the flow of blood back to the heart.

SYMPTOMS

Since the clot blocks the return of blood the affected limb swells

Thigh/leg are swollen
warm and painful
Heaviness/difficulty in walking

Sometimes the clot may break off and travel through blood stream to the heart and block the blood vessel to the lung (Pulmonary embolism). If a large clot moves to the pulmonary artery it could be fatal.

Symptoms of Pulmonary Embolism are
Chest pain, Cough, Blood in the sputum and Breathing difficulty

Who are at risk for DVT?

RISK FACTORS

Prolonged sitting – Long flight journey more than 4 hours
- Long car trips.
Prolonged bed rest - More than 3 days of hospitalization (ICU care)
After major surgeries especially orthopedic, pelvic and cancer surgeries
After pregnancy and delivery
After accidents -Fracture in the lower limb
Cancers
Lower limb paralysis or stroke patients
Medicine intake – Estrogen for regulating menstruation
- Birth control pills
Varicose veins - Mostly clots develop in the superficial veins but can extend into the deep veins.
Hypercoagulability – There are some conditions which are genetic in which blood is more likely to spontaneously clot.
Overweight.

How is DVT diagnosed?

Clinically – Thinking of the possibility of DVT in risk groups. DVT must be ruled out if leg swelling develops in the risk group
Doppler ultrasound examination of the limb-A simple non- invasive test
ECHO to check the heart function. /CT angiogram lungs are needed to diagnose pulmonary embolism

How is DVT treated?

The aim of the treatment is to dissolve the clots and to prevent pulmonary embolism

Usually a drug that prevents clotting- heparin or its substitutes are injected. Later it is substituted with an oral anti- clotting tablet. The medicines will have to be taken for 3- 6 months depending on the extent of the clot.. Compression bandage or stockings also should be worn to reduce the swelling. In some patients if there is risk to life in the form of pulmonary embolism, a wire mesh filter (Vena caval filter) can be inserted into the bigger vein in abdomen to prevent the clot from moving to the heart. This filter can be removed once the risk of pulmonary embolism is reduced -usually after 2-3 months

Recent advances:

Clot in the vein can be sucked out and the residual clot can be dissolved quickly by inserting a tube into the vein and giving a strong clot dissolving medicine (Thrombolytic drug) over 24 hours. This is followed by continuing the regular anti- clotting medicine for 6- 12 months More effective clot dissolution is achieved by this method and long- term complications are also reduced

Preventive steps in DVT

Early mobilization after surgery
Avoid immobility for long hours. If the work demands sitting for a long time, get up and walk every hour or so. Frequent pedaling action of the foot also prevents blood stagnation
Talk to your doctor about preventing DVT if you are going to undergo a major surgery. Anti- clotting injection (Heparin or its substitutes) can be given to prevent clot from developing.
Stockings (Anti-embolic stockings) Compressions stockings are used in people who are at risk of developing DVT during travel and hospitalization
If you are pregnant or just delivered drink lot of fluids to prevent dehydration and keep walking
Keep drinking lot of water and keep walking inside the aircraft if you are taking a Trans- continental flight. Compression stockings are also helpful
Pedaling action of your foot works like a pump pushing the blood towards the heart.
Leg swelling can also be caused by Cardiac, Kidney and Liver diseases. If you develop swelling in your leg, go to your doctor immediately. A simple test called Doppler can pick up thrombosis which may save your life.

What are late problems of DVT?

Post-Phlebitic syndrome happens after some years. The clots in the deep veins disappear slowly over years. But the blood clot damages the one-way valves in the deep veins, and blood stagnates in the deep veins in legs, whenever the patient is upright.

What happens because of this?
Foot &/leg swelling on prolonged standing.
Pain on walking
Black pigmentation of the legs and Itching – mostly around ankle
Ulcer which heals and comes back quickly
Varicose veins
Bleeding from the varicose veins or the ulcer

How are they managed?
Medicines
Wound care
Compression stockings
Sclerotherapy
Rarely surgery

Sometimes the blood clot does not dissolve fully leaving a vein severely narrowed. This can be dilated by balloon angioplasty and a stent may be deployed to keep the vein open.
It is very difficult to completely cure this problem and one has to suffer this for a very long time. Hence it is very important to prevent Deep Vein thrombosis.