March 29, 2006
Deep Vein Thrombosis
Amy Movius, MD
March is Deep Vein Thrombosis (DVT) awareness month. A DVT is a blood clot that forms in a vein deep within the muscles. They usually occur in the calf or thigh and approximately 1 in every 1000 Americans will develop a DVT. The symptoms of a DVT occur from the clot obstructing blood flow in the vein (like a dam in a stream). Swelling downstream from the clot and pain are common symptoms. There may be warmth or discoloration over the leg as well. However, up to ½ of people with DVTs have no symptoms at all.
The most serious problem associated with a DVT is development of a Pulmonary Embolism (PE). An embolism is a clot that breaks free and travels through the vein. An embolism that lodges in the lungs is a PE. A PE blocks blood flow to the lungs and is a life-threatening condition. More than 50,000 people in the US die each year from pulmonary embolism, most within 1 hour of developing symptoms. The signs of a pulmonary embolism include sudden chest pain, shortness of breath, and coughing sometimes with blood. If you develop these symptoms don’t wait; call 911 or tell someone else to immediately.
Though anyone can develop DVTs, there are risk factors that make it more likely. First, there are genetic conditions that cause blood to clot more easily. DVTs occur more often in younger people with these conditions. There are a lot of other risk factors for DVTs as well, including trauma, pregnancy, obesity, some medications, immobilization, and some cancers. Smoking, increasing age and having a DVT previously are also concerns. More than 80% of patients with DVTs have at least one risk factor. These risk factors do “add up” which means if you have more than one, your chance of developing a DVT is even higher.
Sluggish blood flow makes clot formation more likely, so maintaining active blood flow in your legs is a good way to decrease your chance of developing a DVT. This is why after surgical procedures patients are encouraged to start walking as soon as possible. Traveling long distances with little movement is a common culprit of slow blood flow in the legs. When traveling, move legs frequently, walking if possible every couple of hours. Also, avoid wearing socks with tight bands and crossing legs. Likewise, drinking plenty of liquids, avoiding alcohol and caffeine – which are dehydrating – is recommended during prolonged inactivity. Use of compression stockings, which stimulate leg muscles, can also be helpful.
Fortunately, DVTs are usually easy and painless to diagnose using ultrasound. The main goals of treatment are to stop the clot from growing, prevent it from breaking off and traveling to the lungs, and decreasing the chance of getting more clots. The therapy most commonly used is anticoagulant medications, often referred to as “blood thinners”. These medications need to be taken for months or years and because they can increase the risk of other bleeding, need to be monitoring closely by your provider.