What is deep vein thrombosis?
Deep vein thrombosis (also called DVT) is a blood clot in a vein deep inside your body. These clots usually occur in your leg veins. While DVT is a fairly common condition, it is also a dangerous one. If the blood clot breaks away and travels through your bloodstream, it could block a blood vessel in your lungs. This blockage (called a pulmonary embolism) can be fatal.
Am I at risk for DVT?
You are at higher risk for DVT if you:
are older than 60 years of age;
are inactive for a long period of time, such as when you are flying in an airplane, taking a long car trip or recovering in bed after surgery;
have inherited a condition that causes increased blood clotting;
have an injury or surgery that reduces blood flow to a body part;
are pregnant or have recently given birth;
have varicose veins;
have cancer, even if you are being treated for it;
are taking birth control pills or hormone therapy, including for postmenopausal symptoms; or
have a central venous catheter.
Your risk for DVT increases if you have several risk factors at the same time.
How can I prevent DVT?
Frequently exercise your lower leg muscles if you'll be inactive for a long period of time.
Get out of bed and move around as soon as you can after having surgery or being ill.
After some types of surgery, take medicine to prevent blood clots as directed by your doctor.
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What are the symptoms of DVT?
Some people have no symptoms at all. Most have some swelling in one or both legs. Often there is pain or tenderness in one leg (may happen only when you stand or walk). You may also notice warmth, or red or discolored skin in the affected leg. If you have any of these symptoms, call your doctor right away.
If your doctor thinks you might have DVT, he or she will do one or more tests. These may include an ultrasound (uses sound waves to check the blood flow in your veins) or venography (a doctor injects dye into your vein, then takes an x-ray to look for blood clots).
What medicines are used to treat DVT?
The following are the main goals in treating DVT:
Stopping the clot from getting bigger.
Preventing the clot from breaking off and traveling to your lungs.
Preventing any future blood clots.
Several medicines are used to treat or prevent DVT. The most common are anticoagulants (also called blood thinners) such as warfarin (brand name: Coumadin) or heparin. Anticoagulants thin your blood so that clots won't form. Warfarin is taken as a pill, and heparin is given intravenously (in your veins). If you can't take heparin, your doctor may prescribe another kind of anticoagulant called a thrombin inhibitor.
What are the side effects of anticoagulants?
Anticoagulants can cause you to bleed more easily. For example, you might notice that your blood takes longer to clot when you cut yourself. You might also bruise more easily. If you have any unusual or heavy bleeding, call your doctor right away.
Warfarin can cause birth defects. Women who are pregnant shouldn't take warfarin.
Some other medicines can affect how well an anticoagulant works. If you're taking an anticoagulant, ask your doctor before you take any new medicine, including over-the-counter medicines or vitamins. Certain foods rich in vitamin K, such as dark green vegetables, can also affect how well an anticoagulant works.
What other treatments are used for DVT?
If you can't take medicine to thin your blood, or if a blood thinner doesn't work, your doctor may recommend that you have a filter put into your vena cava (the main vein going back to your heart from your lower body). This filter can catch a clot as it moves through your bloodstream and prevent it from reaching your lungs. This treatment is used mostly for people who have had several blood clots travel to their lungs.
Elevation of the affected leg and compression can help reduce swelling and pain from DVT. Your doctor can prescribe graduated compression stockings to reduce swelling in your leg after a blood clot has developed. These stockings are worn from the arch of your foot to just above or below your knee. They cause a gentle compression (pressure) of your leg.
A blood clot in one of the arteries carrying blood to the lungs. The blood clot usually begins in a deep vein of the leg or, less often, another place in the body. The clot moves through the bloodstream, passing through the heart and into an artery in the lungs. The blockage reduces breathing ability and can destroy lung tissue. Rarely, other types of clots form that are made up of fat, air bubbles, tissue from a tumor, or bacteria. Pulmonary embolism is more common in adults.
Frequent Signs and Symptoms
Sudden shortness of breath.
Faintness or fainting.
Pain in the chest.
Cough (sometimes with bloody sputum).
These symptoms are often preceded by swelling and pain in the leg.
Deep-vein thrombosis, which can occur any time blood pools in a vein.
risk increases with
Previous embolism or deep-vein thrombosis.
Any injury or illness that requires prolonged bed rest.
Sitting for long periods, as on car or plane trips.
Heart disease, high blood pressure, or lung disorders.
Bone fractures, such as hip fracture.
Use of birth-control pills; risk increases with smokers.
Family history of tendency to form blood clots.
Avoid prolonged bed rest during illnesses. Wear compressive stockings during recovery (in or out of bed).
Start moving legs and walking as soon as possible after surgery.
Don't smoke, especially if you are a woman age 35 or older who takes birth-control pills.
When traveling, stand and walk every 1 to 2 hours.
Usually curable with treatment. Embolism may recur.
High blood pressure in the lungs (pulmonary hypertension).
Heart damage (a condition called cor pulmonale).
Death (from a large clot that blocks the artery).
Diagnosis & Treatment
Your health care provider will do a physical exam and ask questions about your symptoms and activities. Medical tests may include chest X-ray, lung scan, pulmonary angiogram (a special X-ray study of blood flow), CT, blood studies, and other tests as needed.
Treatment is aimed at maintaining heart, blood vessel, and lung functions as well as preventing clot recurrence.
Hospital care is necessary. Supplemental oxygen will be provided, and drugs will be given through a vein (IV).
Surgery may be necessary to tie off the big vein leading to the heart and lungs (vena cava), or to insert a filter to trap recurrent clots.
Self-care steps (if advised by your health care provider). Wear elastic or compressive stockings or leg wraps with elastic bandages. Don't sit with your legs or ankles crossed. Elevate your feet higher than your hips if sitting for long periods. Raise the foot of your bed.
Anticoagulant drugs to treat the clots will be prescribed. You may need indefinite treatment with these drugs to prevent a recurrence. Your health care provider will explain their risks and benefits.
Clot-dissolving (clot buster) drugs may be prescribed. They break down the blood clots.
Drugs to treat other disorders may be prescribed.
Rest in bed until all symptoms of the clot improve. While in bed, move your legs often.
Texas Hills Urgent Care Centers have on-site diagnostic testing ability that allows us to immediately detect and treat dangerous blood clots. The advanced laboratory at THUCC can perform within 15 minutes the most important blood clot detecting blood test (d-dimer test). Other important blood test needed for the immediate evaluation of someone suspected of possibly having a blood clot include the prothrombin time (PT-INR) and complete blood count (CBC) test. Both of these test are also immediately available and run routinely within a matter of only a few minutes in our in-house lab.
Texas Hills Urgent Care Centers also have in house CT scanners that allow us to immediately diagnosis the location and the severity of these serious blood clots. These CT scans are interpreted by Board Certified, Texas Licensed Radiologist within a matter of only a few minutes using the advanced Tele-Radiology service available at each of the THUCC sites.
Lovenox (low molecular weight heparin) in recent years has become the most important treatment for the initial treatment of blood clots. Texas Hills Urgent Care Centers keep a supply in stock at all of our facilities. It is given subcutaneously (into the fat layer just beneath your skin). Often it is given as a once a day shot (subcutaneous injection) for a few days to a week after someone suffers a blood clot.
Heparin has long been the mainstay of treatment for blood clots of multiple types. It is also kept in stock at Texas Hills Urgent Care Centers. It is given intravenously. It is not used as often now that Lovenox has become available. It still has a use in patients that may only need to be on an anticoagulant for a few hours because it quits working quickly once the IV has been discontinued.
Coumadin is a medication taken by mouth for a period of time after a blood clot that helps prevent the blood clot from getting any bigger and helps the body to remove the blood clot. The limitation of Coumadin is that it takes a number of days to start working. So people that suffer from a blood clot usually have to take Lovenox shots for a few days to a week before the Coumadin starts working fully. Also Coumadin's therapeutic affect must be monitored frequently with the prothrombin time (PT-INR) blood test. It is unsafe to take coumadin without having this blood test monitored by a physician.