Deep vein thrombosis (DVT) is a blood clot that develops within a deep vein in the body, usually in the leg. This is a serious condition if a piece of blood clot breaks off into the bloodstream and blocks one of the blood vessels in the lungs (see below). DVT and pulmonary embolism together are known as venous thromboembolism (VTE).

Symptoms

One/both of your legs may show

• Heaviness, tenderness, or throbbing of leg
• Pain that feels like a cramp
• Skin that’s warm to the touch
• Swelling
• Veins that look larger than usual
• Changes in skin color (more red or purple than normal in fair individuals)
• in severe cases- change in color of skin to blue/black indicating death of tissue due to blockage of blood supply(phlegmasia)

Pulmonary Embolism

• Breathlessness – which may come on gradually or suddenly
• Chest pain – which may become worse when you breathe in
• Sudden collapse
• Coughing blood

Causes

Anyone can develop DVT, but it becomes more common over the age of 40. Risk factors, including

• Having a history of DVT or pulmonary embolism
• Having a family history of blood clots
• Being inactive for long periods – such as after an operation or during a long journey
• Blood vessel damage – a damaged blood vessel wall can result in the formation of a blood clot
• Having certain conditions or treatments that cause your blood to clot more easily than normal – such as cancer (including chemotherapy and radiotherapy treatment), heart and lung disease, thrombophilia and Hughes syndrome
• being pregnant – your blood also clots more easily during pregnancy
• being overweight or obese

The combined contraceptive pill and hormone replacement therapy (HRT) both contain the female hormone oestrogen, which causes the blood to clot more easily. If you’re taking either of these, your risk of developing DVT is slightly increased.

Diagnosis DVT

D-dimer test

Detects pieces of blood clot that have been broken down Larger the number of fragments found, the more likely it is that you have a blood clot in your vein.

However, the D-dimer test isn’t always reliable and additional tests maybe required

Ultrasound scan

It is standard baseline test for any patient suspected of having a DVT

Doppler ultrasound detects the presence of clot and its age, sites affected and also how fast the blood is flowing through a blood vessel.

CT Venogram

A CTvenogram may be used if the results of a D-dimer test and ultrasound scan can’t confirm a diagnosis of DVT or DVT is suspected in areas of the body where ultrasound cannot be done reliably. Also sometimes helps to detect the cause of the DVT. A invasive venogram is rarely used for the purpose of diagnosis

Treatment

Conservative

Most patients do not need any form of procedure to treat the clot and can be managed conservatively with medications. Treatment for DVT usually involves taking anticoagulant medicines(blood thinners), which reduce the blood’s ability to clot and stop existing clots getting bigger. Heparin and warfarin/coumarin are 2 types of anticoagulant often used to treat DVT. Heparin is usually prescribed first because it works immediately to prevent further clotting. New drugs called directly acting oral anticoagulants (DOACs), or NOACs (for Novel or Newer -) may also be used to treat conditions such as DVT. These medications are shown to be as effective as heparin. Stockings help to relieve the swelling in the leg and are generally recommended for a few months Strong clot dissolving medications(thrombolytics) given directly into the vein in patient with extensive DVT

Clot aspiration

Using negative pressure pumps to suck out the clot from the veins. Helps to avoid thrombolytics or reduce its dose used(thereby reducing its complications)

Venous angioplasty and stenting

If a narrowing(stenosis) or block(occlusion) is detected in the major veins draining the leg, then angioplasty and stenting maybe needed to improve the blood flow in the vein and provide rapid symptom improvement

Vena cava filter

You might get this if you can’t take blood thinners or if they don’t work well for you. Filter won’t prevent clots from forming but will catch them before they end up in your lungs. Filter can be removed after a specified period of time.