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Deep Vein Thrombosis
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A deep vein thrombosis is a blood clot (thrombus) that develops in a deep vein, usually in the leg. This can happen if the vein is damaged or if the flow of blood slows down or stops.
Where does Deep Vein Thrombosis happen?
The are two types of veins in the legs:
Deep and superficial. The deep veins pass through the centre of the leg, surrounded by the muscles. It's here that DVTs most often develop. Less commonly DVTs occur in the deep veins of the arm or pelvis.
Who gets Deep Vein Thrombosis?
Certain factors make a DVT more likely to occur. They are more common in people aged over 40 and in people who are obese, or who have already had a DVT. Several inherited conditions make the blood more likely to clot than usual, increasing the risk.
Other factors include:
Prolonged bed rest, (immobility)
Major injuries, or paralysis
Surgery, especially if it lasts more than 30 minutes, or involves the leg joints or pelvis
Cancer and its treatments, which can cause the blood to clot more easily
Long-distance travel, because of prolonged immobility. It is unclear whether or not air travel is more risky than other long journeys - for example by car or coach
Pregnancy and childbirth - related to hormone changes that make the blood clot more easily and because the fetus puts added pressure on the veins of the pelvis. There is also risk of injury to veins during delivery or a caesarean. The risk is at its highest just after childbirth
Taking a contraceptive pill that contains oestrogen. Most modern pills contain a low dose, which increases the risk by an amount that is acceptable for most women
Hormone replacement therapy (HRT). For many women, the benefits outweigh the increase in risk.
Other circulation or heart problems
Problems caused by Deep Vein Thrombosis
A DVT below the knee is unlikely to cause complications and may only need to be monitored. But when a clot forms in or above the knee, there is a risk that it will break away and travel up the vein to block a blood vessel in the lung. This is called a pulmonary embolism (PE). Depending on the size of the clot, it can be a life-threatening condition. But with appropriate treatment, it is rare for a DVT to lead to a pulmonary embolism.
A DVT can damage the valves in the vein, so that instead of flowing upwards, the blood pools in the lower leg. This is called post-thrombotic syndrome, and can result in pain, swelling, discolouration and sores on the leg.
Symptoms of Deep Vein Thrombosis
When a clot forms, it can either partially or totally block the blood flow in that vein.
Symptoms of a DVT can include:
Swelling of the leg
Warmth and redness of the leg
Pain that is noticeable, or worse when standing or walking
These are not always a sign of a DVT, but anyone who experiences them should contact a doctor immediately.
Symptoms of pulmonary embolism
These include shortness of breath; chest pain which may be worsened by deep breaths; and coughing up phlegm, possibly flecked with blood.
Anyone with these symptoms should seek emergency medical treatment.
Diagnosing Deep Vein Thrombosis
If a DVT is suspected, the doctor will take a full medical history and carry out a physical examination. Tests that also may be required include:
The clotting properties of the blood
An ultrasound scan
Venography – using X-rays to show the flow of blood when special dye is injected into the veins.
Treating Deep Vein Thrombosis
Treatment aims to prevent:
The clot becoming larger
The blood clot breaking loose and travelling to the lungs
New clots from forming
Post-thrombotic syndrome
Medicines
The most common treatment is anticoagulant (blood thinning) medicines, which reduce the blood's tendency to clot. These are usually taken for three to six months. Regular blood tests are needed to check the levels of the drug in the blood.
Anticoagulants can stop new blood clots from forming and old ones growing. They can't dissolve existing clots. The body does this itself over time.
The anticoagulants used are heparin (given through a vein as a "drip" or injected just under the skin twice each day) or warfarin (taken as tablets). Anyone taking these medicines should avoid activities that could increase the risk of injury. This is because one of the main ways a wound heals is through clotting, and anticoagulants interfere with this process.
Less commonly, clot dissolving drugs called thrombolytics are used to dissolve a DVT. They carry a high risk of bleeding, so are only used in severe cases, where a life or limb is threatened.
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Compression stockings
To relieve pain and swelling, and to prevent post-thrombotic syndrome, some doctors recommend wearing graduated compression stockings (also called TED or thrombo-embolic deterrent stockings), which are tighter at the foot than higher up the leg. These may need to be worn for several months or more.
Putting your feet up
Most people with a DVT are advised to place a cushion under their feet while resting or sleeping, so that the feet are raised higher than the hips. This helps to reduce the pressure in the veins of the calves.
Preventing Deep Vein Thrombosis around surgery
Surgery and some medical treatments can increase the risk of having a DVT. So, hospitals often do a pre-operative risk assessment for DVT, which takes into account your personal risk factors and the type of surgery you are having. Various measures can then be used to keep the risk as low as possible.
These include anticoagulant medicines, compression stockings, and an intermittent compression pump. This is a mechanical device that automatically squeezes the feet and lower legs. This helps the circulation of blood from the legs in the first few days after surgery.
General preventive advice
Anyone who feels they are at high risk of developing a DVT should seek medical advice.
There are measures anybody can take to help prevent a DVT:
Exercise the legs regularly – take a brisk 30-minute walk every day
Maintain a weight that's appropriate for your height
Avoid sitting or lying in bed for long periods of time without moving the legs
Women, particularly those over the age of 35, should consider the risks and benefits of taking the contraceptive pill
Preventive measures for travellers
Although the added risk of developing a DVT caused by travelling appears to be low, it can be reduced even further by exercising the legs at least once every hour during long-distance travel. This means taking regular breaks if driving, or walking up and down the aisle of a coach, train or plane.
The muscles of the lower legs (which act as a pump for the blood in the veins) can be exercised while sitting by pulling the toes towards the knees then relaxing, or by pressing the balls of the feet down while raising the heel.
Other preventive measures:
Don't take sleeping pills. These cause immobility, increasing the risk of DVT
Wear loose-fitting clothing
Keep the legs uncrossed
Keep hydrated by drinking normally (urine should be no darker than a pale yellow). Avoid alcohol to Prevent dehydration
Wear graduated compression stockings (TEDs). This is particularly important for travellers who have other risk factors for DVT
Some doctors recommend taking aspirin before travelling because of its blood thinning effects. But it is not suitable for children and can have side-effects. If in doubt, seek advice from a pharmacist or doctor.
People who have one or more of the risk factors mentioned earlier should seek medical advice before travelling.
Anyone who develops swelling or pain in the leg, or breathing problems after travelling should seek medical advice urgently.
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Disclaimer!!!
Before you read any further, I want to make it clear I am not a doctor.
I AM NOT PRESCRIBING MEDICINE OR TREATMENTS BUT SIMPLY PASSING ON TO YOU INFORMATION DESCRIBING HOW OTHER SUFFERERS AND MYSELF HAVE FOUND SATISFACTORY RELIEF
I make no guarantees.
This is simply a collection of information in the public domain.
Information conveyed herein is based on pharmacological and other records, both ancient and modern .
Take everything you read here with a grain of salt and apply it to your own experience.
Check with a doctor before you employ, attempt or invoke any of the advice you read herein.
If you are easily influenced or timid of mind and weak of volition, I urge you to read no further!
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