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Deep venous thrombosisDefinition Deep venous thrombosis is a condition where there is a blood clot in a deep vein (a vein that accompanies an artery). Causes, incidence, and risk factors Deep venous thrombosis (DVT) affects mainly the veins in the lower leg and the thigh. It involves the formation of a clot (thrombus ) in the larger veins of the area. This clot may interfere with circulation, and it may break off and travel through the blood stream (embolize). A resulting embolus can lodge in the brain, lungs, heart, or other area, causing severe damage to that organ. Risks include prolonged sitting, bedrest, or immobilization (such as on long plane or car trips), recent surgery or trauma (especially hip, knee or gynecological surgery), fractures, childbirth within the last 6 months and the use of medications such as estrogen and birth control pills. Risks also include a history of polycythemia vera, malignant (cancerous) tumor, and inherited or acquired hypercoagulability (a condition where the blood is more likely to clot). Deep venous thrombosis is most common in adults over age 60 but can occur in any age group. Symptoms
Signs and tests An examination may reveal a red, swollen, or tender leg. The presence of deep venous thrombosis may be seen on:
Treatment Treatment of DVT is intended to prevent the development of a pulmonary embolus and to prevent another DVT. For years, the standard treatment has been an anticoagulant medication called heparin, which was given through the vein. This results in very quick anticoagulation and treatment of the clot. Along with heparin an oral medication called warfarin is given. Warfarin usually takes several days to become fully effective, so heparin is continued until the warfarin has been fully effective for at least 24 hours. The warfarin is usually continued for about 6 months. In almost all circumstances, warfarin is started only after heparin has been started. Because heparin is given as a continuous intravenous (I.V.) infusion, it requires hospitalization. However, newer forms of heparin, known as low molecular-weight heparin (usually a drug called enoxaparin) can be used in some circumstances. This heparin can be given by injection once or twice a day and thus can shorten or eliminate the need for hospitalization. Warfarin causes an increase in the time it takes blood to clot (known as the PT). The PT is monitored to determine if the blood is sufficiently anticoagulated. A measurement known as the INR standardizes PT measurements between labs. For most patients warfarin is adjusted to keep the INR between 2 and 3. Expectations (prognosis) Most DVT's disappear without difficulty, however there is a risk of recurrence. Some patients may develop some chronic pain and swelling in the leg known as post phlebitic syndrome. Pulmonary embolus is uncommon when DVT's are treated properly but can occur and can be life threatening. Complications
Calling your health care provider Call your health care provider if symptoms suggestive of DVT occur. Go to the emergency room or call the local emergency number (such as 911) if chest pain, difficulty breathing, fainting, loss of consciousness, or other severe symptoms occur in a person with a DVT. Prevention Anticoagulants may be prescribed as a preventive measure for high risk people or people undergoing high risk surgical procedures. Minimize immobility of the legs (ambulate frequently during long plane trips, car trips, etc). Illustrations
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