Deep vein thrombosis (DVT) (2023)

overview

What is deep vein thrombosis?

Deep vein thrombosis (DVT, also called venous thrombosis) occurs when a thrombus (blood clot) forms in the deep veins of your body because your veins are injured or because blood flows through them too slowly. Blood clots can partially or completely block blood flow in the vein. Most DVTs occur in the lower leg, thigh, or pelvis, but they can also occur in other parts of the body, such as the arm, brain, intestines, liver, or kidneys.

What is the danger of DVT?

While DVT itself isn't life-threatening, blood clots can break loose and travel through the bloodstream. Apulmonary embolism(PE) occurs when migrating blood clots (emboli) lodge in the blood vessels of the lungs. Because this can be a life-threatening condition, it requires prompt diagnosis and treatment.

Half of people with DVT in the legs develop symptoms of intermittent leg pain and swelling that can last for months to years. These symptoms are called postthrombotic syndrome and can occur due to damage to the valves and lining of the veins, causing more blood to "pool" than it should. This increases pressure in the veins, causing pain and swelling.

Characteristics of this condition include:

• puddle of blood.
• Chronic swelling in the legs.
• Increased pressure in the veins.
• Increased pigmentation or discoloration of the skin.
• Beingeschwüreknown as venous stasis ulcers.

What is the difference between DVT and superficial vein thrombosis?

Asuperficial vein thrombosis(also called phlebitis or superficial thrombophlebitis) occurs when blood clots form in a vein near the surface of the skin. These types of blood clots rarely travel to the lungs unless they first make their way from the superficial system to the deep venous system. Although a doctor can diagnose superficial venous clots with a physical exam, they can only diagnose DVT with an ultrasound.

How common is deep vein thrombosis?

Approximately 1 to 3 in every 1,000 adults in the United States will develop a DVT, or pulmonary embolism, each year, and up to 300,000 people will die each year as a result of DVT/PE. It is the third most common vascular disease after heart attacks and strokes. Acute DVT/PE can occur at any age but is less common in children and adolescents and more common in people over 60 years of age. Surgery. The reason DVT is more common after a hospital stay is because you are in bed most of the time, rather than moving around as you normally would.

symptoms and causes

What are the symptoms of deep vein thrombosis?

DVT usually forms in the veins of the legs or arms. Up to 30% of people with DVT have no symptoms, but sometimes the symptoms are very mild and not a cause for concern. Symptoms of acute DVT include:

• Swelling of the leg or arm (sometimes this happens suddenly).
• Leg or arm pain or tenderness (may only occur when standing or walking).
• The swollen or painful area of ​​the leg or arm may be warmer than usual.
• Egg peel discolored red.
• Veins near the surface of the skin may be larger than normal.
• Abdominal pain or pain in your flanks (when blood clots affect the deep veins of the abdomen).
• Severe headache (usually sudden) and/or seizures (when blood clots affect the veins in the brain).

Some people don't know they have DVT until the clot moves from the leg or arm and travels to the lungs. Symptoms of acute Parkinson's disease include chest pain, shortness of breath, coughing up blood, dizziness and fainting.

It's important to call your doctor or go to the emergency room right away if you experience symptoms of DVT.Don't wait to see if your symptoms go away. Get treatment right away to avoid serious complications.

What causes deep vein thrombosis?

These conditions can increase your risk of deep vein thrombosis:

• a... havehereditary disease (genetic)increases the risk of blood clots.
• have cancer and some of its treatments (chemotherapy).
• You or your family have a history of deep vein thrombosis.
• Restricted blood flow in a deep vein due to injury, surgery, or immobilization.
• Not moving for a long time, e.g. B. sitting in a car, truck, bus, train or plane for a long time, or standing still after an operation or a serious injury.
• Be pregnant or have recently given birth.
• Being over 40 years of age (although DVT can affect people of any age).
• being overweight/obese.
• An autoimmune disease such as lupus, vasculitis orInflammatory Bowel Disease.
• consumption of tobacco products.
• have varicose veins.
• taking birth control pills orhormonal therapy.
• Have a central venous catheter or pacemaker.
• To haveCOVID-19.

diagnosis and testing

How is DVT diagnosed?

Your doctor will perform a physical exam and review your medical history. You will also need to undergo imaging tests.

Tests to diagnose DVT

duplex venous ultrasound. This is the most common test used to diagnose DVT because it is noninvasive and widely used. This test uses ultrasound waves to show blood flow and blood clots in the veins. A vascular ultrasound technician applies pressure while scanning your arm or leg. If the pressure isn't squeezing the vein, it could mean a blood clot is present. If duplex ultrasound results are inconclusive, your doctor may use another imaging test

Venography. In this invasive test, your doctor numbs the skin on your neck or groin and uses a catheter to inject a special dye (contrast agent) into your veins to see if blood clots are partially or completely blocking blood flow in your veins. his veins. Venography is rarely used today, but is sometimes necessary

Magnetic resonance imaging (MRI)or magnetic resonance venography (MRV).MRIs show images of organs and structures in your body. MRV shows images of veins in specific locations in your body. In many cases, MRI and MRI can provide more information than a duplex ultrasound or CT scan.

Computed tomography (CT)is a type of X-ray that shows structures in your body. Your doctor can use a CT scan to find a DVT in your abdomen, pelvis, or brain, as well as blood clots in your lungs (pulmonary embolism).

If your doctor thinks you have a genetic or acquired bleeding disorder, you may need special blood tests. This can be important when:

• You have a history of blood clots that your doctor cannot assign to any other cause.
• you have a blood clot in an unusual place, e.g. B. in a vein in the intestine, in the liver, in the kidneys or in the brain.
• You have a strong family history of blood clots.
• You have a family history of a specific genetic bleeding disorder.

management and treatment

Activity Policies

DVT can initially make it difficult to move due to pain and swelling in the legs. But you will be able to slowly return to your normal activities. If your legs are swollen or heavy, lie on the bed with your heels 5 to 6 inches apart. This helps improve circulation and reduce swelling.

Next to:

• Exercise your calf muscles if you sit for a long time.
• Get up and walk around for a few minutes every hour while you're awake, and especially during a long-haul flight or car ride.
• Wear knee-high compression stockings. They minimize leg pain and swelling by at least 50% when used daily.
• Avoid activities that can cause serious injury.
• Always stay hydrated, especially when travelling.

What treatments are available for people with deep vein thrombosis?

Some people with DVT may need hospital treatment. Others can be treated on an outpatient basis.

Treatments include drugs called anticoagulants (blood thinners), compression stockings, and elevating the affected leg(s) at different times of the day. In a minority of cases, when DVT is extensive, invasive treatments (catheter procedures) may be needed.

The main treatment goals are:

• Prevent the clot from growing and affecting other veins.
• Prevent the clot from dissolving in the vein and traveling to the lungs.
• Lower the risk of another blood clot.
• Prevent long-term complications of the blood clot (such as chronic venous insufficiency).

Important information about medication

• Take your medicines exactly as your doctor has told you.
• Arrange blood tests from your provider and keep all scheduled lab appointments.
• Do not stop or start taking any medicines (including medicines and dietary supplements you take without a prescription) without talking to your doctor.
• Talk to your provider about your diet. Changes may be needed depending on the medicine you are taking.

DVT treatments

anticoagulants(anticoagulants)

This type of medication makes blood clotting difficult. Blood thinners also prevent blood clots from growing and moving. Blood thinners do not dissolve or "melt" blood clots. Your body can dissolve a clot naturally, but sometimes clots don't go away completely. If they don't, they usually shrink and become small "scars" in the veins. These "old" blood clots can sometimes cause swelling in the legs, but often don't cause any symptoms.

There are different types of anticoagulants:Warfarin, heparin and oral Xa inhibitors. Your doctor will talk to you about the type of medicine that is best for you.

If you need to take a blood thinner, you may only need to take it for a few months (usually three to six months) or indefinitely. The timing of your treatment may vary depending on each individual's specific situation, including if:

• You've had clots before.
• You are being treated for another condition, such as cancer or an autoimmune disease (you may need to take a blood thinner if your risk of clotting is higher).

Bleeding is the most common side effect of blood thinners. You should see your doctor right away if you experience easy bruising or bleeding while taking this medicine.

compression stockings

You may need to wear graduated elastic compression stockings to improve or completely eliminate leg swelling. Damage to the tiny valves in the veins often causes this inflammation. You may also have swelling because the DVT is blocking blood flow in your vein. Most compression stockings are worn just below the knee. These socks are tight around the ankle and loosen as they get further from the ankle. This creates a slight pressure (compression) on the leg. Some people have to wear them for two years or more. Several clinical studies have shown that compression stockings improve symptoms of leg pain and swelling by at least 50% when worn daily from morning to night (no need to wear them overnight).

After the operation, your providers can placecompression deviceson the calves to put pressure on them. These machines tighten and loosen fabric-covered devices around your calves while you lie in bed. These devices help prevent DVT when you're in the hospital, but they're not prescribed outside of the hospital setting. Unlike compression stockings, which you can safely wear if you have a DVT in your leg, you should not wear these DVT prevention devices if you have a DVT.

DVT treatment procedure

If you cannot take anticoagulants or have blood clots while taking anticoagulants without forgetting the dose, a surgeon may need to perform a procedure to place an inferior anticoagulant.Vena-Cava-Filter (IVC). The procedure is performed under local anesthesia. Your surgeon inserts the IVC filter through a catheter into a large vein in your groin or neck, and then into the vena cava (the largest vein in your body). When blood clots break loose and travel in the veins of the legs, the IVC filter is designed to prevent large blood clots (emboli) from traveling to the lungs and causing a pulmonary embolism. Although an IVC filter helps prevent a pulmonary embolism, it doesn't prevent more blood clots from forming in the veins.

prevention

How can I reduce my risk?

Once you have a DVT, you need to reduce your risk of future DVT/PE clots by:

• Take your medicines exactly as your doctor has told you.
• Keep your follow-up appointments with your doctor and the lab. These tell your provider how your treatment works.
• Make lifestyle changes, e.g. B. Eating healthier foods, being more active and avoiding tobacco products.

If you've never had DVT but are at higher risk of developing one, be sure to:

• Train your calf muscles if you have to sit still for a long time. Get up and walk around at least every half hour on a long flight. Or get out of the car every hour when going on a long journey.
• Get out of bed and move as soon as possible after falling ill or undergoing surgery. The sooner you exercise, the less likely you are to develop DVT.
• After surgery, take medication or wear compression stockings (if your doctor prescribes them) to reduce the risk of a blood clot.
• See your doctor as directed and follow their recommendations to reduce the risk of a blood clot.

Outlook / Forecast

What can I expect if I have deep vein thrombosis?

It can take several months to a year for a DVT to go away, so you must continue to take blood-thinning medications as prescribed and continue to wear compression stockings until your doctor tells you to stop. You may need blood tests to make sure you're on the right dose of blood thinners. Your doctor may want to do more ultrasounds later to find out if the clot is still in the same place, is getting better, or is growing.

to live with

When should I see my doctor?

Let your doctor know if your symptoms don't improve. You should also tell him if you bruise very easily or if you have heavy periods.

When should I go to the emergency room?

You should seek emergency care if the blood thinners you are taking make you bleed profusely or cause problems such as bright red blood in your vomit or stool.

What questions should I ask my doctor?

• How long do I have to take blood thinners?
• When can I travel again?
• How often do I need follow-up appointments?

A note from the Cleveland Clinic

If you have deep vein thrombosis, you are not alone. At least 1 million Americans receive one each year. Several treatments can help, and your doctor can tailor your treatment to your situation. If you're prescribed blood thinners, be sure to keep all of your follow-up appointments to make sure you're getting the right dose.