Deep Vein Thrombosis & Pulmonary Embolism

Deep vein thrombosis, also known as DVT, is a serious condition in which a blood clot develops in a person’s veins, causing a partial or complete blockage of blood flow. DVT generally causes pain and swelling in the involved area, as well as skin discoloration. In more serious cases, the blood clot breaks loose and travels through the bloodstream to the lungs, blocking circulation to that organ. This condition, known as pulmonary embolism (PE), is life threatening and requires immediate medical attention.

Nearly 40% of patients with DVT will develop PE, with the latter causing approximately 300,000 deaths in the United States each year. It’s important to realize the DVT can occur to anyone and that it can result in disability and even death, however, DVT can be prevented and treated, if discovered early.

SIGNS AND SYMPTOMS OF DEEP VEIN THROMBOSIS

Some people have no signs of DVT, but the most common symptoms are:

• Pain, swelling and tenderness in involved leg or arm.
• Reddish or bluish skin color over the affected area

DVT RISK FACTORS

DVT can affect almost anyone. Common risk factors include:

• A family history of DVT
• Obesity
• Damaged blood vessels
• Having certain conditions that cause your blood to clot more easily, such as having chemotherapy or radiation therapy for cancer, heart and lung disease thrombophilia and Hughes syndrome
• Being inactive when traveling during long journeys, which slows blood flow and increases the risk of clots developing
• Pregnancy
• Taking contraceptive pills and hormone replacement therapy can increase the likelihood of blood clots

Having one or more of the above risk factors also increases your chances of having DVT. It’s also worthy to note that about half of DVT cases occur during or soon after a hospital stay or surgery. 

TIPS TO PREVENT DVT

Take these following steps to reduce your risk of DVT:

• Move around as soon as possible after surgery or injury
• Consider medical compression stockings or anticoagulants if you are at risk
• When sitting for long periods of time, get up and walk around, perform in-seat leg exercises and wear loose-fitting clothes
• Maintain a healthy weight

DIAGNOSIS AND TREATMENT

It is very important to do an ultrasound to promptly diagnose DVT if the symptoms are concerning. At VIVAA, we will discuss the symptoms and will do an ultrasound right away if DVT is suspected. Ultrasound allows Dr. Sidhu to watch and monitor your blood flow and see the areas where the overall flow of blood is constrained or restricted because of the thrombus. Once the diagnosis is made, treatment depends on the extent of the thrombus.

Treating DVT aggressively to prevent long-term disability is important. Dr. Sidhu will discuss the latest medications and treatments to determine the best course for you. Depending on your symptoms, you may be a candidate for thrombolytic treatment to dissolve the clot. If your symptoms aren’t life threatening, or if using a thrombolytic is too dangerous, you may receive anti-coagulant medications that interrupt the clotting process. These medications don’t break down the clot but will keep it from getting bigger while your body works on dissolving it. Using compression stockings to prevent tissue damage and to help reduce swelling may also be part of your treatment.

Sometimes patients will need surgery to place an inferior vena cava (IVC) filter to prevent the blood clot from traveling to the lungs. This screen, placed in a big vein in the abdomen, is generally only used when anticoagulant treatment is not suitable or needs to be stopped.

CHRONIC DVT AND POST PHLEBITIC SYNDROME

Chronic ilio-femoral DVT can lead to occlusion of the iliac veins. Also called post-phlebetic syndrome, this medical condition can occur as a long-term complication of DVT. This results in chronic leg swelling, pain in the leg, ultimately thickening/redness of the skin and even development of wounds. The process to rid the body of the clot can damage the vein’s function, particularly the valves that regulate blood flow. If a patient has leg swelling after acute DVT, the person should wear a compression stocking to decrease the swelling and include other lifestyle modifications such as elevating the extremity at night, weight loss and exercises to strengthen the extremity muscles.

PULMONARY EMBOLISM

The most serious complication of DVT occurs when a clot breaks up and travels to the lungs where it can cause pulmonary embolism. Pulmonary embolism is diagnosed with a CT scan and, in the most serious cases, can require a procedure to dissolve the clot to prevent the long-term sequel of pulmonary hypertension.

If your clot is small and has appropriate treatment, your can recover from PE. However, there could be some damage to the lungs. If the clot is large, it can stop blood from reaching the lungs and is fatal.

With early intervention, patients with DVT can reduce their risk of pulmonary embolism to about 1%. Pulmonary embolism is a serious complication of DVT that may be prevented if action is taken to dissolve the clots early.  PE results in reduced blood flow to the lungs which can have life-threatening results.

Signs of Pulmonary Embolism

The signs are not the same for each person, however, they can include:

• Shortness of breath
• Rapid breathing
• A sharp, stabbing pain in the chest that may worsen when you inhale
• Rapid heart rate
• Coughing, sometimes with blood
• Fainting
• Low blood pressure
• Fever