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What Is Deep Vein Thrombosis?

Deep vein thrombosis (DVT) is a medical condition where the blood clot is formed in the deep vein. The presence of blood clots is usually found in lower extremities such as lower leg, thigh, or pelvis but the arms also may be. The blood clot blocks the blood flow from lower body back to the heart in the vein. DVT is a subset of the venous thromboembolism (VTE). It is a worldwide preventable medical condition which leads to morbidity and mortality.

Risk Factors

Anyone is at risk to have a DVT. However, DVT is more likely to occur in those who are over 60 years old, overweight, smoking, had history of DVT, had family history of venous thromboembolism (VTE), taking oral contraceptive pills (OCP), taking hormone replacement therapy (HRT), having heart failure or cancer, pregnancy, and having varicose veins. Besides, several factors also increase the risk of DVT. For example:

  • Confinement to bed (eg. paralysis). The increased risk of blood clots is due to less blood circulation.
  • Extended travel by plane or car. When a person sit for long periods of time, the calf muscles do not contract as the legs remain still for hours. This reduces blood circulation and increases risk of blood clotting.
  • Injury or trauma which leads to surgery or hospital stay. One-half of blood clots happen during or after the operation or hospital stay.

Common symptoms:

  • Pain
  • Tenderness
  • Swelling
  • Redness
  • Warm skin on the leg
  • Leg cramps
  • Red or discoloration of skin

However, some patients may also have no symptoms at all. Patients are recommended to contact doctor if the signs and symptoms of DVT are developed.

 

Complications

The symptoms such as swelling and pain are usually absent or not specific. The blood clot may dislodge and travels to block the blood arteries to the lungs if left untreated, resulting in pulmonary embolism (PE) which is a serious complication of DVT. Hence, it is important to prevent or treat DVT to avoid serious illness, disability and death.

Treatments

The aim of DVT treatment is to prevent the clot from becoming larger and to reduce the risk of complications such as PE. The main medical treatment for DVT is anticoagulants. These anticoagulants are also referred as blood thinners that can avoid the expansion or dislogement of the existing clot and formation of new clots by decreasing the blood’s ability to clot. But, they unable to dissolve an existing clot. The example of medications that used for anticoagulation are:

  • Unfractionated heparin (UFH)
  • Low molecular weight heparin (LMWH): Enoxaparin
  • Fondaparinux
  • Novel oral anticoagulants (NOACs): Apixaban, Dabigatran, Rivaroxaban
  • Vitamin K antagonist (VKA): Warfarin

Furthermore, thrombolytic agent which also called as clot-busters is recommended if the patient has high risk for PE, has DVT in the arm instead of leg, or has large clots that cause pain, swelling and blood circulation problems. Thrombolytic agent such as streptokinase helps to break up the clot and restores blood flow but it has higher risk of bleeding problems and stroke compared to blood thinners (WebMD). If both anticoagulants and thrombolytic agents are ineffective, surgery may be carried out by the doctor.

 

Lifestyle modification is recommended for the prevention of DVT:

  • Weight lose can be achieved by exercising regularly such as walking, cycling, and swimming.
  • Healthy diet with low-fat and high fiber can be taken by eating more vegetables and fruits.
  • Smokers should stop smoking as smoking is one of the risk factors for DVT.

Medications:

  • The anticoagulant medications may be prescribed by doctor to prevent DVT. During recovery, the foot of the bed can be elevated to be taller than the pillow end.

Exercise:

  • Simple exercises such as leg lifting and ankle movements can also be done to increase blood circulation.
  • If you are traveling long distance by plane, exercise your legs by raising and lowering your heels with your toes on the floor and vice versa. You may also stand or walk at regular intervals. For example, you can stop occasionally to walk around if travelling by car. It is encouraged to wear loose-fitting clothes and drink plenty of water as well.

Besides, mechanical methods against DVT such as the graduated elastic compression stockings are recommended as it helps to prevent DVT by squeezing the muscles to maintain the blood flow.

References

  1. Stone, J., Hangge, P., Albadawi, H., Wallace, A., Shamoun, F., Knuttien, M., Naidu, S. and Oklu, R. (2017). Deep vein thrombosis: pathogenesis, diagnosis, and medical management. Cardiovascular Diagnosis and Therapy, 7(S3), pp.S276-S284.
  2. Centers for Disease Control and Prevention. (n.d.). What is Venous Thromboembolism? | CDC. [online] Available at: https://www.cdc.gov/ncbddd/dvt/facts.html [Accessed 9 Jan. 2020].
  3. NHS. (n.d.). DVT (deep vein thrombosis). [online] Available at: https://www.nhs.uk/conditions/deep-vein-thrombosis-dvt/ [Accessed 9 Jan. 2020].
  4. WebMD. (n.d.). DVT Symptoms and Diagnosis. [online] Available at: https://www.webmd.com/dvt/deep-vein-thrombosis-dvt-symptoms-diagnosis [Accessed 9 Jan. 2020].
  5. Patel, K. (2019). Deep Venous Thrombosis (DVT): Practice Essentials, Background, Anatomy. [online] Medscape. Available at: https://emedicine.medscape.com/article/1911303-overview [Accessed 9 Jan. 2020].
  6. Prevention and Treatment of Venous Thromboembolism. (2013). [ebook] Ministry of Health. Available at: http://www.moh.gov.my/moh/attachments/9005.pdf [Accessed 9 Jan. 2020].
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