A blood clot embedded in one of the major deep veins of the lower legs, thighs, or pelvis, commonly referred to as deep venous thrombosis (DVT), blocks blood circulation through these veins, which carry blood from the lower body back to the heart. The blockage can cause pain, swelling, or warmth in the affected leg.
Blood clots in the veins can cause inflammation (irritation) called thrombophlebitis. The most worrisome complications of DVT occur when a clot breaks loose (or embolizes) and travels through the bloodstream and causes blockage of blood vessels (pulmonary arteries) in the lung. This can lead to severe difficulty in breathing and even death, depending on the degree of blockage.
People who are elderly and those who are obese experience the highest rates of deep vein thrombosis; however, this in no way means that healthy, young individuals have nothing to worry about. Certain people, born without important blood thinning properties, are always at an increased risk for developing blood clot.
Prolonged sitting, such as during a long plane or car rideProlonged sitting, such as during a long plane or car ride; Prolonged bed rest or immobility, such as after an injury or during an illness (stroke); Recent surgery, particularly orthopedic, gynecologic, or heart surgery ; Obesity; Recent childbirth ; Use of estrogen replacement (hormone replacement therapy, or HRT) or birth control pills; Malignant tumors (cancer) and Disseminated intravascular coagulation (DIC), a medical condition in which blood clotting occurs inappropriately, usually caused by overwhelming infection or organ failure are some of the causes for DVT.
The most common symptoms of blood clots in the legs include tenderness, redness, pain, swelling, fever, rapid heartbeat, a sudden and unexplained cough, and joint pain and soreness. DVT can also have potentially devastating effects on pregnant women causing miscarriage or stillbirth if the clot travels to an artery in the placenta where it can reduce the supply of oxygen to the fetus.
When your physician suspects that you may have a blood clot, s/he will perform a complete physical exam that includes a review of your medical history. An easy in-the-office indicator of DVT is a sharp pain in your leg when you flex your foot upward. Other tests, which can aid in your physician's diagnosis of DVT, include: an ultrasound of the leg or an x-ray of the veins in your leg after dye is injected into a vein in your foot to allow your physician to see your blood flow. If you are in a high-risk group for developing DVT, your physician may order additional tests that measure your blood's clotting ability.
Treatment of DVT begins with self-help techniques that you can incorporate at home including: avoiding prolonged bed rest. If bed rest is unavoidable such as in pregnancy or other medical conditions that require you to remain inactive, it's important that you remember to move your legs on a regular basis even if it's just swinging them over the side of your bed a few times an hour or putting your knees up and down several times. If you smoke, quit. If you don't smoke, don't start! Smoking is especially dangerous for people at risk for DVT. As always, regular exercise is important to reduce your risk of blood clots forming in your legs. If you have severe varicose veins, the use of support stockings can help decrease the chance that a blood clot will form.
Although a DVT may resolve on its own, the life-threatening consequences of a clot reaching the lung, called pulmonary embolism, are severe enough to warrant seeking medical attention at once Your doctor may tell you to go immediately to a hospital emergency department if you have leg pain or swelling with any of the risk factors, go to a hospital emergency department immediately.
If you have a DVT, you will be treated with a blood-thinning medication (anticoagulant). These medications do not make the clot go away. They stabilize the clot and make it adhere to the vessel wall. The body normally lyses (breaks up) the clot on its own. This is a gradual process that may take several days or weeks. Anticoagulants prevent further clotting and worsening of the condition.
Thrombectomy is surgical removal of the clot. Much controversy surrounds using this treatment instead of anticoagulation. Thrombectomy is performed when a large blood clot is obstructing the vessels in the lung and the patient is in critical condition. Surgery is effective, and the results are immediate.
People who cannot take anticoagulant medication may undergo a placement of an umbrellalike device (filter), which is usually placed via the veins in the leg or neck, under local anesthesia. A small, metal, umbrellalike filter is inserted into the inferior/superior vena cava, the main large vein that carries blood back to the heart from the upper/lower body. This technique is performed in a hospital. The umbrella should catch any clots that break loose from the veins of your lower body before they travel to your lung.
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