Deep Vein Thrombosis
According to the Centers for Disease Control and Prevention, more than 900,000 Americans each year experience what doctors call deep vein thrombosis, or DVT. DVT occurs when a clot forms in the deep veins of the leg or arm, typically following an extended period of inactivity such as prolonged sitting, bed rest, surgery or even simply after a long airplane flight. Family history, obesity, cancer and birth control pills or supplemental female hormones are other risk factors for DVT. If left untreated, DVT may lead to a dangerous, life-threatening condition called pulmonary embolism (PE).
With prompt diagnosis, DVT is treatable. A blood clot that forms in the deep veins can be life-threatening. Others that develop in the visible superficial veins, smaller veins that lie just beneath the skin, are not life-threatening. That’s because a large clot that forms in the deep veins are more likely to break free and travel through the larger central veins and into the lungs causing a pulmonary embolism.
“Patients who have had a major surgery, such as a hip or knee replacement or even extensive cancer surgery are at increased risk for DVT,” explains Guy Mayeda MD, cardiologist at PIH Health Good Samaritan Hospital. “Anything that keeps a person immobile for a long period of time is going to raise the chances of developing a DVT unless some form of preventive measures are used such as mechanical leg squeezers or compression boots, or blood thinners such as Coumadin, Heparin® or Lovenox®.”
For those who are not undergoing surgery but are still at risk for developing DVT, they need to keep active, especially when traveling on long trips or sitting at a desk for hours at a time. Regular stretching and leg movement are important to keep blood flowing.
Once a patient has been diagnosed with a distal DVT (clot below the knee), treatment may vary. For most cases, physicians recommend wearing graduated compression stockings (i.e. T.E.D.® hose), elevating the legs and close follow-up with their doctor. Taking an anticoagulant (blood thinning medication) agents to prevent further clots from forming and reducing the risk of a PE is a consideration. All proximal DVT (clot in veins above the knee) require treatment with anti-coagulation agents for several days with either Heparin® or Lovenox® and a patient may or may not stay in the hospital as it can be performed in an outpatient setting. Further anti-coagulation therapy for several months may be needed to prevent new clots from forming. In severe cases, some physicians may recommend thrombolysis, an intravenous medication that dissolves clots, or mechanical thrombectomy in which the clot is removed from the vein using a vacuum device in the Cath Lab. Both therapies are then followed by treatment with blood thinning medications to prevent recurrence of the DVT.
Individuals who have a family history of blood clots or other associated risk factors and experience pain, swelling or discoloration in the legs or arms should immediately see a doctor who may need to conduct tests, such as an ultrasound scan of the veins.
“Classic signs of a heart attack, such as chest pain, pleurisy (pain with deep breathing), sudden shortness of breath or a rapid pulse can also be signs of a pulmonary embolism,” explains Dr. Mayeda. “Nearly 50 percent of patients with a DVT never recognize the symptoms, but they’re more likely to notice the signs of a PE when it occurs.”
While the symptoms of a PE can also be associated with a heart attack, pneumonia and other medical conditions, it’s important to recognize these signs as a potentially life-threatening emergency. Call 911 immediately or go to your nearest emergency room.
