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Deep venous thrombosis

Alternative names

DVT; Blood clot in the legs

Definition

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

• leg pain in one leg only


• leg tenderness in one leg only
• swelling (edema) of only one leg
• increased warmth of one leg
• changes in skin color of one leg, redness

Signs and tests

An examination may reveal a red, swollen, or tender leg.

The presence of deep venous thrombosis may be seen on:

• venography of the legs


• Doppler ultrasound exam of an extremity
• plethysmography of the legs
• D-dimer blood test
Many of the inherited and acquired causes of hypercoagulability (clotting tendency) can be
detected by blood tests:

• antithrombin III, protein C, protein S


• Factor V Leyden
• Prothrombin 20210a mutation
• DIC screening
• lupus anticoagulant and anticardiolipin antibodies

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

• pulmonary embolus
• post-phlebitic syndrome

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).

— MAHMUD CD9