Deep Vein Thrombosis or DVT Involving Inferior Vena Cava Tied to Higher Mortality

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.

Deep Vein Thrombosis or DVT Involving Inferior Vena Cava Tied to Higher Mortality
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

If you have any suggestions, please let us know.

Post a Comment (0)
Previous Post Next Post