Deep Vein Thrombosis (DVT)

Deep Vein Thrombosis (DVT) is a condition where a blood cot forms in one of the deep veins within the pelvis, thigh, or calf. Deep vein thrombosis can also occur in the upper extremities (see Paget-Schroetter Syndrome), although it is less common. Deep vein thrombosis is a serious condition because the clot may move to the lungs. This condition is called "pulmonary embolism" and requires immediate treatment. A large clot blocking circulation of blood to the lungs can result in death.

Causes of DVT:

Deep vein thrombosis can occur as a result of prolonged periods of immobility. Long flights on an airplane, prolonged bedrest following surgery or during a lengthy hospitalization are examples of predisposing factors for the development of deep vein thrombosis. Other causes of deep vein thrombosis are an abnormality of the blood itself which causes it to clot more readily than normal. Inherited or acquired conditions such as protein C deficiency, protein S deficiency, antithrombin III deficiency, factor V Leiden mutation, lupus anticoagulant or anticardiolipin antibodies are blood conditions that can predispose a person to develop lower extremity deep vein thrombosis. There are many causes of thrombophlebitis.

Diagnosis:

The diagnosis of deep vein thrombosis is suspected when a patient develops sudden onset of pain and swelling in the lower extremity, particularly in the setting of one of the predisposing factors mentioned above. The diagnosis cannot be made solely on clinical examination, but rather requires performance of an ultrasound test to examine the veins of lower extremities.

Treatment:

If a diagnosis of deep vein thrombosis is confirmed, patients are usually treated with anticoagulants (unless there is some contraindication). Typically, intravenous heparin or injectable enoxaparin (Lovenox) is begun as soon as the diagnosis is made because these anticoagulant medications are fast acting and serve to help prevent progression of clotting in the extremity. A typical treatment course would be to begin heparin or enoxaparin (Lovenox) and then, over the course of about 5 days, convert the patient from injectable therapy to oral anticoagulant therapy (such as warfarin) and continue the warfarin (Coumadin) for periods of typically not less than three months in duration. In the early stages of DVT, it is common to confine a patient to bedrest to prevent movement of the clot from the lower extremities into the lungs (pulmonary embolus). After a period of approximately five days, patients typically are allowed to begin ambulation. Another form of therapy for acute DVT is thrombolysis. With this therapy, clot-dissolving medications are injected into the portion of the vein where the clot has developed. Although thrombolysis dissolves the clot rapidly, it carries a risk of serious bleeding. Among the most worrisome sites of bleeding is the brain which can lead to a stroke. It is extremely unlikely and uncommon that a surgeon would recommend surgical removal of a clot in the lower extremities (see Video #3, Video #9) .