Deep Vein Thrombosis (DVT) – A Detailed Overview

leading to serious complications if not treated promptly.

Causes of DVT

DVT occurs due to a combination of factors known as Virchow’s Triad:

Venous Stasis (Slow or stagnant blood flow) – Often due to prolonged immobility, such as long flights, bed rest, or paralysis.

Hypercoagulability (Increased tendency of blood to clot) – Can result from genetic disorders, cancer, pregnancy, or certain medications like birth control pills.

Endothelial Damage (Damage to the inner lining of the vein) – Caused by surgery, trauma, infection, or inflammation.

Risk Factors for DVT

Prolonged immobility (long flights, hospitalization, bed rest)

Surgery or trauma (especially orthopedic surgeries)

Obesity

Smoking

Pregnancy and postpartum period

Cancer and chemotherapy

Use of birth control pills or hormone replacement therapy

Genetic clotting disorders (e.g., Factor V Leiden, Prothrombin mutation)

Older age (>60 years)

Chronic illnesses like heart failure or inflammatory diseases

Symptoms of DVT

Swelling in one leg (rarely in both)

Pain or tenderness in the calf or thigh

Red or discolored skin over the affected area

Warmth in the affected limb

Dilated superficial veins (visible veins near the skin’s surface)

Some DVTs may be asymptomatic and only discovered after a complication arises.

Complications of DVT

Pulmonary Embolism (PE):

The most serious complication occurs when part of the clot breaks off and travels to the lungs, blocking blood flow.

Symptoms: Sudden shortness of breath, chest pain, coughing (sometimes with blood), rapid heart rate.

This can be life-threatening and requires immediate medical attention.

Post-Thrombotic Syndrome (PTS):

Long-term pain, swelling, skin discoloration, and ulcers due to damaged veins.

Can develop months or years after a DVT episode.

Chronic Venous Insufficiency (CVI):

Damaged veins cause long-term circulation issues in the legs.

Diagnosis of DVT

D-dimer Test: Blood test that detects fibrin breakdown products. High levels suggest clot formation.

Ultrasound (Doppler Scan): Primary imaging test to visualize clots.

Venography: Uses contrast dye and X-ray to detect clot location.

MRI or CT Venography: Used in special cases for more detailed imaging.

Treatment of DVT

Anticoagulants (Blood Thinners)

Heparin (IV or Subcutaneous injection): Fast-acting initial treatment.

Low Molecular Weight Heparin (LMWH) (e.g., Enoxaparin, Dalteparin): Often used in outpatient settings.

Warfarin (Coumadin): Requires regular INR monitoring.

Direct Oral Anticoagulants (DOACs) (e.g., Apixaban, Rivaroxaban, Dabigatran, Edoxaban): No need for routine blood tests, preferred in many cases.

Thrombolytics (Clot-Busting Drugs)

Used in severe cases or when a large clot is causing major complications (e.g., massive DVT or PE).

Includes Alteplase, Streptokinase, and Tenecteplase.

Inferior Vena Cava (IVC) Filter

Used in patients who cannot take blood thinners to prevent clots from traveling to the lungs.

Inserted into the vena cava to trap clots before they reach the heart or lungs.

Compression Therapy

Compression stockings help reduce swelling and prevent PTS.

Elevating the leg can help improve circulation.

Lifestyle Modifications & Prevention

Exercise and movement: Avoid prolonged sitting or bed rest.

Hydration: Prevents blood thickening.

Weight management: Reduces clotting risk.

Avoid smoking: Smoking increases blood clot risk.

Post-surgery care: Early ambulation and blood thinners if necessary.

Prognosis

With timely treatment, most patients recover well, but lifelong management may be needed to prevent recurrence.

DVT recurrence is common in those with underlying conditions or poor lifestyle habits.