Deep vein thrombosis occurs when blood clumps together forming a clot and plugging a major vein of your body. Most commonly, the clots are in an extremity and cause swelling in one of your arms or legs. In some patients, the clots may be in more than one vein, but the hallmark of DVT is a swollen arm or leg. If untreated, a blood clot may break off, travel through the major veins and reach your heart and lungs causing a pulmonary embolism (PE). If the clot is large enough, it can cause severe shortness of breath and possibly death.
What causes blood clots to form?
Blood is kept in a liquid form by natural blood thinners in your body. A delicate balance exists between factors in your body that keeps the blood thin and factors that tend to cause it to clot. When this balance is disrupted, clot may form inside your blood vessels. The ability of your body to get rid of the clot may be quickly overwhelmed and the blood clot will continue to form and eventually may plug a major vein.
Why do blood clot form?
When the blood flow in your veins becomes very sluggish, it will have a tendency to clot.
Some risk factors which cause sluggish blood flow and provoke a DVT include:
- Older age
- History of prior blood clot
- Trauma (particularly leg and pelvis, especially if in a cast
- Lack of movement after major surgery, recent illness, long travel
- Prolonged recovery after major illness (hip or knee surgery, major pelvic or abdominal surgery)
- Pregnancy and the first 6 weeks after delivery
- Birth control pills and hormonal therapy
- Recent or ongoing treatment for cancer
- Some inherited blood clotting conditions
The risk may be cumulative if you have more than one risk factor.
What are some symptoms of having a DVT?
Only about half of the people who have DVT have signs and symptoms. The signs and symptoms will occur in the extremity affected by the deep vein clot. These include:
- Pain worsening when walking
- Warming sensation
- If you develop sudden onset of swelling in one leg and shortness of breath, rapid heart rate or chest pain, and or the affected leg starts turning blue and getting numb, call 911 immediately.
How is a DVT diagnosed?
Your doctor will diagnose deep vein thrombosis (DVT) based on your symptoms, medical history, a physical exam, and tests which may include:
- Duplex Ultrasound uses high-frequency sound waves to create pictures of blood flowing through the veins in the affected leg. The ultrasound allows our vascular specialists to see the structure of your veins and identify the location and extent of any clot. At SCGVS Vascular and Vein Center, our highly trained technologists use the most advanced ultrasound to give your doctor an immediate and accurate report. We will contact your physician immediately so that, if needed, your treatment can be started without delay.
- D-Dimer blood test measures a factor in the blood that is released after a blood clot dissolves. High levels suggest a deep vein blood clot. If your test results are normal and you have few risk factors, DVT is not likely. If you have repeated blood clots that are not related to another cause, or blood clots in unusual locations (intestines, brain, liver or kidneys), additional blood tests may be needed to check if you have an inherited blood clotting condition.
- CT scan chest: If your doctor suspects that a clot has traveled to your lungs, he or she may also order a chest CT. This condition is known as a pulmonary embolism (PE)
How is DVT treated?
Blood thinners: Treatment for DVT should begin immediately. The immediate goals of DVT treatment are to stabilize the clots and to prevent the clots from traveling to the heart and lungs. Reducing the formation of blood clots by blood thinning anticoagulation medication is the mainstay of treatment. Some of the medications used in treating DVT include heparin or Lovenox®, Warfarin, Xarelto®, Eliquis®, or any of the similar medications.
Your doctor will discuss with you the different options and make a recommendation. The body takes time to resolve the clot and the duration of treatment may vary between three months to a year depending on whether a clear cause for the clot is identified (provoked) or not (unprovoked). In the event that have an inherited condition or if your risk factors are many, a more long-term treatment may be warranted, even lifelong.
Thrombolysis (busting the clot): When the clot is extensive and severely obstructing the venous return from the leg, additional treatment may be warranted to quickly remove the clot and restore the venous drainage to prevent the leg from developing long-lasting sequelae. Actively removing the clots using catheter-directed dissolving techniques can dramatically reduce the long term and short-term consequences of DVT. It requires an invasive procedure after admission to the hospital. It also may need to be continued for a few hours to obtain the best result.
Elastic compression stockings are also be used to reduce swelling and prevent blood from pooling in your veins and legs.
IVC filter: if you are not a candidate for anticoagulation, your doctor may refer you to our office for placement of an IVC filter.
How will I know if my DVT is gone?
We recommend a follow up ultrasound after one week, one month, and at three months to monitor the clot and determine if the medicine has been effective.
Your risk of developing DVT increases if your travel time is longer than 4 hours, or if you have other DVT risk factors.
During long trips, it may help you to:
- Drink plenty of fluids and avoid alcohol.
- Wear loose and comfortable clothing.
- Move your legs and flex and stretch your feet to improve blood flow in your calves every two to three hours.
- Walk up and down the aisles of the bus, or airplane. If traveling by car, stop about every hour and walk around for a few minutes.
- If you have risk factors for DVT, your doctor may advise you to wear compression stockings while traveling, or he or she may suggest that you take a blood-thinning medicine before traveling.
To make an appointment with one of our DVT specialists or have your leg checked for DVT, call us or request an appointment online.