Deep Vein Thrombosis (DVT)

DVT

DEEP vein thrombosis (DVT) is a blood clot in a vein. Blood clots in veins most often occur in the legs but can occur elsewhere in the body, including the arms

The most common cause is immobility.

A complication can occur in some cases where part of the blood clot breaks off and travels to the lung (pulmonary embolus). Deep leg veins are the larger veins that go through the muscles of the calf and thighs. They are not the veins that seen just below the skin, neither are they the same as varicose veins.When you have a DVT, the blood flow in the vein is partially or completely blocked by the blood clot.calf vein is the common site for a DVT. A thigh vein is less commonly affected. Rarely, other deep veins in the body can be blocked by blood clots. Blood normally flows quickly through veins, and does not usually clot. Blood flow in leg veins is helped along by leg movements, because muscle action squeezes the veins.

However, the following increase your risk of having a DVT :

Immobility which causes blood flow in the veins to be slow. Slow-flowing blood is more likely to clot than normal-flowing blood.
surgical operation especially operations on the pelvis or legs increase the risk of DVT even more.
Any illness or injury that causes immobility increases the risk. This includes having a leg in a hard plaster cast after a fracture.
People who are admitted to intensive care units are at an increased risk of DVT, for a number of reasons, but mainly because they are very ill and secondly because they are immobile (they may even be kept asleep by anaesthetic medications).
Long journeys by plane, train or coach/car may cause a slightly increased risk. This is because you are mostly sitting still and not moving around very much.

Signs and Symptoms

It is estimated that about 1 in 1,000 people have a DVT each year.
DVT symptoms include, Pain and tenderness of the calf, Swelling of the calf, Colour and temperature changes of the calf.
Blood that would normally go through the blocked vein is diverted to outer veins. The calf may then become warm and red.
Sometimes there are no symptoms and a DVT is only diagnosed if a complication occurs, such as a pulmonary embolus.
Two commonly used tests are: D-dimer blood test And venous duplex which show blood flow in the leg veins, and any blockage to blood flow. Duplex is useful because it is an easy, non-invasive test. Sometimes these tests are not 100% conclusive and more detailed tests are necessary.
DVT leads to pulmonary embolus life threatening condition and post phlebitis syndrome which have persistent calf symptoms.

Treatment of DVT

To prevent the clot spreading up the vein and getting larger. This may prevent a large embolus breaking off and travelling to the lungs (a pulmonary embolus
To reduce the risk of post-thrombotic syndrome.
To reduce the risk of a further DVT in the future.

Treatment options mainly include

Anticoagulation – preventing the clot from getting larger.
Compression stockings.
Thrombolytic therapy (often called clot busting) with drugs such as streptokinase or urokinase.
IVC filter to prevent Pulmonary embolism.
Pharmacomechanical thrombectomy.
We all know about routinely used anticoagulants like heparin,low molecular weight heparin,warfarin and acenocoumarol. We will discuss about some newer oral anticoagulants and their role in prophylaxis and treatment of DVT.

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