What is Deep Vein Thrombosis (DVT)?
A deep vein thrombosis (DVT) is a blood clot occurring in a deep vein. The clot forms in a valve cup and may grow big enough to completely block the vein. If part of the clot breaks off and travels to your lungs, the risk to your health can be serious. Hospital and home treatment for DVT both include medications to keep the clot from growing. Although the size of a clot can be controlled, some clots never fully go away.
Treating DVT
You may be hospitalized for 5 to 10 days. In the hospital, you'll be given anticoagulants, commonly called blood thinners. These medications control your blood's ability to clot. Anticoagulants are given by IV (intravenous) line, as well as in pill form. If bed rest is ordered, your leg may be elevated to prevent swelling. You may be fitted with prescription elastic support stockings before going home. By wearing these stockings, you may prevent ongoing leg swelling that could cause tissue damage.
Understanding Your Medication
To keep blood from forming clots, anticoagulants must be taken at the same time every day. Make this easier to do by always taking your medication at the same time each day. While taking anticoagulants, do not use over-the-counter or prescription medications without first checking with your doctor. The combined effect of the drugs may be dangerous.
Frequent Blood Tests
Your blood will be tested often to monitor how well your medication is controlling clotting. Don't miss these tests. Too much medication may cause bleeding, too little may cause clots. If you have bruising or your gums begin bleeding, have your blood tested. Your anticoagulant dosage may need to be changed.
What You Can Do
You can improve blood flow back to your heart by elevating your leg whenever it feels swollen or heavy. Return to normal activities gradually and talk with your doctor before going back to a strenuous exercise program, such as aerobics.
To help reduce leg swelling, follow the tips below:
Elevate the foot of your bed 5 to 6 inches if your leg is usually swollen when you wake up. This helps send blood back toward the heart.
- Exercise both legs, even when you're sitting. Wiggle your toes and tighten your calves to keep blood moving. Walk around for a few minutes every hour.
- Wear elastic stockings whenever you are out of bed.
Venous Thrombolytic Therapy
Deep vein thrombosis may not cause symptoms until the blockage severely interrupts blood flow. Then, you experience symptoms, such as:
- Pain
- Sudden swelling in the affected leg
- Enlargement of the superficial veins
- Reddish-blue discoloration
- Skin that is warm to the touch
If you have symptoms like these, you should contact your doctor immediately. Untreated, DVT may cause serious problems.
A clot can grow in size and block other veins. In addition, portions of the clot may break away from the vein wall and travel through the veins into the lung, where it can lodge in a pulmonary artery. This condition is known as pulmonary embolism, and the traveling clot is called an embolus. Pulmonary embolism can be life threatening if the embolus blocks the main pulmonary artery or if there are many clots. Pulmonary embolism can be treated with drugs that dissolve the clot and restore normal blood flow. You should get medical help immediately if you experience any symptoms of pulmonary embolism:
- A feeling of apprehension
- Shortness of breath
- Sharp chest pain
- Rapid pulse
- Sweating
- Cough with bloody sputum
- Fainting
Over time, untreated DVT may damage a venous valve so that it does not close completely. Consequently, blood flows back into the vein below the valve and collects in the lower leg veins. Pooling of blood in these lower leg veins causes swelling and tissue damage that may lead to painful ulcers. This condition is known as venous stasis disease.
Fortunately, prompt treatment of DVT can prevent complications such as pulmonary embolism and venous stasis disease.
Diagnosing DVT
If DVT is suspected, additional tests will be needed to confirm the diagnosis. These tests may be performed by your doctor in his or her office. In some cases, they will be done in the hospital.
The tests used most often to diagnose DVT do not involve any needles and are relatively painless. Your doctor may listen to blood flowing through the veins in your calf and thigh and behind your knee, using a special stethoscope placed on your leg.
He or she can measure blood flow through your veins by placing a blood pressure cuff thigh and inflating. This way, the doctor can record the amount of blood flow through electronic sensors placed on your lower leg. A third method of diagnosing DVT is called a duplex scan. An ultrasound microphone is placed on the leg over the affected area, and sound waves measure the veins and blood flow on a screen.
The duplex scan is very accurate for DVT because it shows the vein and any blood clots on the screen. If your doctor is unsure whether you have DVT after these tests, he or she may refer you to an interventional radiologist for a venogram. In a venogram, dye is injected into a vein in the foot and an x-ray is taken of the leg. In most cases, if a clot is present, it will be shown on the x-ray. In another type of venogram, a radioactive substance is injected into a vein in the foot and a special camera is used to record the concentration of radioactivity. Areas dense in concentration of radioactivity indicate sites of blockage.
The Traditional Treatments
Traditional treatments are bed rest, elevation of the affected limb, pressure stockings and drugs to prevent blood clotting. These drugs, called anticoagulants, keep the clot from increasing in size and help prevent pulmonary embolism. But, they do not dissolve clots that have already formed. Your body's own system for breaking down clots is needed for that.
Catheter-directed thrombolysis is a new treatment that actually dissolves blood clots in veins. A clot-dissolving drug, called a thrombolytic agent, is placed directly into the thrombus through a long, thin plastic tube called a catheter. Catheter-directed thrombolysis is generally performed in a hospital radiology suite by an Interventional Radiologist. The Interventional Radiologist inserts the catheter into the jugular vein or femoral vein and threads it into the vein containing the clot.
The catheter tip is placed into the clot, and the clot-dissolving drug is infused into the clot. It usually takes a few days for the clot to dissolve. During that time, the Interventional Radiologist monitors the progress of the treatment using venogram and duplex scans. Once the clot has been dissolved, any narrowing in the vein wall that might cause future clot formation can be seen on the venogram or duplex scan and may be treated.
Balloon angioplasty may be used to widen the vein after catheter-directed thrombolysis. In this procedure, a catheter with a balloon on the end is threaded into the vein to the narrow area.
The balloon is expanded and left in place. After a period of time the balloon is deflated and the catheter removed. The interior of the vein is wider than it was before treatment and blood flow is improved.
A stent is a small mesh tube that may be inserted into a vein to keep the vein open if it tends to collapse. A stent is inserted into the vein using a catheter. Once it is in proper location, the stent is expanded. Some stents are inserted on a balloon, which is expanded once the stent is in place. Other stents are inserted without a balloon and expand by themselves. After the stent is expanded, the catheter and balloon, if used are withdrawn, leaving the stent behind to support the vein walls.
After Your Treatment
If you have no complications, you may stay in the hospital for a day or two after your vein has been reopened. Your doctor will want you to take an oral anticoagulant drug for a few months to prevent further clots from forming.
He or she may order follow-up tests to make sure your veins stay open and monitor your anticoagulant dosage. Many patients go on to lead active, healthy lives after being treated for DVT. If you follow your doctor's instructions, so can you.