Deep venous thrombosis

Several different terms are used for the chronic symptoms that can occur after a deep vein thrombosis:
1. Venous stasis syndrome
2. Postthrombotic syndrome
3. Venous insufficiency syndrome
4. Postphlebitic syndrome

Symptoms:

* chronic leg swelling
* chronic (or waxing) pain
* diffuse aching
* leg heaviness
* leg tiredness
* leg cramping
* dark skin pigmentation (=postthrombotic pigmentation; figure)
* hardening of the skin
* skin dryness
* formation of varicose veins
* skin ulcer (stasis ulcer)

Complications of DVT:
- Pulmonary embolism (the most important) WATCH VIDEO
- Post thrombotic syndrome
- Limb ischaemia

Investigation:
* A blood test called a D-Dimer. This measures a substance which develops when a
blood clot breaks down. If this is negative it's unlikely that you have a DVT.
* A Doppler ultrasound. This is a test that uses sound waves to look at your
blood as it flows through your blood vessels. It's the best test to detect
blood clots above your knee.
* A venogram. In this test, a special dye is injected into your vein, which shows
up the vein on X-ray. This is the best way of showing clots below your knee.


Prevention:
There are a number of things you may be able to do to reduce your risk, such as stopping smoking if you smoke, or losing weight if you're overweight. Regular walking can help to improve the blood circulation in your legs and help to prevent another DVT from developing.

There is no good evidence that taking aspirin reduces your risk of developing DVT.

Treatment of DVT:
The treatment for deep venous thrombosis above the knee is anticoagulation, unless a contraindication exists (recent major surgery or abnormal reactions).Anticoagulation prevents further growth of the blood clot and prevents it from forming an embolus that can travel to the lung.

. Warfarin (Coumadin) is the drug of choice. It is begun immediately, but unfortunately it may take a week or more for the blood to be appropriately thinned. Therefore, low molecular weight heparin [enoxaparin (Lovenox)] is administered at the same time. It thins the blood via a different mechanism and is used as a bridge therapy until the warfarin has reached its therapeutic level.

The dosage of warfarin is monitored by blood tests measuring the prothrombin time or INR (international normalized ratio). For an uncomplicated deep vein thrombosis, the recommended length of therapy with warfarin is three to six months.

Some patients may have contraindications for warfarin therapy, for example a patient with bleeding in the brain, major trauma, or recent significant surgery. An alternative may be to place a filter in the inferior vena cava to prevent emboli from reaching the heart and lungs. These filters may be effective but also may be the source of new clot formation.

Compression stockings
These are also called graduated compression stockings.It eases pain and reduce swelling, and to prevent post-thrombotic syndrome. You may need to wear them for two years or more after having a DVT.

In rare cases, surgery may be needed if medicines do not work. Surgery may involve:

* Placement of a filter in the body's largest vein to prevent blood clots from
traveling to the lungs
* Removal of a large blood clot from the vein or injection of clot-busting
medicines.