Deep Vein Thrombosis

Definition

Deep vein thrombosis (throm-BO-sis), or DVT, is a blood clot that can form in one or more of the deep veins in your body, usually in the lower leg or thigh. Blood clots occur when blood thickens and clumps together. DVT can cause swelling or leg pain, and occur without any warning or symptoms.

DVT is a serious condition because a blood clot in a deep vein can break off and travel through the bloodstream. When this occurs, the clot can lodge into the lungs or other parts of the body, blocking blood flow (pulmonary embolism). Pulmonary embolism (PULL-mun-ary EM-bo-lizm) or PE can damage lungs and other organs in the body and cause death.

PE is more likely to occur in the thighs than lower legs or other parts of the body. Blood clots also can form in veins closer to the skins surface, however these clots will not cause PE.

To find out more on how DVT forms and can cause PE, check out the National Heart, Lung, and Blood Institute animation.

Alternative Names

  • Thrombophlebitis
  • Venous thrombosis
  • Venous thromboembolism (VTE), which can be used for both deep vein thrombosis and pulmonary embolism (PE)
  • Blood clot in the leg

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Causes

  • Injuries caused by physical, chemical or biological factors that can damage a vein’s inner lining. Dependent upon your medical condition, DVT can develop and affect how your blood clots.
  • Not moving for long periods of time such as after surgery, following an accident, traveling, or when you are confined to a bed can cause blood flow to become sluggish or slow.
  • Inherited conditions (such as factor V Leiden) that cause your blood to thicken is more likely to clot than normal. Taking hormone therapy or birth control pills can also increase the risk of clotting.

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Symptoms

If not treated, both DVT and PE can cause seriously, possible life-threating problems.

Deep Vein Thrombosis:

Only about half of the people who have DVT have signs and symptoms. These signs and symptoms occur in the leg affected by the deep vein clot. They include:

  • Swelling of the leg or along a vein in the leg
  • Pain or tenderness in the leg, which you may feel only when standing or walking
  • Increased warmth in the area of the leg that’s swollen or painful
  • Red or discolored skin on the leg

Pulmonary Embolism:

Some people aren’t aware of a deep vein clot until they have signs and symptoms of PE. Signs and symptoms of PE include:

  • Unexplained shortness of breath
  • Pain with deep breathing
  • Coughing up blood

Rapid breathing and a fast heart rate also may be signs of PE.

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Exams & Tests

Your doctor will diagnose deep vein thrombosis (DVT) based on your medical history, a physical exam, and test results. He or she will identify your risk factors and rule out other causes of your symptoms.

For some people, DVT might not be diagnosed until after they receive emergency treatment for pulmonary embolism (PE).

Medical History:

To learn about your medical history, your doctor may ask about:

  • Your overall health
  • Any prescription medicines you’re taking
  • Any recent surgeries or injuries you’ve had
  • Whether you’ve been treated for cancer

Physical Exam:

Your doctor will check your legs for signs of DVT, such as swelling or redness. He or she also will check your blood pressure and your heart and lungs.

Common Tests:

The most common test for diagnosing deep vein blood clots is ultrasound. This test uses sound waves to create pictures of blood flowing through the arteries and veins in the affected leg.

Your doctor also may recommend a D-dimer test or venography (ve-NOG-rah-fee).

A D-dimer test measures a substance in the blood that’s released when a blood clot dissolves. If the test shows high levels of the substance, you may have a deep vein blood clot. If your test results are normal and you have few risk factors, DVT isn’t likely.

Your doctor may suggest venography if an ultrasound doesn’t provide a clear diagnosis. For venography, dye is injected into a vein in the affected leg. The dye makes the vein visible on an x-ray image. The x ray will show whether blood flow is slow in the vein, which may suggest a blood clot.

Other Tests:

Other tests used to diagnose DVT include magnetic resonance imaging (MRI) and computed tomography (to-MOG-rah-fee), or CT, scanning. These tests create pictures of your organs and tissues.

You may need blood tests to check whether you have an inherited blood clotting disorder that can cause DVT. This may be the case if you have repeated blood clots that are not related to another cause. Blood clots in an unusual location (such as the liver, kidney, or brain) also may suggest an inherited clotting disorder.

If your doctor thinks that you have PE, he or she may recommend more tests, such as a lung ventilation perfusion scan (VQ scan). A lung VQ scan shows how well oxygen and blood are flowing to all areas of the lungs.

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Treatments

Doctors treat deep vein thrombosis (DVT) with medicines and other devices and therapies. The main goals of treating DVT are to:

  • Stop the blood clot from getting bigger
  • Prevent the blood clot from breaking off and moving to your lungs
  • Reduce your chance of having another blood clot

Lifestyle Changes:

Certain lifestyle choices can help reduce your risk of deep vein thrombosis (DVT). For example, people who smoke, who are very inactive for long periods of time, or who are obese may have a greater risk of DVT, because these situations impair or decrease circulation. So making the decision to lose weight, live an active lifestyle, and not smoke may help you reduce your risk of this condition and its complications.

 Medications:

Anticoagulants

Anticoagulants (AN-te-ko-AG-u-lants) are the most common medicines for treating DVT. They’re also known as blood thinners.

These medicines decrease your blood’s ability to clot. They also stop existing blood clots from getting bigger. However, blood thinners can’t break up blood clots that have already formed. (The body dissolves most blood clots with time.)

Blood thinners can be taken as a pill, an injection under the skin, or through a needle or tube inserted into a vein (called intravenous, or IV, injection).

Warfarin and heparin are two blood thinners used to treat DVT. Warfarin is given in pill form. (Coumadin® is a common brand name for warfarin.) Heparin is given as an injection or through an IV tube. There are different types of heparin. Your doctor will discuss the options with you.

Your doctor may treat you with both heparin and warfarin at the same time. Heparin acts quickly. Warfarin takes 2 to 3 days before it starts to work. Once the warfarin starts to work, the heparin is stopped.

Pregnant women usually are treated with just heparin because warfarin is dangerous during pregnancy.

Treatment for DVT using blood thinners usually lasts for 6 months. The following situations may change the length of treatment:

  • If your blood clot occurred after a short-term risk (for example, surgery), your treatment time may be shorter.
  • If you’ve had blood clots before, your treatment time may be longer.
  • If you have certain other illnesses, such as cancer, you may need to take blood thinners for as long as you have the illness.

The most common side effect of blood thinners is bleeding. Bleeding can happen if the medicine thins your blood too much. This side effect can be life threatening.

Sometimes the bleeding is internal (inside your body). People treated with blood thinners usually have regular blood tests to measure their blood’s ability to clot. These tests are called PT and PTT tests.

These tests also help your doctor make sure you’re taking the right amount of medicine. Call your doctor right away if you have easy bruising or bleeding. These may be signs that your medicines have thinned your blood too much.

Thrombin Inhibitors
These medicines interfere with the blood clotting process. They’re used to treat blood clots in patients who can’t take heparin.

Thrombolytics
Doctors prescribe these medicines to quickly dissolve large blood clots that cause severe symptoms. Because thrombolytics can cause sudden bleeding, they’re used only in life-threatening situations.

Surgery and Other Treatments:

Vena Cava Filter

If you can’t take blood thinners or they’re not working well, your doctor may recommend a vena cava filter.

The filter is inserted inside a large vein called the vena cava. The filter catches blood clots before they travel to the lungs, which prevents pulmonary embolism.  However, the filter doesn’t stop new blood clots from forming.

Graduated Compression Stockings

Graduated compression stockings can reduce leg swelling caused by a blood clot. These stockings are worn on the legs from the arch of the foot to just above or below the knee.

Compression stockings are tight at the ankle and become looser as they go up the leg. This creates gentle pressure up the leg. The pressure keeps blood from pooling and clotting.

There are three types of compression stockings. One type is support pantyhose, which offer the least amount of pressure.

The second type is over-the-counter compression hose. These stockings give a little more pressure than support pantyhose. Over-the-counter compression hose are sold in medical supply stores and pharmacies.

Prescription-strength compression hose offer the greatest amount of pressure. They also are sold in medical supply stores and pharmacies. However, a specially trained person needs to fit you for these stockings.

Talk with your doctor about how long you should wear compression stockings.

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Possible Complications

The two main complications of deep vein thrombosis (DVT) are pulmonary embolism and post-thrombotic syndrome.

A pulmonary embolism is the most serious complication of DVT. It happens when a piece of blood clot (DVT) breaks off and travels through your bloodstream to your lungs, where it blocks one of the blood vessels. In severe cases this can be fatal.

If you have had a DVT, you may develop long-term symptoms in your calf known as post-thrombotic syndrome. This affects around 20-40% of people with a history of DVT.

If you have DVT, the blood clot in the vein of your calf can divert the flow of blood to other veins, causing an increase in pressure. This can affect the tissues of your calf and lead to symptoms that include:

  • calf pain
  • swelling
  • a rash
  • ulcers on the calf (in severe cases)

When a DVT develops in your thigh vein, there is an increased risk of post-thrombotic syndrome occurring. It is also more likely to occur if you are overweight or if you have had more than one DVT in the same leg.

When to contact a medical professional:

Call your doctor if you experience:

  • Sudden shortness of breath
  • Sharp chest pain that sometimes becomes worse with deep breathing or coughing
  • Coughing up blood
  • Fainting
  • Rapid pulse or irregular heartbeat
  • Anxiety or sweating
  • Swelling, warmth, or tenderness in the soft tissues of your leg. Swelling may also appear as a swollen ridge along a blood vessel that you can feel
  • Pain in your leg that gets worse when you stand or walk. This is especially important if there is also swelling or redness in your leg

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Preventions

You can take steps to prevent deep vein thrombosis (DVT) and pulmonary embolism (PE). If you’re at risk for these conditions:

  • See your doctor for regular checkups.
  • Take all medicines as your doctor prescribes.
  • Get out of bed and move around as soon as possible after surgery or illness (as your doctor recommends). Moving around lowers your chance of developing a blood clot.
  • Exercise your lower leg muscles during long trips. This helps prevent blood clots from forming.

If you’ve had DVT or PE before, you can help prevent future blood clots. Follow the steps above and:

  • Take all medicines that your doctor prescribes to prevent or treat blood clots
  • Follow up with your doctor for tests and treatment
  • Use compression stockings as your doctor directs to prevent leg swelling

Travel Tips:

The risk of developing DVT while traveling is low. The risk increases if the travel time is longer than 4 hours or you have other DVT risk factors.

During long trips, it may help to:

  • Walk up and down the aisles of the bus, train, or airplane. If traveling by car, stop about every hour and walk around.
  • Move your legs and flex and stretch your feet to improve blood flow in your calves.
  • Wear loose and comfortable clothing.
  • Drink plenty of fluids and avoid alcohol.

If you have risk factors for DVT, your doctor may advise you to wear compression stockings while traveling. Or, he or she may suggest that you take a blood-thinning medicine before traveling.