Deep vein thrombosis and post-thrombotic syndrome

Most of the common people are not aware of deep vein thrombosis (DVT) and post thrombotic syndrome(PTS). Let alone the general public, many health care providers are also not aware of their implications and their treatment. Although this is a very common problem, many patients keep on living with them due to lack of guidance regarding their treatment. 

In this article, you’ll get to know all the details regarding-

  • Deep vein thrombosis – its causes, symptoms, preventive measures and treatment options. 
  • Post-Thrombotic Syndrome – its causes, symptoms, preventive measures and treatment options. 

Deep Vein Thrombosis (DVT)

Deep vein thrombosis (DVT) refers to blood clots that form in one or more veins in your body. Most commonly, this disease occurs in the veins of the lower limb; although, DVT of other sites are also seen in medical practice

Deep Vein Thrombosis can potentially convert to a life-threatening medical condition. The known perilious complications of DVT includes pulmonary embolism. 

This develops when the blood clots break loose and enter the blood vessels of the lungs. This blockade can impair the oxygenation of the blood in the lungs and treatment may require intensive care (ICU) admission +/- administration of very strong blood thinning injections. 

What is Pulmonary Embolism?

The word “pulmonary” relates to lungs and the word “embolism” denotes small particles of clot / any other material travelling in the blood vessels to the lungs. So essentially, this embolus (clot if it arises from DVT) causes occlusion of blood vessels of the lungs and damages the system of exchange of gases in the lungs. This can lead to a dangerous condition that may even be life threatening. 

Warning signs of pulmonary embolism 

Here is the list of some warning signs of pulmonary embolism. If you notice any such symptoms, you should take medical help immediately. 

  • Shortness of breath.
  • Chest pain that may worsen when you cough or take a deep breath.
  • Discomfort in the  chest
  • Feeling dizzy 
  • Coughing up blood 
  • Rapid pulse
  • Irregular heartbeat
  • Fever

Causes of Deep Vein Thrombosis?

Deep Vein Thrombosis is caused when something prevents proper blood flow in the veins. In the case of DVT, it’s the clots that occlude / narrow the lumen of the veins and cause reduction of blood flow back to the heart from the legs. 

Numerous reasons can cause blood clots. In the arteries (blood vessels that carry blood from the heart to the legs), the pressure of blood flow is quite high because of the wonderful pumping of our heart. However, after supplying oxygen to our tissues, when this blood comes into the veins, there is no pressure because of the pumping of the heart. Apart from that, in the lower limbs, it has to travel against the gravity. Therefore, the veins are easily compressible (as the pressure is low) and, are also susceptible to stasis. 

So, the veins can clot off due to two main reasons – either stasis of blood (especially when the patient becomes immobile or bedridden or standing for too long) or due to compression (trauma / any tumor / pregnancy / obesity)

Causes of DVT include:

  • Injury 
  • Surgery 
  • Limited movement
  • Age
  • Sitting or standing for too long
  • Pregnancy 
  • Bed rest 
  • Obesity 
  • Certain hereditary blood disorders.

Symptoms of Deep Vein Thrombosis 

Not everyone who is suffering from DVT develops symptoms. According to the CDC, only half of the people who are suffering from DVT develop symptoms.

Here are some common symptoms-

  •  Swelling in the affected leg.
  • Pain and soreness in the leg.
  • Warmth feeling or burning sensation in a particular skin area of the leg.
  • Severe pain in the leg.
  • Redness and itchiness
  • Rashes 
  • Upper limb DVT can cause similar symptoms in the arms. One problem is Paget Schroetter syndrome. In this, there is an extra rib or the first rib is abnormal or there may be a thickened muscle in the neck. This extra rib / abnormal first rib / thickened muscle may compress the main deep vein that is draining the blood from the upper limb back to the heart and predispose to DVT. 

Usually, there is a history of sudden severe exertion (eg playing after a long time) followed by occurrence of severe swelling in the upper limb. This is an indication of acute DVT of the upper limb. 

Risk factors

Some people are at risk of developing this condition. Some factors increase the chances of developing Deep Vein Thrombosis.

Risk factors include:

  • Any Injury or surgery that damage the veins
  • Taking birth control pills 
  • Pregnancy 
  • Obesity 
  • Undergoing Hormone therapy
  • Inherited venous disease
  • Blood clotting disorder
  • Smoking 
  • Cancer 
  • Heart failure
  • Age
  • Irritable Bowel Disease (IBD)
  • Sitting or standing for too long (limited movement)
  • A family history of DVT or Pulmonary embolism.

Measures to prevent Deep Vein Thrombosis  

There are some measures to prevent DVT. If you follow these measures, it can reduce the possibility of developing DVT.

Precautions to follow:

  • Avoid sitting or standing for a prolonged period.
  • Daily exercise
  • Stretch your leg
  • Avoid wearing tight clothes
  • Maintain a healthy weight
  • Quit smoking

Treatment options for Deep Vein Thrombosis

Nothing to worry, there are numerous treatment options available to treat Deep Vein Thrombosis.

Here are some of the most effective treatments to treat DVT-

  • Compression stockings

Wearing compression stockings help to prevent blood pooling and swelling in the leg. Compression stockings give pressure externally to increase the blood flow in the legs. Also, these stockings are commonly used to prevent DVT in patients who undergo prolonged surgeries or may have to be in bed rest for a considerable period of time after surgery. 

  • Anticoagulant medication

Anticoagulant medicines are blood thinner medicines like heparin, enoxaparin, etc. These medicines help to make the blood thin and prevent the risk of more formation of blood clots. 

These medicines help to decrease the size of the existing blood clots. Usually, these medicines are to be taken regularly for 3 months. Additional precautions have to be taken with each type of anticoagulant drug which is to be discussed by the concerned doctor with the patient. Not following those instructions can be very detrimental to the health of the patients and can even cause life threatening situations. 

  • Thrombolysis medicine 

Thrombolysis is a blood clot-busting medicine. Doctors may suggest these Thrombolytic drugs to those who are suffering from extremity DVT. This is a procedure which helps to dissolve blood clots immediately, thus providing symptomatic relief to the patient as well as reducing the probability of long term complications of DVT. However, this is a risky procedure and should be proceeded with caution as the clot can break off during the procedure and go into the lungs. Also, as the thrombolysis medicine is a very strong blood thinner, this can cause bleeding from various sites in the body. Therefore, this should be done only when indicated, in a setting where ICU facilities are available and also, this should be done only by a vascular surgeon who can handle all complications that may happen. 

  • Inferior vena cava (IVC) filter

In this procedure, a large filtering device will be placed in a large vein in the abdomen (this vein forms by merger of the main deep veins that drain blood from both the lower limbs). This is done only when there is a contraindication to giving blood thinning medicines or the blood thinning medications fail to act or they are causing serious complications. As placing a foreign material in such a large vein can itself cause many complications, therefore, this has to be done very carefully and only when there is a clear reason to do that. 

  • Surgery 

In surgery, the doctors remove the blood clots or DVT from the affected part.

Doctors suggest surgery options when the condition is in a severe state. Also DVT can cause reduction in blood supply to the legs (rare cases) because of increased blood pooling of de-oxygenated blood in the leg. In these cases the pressure in the muscular compartment may be so high that it starts damaging the muscles (Compartment syndrome). These cases may require surgically opening up of the muscular compartments of the leg to protect the muscles. 

The treatment option will vary from one person to another, depending upon the severity condition of the patients. 

Post-Thrombotic Syndrome

DVT comes with a risk of getting Post-thrombotic syndrome. 

Post-thrombotic syndrome is a chronically troubling condition that can cause severe leg pain and discomfort. PTS won’t let you enjoy your life like before, and it causes interference in your day to day activities such as walking and standing.  

Causes of Post-thrombotic syndrome

The leading cause of Post-thrombotic syndrome is when the valves and walls in the veins get damaged as a result of DVT. 

Valves and walls in the veins play a vital role in ensuring blood flows back in the correct direction towards the heart. The valves and walls in the veins become damaged due to DVT, and it causes blood to flow in the wrong direction or starts pooling in the lower leg.

Some other causes of PTS-

  • Recent surgery 
  • Any injury in the deep vein
  • Cancer treatment
  • Inherited blood clotting disorder

Symptoms of Post-thrombotic syndrome

A person with post-thrombotic syndrome may experience the underlying signs and symptoms.  

  • Aching and swelling in the affected leg
  • Severe pain in the leg, it gets worse while walking or standing for too long
  • Ulcers on the leg 
  • Itchy and tingling leg
  • Cramps in the leg
  • Heaviness & tiredness feeling in the leg
  • Skin discolouration of the affected area 
  • Skin dryness
  • Formation of varicose veins.

Risk factors

Some people are at high risk of developing this condition. Some factors increase the chances of developing Post-Thrombotic Syndrome.

Risk factors include:

  • Have blood clots in the deep veins called DVT
  • Symptoms of a new blood clot after being diagnosed with one recently. 
  • Age above 65
  • Obesity

Measures to prevent Post-thrombotic syndrome

There are some measures to prevent PTS. If you follow these measures, it can reduce the possibility of developing PTS.

Precautions to follow:

  • Should wear compression stockings
  • Avoid sitting or standing for too long
  • Exercise daily
  • Take care of yourself after being diagnosed by DVT

Treatment options for PTS

Numerous treatment options are available to treat PTS.

Here are some of the effective treatments that help, to some extent, to cure PTS.

  • Compression stocking

Compression therapy is the cornerstone and the most important component of treatment of any venous disease and more so in case of post thrombotic syndrome. All other treatment components are combined with compression treatment for management of these patients. Compression therapy is commonly used to get relief from swelling and leg pain. 

They apply pressure on the legs, and it improves blood circulation and also reduces swelling and pain. 

  • Venogram + venoplasty + / – stenting

The root cause of the problems in the leg is narrowing of the veins in the pelvic region. Once this is resolved, the problems that come with post thrombotic syndrome can be reduced to a huge extent. 

This needs angioplasty of the veins (balloon inflation) in the narrowed segments so that blood flows properly towards the heart. Also, this disease is notorious for coming back. Therefore, stenting may often be required to manage these lesions. 

  • Elevated your leg

Elevated leg helps to send the blood back towards the heart by using gravity.   

It helps to circulate the blood and prevents it from pooling in the lower limbs.

  • Surgery 

The surgeon suggests surgery only when the condition has converted into a severe state. This is very rarely advised

PTS surgery options are:

  1. Debridement.
  2. Thrombo Endovenectomy.
  3. Bypass & valvuloplasty.

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