Deep Vein Thrombosis

Arteries carry blood away from the heart to the entire body, and veins return the same blood from the body to the heart. Within the leg, there are generally two zones of veins, deep veins and superficial veins, both of which transport blood up the leg from bottom to top. Each vein system has one-way valves that help direct the blood against the pressure of gravity. Both the deep and superficial veins can develop blood clots.

 

What is a Deep Vein Thrombosis (DVT)

When blood clots in the deep veins of the leg, it is known as a deep vein thrombosis (DVT). Patients often may experience leg pain and swelling caused by the DVT, but the presentation is variable, and some patients can feel just a mild ache. DVT is a serious medical condition for several reasons, but the most concerning is the risk that a piece of the clot breaks off and travels through the blood stream into the heart, and then to the lungs.

 

Complications of DVT

Pulmonary embolism: If a clot passes to the lung, it is known as a pulmonary embolism (PE). A PE can be life threatening as it may interfere with the ability of the lungs to oxygenate the blood and the ability of the heart to pump effectively.

 

Postphlebitic Syndrome: A common condition after DVT is the postphlebitic syndrome which causes chronic leg pain, swelling, skin discoloration and potentially skin ulceration. The extensive damage to the fine one-way valves of the deep veins in the leg lead to reflux (backflow) in the vein, elevated venous pressures, chronic inflammation, and the symptoms noted above. Often there is no cure for the postphlebitic syndrome, though we can often help manage it effectively.

 

Varicose veins: DVT causes damage to the valves in the deep veins. This leads to backpressure being transmitted to the superficial veins, and varicose veins are commonly seen after a deep vein blood clot.

 

What Causes DVT

Many factors have the potential to increase your risk of blood clot. Some of the common ones are:

  • an inherited blood clotting disorder
  • prolonged bed rest or immobility (chronic disease, injury or prolonged surgery, long flights)
  • birth control pills
  • smoking
  • cancer

 

Treatment of DVT 

The goals of DVT treatment are to prevent the clot from growing larger, prevent the clot from traveling to the heart and lungs, reduce the risk of recurrent clot, and reduce the risk of postphlebitic syndrome. Controlling risk factors that predispose to DVT is essential.

  • Blood thinners (anticoagulants) reduce the ability of the blood to clot and therefore help prevent clot growth. Common medications include Coumadin (Warfarin), heparin. Xarelto, Eliquis, and Predaxa. The duration of anticoagulant use is determined by your doctor and you, but usually at least 3 months use is needed.
  • Blood clot dissolvers (thrombolytics) are very powerful drugs that help your body break up the clots. The medications are only used in very specific circumstances as the risk of bleeding is high and not all DVT respond favorably.