Deep Vein Thrombosis

Deep vein thrombosis (DVT) is a condition in which a blood clot forms in a vein of the deep venous system. This can occur in the lower leg, thigh, pelvis, arm, or neck. A clot is blood that has thickened into a gel or solid. This condition is serious and can be life-threatening if the clot travels to the arteries of the lungs and causes a blockage (pulmonary embolism). A DVT can also damage veins in the leg, which can lead to long-term venous disease, leg pain, swelling, discoloration, and ulcers or sores (post-thrombotic syndrome).

What are the causes?

• A slowdown of blood flow.
• Damage to a vein.
• A condition that causes blood to clot more easily, such as certain bleeding disorders.

What increases the risk?

• Obesity.
• Being older, especially older than age 60.
• Being inactive or not moving around (sedentary lifestyle). This may include:
  • Sitting or lying down for longer than 4–6 hours other than to sleep at night.
  • Being in the hospital, or having major or lengthy surgery.
  • Having any recent bone injuries, such as breaks (fractures), that reduce movement, especially in the lower extremities.
  • Having recent orthopedic surgery on the lower extremities.
• Being pregnant, giving birth, or having recently given birth.
• Taking medicines that contain estrogen, such as birth control or hormone replacement therapy.
• Using products that contain nicotine or tobacco, especially if you use hormonal birth control.
• Having a history of a blood vessel disease (peripheral vascular disease) or congestive heart disease.
• Having a history of cancer, especially if being treated with chemotherapy.

What are the signs or symptoms?

• Swelling, pain, pressure, or tenderness in an arm or a leg.
• An arm or a leg becoming warm, red, or discolored.
• A leg turning very pale or blue. You may have a large DVT. This is rare.

If the clot is in your leg, you may notice that symptoms get worse when you stand or walk.

In some cases, there are no symptoms.

How is this diagnosed?

• Your medical history and a physical exam.
• Tests, such as:
  • Blood tests to check how well your blood clots.
  • Doppler ultrasound. This is the best way to find a DVT.
  • CT venogram. Contrast dye is injected into a vein, and X-rays are taken to check for clots. This is helpful for veins in the chest or pelvis.

How is this treated?

• The cause of your DVT.
• The size and location of your DVT, or having more than one DVT.
• Your risk for bleeding or developing more clots.
• Other medical conditions you may have.

• Taking a blood thinner medicine (anticoagulant) to prevent more clots from forming or current clots from growing.
• Wearing compression stockings.
• Injecting medicines into the affected vein to break up the clot (catheter-directed thrombolysis).
• Surgical procedures, when DVT is severe or hard to treat. These may be done to:
  • Isolate and remove your clot.
  • Place an inferior vena cava (IVC) filter. This filter is placed into a large vein called the inferior vena cava to catch blood clots before they reach your lungs.

You may get some medical treatments for 6 months or longer.

Follow these instructions at home:

If you are taking blood thinners:

• Talk with your health care provider before you take any medicines that contain aspirin or NSAIDs, such as ibuprofen. These medicines increase your risk for dangerous bleeding.
• Take your medicine exactly as told, at the same time every day. Do not skip a dose. Do not take more than the prescribed dose. This is important.
• Ask your health care provider about foods and medicines that could change or interact with the way your blood thinner works. Avoid these foods and medicines if you are told to do so.
• Avoid anything that may cause bleeding or bruising. You may bleed more easily while taking blood thinners.
  • Be very careful when using knives, scissors, or other sharp objects.
  • Use an electric razor instead of a blade.
  • Avoid activities that could cause injury or bruising, and follow instructions for preventing falls.
  • Tell your health care provider if you have had any internal bleeding, bleeding ulcers, or neurologic diseases, such as strokes or cerebral aneurysms.
• Wear a medical alert bracelet or carry a card that lists what medicines you take.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• If recommended, wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs. Never wear your compression stockings while sleeping at night.
• Keep all follow-up visits. This is important.

Where to find more information

• American Heart Association: www.heart.org
• Centers for Disease Control and Prevention: www.cdc.gov
• National Heart, Lung, and Blood Institute: www.nhlbi.nih.gov

Contact a health care provider if:

• You miss a dose of your blood thinner.
• You have unusual bruising or other color changes.
• You have new or worse pain, swelling, or redness in an arm or a leg.
• You have worsening numbness or tingling in an arm or a leg.
• You have a significant color change (pale or blue) in the extremity that has the DVT.

Get help right away if:

• You have signs or symptoms that a blood clot has moved to the lungs. These may include:
  • Shortness of breath.
  • Chest pain.
  • Fast or irregular heartbeats (palpitations).
  • Light-headedness, dizziness, or fainting.
  • Coughing up blood.
• You have signs or symptoms that your blood is too thin. These may include:
  • Blood in your vomit, stool, or urine.
  • A cut that will not stop bleeding.
  • A menstrual period that is heavier than usual.
  • A severe headache or confusion.

• Do not wait to see if the symptoms will go away.
• Do not drive yourself to the hospital.

Summary

• Deep vein thrombosis (DVT) happens when a blood clot forms in a deep vein. This may occur in the lower leg, thigh, pelvis, arm, or neck.
• Symptoms affect the arm or leg and can include swelling, pain, tenderness, warmth, redness, or discoloration.
• This condition may be treated with medicines. In severe cases, a procedure or surgery may be done to remove or dissolve the clots.
• If you are taking blood thinners, take them exactly as told. Do not skip a dose. Do not take more than is prescribed.
• Get help right away if you have a severe headache, shortness of breath, chest pain, fast or irregular heartbeats, or blood in your vomit, urine, or stool.