DEEP VEIN THROMBOSIS

 

 

Deep Vein Thrombosis (DVT) is a medical condition where a blood clot forms in a deep vein, typically in the legs. This can lead to pain, swelling, and in severe cases, can cause clots to break free and travel to vital organs, such as the lungs, leading to life-threatening complications. Recognizing the factors that increase the risk of DVT and adopting preventive measures is crucial for maintaining vascular health.

Veins are responsible for returning the deoxygenated blood back to the heart so that it can send it to the lungs to get oxygenated once again. There are two sets of veins, the superficial veins that pop up when a tourniquet is applied to take blood samples for pathology investigations and are running just under the skin, and the deep veins, which run in the depth, usually along with the arteries. The two are interconnected at places. The veins have valves which help the blood to flow towards the heart even against the gravity.

DVT should not be confused with Varicose Veins. They are both venous diseases but two very different entities. Varicose veins are are swollen, twisted veins that lie just under the skin. These effect the superficial veins and can, at times, be caused by DVT.

The term venous thromboembolism (VTE) is used to describe two conditions, deep vein thrombosis (DVT) and pulmonary embolism (PE). This term is used because the two conditions are very closely related, and, because their prevention and treatment are also closely related.

 

Symptoms of DVT

These can include:

• Leg swelling
• Leg pain, cramping or soreness that often starts in the calf
• Change in skin color on the leg — such as red or purple, depending on the color of your skin
• A feeling of warmth on the affected leg

Deep vein thrombosis can occur without noticeable symptoms as well.

Phlegmasia cerulea dolens (PCD) is an uncommon but potentially life-threatening complication of acute DVT characterized by marked swelling of the extremities with pain and cyanosis, which in turn may lead to arterial ischemia and ultimately cause gangrene with high amputation and mortality rates.

 

Risk Factors for DVT

Previous Blood Clot: Individuals who have experienced DVT are at a heightened risk of recurrence.

Family History: A genetic predisposition to DVT is significant. The risk is further amplified if both parents have a history of the condition.

Age: The likelihood of DVT increases with age, particularly for those over 40.

Prolonged Immobility: Extended periods of immobility, such as bed rest due to hospitalization or long-duration flights, can significantly increase the risk of DVT. When muscles are not active, blood flow in the deep veins of the legs slows down, making it easier for clots to form. This is why it's crucial to take breaks, move around, and stretch regularly during prolonged sitting or when confined to a bed or chair for extended periods.

Gender and Age: Men aged between 45 and 60 are slightly more susceptible to DVT. However, women's risk may increase during pregnancy due to hormonal changes.

Genetic Factors: Genetic predispositions play a significant role in the risk of developing DVT. Conditions such as Factor V Leiden mutation increase the blood's tendency to clot. While a single genetic factor may not cause DVT on its own, in combination with other risks, it can significantly increase the likelihood of clot formation. Knowing family history and discussing genetic testing with a healthcare provider can help assess and manage this risk.

Pregnancy and Hormone Therapy: Elevated estrogen levels during pregnancy or from hormone-based medications can increase clotting risk. Apart from pregnancy, other conditions and medications that alter hormone levels can also elevate DVT risk. This includes hormone replacement therapy and certain types of birth control. The increased estrogen can make the blood more prone to clotting. It's essential for individuals undergoing these treatments to consult with their healthcare providers about their specific risk and possible preventive measures.

Clotting Disorders: Inherent blood clotting disorders can lead to abnormally thick blood.​

Obesity: Obesity is a significant risk factor for DVT. Excess weight, especially around the abdomen, can exert additional pressure on the veins in the pelvis and legs, impeding blood flow back to the heart. This can lead to blood pooling and clot formation. Furthermore, obesity alters the chemical composition of the blood, increasing its propensity to clot. Managing weight through diet, exercise, and lifestyle changes can help reduce the risk of DVT and improve overall health.

Health Conditions: Diseases like heart disease, lung disease, inflammatory bowel disease, and cancer can elevate DVT risk. Injury or Surgery: Physical trauma, such as a bone fracture or muscle injury, can damage blood vessels and lead to clot formation.

Surgery: Surgeries, particularly those involving the abdomen, pelvis, hip, or legs, can increase the risk of DVT due to immobility during recovery and potential damage to blood vessels. Taking preventive measures, such as using compression stockings or medication for blood thinning as recommended by healthcare providers, can help reduce this risk. We routinely use prophylactic anticoagulation therapy in all surgeries below the level of umbilicus in patients over 40 years of age.

Chronic diseases: Certain chronic conditions, such as heart disease, cancer, and inflammatory bowel disease, can increase the risk of DVT. These diseases can alter blood flow, contribute to inflammation, and affect the blood's ability to clot. For instance, cancer and its treatments can increase clotting factors in the blood, while heart disease can lead to reduced mobility and blood flow. Managing these conditions with the guidance of healthcare professionals is crucial for minimizing DVT risk.

Inflammatory Diseases: Conditions like inflammatory bowel disease (IBD) not only disrupt the digestive tract but also contribute to a systemic inflammatory response. This state of heightened inflammation can increase the risk of blood clot formation. Managing inflammation through appropriate treatments and lifestyle changes is crucial.

 

Strategies to Lower DVT Risk

While some risk factors for DVT cannot be modified, several strategies can help mitigate the risk:

1. Avoid Prolonged Immobility: Stand, stretch, or walk at least every 2 hours. Perform simple leg exercises even while seated. If you work at a desk or engage in activities that require sitting for extended periods, integrate short breaks into your routine. Use a timer as a reminder to stand up or stretch every hour. Even minimal movements, such as ankle circles or foot pumps, can stimulate blood flow in your legs.​

2. Post-Surgery Mobility:  After surgery, particularly operations involving the abdomen, pelvis, hip, or legs, it's crucial to start moving as soon as medically advised. Gentle exercises, like ankle pumps, knee bends, and leg lifts, can be performed even in bed. These movements help in maintaining circulation and preventing blood clots.

3. Medical Consultation: Discuss with your doctor about the potential need for blood thinners or compression stockings if at high risk.

4. Travel Precautions: During long flights or car rides, make it a point to stand or walk around every couple of hours. Choose seats that offer more legroom when possible, and perform seated exercises like foot lifts or knee bends. Wearing loose, comfortable clothing and staying hydrated are essential, while avoiding alcohol and caffeine, which can lead to dehydration.

5. Stay Active: Regular physical activity is beneficial for overall health and plays a key role in preventing DVT. Activities like walking, swimming, or cycling improve circulation and vein health. Aim for at least 30 minutes of moderate exercise most days of the week. Even those with limited mobility can find suitable exercises to keep blood flowing efficiently.

6. Health Management: Addressing obesity, quitting smoking, and managing chronic diseases are crucial steps in reducing DVT risk.

7. Lifestyle Adjustments: For individuals who are overweight, losing weight can significantly reduce the pressure on veins in the legs and improve blood flow. Quitting smoking is also crucial, as smoking affects blood circulation and increases the risk of clotting. Managing chronic conditions such as diabetes, high blood pressure, and heart disease through medication, diet, and exercise is vital in reducing the risk of DVT.

8. Proactive Health Checks: For those with a high risk of DVT, regular check-ups and screenings can be lifesaving. This includes monitoring for any signs of clotting disorders, reviewing medication impacts, and assessing the need for preventive measures like compression garments or anticoagulants.

Pulmonary Embolism (PE).

This is the most dreaded complication of DVT. A pulmonary embolism (PE) occurs when a blood clot gets stuck in an artery in the lung, blocking blood flow to part of the lung. Blood clots most often start in the legs, from where they break loose and travel up through the right side of the heart and into the lungs. The warning signs and symptoms of a pulmonary embolism include:

• Sudden shortness of breath
• Chest pain or discomfort that worsens when you take a deep breath or when you cough
• Feeling lightheaded or dizzy
• Fainting
• Rapid pulse
• Rapid breathing
• Coughing up blood

This is a life threatening condition and needs urgent hospitalization and emergency care.

 

So, DVT is not a casual swelling of the leg, which gets all right on rest and limb elevation every time. It needs medical attention and certain investigations and effective care. At least one of its complication, PE, can be life threatening.