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Deep venous thrombosis Causes and Risks:
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 thrombus may interfere with circulation of the area, and it may break off and travel through the blood stream
(embolize). The embolus thus created can lodge in the brain, lungs, heart, or other area, causing severe damage to that organ.
Risks include prolonged sitting, bedrest, or immobilization; recent surgery or trauma, especially hip surgery, gynecological surgery, heart surgery, or fractures ; childbirth within the last 6 months; obesity ; and the use of medications such as estrogen and birth control pills. Risks also include a history of polycythemia vera , malignant tumor , hypercoagulability (changes in the levels of blood clotting factors making the blood more likely to clot), disseminated intravascular coagulation (DIC) , and dysfibrinogenia. DVT may be associated with, or may cause, pulmonary embolus .
Deep venous thrombosis occurs in approximately 2 out of 1,000 people. The condition is most commonly seen in adults over age 60.
Prevention:
Anticoagulants may be prescribed as a preventive measure for high risk people. Minimize immobility of the legs.
Symptoms:
Signs and Tests:
An examination may reveal a red, swollen, tender area of the leg. The Homans sign is positive--there is sharp pain when the foot is flexed upward (dorsiflexion).
The presence of deep venous thrombosis may be seen on: Increased coagulability (clotting tendency) may be indicated by:
Treatment:
The clot itself usually will resolve through the natural healing processes. Treatment is also aimed at relieving symptoms and preventing the clot from traveling to the lungs, heart, brain, or other areas. Treatment usually requires hospitalization, at least initially.
Anticoagulants (such as heparin or warfarin) or antiplatelet medications (such as aspirin) are prescribed to prevent further clotting. Analgesics may be needed to control pain. Thrombolytics (clot dissolving medications) are rarely needed.
Bedrest may be recommended until the symptoms are relieved. The leg may be elevated to reduce swelling . Avoid prolonged sitting. Warm, moist heat to the area may help relieve pain.
After return home, the patient may continue oral anticoagulants or antiplatelet medications for a prolonged period of time. Warm compresses may also be continued. Continue to avoid prolonged sitting or standing in one position.
Prognosis:
Most DVT's disappear without difficulty. Complications may be life threatening.
Complications:
Call Your Healthcare 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.
This picture shows deep vein thrombosis with phlebitis in the leg. The deep veins in this patient's left leg are clotted (deep venous thrombosis) and blood cannot return properly to the main circulation. Note the swelling and discoloration of the left leg.
This picture shows deep venous thrombosis with phlebitis in the right forefoot. The blood clotting has caused tissue death (necrosis) in the toes.
This picture shows a red and swollen thigh and leg caused by a blood clot (thrombus) in the deep veins in the groin (ileofemoral veins) which prevents normal return of blood from the leg to the heart.
This is a person with clotting of the deep veins (ileofemoral deep venous thrombosis) which prevents return of blood from the leg to the heart. Note the deepening red cast and the marked swelling of the leg. Splitting of the skin as a result of the swelling.
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