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Deep Vein Thrombosis

Clots you can live without

Image converted using ifftoanyBeing a vascular surgeon, I am often called upon to evaluate patients who present with seemingly innocuous symptoms, such as calf swelling and pain, to exclude deep vein thrombosis (DVT). Most of them are usually caught by surprise as they have little to no knowledge of DVT, and were hence unable to prevent its occurrence.

What exactly is DVT?

DVT is a blood clot that forms within the lumen of a vein deep inside the human body. Most deep vein clots appear in the lower limbs of the body, but can also appear in other parts of the body. Some people may develop DVT and not be aware of it as there may be no symptoms.

However, the typical DVT patient may experience pain, swelling, redness, tenderness and warmth in the affected part of the body. Superficial veins may swell up too.

What factors can cause DVT?

DVT does not occur exclusively due to air travel. In fact, there are three main factors that predispose a person to clot formation in the veins:

  1. Changes in blood flow (Circulatory stasis) – Blood flow in the venous system is slower, which increases the likelihood of blood clot formation, especially in immobile patients such as stroke victims.
  2. Changes in the thickness of blood (Hypercoagulability) – People who indulge in vices such as smoking and excessive alcohol consumption tend to have thicker blood due to the body’s responses.
  3. Damage to the inner lining of the vessel wall (Endothelial injury) – Damaged blood vessel walls as a result of external trauma from injuries or surgery, can put a person at greater risk of DVT.

What are the complications of DVT?

Deep vein clots can hamper blood circulation when they dislodge during the first 48 hours of onset, flow through the bloodstream towards the heart and subsequently to the lungs.

The size of the blood clot matters. If it is a small clot, it is unlikely to cause significant damage. However, if the clot is big, it can jam and obstruct the pulmonary artery, which may cause the patient to collapse due to the lack of oxygen. This potentially fatal condition is known as pulmonary embolism.

Symptoms of pulmonary embolism include chest pains, rapid heart rate, fainting, shortness of breath and anxiety. It is important to note that DVT should be treated as a medical emergency as there are patients who may die from DVT, commonly due to pulmonary embolism complications.

How is DVT treated?

DVT is treated in four main ways.

  1. Anti-coagulation medication – These drugs are instrumental in the prevention of new clot formation. For those who are prone to recurrent episodes of DVT, anti-coagulant medication is usually taken for the rest of the patient’s life.
  2. Thrombolysis– Drugs are used to help break down blood clots. Patients with more severe DVT or pulmonary embolism may require such drugs.
  3. Inferior vena cava filter– This is a small device that is inserted into the vein to contain blood clots, stopping them from moving into the lungs, while simultaneously allowing blood flow to continue. It is inserted in the vena cava, the large vein that carries deoxygenated blood from the lower half of the body into the heart.
  4. Compression stockings– These are worn to help reduce calf pain and swelling, and to prevent ulcers from developing. Stockings can also protect the patient from post-thrombotic syndrome, a long-term DVT complication which affects up to one in two patients with DVT. In post-thrombotic syndrome, tissue in the calf becomes damaged, resulting in pain, itching, tingling, formation of ulcers, skin discoloration and swelling.

How can DVT be prevented?

Fear not, prevention of DVT is basically about making healthy changes to your lifestyle so that the risk factors are lowered, if not absent in your life.

 

  1. Facilitating circulation – It is best to keep blood circulating by going for frequent exercises such as brisk walking and jogging in loose, non-restrictive clothing. Having an active lifestyle as opposed to a sedentary one encourages the body’s circulatory system to be optimised for overall blood circulation.
  2. Maintaining natural ‘blood thinning’ – Adequate hydration is essential, especially if travelling to a new country for short periods as there is not enough time for our body to adapt to the new surroundings. Avoid caffeinated drinks and alcohol which cause frequent urination and worsen dehydration. Quitting smoking would be ideal as well. Do not jump at the opportunity to take medications for quick relief; they should only be consumed when prescribed by a doctor after an extensive consultation and examination.
  3. Avoiding injuries – Of course, avoiding injury to blood vessels in the course of undergoing surgery is almost impossible due to the invasive nature of the procedure. However, we can still avoid accidental traumatic injuries which may happen when we indulge in sports and games when our physical fitness is not optimal. The trauma may then be aggravated and exacerbated when it is treated and managed by over-exuberant deep massages to treat the original injury.

Stop DVT in Its Tracks!

  • Always be alert. DVT is not usually fatal. Once you recognise any of the symptoms matching with the risk factors, seek medical attention immediately. Caught early, doctor and patient can work hand-in-hand to manage the condition.
  • Have healthy habits. DVT can be easily prevented through healthy lifestyle habits. Simple lifestyle changes such as reducing alcohol consumption and quitting smoking can work wonders in a matter of weeks!
  • Share and save someone. Sharing your knowledge can help to save someone else’s life. Some of my patients were able to seek medical treatment early as they were advised by well-meaning friends who had knowledge of the condition.
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Dr Chia Kok Hoong is a General Surgeon at Mount Elizabeth Hospital, Singapore. He has a special interest in Vascular Surgery.
Posted by ezyhealth on Mar 5 2015. Filed under Health. You can follow any responses to this entry through the RSS 2.0. Both comments and pings are currently closed.

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