DEEP VEIN

THROMBOSIS
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Definition
• DVT refers to the formation of one or more blood clots (a blood clot is also known as a
“thrombus,” while multiple clots are called “thrombi”) in one of the body’s large veins most
commonly in the lower limbs (e.g.,lower leg or calf)

• Veins are blood vessels that carry blood to the heart, from other body regions. There are
two types of veins, namely superficial veins that lie just below the skin, and deep veins,
located deep within the body (such as the leg muscles).

• Deep Vein Thrombosis (DVT) is a blood clot that occurs in a deep vein of the leg. Most of
these blood clots occur in the leg or thigh; though, they may also occur in other parts of
the body. A calf vein in the leg, is the most common site for a DVT (clot) to occur.

• When an individual suffers from such a condition, the blood flow in the vein is partially or
completely stopped by the blood clot.
Who gets Deep Vein Thrombosis? (Age and
Sex Distribution)
• Deep Vein Thrombosis can occur in any individual, at any age

• Adults, over the age of 60 years are commonly affected by this condition, with a
slightly higher male incidence
 Predisposing Factors
• Risk factors that increase the incidence of Deep Vein Thrombosis are:

• Immobility: Sitting in a single place for a long time without moving the legs, can affect the
flow of blood in the veins and consequently lead to DVT, like during a long distance
air/train/car travel

• Surgical operation: During surgery, the individual is administered anesthesia and hence
remains immobilized/still, for long hours. This could cause a paralysis in some muscles and
slow down the blood flow in the veins, increasing the risk of blood clots

• Illness or injury that causes immobility for a long time duration, like a leg fracture (especially
in the long bones of the leg)
Damages caused to the inside lining of the vein due to:Inflammation of the vein wall

• Drugs taken for curing certain illnesses; chemotherapy drugs may damage the veins

• Injury to the vein caused by needle, when an intravenous catheter is inserted into a vein

• Consumption of harmful drugs like heroin

Other reasons for blood clot formation may include:Nephrotic syndrome (kidney disease)

• Thrombophilia (a blood coagulation abnormality)

• Rare inherited conditions (like Factor V Leiden mutation)

• Family history of blood clotting disorders

• Use of contraceptive pills; these contain estrogen which can clot blood more easily

• Hormone replacement therapy: Those undergoing this therapy have a high risk of contracting Deep Vein Thrombosis

• Individuals with cancer or heart diseases, are more susceptible than othersMale adults over the age of 60 years have
a higher risk

• Pregnancy

• Obesity or overweight conditions

• Dehydration

• Smoking

• A pacemaker catheter that passes through the vein in the groin

• Polycythemia vera: A disorder, where the bone marrow makes too many blood cells, causing the blood to become
thicker and slower
Etiology

A Deep Vein Thrombosis may be caused due to the following reasons:

1. When the inner lining of the veins are damaged, which may be due to physical,
chemical, and biological factors, such as:
• Surgery

• Serious injuries

• Inflammation

• Immune responses
2. Sluggishness or slowness in the flow of blood, which may be due to:

• Lack of motion that occurs from a recent surgery, or if an individual is confined to

bed rest after a long illness, or has been traveling for a long time at a stretch

• When the blood becomes more thicker, which may be due to inherited conditions
(such as Factor V Leiden), or hormone therapy, the use of contraceptive pills, or
caused by blood-related disorders (like polycythemia vera)
Signs and Symptoms of Deep Vein
Thrombosis

The signs and symptoms of Deep Vein Thrombosis include:

• Pain and tenderness of the calf muscle

• Calf muscles begins to swell

• Changes in skin color

• Skin feels warmer to touch

Deep Vein Thrombosis Diagnosed

Deep Vein Thrombosis can be diagnosed by adopting the following procedures:

• Physical examination, to check for symptoms like red, swollen, and tender calf
muscle, including evaluation of medical history

• Laboratory tests performed might include:

• D-Dimer blood test

• Doppler ultrasound exam of the legs

Blood tests are done to check for the following:

• Activated protein C resistance (for any genetic defect)

• Antithrombin III levels

• Antiphospholipid antibodies

• Complete blood count

• Genetic testing to check for mutations

• Lupus anticoagulant

• Protein C and protein S levels

Complications of Deep Vein Thrombosis

The major complications that might arise from Deep Vein Thrombosis are
pulmonary embolism and post-thrombotic syndrome, which are explained below:

Pulmonary embolism: A blood clot may break away and move up through the
bloodstream and block the lungs, leading to a condition known as pulmonary
embolism. Any individual with a pulmonary embolism might be at risk for the
following complications:
• Sudden cough accompanied by bloody sputum

• Rapid breathing or shortness of breath; breathing difficulties

• Chest pain, which may be sharp, severe, and intense

• Palpitations of the heart
• Heart failure
• Cardiogenic shockPulmonary hypertension
 Post-thrombotic syndrome: When a clot remains in the vein for a very long time, it
can damage the veins or the valve in the veins. If the valve is damaged, it causes the blood
to backflow, called reflux, which causes blood to pool in the leg. Due to this, further
complications may be observed, like:

• Pain

• Swelling and fluid buildup, called edema

• Hyperpigmentation, the skin color becomes dark

• Ulcers of the skin

• Swollen veins called varicose veins

• Recurrent DVT or primary embolism

Deep Vein Thrombosis Treated
Treatment and management methods for Deep Vein Thrombosis include:

• Anticoagulant medications are prescribed to thin blood

• Heparin is normally the first drug administered (through a vein), and this requires hospitalization

• Warfarin drug is administered orally along with heparin, and it may be continued for more than 3 months or longer

• The use of pressure stockings, which is worn on the legs, helps improve the blood flow in the legs and reduce the
complications arising out of a blood clot

• Surgery may be recommended if medicines are not helpful. The procedures may involve:
• A filter may be placed in the largest vein, in order to prevent blood clots from moving to other parts of the body, from the lungs

• Removing blood clots in the vein

Deep Vein Thrombosis be Prevented
The following preventive measures may be adopted for reducing the risk of Deep Vein
Thrombosis:

• The pressure stockings, prescribed by the doctor, should be worn continuously to improve blood
flow in the legs

• Try not to remain immobile for a long duration especially while traveling or taking a long drive.
Move your legs during a long plane trip or long distance drive; avoid sitting in one place for a
very long time

• Individuals having a high risk for DVT could take heparin shots (per physician’s advice), while
going on long air/car trips

• Stop smoking completely

Prognosis of DVT

• In most cases Deep Vein Thrombosis cures without any complications; however,
the risk of recurrence is always present

• Some individuals may experience long-term pain and swelling in the legs, called
postphlebtic syndrome. Sometimes, pain and changes in skin color, may also be
seen

• In some cases, the blood clots in the thighs, may break-off and travel to the lungs,
which may lead to dangerous medical issues
Additional and Relevant Useful Information
for Deep Vein Thrombosis:

Polycythemia vera is a blood-related disorder, in which there is too much red

blood cells being produced by the body, causing the blood to thicken. Formation
of blood clots, due to the accumulation of red blood cells, is a complication
associated with this disorder.
Reference
• http://www.nlm.nih.gov/medlineplus/ency/article/000156.htm (accessed on
01/10/2018)
• http://www.nhlbi.nih.gov/health/health-topics/topics/dvt/ (accessed on
01/10/2018)
• http://www.mayoclinic.com/health/deep-vein-thrombosis/DS01005 (accessed on
01/10/2018)
• http://www.nhs.uk/conditions/Deep-vein-thrombosis/Pages/Introduction.aspx
(accessed on 01/10/2018)
• http://www.patient.co.uk/health/deep-vein-thrombosis (accessed on 01/10/2018)
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