Introduction

A deep vein thrombosis (DVT) is a blood clot that forms in the deep large veins of the pelvis, legs, thighs, or arms. A DVT can reduce or block the flow of blood in a vein. It may dislodge and travel in the bloodstream, causing a stroke, pulmonary embolism, heart attack, or death. DVT is a potentially life-threatening condition and requires immediate medical attention. DVTs may be treated with medications or surgery.

Anatomy

The heart has several large arteries and veins connected to it that branch out and become smaller as they travel throughout your body. Your arteries and veins are blood vessels that deliver blood throughout your body in a process called circulation. Arteries carry oxygenated blood away from your heart. Veins carry deoxygenated blood from your body and lungs back to your heart.

Causes

DVTs can occur in the deep large veins of the pelvis, legs, thighs, or arms. They may develop after prolonged bed rest or immobility, such as after long plane or car trips. Risk factors may increase the likelihood of DVT development.

Symptoms

A DVT can cause pain or tenderness, redness, warmth, and swelling. A DVT in the leg may cause the one leg to swell, discolor, and cramp like a “charley horse.” A DVT in the arm may cause upper arm or neck swelling.

Because of the life-threatening medical complications, you should contact your doctor immediately if you suspect that you have a DVT. The concern is that sometimes clots can break off and travel through the bloodstream. This is termed an embolism. Embolisms can reduce or block the flow of blood in a blood vessel. Depending on their location, an embolism can cause a stroke, lung damage, heart attack, or death. You should call the emergency medical services in your area, usually 911, if you are having a stroke or heart attack.

After experiencing a DVT, some people develop phlebitis or “post-thrombotic syndrome,” a painful leg condition. This causes a vein to feel hard and extremely sensitive to pressure. Deep vein thrombophlebitis in the leg can cause aching or cramping, especially when walking or flexing the foot.

Diagnosis

You should contact your doctor immediately if you suspect that you have a DVT. Your doctor will examine you and conduct some tests to determine if a clot is present. If a clot is present, your doctor will determine the severity of the clot. Blood tests and imaging tests are commonly conducted. A Doppler ultrasound of the legs may identify a blood clot by using sound waves to create an image when a device is gently placed on your skin. A venography is used to identify blood clots in a procedure that uses X-rays and dye administered through a catheter that is inserted into a vein. You may receive a general or local anesthesia for the procedure. An impedance plethysmography is a non-invasive blood circulation test used to detect the presence of a blood clot. It may be used as an alternative to a venography.

Treatment

The goal of treatment is to prevent an embolism and another DVT. The treatment that you receive depends on the severity of your DVT. DVTs may be treated with blood thinning medications called anticoagulants or clot busting medications termed thrombolytic therapy. In some cases, clots are removed with a catheter or surgery. People that cannot tolerate or do not respond to anticoagulation may have a permanent filter inserted in their vein. The filter prevents large embolisms from entering the lungs but it does not stop blood clots from developing.

Prevention

Your doctor may recommend that you receive blood thinning medications or anticoagulants if you are at risk for DVT. You can minimize immobility during plane or car trips by walking frequently and pumping your feet while sitting. It may also be helpful to drink plenty of water, quit cigarette smoking, and achieve and maintain a healthy weight.

Am I at Risk

Risk factors may increase your likelihood of developing DVT, although some people that develop the condition do not have any risk factors. People with all of the risk factors may never develop DVT; however, the chance of developing the condition increases with the more risk factors you have. You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for DVT:

• People with a history of cardiovascular disease, stroke, and blood clots have an increased risk of developing DVT.
• Prolonged inactivity, such as sitting, bed rest, immobilization, or paralysis increases the risk of blood clots.
• Recent surgery, particularly knee, hip, and gynecological surgery, is a risk factor for DVT.
• Bone fractures increases the risk of DVT.
• A female may have an increased risk of blood clotting after childbirth or miscarriage.
• Cigarette smoking increases the risk of DVT.
• Using birth control pills or estrogen pills increases the risk of DVT. Cigarette smoking and the use of birth control pills together can increase the risk even further.
• Hypercoagulability, a blood clotting condition, is associated with an increased risk of DVT.
• People with a history of polycythemia vera, a condition that causes excess red blood cell, white blood cell, and platelet production, have an increased risk for DVT.
• Some cancer tumors may increase the risk of DVT.
• Sitting in an airplane for several hours can increase the risk of DVT because of inactivity, the cabin pressure, low humidity, and dehydration. DVT development as a consequence of a plane ride is referred to as “economy-class syndrome” or “coach-class syndrome.”
• DVT occurs most frequently in people that are over the age of 60; however, it can occur at any age.
• High blood pressure is a risk factor for DVT.
• Obesity is a risk factor for DVT.
• People with hypercoagulability, a condition that increases the likelihood of blood clots, have an increased risk of developing DVTs.

Complications

If you experience one DVT you are at risk for developing another. Be aware of the signs and symptoms of DVT and contact your doctor if you suspect that you have one.
Because of the life-threatening medical complications, you should contact your doctor immediately if you suspect that you have a DVT. The concern is that sometimes clots can break off and travel through the bloodstream. This is termed an embolism. Embolisms can reduce or block the flow of blood in a blood vessel. Depending on their location, an embolism can cause a stroke, lung damage, heart attack, or death. You should call the emergency medical services in your area, usually 911, if you are having a stroke or heart attack.

After experiencing a DVT, some people develop phlebitis or thrombophlebitis. This causes a vein to feel hard and extremely sensitive to pressure. Deep vein thrombophlebitis in the leg can cause aching or cramping, especially when walking or flexing the foot.