A deep vein thrombosis or DVT is a very serious condition in which blood begins to clot in the deep veins of the lower leg near the ankle and travels up the veins, sometimes reaching the height of the upper abdomen or pelvic veins. The higher the blood has clotted, the greater the risk of a piece of a clot breaking off and traveling up the vena cava to the lungs, where it causes a pulmonary embolism, which is a condition where a blood clot in the lung interferes with the oxygenation of the lungs. If the clot is big and the amount of oxygen in the lungs becomes too low, the end result could be cardiovascular collapse and sudden death.
People, unfortunately, get deep vein thromboses all the time. Those at highest risk are patients who are resting in a hospital after surgery, especially surgery to the lower legs, pelvis, or back for more information click here http://www.wylaonline.com/. If the patient is not given supportive stockings or compression devices, they can begin to clot in the legs, growing a DVT.
The other population of people at risk for DVT is long-term travelers, particularly those who can’t get up and walk around to take a break during the flight or bus/train ride. It has even been seen in people who travel long distances by car, particularly if they become dehydrated. Patients who are obese, pregnant, have cancer, or are elderly are at a greater risk of getting a DVT.
Upon getting a DVT, patients often notice a cluster of symptoms. They notice that one lower leg or calf is more swollen than the other. That calf may be reddened or dusky in color. There can be a pain in the back of the calf with or without touching it. The doctor will note that when he lifts the foot by the ankle, a motion called dorsiflexion, the patient will tend to have increased pain. This is called a positive Homan’s sign and is a sign of a DVT.
If a physician is suspicious of a DVT, he or she will likely do a d-dimer test. This is a blood test that registers products of clotting and indicates there is clotting happening somewhere in the body. What the blood test won’t show the doctor is exactly where the clotting is happening. Depending on the d-dimer test, the doctor will go ahead and do imaging tests of the lower veins. A Duplex Doppler Ultrasound is an ultrasound test that can show the blood flow of the veins and if there are any clots. In less common cases, the doctor will do a dye study called a venogram. It uses dye to outline the nature of the veins.
If there is a DVT, the doctor must treat this carefully because fifteen percent of DVTs will go on to become a dangerous pulmonary embolism or PE. The doctor will likely start intravenous heparin and oral Coumadin together. Both are blood thinners that do not break up clots but keep them from getting any worse while the body heals itself. Very large DVTs at high risk of going to become PE are treated with tissue plasminogen activator or TPA, which actually breaks up clots fairly quickly. Patients on IV heparin and oral Coumadin are treated with both medications until the Coumadin is at a therapeutic level. Then a stable patient is allowed to go home on only Coumadin for up to three months.
Clots that unfortunately break off from a DVT invariably go to the lungs. A large clot will settle at the opening of both lungs at the same time and will cause sudden death. Up to fifteen percent of cases of interfere with the oxygenation of the lungs. Patients will feel shortness of breath and may feel a type of pain in the lungs known as “pleuritic chest pain”. This is chest pain that gets worse when the patient takes a deep breath. The patient may also notice blueness of the lips and might feel very anxious.
If the doctor gets a chance to see the patient, he or she will notice shortness of breath, low oxygen levels, sometimes a positive Homan’s sign, and sometimes what’s called a friction rub, which is a noise heard during inspiration and expiration and is heard with a stethoscope. A doctor suspicious of a PE may do a d-dimer test similar to what’s done in DVTs before going on to doing a dye study involving a CT scan of the chest. Dye is injected into a vein and a CT scan of the chest is done afterward. Rarely an MRI study of the chest can be done to find blood clots in the lungs but MRI scans are less available.
PEs are considered medical emergencies, regardless of how big they are. If the patient is surviving a big blood clot, a surgeon can go in and remove the big clot through a procedure called a pulmonary thrombectomy. More commonly, however, the doctor will give the patient tissue plasminogen activator or TPA to quickly break up the clot and hopefully save the patient. If the patient has small clots in the lungs, the protocol turns into one of giving intravenous heparin and Coumadin together. When the Coumadin becomes in the therapeutic range, the IV heparin is stopped and the patient is continued on oral Coumadin for the clots. People who get PEs are at risk of getting another one. Patients are continued on oral Coumadin for a minimum of three months.
There is a small subset of patients who need to be on Coumadin for the rest of their lives in spite of the fact that Coumadin patients require careful and frequent follow-up. These are patients who have known recurrent pulmonary emboli and patients who are found to have a genetic disorder that makes them prone to clotting. If a person has a PE from a vein originating in their arm, they likely have a genetic disorder predisposing them to pulmonary emboli and other forms of clotting disorder. They, too, need to be on Coumadin for the rest of their lives.