Deep Vein Thrombosis

Introduction:
Deep vein thrombosis is a condition in which a blood clot forms in one or more of the deep veins usually in the legs. A potentially life threatening complication may occur if this clot detaches and travels to the lungs leading to pulmonary embolism.

Etiology:
DVT (Deep vein thrombosis) results from conditions that impair venous return, lead to endothelial injury or dysfunction, or cause hypercoagulability. The conditions leading to DVT and the risk factors include:

• Occult cancer.
• Immobilized patients.
• Adults over the age of 60 years
• Recent history of a major surgery or trauma
• Prolonged sitting like long travels
• Family history of blood clots.
• Pregnancy or delivery in last 6 months
• Obesity
• Fracture of the pelvis or legs.
• Taking oral contraceptives or hormonal replacement therapy.
• Certain autoimmune disorders
• Cigarette smoking.

Clinical Signs And Symptoms:The clinical features of deep vein thrombosis include:

• Swelling in the affected leg. ( Rarely both legs are involved)
• Changes in skin color
• Pain in the leg
• Warmth and tenderness over the affected part
• Positive Homan’s sign ( Calf discomfort elicited by ankle dorsiflexion with the knee extended)

Management:
The two main tests done to diagnose DVT are :

1. D-dimer blood test.
2. Doppler ultrasound exam of the legs.

Other routine tests may also be done like complete blood count and coagulation studies. More tests may be needed later on to find out the underlying cause for DVT.

Treatment aims to prevent the formation of blood clot.

• Heparin is usually the first line drug which is given through intravenous route.
• Warfarin that can be taken orally can be started along with heparin and continued depending on need.
• Pressure stocking can be given to wear on the legs which helps improve blood flow and reduces the risk of complications from blood clots.
• Sometimes a surgery may be needed to place a filter in the body’s largest vein to prevent the clots form the deep veins to enter the lung circulation.