Cardiac & VascularCardiac and VascularDiseases and Conditions

Deep Vein Thrombosis (DVT) / Thrombophlebitis

(DVT; Thrombophlebitis)

Definition

Deep vein thrombosis (DVT) is a blood clot in a vein deep in the body. Veins are blood vessels with valves that help prevent backward blood flow. Blood is pushed through the veins in legs and arms when muscles contract.

Deposits of red blood cells and clotting elements in the blood can build up in a vein. This build up leads to a blood clot. Clots usually occur in the legs but can occur in other locations. As the clot grows, it blocks blood flow in the vein.

Deep Vein Thrombosis
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  • Causes

    Several factors contribute to clot formation, including:

    • Slow blood flow, often due to lying or sitting still for an extended period of time
    • Pooling of blood in a vein, often due to:
      • Immobility
      • Medical conditions
      • Damage to valves in a vein or pressure on the valves, such as during pregnancy
    • Injury to a blood vessel
    • Clotting problems (can occur due to aging or disease)
    • Catheters placed in a vein

  • Risk Factors

    Risk factors for DVT include:

    • Personal or family history of deep vein thrombosis
    • Hospitalization
    • Not moving your body
    • Surgery, especially involving bones or joints
    • Medical conditions, such as:
      • Varicose veins
      • Cancer
      • Heart failure
      • Heart attack
      • Inflammatory bowel disease
      • Blood disorders
      • Blood poisoning (sepsis)
    • Obesity
    • Pregnancy
    • Genetic factors whether inherited or by natural changes in life can change your body protein levels
    • Take certain medications such as birth control pills, estrogen therapy, or antipsychotic medicine

  • Symptoms

    Symptoms occur when:

    • The clot interferes with blood flow in the vein.
    • Local inflammation occurs.
    • A clot breaks free and travels to the lungs.

    Some patients may not have any symptoms until the clot moves to the lungs. This condition is called pulmonary embolism.

    Symptoms of DVT may include:

    • Pain
    • Swelling of a limb
    • Tenderness along the vein, especially near the thigh
    • Warmth
    • Redness, paleness, or blueness of the skin of the affected limb

  • Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done.

    Tests may include:

    • Blood tests to look for blood clotting proteins
    • Duplex venous ultrasound — uses sound waves to detect changes in blood flow
    • Venography — X-rays taken after dye is injected into a small vein to show areas of normal and abnormal blood flow
    • Impedance plethysmography — measures changes in blood volume in the veins as a blood pressure cuff wrapped around the thigh is inflated and deflated
  • Treatment

    Treatment aims to:

    • Prevent pulmonary embolism
    • Stop the clot from growing
    • Dissolve the clot (sometimes)

    Treatments include:

  •  
  • Supportive Care

  • This may include:

    • Resting in bed
    • Elevating the affected limb above the heart
    • Wearing compression stockings as recommended by your doctor

    Medications

  • Anticoagulant drugs to prevent additional clot formation include:
    • Heparin injection — fast-acting drug that prevents more clot formation; given for several days
      • Can be of normal or low-molecular weight (Lovenox)
    • Warfarin (taken by mouth) — slowly prevents more clot formation; usually given for several months
    • Direct thrombin inhibitors, such as fondaparinux (Arixtra)
    • Fibrinolytic enzymes — help to dissolve a major clot. These include:
      • Streptokinase
      • Urokinase
      • tPA

    Surgery

  • In some cases, a filter may be placed in the inferior vena cava. The vena cava is a major vein. Blood from the lower body returns to the heart through this vein. The filter may trap any clots that break loose before it travels to the lungs.

    If you are diagnosed with deep vein thrombosis, follow your doctor's instructions.

    If you are diagnosed with deep vein thrombosis, follow your doctor's instructions.

  • Prevention

    General prevention measures include:

    • Do not sit for long periods. If you are in a car or airplane or at a computer, get up often and move around.
    • Do not smoke.

    If you are admitted to the hospital, talk to your doctor about how to prevent blood clots, such as:

    • Get out of bed and walk as soon as possible during your recovery.
    • If you are restricted to bed:
      • Do range of motion exercises in bed.
      • Change your position at least every two hours.
    • Wear compression stockings to promote venous blood flow.
    • Use a pneumatic compression device. This device uses air to compress your legs and help improve venous blood flow.
    • If prescribed by your doctor, take medication to reduce blood clots. This medication can reduce your chance of death due to blood clots.

  • RESOURCES

    American Heart Association http://www.americanheart.org/

    American Venous Forum http://www.venous-info.com/index.html/

    CANADIAN RESOURCES

    Canadian Heart and Stroke Association http://ww1.heartandstroke.ca/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    References

    Buller HR, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(suppl 3):401S-428S.

    Cecil RL, Goldman L, Bennett J. Cecil Textbook of Medicine. 21st ed. Philadelphia, PA: WB Saunders Company; 2000.

    Church V. Staying on guard for DVT & PE. Nursing. 2000;30(2):34-42.

    Conn HF, Rakel RE. Conn's Current Therapy 2001. 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.

    Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(suppl 3):338S-400S.

    Harrison TR, Fauci AS. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.

    Hirsch J, Hoak J. Management of deep vein thrombosis and pulmonary embolism. Circulation. 1996;93(12):2212-2245.

    Ramzi DW, Leeper KV. DVT and pulmonary embolism: Part I. Diagnosis. Am Fam Physician. 2004;69(12):2829-2836.

    Ramzi DW, Leeper KV. DVT and pulmonary embolism: Part II. Treatment and prevention. Am Fam Physician. 2004;69(12):2841-2848.

    Rosen P, Barkin RM, Danzl DF, et al. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St. Louis, MO: Mosby-Year Book, Inc; 1998.

    Segal JB. Streiff MB. Hoffman LV. Thornton K. Bass EB. Management of venous thromboembolism: a systematic review for a practice guideline. Ann Intern Med. 2007;146(3):211-222.

    10/27/2006 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Junger M, Diehm C, Storiko H, et al. Mobilization versus immobilization in the treatment of acute proximal deep venous thrombosis: a prospective, randomized, open, multicentre trial. Curr Med Res Opin. 2006;22:593-602.

    5/11/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Bezemer ID, van der Meer FJ, Eikenboom JC, Rosendaal FR, Doggen CJ. The value of family history as a risk indicator for venous thrombosis. Arch Intern Med. 2009;169:610-615.

    6/4/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Bahl V, Hu HM, Henke PK, Wakefield TW, Campbell DA Jr, Caprini JA. A validation study of a retrospective venous thromboembolism risk scoring method. Ann Surg. 2010;251(2):344-350.

    10/5/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Parker C, Coupland C, Hippisley-Cox J. Antipsychotic drugs and risk of venous thromboembolism: nested case-control study. BMJ. 2010;341:c4245.

    Revision Information

    • Reviewer:Michael J. Fucci, DO
    • Review Date: 09/2012
    • Update Date: 00/92/2012
  • This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

    Copyright © 2012 EBSCO Publishing
    All rights reserved.


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