Management of Deep Vein Thrombosis

Deep vein thrombosis (DVT) is a blood clot (thrombosis) that usually develop in the deep veins of lower leg, thigh, or pelvis, and arms (not very often). It is often underdiagnosed, and if left untreated, it could lead to serious complications. However, certain preventive measures can help to keep this problem at bay for susceptible patients.

Complications of DVT

Sometimes a part of the clot present in the lower leg can break off and travel through bloodstream to the lungs. This causes a blockade of the blood vessels in the lungs and is called pulmonary embolism (PE). This can be a serious complication if the clot is large in size, as it can stop blood from reaching the lungs.

Both DVT and PE are subtypes of venous thromboembolism. Only about 30% of people who have had DVT or PE are likely to develop another episode of it.

You can develop PE without experiencing any symptoms of DVT. Common PE symptoms include chest pain, difficulty in breathing, coughing up blood, and low blood pressure. If you observe any of these symptoms, seek medical attention immediately.

Common Risk Factors

The following factors increase your risk for developing DVT:

• Injury to a vein: This could be due to fractures or previous surgeries involving your abdomen or legs.
• Serious illnesses: Such as heart, lung conditions or inflammatory bowel disease (IBD).
• Cancer: Undergoing cancer treatments can increase your risk of blood clotting and DVT.
• Elevated estrogen levels: Due to intake of birth control pills, pregnancy, menopause, and hormone therapy.
• Restricted blood flow: Slow blood flow can be due to sitting still for longer periods. Example – Driving for prolonged duration.
• Limited movement: Limited movement due to surgery or paralysis.
• Smoking: Smoking affects blood clotting and circulation.
• Being overweight: Being obese puts pressure in your veins in your legs.
• Age: DVT is Usually seen in those over the age of 60.
• Genetics: Family history of DVT, PE or clotting disorders.
• Personal history of DVT or PE.

Symptoms

Some people with DVT show no symptoms. Some common symptoms that occur in the affected part of the body include

• Swelling
• Cramping pain
• Skin redness
• Tenderness over the vein area

Diagnosis

If your healthcare provider suspects DVT, he/she would recommend some tests such as:

• Ultrasound scan: An ultrasound scan helps to check whether the blood flow is normal through the vein.
• Venography: This gives X-ray of the vein (venogram). The procedure is done by injecting a dye and helps to locate the blood clot in the vein
• Magnetic resonance imaging (MRI) scan: MRI is useful to diagnose DVT in the veins of the abdomen.

Other tests include D-dimer blood test and duplex ultrasound.

Management of DVT – Treatment & Prevention

If you observe any pain or visible changes on your legs, seek immediate medical attention. Treatment is effective when diagnosed early. DVT is treated with medications that clear out the existing clots and prevent forming of new ones.

Treatment

Treatment aims to reduce the clot size, prevent breakage of clot, and to decrease chances DVT recurrence.

• Medical Management: They are the first-line medication for managing DVT. They do not break the existing clots and only help to prevent the clots from becoming bigger and prevent formation of newer clots. Blood thinners may be taken orally, via IV route or an injection under the skin.
• Needle based clot removal therapy: The procedure is termed as percutaneous mechanical thrombectomy which is done under local anaesthesia in a endovascular suite. The procedure involves technique of pharmaco mechanical thrombo aspiration therapy clearly the entire length of vein occluded by clots in cases which are resistant to medical therapy and in venous gangrene
• Filters: If anticoagulant medicine are not suitable to thin your blood, you may have a filter put into large vein (vena cava) in your abdomen. This filter prevents any clots that break loose to travel to your heart and lungs.
• In severe cases of DVT, the clot may need to be removed surgically. DVT in pregnancy is treated differently.

Recovery from DVT

DVT treatment can take up several months before you are fully healed. Some tips that help in faster recovery are listed below:

• Comply with your follow up schedule
• Continue to take DVT medications as prescribed
• Wear compression stockings regularly
• Walk regularly (walk around atleast once every 1 to 2 hours)
• Keep the affected leg area raised when you’re sitting

Delay any long journeys: If you need to travel for more than 3 hours by any means of transport, here are some things you can do to reduce the risk of DVT:

• Wear loose clothing
• Drink water regularly
• Avoid alcohol consumption and smoking
• Walk around when possible

Tips for Prevention

Prevention tips mainly include choosing a physically active lifestyle and making healthy diet choices. These include:

• Maintain a healthy weight
• Walk regularly
• Include a physical activity to your routine
• Drink water to avoid dehydration – DVT is more likely if you’re dehydrated
• Avoid sitting still or cross legged, it can restrict blood flow
• Limit alcohol intake and quit smoking

Prof Dr S Balakumar

M.S. (General Surgery), M.CH (Vascular Surgery)

Department of Vascular & Endovascular Surgery

Clinical lead and Senior Consult - Vascular Surgeon & Endovascular Surgery