Deep Vein Thrombosis

DEEP VEIN THROMBOSIS

Deep vein thrombosis (DVT) occurs when a blood clot forms in a vein that is located deep inside the body. A blood clot is a mass of blood that has turned to a solid state.

Typically forming in the thigh or lower leg, deep vein blood clots can also develop in other areas of the body. The condition can cause leg pain or swelling, but also can occur with no symptoms.

DVT can also develop if one suffers from certain medical conditions that affect how the blood clots. It can also happen if one remains immobile for long periods, (e.g. after surgery or an accident when you're confined to bed).

DVT can be very serious because blood clots in the veins can break loose and travel all the way into the lungs, where it will have the potential of blocking blood flow (pulmonary embolism).

SYMPTOMS OF DEEP VEIN THROMBOSIS

Symptoms may include:

• Swelling in the foot, ankle, or leg. (Usually on one side),
• Severe, unexplained pain in the foot and ankle,
• A part of skin that may feel warmer than other part,
• Skin over affected area may become discolored.
• Cramping pain in the affected leg (usually begins in the calf),

People with blood clot in the arm (upper extremity DVT), may also not experience symptoms but If they do, the common symptoms may include:

• Neck pain
• Shoulder pain
• Swelling in the arm or hand
• Skin discolor
• Pain which moves from the arm to the forearm
• Weakness in the hand

Most patients may not find out that they suffer from deep vein thrombosis until they have had to go through emergency treatment for relate conditions like blood clot in the lung (pulmonary embolism).

A pulmonary embolism occurs when a DVT clot moves from the arm or leg into the lung. The blockade of an artery in the lung is a life-threatening condition and requires emergency care.

CAUSES/ RISK FACTORS

DVT is caused by blood clot. This clot blocks a vein, and prevents blood from properly circulating in the body. Clotting may occur for several reasons among which are:

• Injury: A blood clot may form as a result of damage to the wall of a blood vessel, it can narrow or block blood flow.
• Surgery: During surgery, blood vessels can be damaged which can lead to the development of blood clots.
• Prolonged Bed rest: May also increase the risk of developing blood clots.
• Reduced mobility or inactivity: Blood can collect in your legs, especially the lower parts if one is unable to move for extended periods. When blood flow slows down, it can cause the development of bloodclots.
• Medications: Some medications increase the chances blood clotting. (e.g. Birth control pills or hormone replacement therapy)
• Inheriting a blood-clotting disorder: Some disorders that makes for blood clotting more easily is inherited. This condition may not cause blood clots unless combined with one or more other risk factors.
• Pregnancy: Pregnancy increases the pressure in the veins in the pelvis and legs. Women with an inherited clotting disorder are especially at risk of this condition.
• Being obese: Being overweight increases the pressure in the veins in within the pelvis and legs.
• Smoking: Smoking affects blood clotting and circulation negatively, which can increase the risk of DVT.
• Cancer: Some forms of cancer actually increases substances in the blood that may cause blood clotting. Some forms of cancer treatment may also increase the risk of blood clots.
• Heart failure: Patients with heart failure have limited heart and lung function. This increases the risk of DVT.
• Age: Though it can occur at any age, being older than 60 increases the risk of DVT.

COMPLICATIONS

Pulmonary embolism: This occurs when a blood vessel in the lung becomes blocked by thrombus (a blood clot) that travels to your lung from another part of your body, usually the leg. This condition is life-threatening, therefore it is important to watch for the signs and symptoms and seek medical attention if they occur.

Signs and symptoms include:

• Sudden shortness of breath
• Chest pain or discomfort (that worsens when one takes a deep breath or coughs)
• Feeling lightheaded, dizzy or fainting
• Rapid pulse
• Coughing up blood
• Postphlebitic syndrome- Also called post thrombotic syndrome, this is a common complication that occurs after Deep Vein Thrombosis. Damage to your veins from the blood clot reduces blood flow in the affected areas, which can cause:
• Persistent swelling of your legs (edema)
• Leg pain
• Skin discoloration
• Skin sores

TREATMENT

DVT is a serious medical condition. Immediately symptoms of DVT is suspected a healthcare provider must be consulted to check out the symptoms. Basically, treatments for DVT focuses on preventing the clot from growing.

• Doctors might prescribe medications that will thin-outthe blood. This will make it harder for the blood to clot, and also keep existing clots as small as possible. In the long run, it decreases the chances of developing more clots.
• If the case of DVT is severe or the blood thinners fail, doctors might use thrombolytic drugs. People with upper extremity DVT may also benefit from this medication.Thrombolytic drugs act by breaking up clots and are given intravenously.
• Compression stockings: Wearing compression stockings can prevent swelling and might lower your chance of developing clots especially if one is at high risk for DVT. It may be recommended that these stockings which come up to just below the knee or right above it are worn every day.
• Filters: This form of treatment helps to prevent pulmonary embolisms by stopping clots from entering the lungs. If a patient is unable to take blood thinners, a filter might be put inside the large abdominal vein called the vena cava to stop the clots. Filters however, have risks. If left for too long, they could actually cause DVT. Filters therefore should be used for short periods, until the risk of thromboembolism is reduced and then blood thinning medications can be used.
• Surgery: Surgery may be suggested to remove a DVT clot in an arm or leg. Typically, this is only recommended in the case of very large blood clots or clots that are causing serious issues, like damaged tissue. The surgeon will make an incision into a blood vessel, locate and remove the clot. Then, repair the blood vessel and tissue afterwards. In some cases, a small inflating balloon to keep the blood vessel open while they remove the clot will be used. The balloon is removed with the clot.

No surgery is without risks, as such many doctors will only use this treatment in severe cases. Risks range from infection, damage to blood vessel, and excessive bleeding.

• DVT exercise

One stands a greater risk of developing a blood clot if he/she sits for long periods. Some specific exercises can be done while sitting to keep the legs in motion and help circulate blood

• Knee pulls: With the leg bent, raise the knee toward the chest. Wrap your knee with your arms for a greater stretch. Hold this position for several seconds, then do the same exercise on the other side. Repeat these stretches several times.
• Foot pumps: With the feet flat on the floor, keep the balls of the feet on the floor, and raisethe heels. Hold for a few seconds, then lower the heels. Raise the balls of thefeet off the floor, keeping the heels in place. Hold for a few seconds, then lower the balls of the feet. Repeat these pumps several times.
• Ankle circles: With both feet lifted off the floor, draw circles with the toes in one direction for a few seconds. Switch directions, and draw circles for a few seconds. Repeat this exercise as many times as possible.

PREVENTION

• Avoid immobility: Patient must try to move as much as possible. Resist crossing the legs as this can hamper blood flow. While on a long distance trip by car, endeavor to stop every hour or so and walk around.
• If on a plane, patient should stand or walk occasionally. Otherwise, exercise the lower legs (as in DVT exercise).

Make lifestyle changes - Lose weight, Quit smoking and exercise. (Regular exercise lowers the risk of blood clots). This is especially important for people who sit a lot or travel frequently.

DVT IN PREGNANCY

Being pregnant increases the risk of DVT. In fact, pregnant women are  more likely to develop DVT than women who aren’t pregnant.

During pregnancy, the level of blood-clotting proteins increases, while the level of anti clotting proteins fall. The elevated risk continues until about six weeks after giving birth. Bed rest or a cesarean delivery also adds to the risk of having DVT.

Women therefore must remain watchful for symptoms of DVT while you’re pregnant