Dr Arvind Kohli
Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in body, usually in legs. Deep vein thrombosis can cause leg pain or swelling, but may occur without any symptoms.
Deep vein thrombosis can develop if patient has certain medical conditions that affect how your blood clots. Deep vein thrombosis can also happen if one doesn’t move for a long time, such as after surgery, following an accident, or when confined to a hospital bed.
Deep vein thrombosis is a serious condition because blood clots in veins can break loose, travel through bloodstream and lodge in lungs, blocking blood flow (pulmonary embolism). Deep vein thrombosis signs and symptoms can include:
* Swelling in the affected leg. Rarely, there may be swelling in both legs.
* Pain in leg. The pain often starts in calf and can feel like cramping or a soreness.
Risk factors
Many factors can increase risk of developing deep vein thrombosis (DVT), and the more you have, the greater your risk. Risk factors for DVT include:
* Inheriting a blood-clotting disorder: Some people inherit a disorder that makes their blood clot more easily. This inherited condition may not cause problems unless combined with one or more other risk factors.
* Prolonged bed rest, such as during a long hospital stay, or paralysis : When legs remain still for long periods, calf muscles don’t contract to help blood circulate, which can increase the risk of blood clots.
* Injury or surgery: Injury to veins or surgery can increase the risk of blood clots.
* Pregnancy: Pregnancy increases the pressure in the veins in your pelvis and legs. Women with an inherited clotting disorder are especially at risk. The risk of blood clots from pregnancy can continue for up to six weeks after delivery.
* Birth control pills or hormone replacement therapy: Birth control pills (oral contraceptives) and hormone replacement therapy both can increase blood’s ability to clot.
* Being overweight or obese : Being overweight increases the pressure in the veins in pelvis and legs.
* Smoking : Smoking affects blood clotting and circulation, which can increase risk of DVT.
* Cancer: Some forms of cancer increase the amount of substances in blood that cause blood to clot. Some forms of cancer treatment also increase the risk of blood clots.
* Heart failure: People with heart failure have a greater risk of DVT and pulmonary embolism. Because people with heart failure already have limited heart and lung function, the symptoms caused by even a small pulmonary embolism are more noticeable.
* Inflammatory bowel disease: Bowel diseases, such as Crohn’s disease or ulcerative colitis, increase the risk of DVT.
* A personal or family history of deep vein thrombosis or pulmonary embolism (PE): If you or someone in your family has had DVT or PE before, you’re more likely to develop DVT.
Deep vein thrombosis treatment :
* Blood thinners: Medications used to treat deep vein thrombosis include the use of anticoagulants, also sometimes called blood thinners, whenever possible. These are drugs that decrease blood’s ability to clot. While they don’t break up existing blood clots, they can prevent clots from getting bigger or reduce risk of developing additional clots.
Treatment starts with injectable blood thinner, such as enoxaparin dalteparin or fondaparinux : Other blood thinners can be given in pill form, such as warfarin (Coumadin, Jantoven) or rivaroxaban (Xarelto). Newer blood thinners also may offer additional options in the near future.
Blood thinners have to be taken for three months or longer : It’s important to take your medication exactly as doctor instructs. Blood-thinning medications can have serious side effects if taken too much or too little.
‘Periodic blood tests like PTI/INR are needed to check how long it takes your blood to clots so that blood thinning medicine dose can be altered. Pregnant women shouldn’t take certain blood-thinning medications.
* Clotbusters : If there is more serious type of deep vein thrombosis or pulmonary embolism, or if other medications aren’t working, clot busters are prescribed.
One group of medications is known as thrombolytics: These drugs, called tissue plasminogen activators
(TPA), are given through an IV line to break up blood clots or may be given through a catheter placed directly into the clot. These drugs can cause serious bleeding and are generally used only in life threatening situations. For these reasons, thrombolytic medications are only given in an intensive care ward of a hospital.
Powerpulse refers to a method of using the AngioJet Rheolytic Thrombectomy system to treat DVT in a single procedure. The AngioJet uses high velocity saline jets to fracture and remove blood clots. With the Powerpulse method, the AngioJet is first used to deliver and disperse a clot-busting drug directly into the blood clot by a powerful pulse-spray injection. The drug is allowed to sit within the clot for 30 minutes, then the AngioJet is used to remove the softened thrombus fragments .
* Filters: If a patient can’t take medicines to thin blood, a filter may be inserted into a large vein – the vena cava. A vena cava filter prevents clots that break loose from lodging in lungs and prevents Pulmonary embolism the dreaded complication of DVT.
* Compression stockings: These help prevent swelling associated with deep vein thrombosis. These stockings are worn on your legs from your feet to about the level of knees. Compression stockings can help prevent postphlebitic syndrome prevented?
Prevention
As is the case with most medical illnesses, prevention is of prime importance. Minimizing risk factors is key to deep vein thrombosis prevention.
In the hospital setting, the staff works hard to minimize the potential for clot formation in immobilized patients. Compression stockings are routinely used. Surgery patients are out of bed walking (ambulatory) earlier and low dose heparin or enoxaparin is being used for deep vein thrombosis prophylaxis (measures taken to prevent DVT).
For those who travel, it is recommended that they get up and walk every couple of hours during a long trip. Compression stockings may be helpful in preventing future deep vein thrombosis formation in patients with a previous history of a clot.
(The author is vascular surgeon SSH Jammu)
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