Deep vein thrombosis (DVT) is an illness that develops when the blood clots in a vein. Affected veins are usually deep in leg muscles but can also be in other areas. The clot (thrombus) causes blood flow to slow. The area becomes swollen, red, and painful. If the clot moves to the lungs, a pulmonary embolism (blocked vein in the lungs) occurs and life threatening breathing problems can develop.
DVT most often affects people who are physically inactive, elderly, pregnant, or have blood disorders that increase the risk of blood clotting.
Prolonged bed rest (more than 3 days), recent surgery (with anesthesia for more than 30 minutes), smoking, being overweight, air or car travel for prolonged periods, using certain oral contraceptives and estrogen replacement therapies, cancer, and family or personal history of blood clotting problems can increase the risk of DVT.
Symptoms are pain, tenderness, warmth, swelling, and redness in the area. Initially there may be no symptoms.
The health care provider will ask about symptoms and do an examination. If DVT is suspected, the health care provider may recommend a sonogram (ultrasound) of the swollen leg or other part to measure blood flow in the area and a blood test (D-dimer). Only in rare cases when the diagnosis is suspected but sonogram and blood tests are inconclusive, the health care provider may also order a special x-ray study (venography) in which a dye is injected into the vein to see whether a clot is blocking blood flow.
Treatment is immediate injection of a blood thinner (heparin) to thin the blood and prevent growth of blood clots. Heparin can be given intravenously or injected under the skin (subcutaneously). Your health care provider will decide which option is best for you. The health care provider will also prescribe blood thinning pills (warfarin) to prevent the clot from enlarging and stop new ones from forming. For a few days, both heparin and warfarin are given. When warfarin reaches the desired level in blood, heparin will be stopped and warfarin will be continued, usually for 3-6 months, at times longer, depending on the cause of the DVT. Lifetime treatment may sometimes be needed. Blood tests to make sure that the warfarin dose is correct must be done. Instead of warfarin, you may be prescribed newer blood thinners such as rivaroxaban (Xarelto) or apixaban (Eliquis); these medications do not require periodic blood tests to monitor levels.
The health care provider may also recommend special stockings to control swelling in the legs. Overweight people should lose weight and become more active to prevent future clots.
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