A study has revealed that incidence of in-hospital mortality is greater among patients with deep vein thrombosis or DVT involving inferior vena cava than those with DVT at other locations. Moreover, pelvic vein DVT is not correlated with higher mortality or more in-hospital embolism compared with proximal lower extremity deep vein thrombosis.
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| Photo: Blood Clotting in the Vein | InStyleHealth |
What Is Deep Vein Thrombosis (DVT)?
Deep vein thrombosis (DVT) is a serious condition that
occurs when a blood clot forms in a vein located deep inside your body. A blood
clot is a clump of blood that’s turned to a solid state.
Deep vein blood clots typically form in your thigh or
lower leg, but they can also develop in other areas of your body. Other names
associated with this condition may include thromboembolism, post-thrombotic
syndrome, and postphlebitic syndrome.
What Are The Symptoms of Deep Vein
Thrombosis (DVT)?
Based on the information from the Centers for Disease
Control and Prevention (CDC) Trusted Source, the symptoms of Deep Vein Thrombosis
or DVT can occur in about 50% of the people who have the following common symptoms:
- The area of skin that feels warmer than the skin on the surrounding areas
- A cramping pain in the affected leg that usually starts in your calf
- A severe, unexplained pain in the foot and ankle
- The skin over the affected area turning pale or a reddish or bluish color
- A swelling in the foot, ankle, or leg, usually on one side
Individuals with upper extremity DVT, or a blood clot
in the arm, may not have or experience symptoms. Although common symptoms may
include:
- A blue-tinted skin color
- A neck pain
- A pain that moves from the arm to the forearm
- A shoulder pain
- A swelling in the arm or hand
- A weakness in the hand
Individuals may not find out that they have deep vein
thrombosis until a person has gone through emergency treatment for a pulmonary
embolism (blood clot in the lungs).
The pulmonary embolism may occur when a DVT clot has
moved from the arm or leg into the lungs. When the artery in the lungs becomes
blocked, it is a life-threatening condition and needs emergency care.
What Are The Causes of Deep Vein
Thrombosis (DVT)?
Deep Vein Thrombosis or DVT is a result of blood
clotting. The blood clots block a vein, inhibiting the blood from properly circulating
in a person’s body. Blood clotting can happen for several reasons. These may
include the following:
Certain medications –
There are some medications that elevates the risk of blood clot formation in a
person’s body.
Injury – Damage to a
blood vessel’s wall may narrow or block the blood flow. Thus, a blood clot may
eventually form as a result.
Reduced mobility or inactivity –
When a person spends most of the time sitting, blood may collect in the legs,
specifically the lower extremities. If the person is unable to move for extended
periods of time, the blood flow in the legs can slow down. It will cause a blood
clot development.
Surgery – The blood
vessels can be damaged during a surgery, that may lead to developing of blood clots.
A bed rest with little to no movement after surgery may also elevate the risk of
developing blood clots in your body.
What Are The Risk Factors of Deep Vein
Thrombosis (DVT)?
Deep Vein Thrombosis or DVT happens most commonly in individuals
who are over 50 years old. However, DVT can still happen at any age. There are
certain conditions that change how the blood flows through the veins can elevate
the risk of developing blood clots. These are the following:
- Having an injury that damages your veins, like a bone fracture
- Being overweight, which puts more pressure on the veins in your legs and pelvis
- Having a family history of Deep Vein Thrombosis (DVT)
- Having a catheter placed in a vein
- Taking birth control pills or undergoing hormone therapy
- Smoking can also elevate the risk of blood clot formation
Staying seated for long periods of time while in a car
or aboard a plane, especially if the person already has at least one other risk
factor.
There are some conditions which may increase the risk
of having blood clots. These include hereditary blood clotting disorders,
especially when a person already has at least one other risk factor existing.
Cancer and inflammatory bowel disease may also increase the risk of developing
a blood clot.
Heart failure – a medical condition which makes it
even more hard for the heart to pump blood, may also result in an increased
risk of blood clots.
Deep Vein Thrombosis (DVT) is considered a major risk correlated
with surgery. It is especially true if a person is having a surgery in the
lower extremities, like joint replacement surgery.
There are also multiple factors which may elevate the
risk of developing a blood clot. Learning more about each one can help an individual
take precautionary measures.
How To Prevent Deep Vein Thrombosis (DVT)?
A person can lower the risk of having Deep Vein
Thrombosis or DVT by making few lifestyle changes. These lifestyle changes
include keeping the blood pressure under control, giving up smoking, and losing
weight if the person is overweight or obese.
Moving the legs around when sitting for a while also
helps keep the blood circulating. Walking around after being on bed rest will
prevent clots from developing.
Take any blood thinners a doctor prescribes if undergoing
surgery, as this can lower the chance of developing blood clots thereafter.
Risk of developing DVT during travel becomes higher if
a person is sitting for more than 4 hours. Minimize the risk by moving around
every so often. Get out of the car and stretch at intervals during long drives.
Walk in the aisles if boarding a plane,
taking a train, or riding a bus.
Stretch the legs and feet while sitting, this will
keep the blood moving steadily in the calves. Don’t wear tight clothes that can
restrict blood circulation. Complications of DVT are preventable. One must need
to know how to cut down the risk.
How Do You Treat Deep Vein Thrombosis?
Deep Vein Thrombosis or DVT is considered a serious
medical condition. A person needs to tell a health professional right away if one
is experiencing symptoms of DVT or go to the closest emergency room for
immediate attention. A healthcare provider will evaluate the symptoms.
DVT treatments will concentrate on keeping the blood
clot from further developing. Furthermore, treatment can help prevent a
pulmonary embolism and reduces the risk of having more blood clots.
Medications for Deep Vein Thrombosis or
DVT
The doctor might prescribe medications for blood thinning,
like heparin, warfarin (Coumadin), enoxaparin (Lovenox), or fondaparinux
(Arixtra). This will make it harder for the blood to clot. This will also keep
existing clots as small as possible and reduces the chance that will develop
more blood clots.
In case blood thinners will not work, or if a person has a severe case of DVT, the doctor
might use thrombolytic medicines. Individuals with upper extremity DVT can
benefit from this type of treatment.
Thrombolytic medications work by breaking up blood clots.
The patient will receive these intravenously.
Compression Stockings for DVT
Once a person is at high risk for DVT, sporting compression
stockings will prevent swelling and will reduce the chance of developing blood clots
in the veins.
The compression stockings reach just below the knee or
right above it. A doctor may recommend to have these worn every day.
Filters for DVT
A person will need to have a filter placed inside the
large abdominal vein called the vena cava if a person cannot take blood
thinners. The type of treatment will help prevent pulmonary embolisms by
stopping clots from entering the lungs.
However, filters have associated risks. If these are
left in for too long a time, these will actually cause in developing DVT.
Filters should be used for a short-term period only, until the risk of
thromboembolism is minimized and blood thinning medications can be safely used.
Deep Vein Thrombosis or DVT Surgery
The doctor may suggest surgery to remove a DVT clot in
the arms or legs. Typically, this is only recommended in cases where large
blood clots are creating serious issues like tissue damage.
In a surgical thrombectomy, or the surgery to remove a
blood clot, the surgeon will make an incision into a blood vessel. Surgeons
will locate and remove the blood clot. Then they will repair the blood vessels
and tissues affected.
There are cases where surgeons may utilize a small
inflating balloon to keep the blood vessel open while removing the blood clot.
When the blood clot is found and removed, the balloon will be removed as well.
A surgical procedure is not without risks involved, many
a doctors will only utilize treatment in sever cases of DVT. The risks involved
will include infection, damage to the blood vessels, and excess bleeding or hemorrhage.
Deep Vein Thrombosis or DVT Exercise
Sitting longer creates the greater your risk of
developing a blood clot in the veins. If one is to be seated for longer periods
of time, there are exercises that can be done while sitting to keep the legs
moving and will help the blood circulation:
Knee Pulls
Bend the leg, and raise the knee toward the chest.
Wrap the knee with the arms for a greater stretch. Hold this position for
several seconds, then do the same exercise on the other side. Repeat these
stretches for several times.
Foot Pumps
Place the feet flat on the floor. Keeping the balls of
the feet on the floor, raise the heels. Hold for a few seconds, then lower the
heels. Raise the balls of the feet off the floor, keeping the heels in place.
Hold for a few seconds, then lower the balls of the feet.
Repeat these foot pumps for several times to ensure
blood flows properly in those areas of the body.
Ankle Circles
Lift both feet off the floor. Draw circles with the
toes in one direction for a few seconds. Switch directions, and draw circles
for a few seconds. Repeat this exercise several times to allow proper flow of
the blood in the lower parts of the body.
According to researchers the incidence of in-hospital
pulmonary embolism was considerable with DVT at all sites.
The retrospective cohort study wanted to determine
whether DVT involving the pelvic veins or inferior vena cava was correlated
with higher in-hospital mortality or higher prevalence of in-hospital pulmonary
embolism than proximal or distal lower extremity DVT. Researchers gathered
administrative data from the Nationwide Inpatient Sample 2016-2017.
International Classification of Diseases-10-Clinical
Modification codes were utilized in identifying patients hospitalized with a
primary diagnosis of DVT at designated locations.
For patients treated only with anticoagulants,
in-hospital all-cause mortality was 2.2% with DVT involving the inferior vena
cava vs 0.8% with pelvic vein DVT, 0.7% with proximal DVT, and 0.2% with distal
DVT.
The mortality with anticoagulants was comparable
between pelvic vein DVT and proximal lower extremity DVT (0.8% vs 0.7%). The
pelvic vein DVT treated with thrombolytics revealed a lower mortality than that
treated with anticoagulants.
Moreover, in-hospital pulmonary embolism occurred in
11-23% regardless of the site or location of occurrence of deep vein
thrombosis.
Source: Am J Med 2021;134:877-881