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Deep venous thrombosis

Definition

Deep venous thrombosis is a blood clot that forms in a vein deep inside a part of the body. It mainly affects the large veins in the lower leg and thigh.

Alternative Names

DVT; Blood clot in the legs; Thromboembolism; Post-phlebitic syndrome; Post-thrombotic syndrome

Causes

DVTs are most common in adults over age 60. But, they can occur at any age. When a clot breaks off and moves through the bloodstream, this is called an embolism. An embolism can get stuck in the brain, lungs, heart, or other area, leading to severe damage.

Blood clots may form when something slows or changes the flow of blood in the veins. Risk factors include:

Blood is more likely to clot in someone who has certain problems or disorders, such as:

Sitting for long periods when traveling can increase the risk of DVTs. This is most likely when you also have one or more of the risk factors listed above.

Symptoms

DVT mainly affects the large veins in the lower leg and thigh, almost always on one side of the body. The clot can block blood flow and cause:

Exams and Tests

Your health care provider will perform a physical exam. The exam may show a red, swollen, or tender leg.

The two tests that are often done first to diagnose a DVT are:

Blood tests may be done to check if you have an increased chance of blood clotting, including:

Treatment

Your doctor will give you medicine to thin your blood (called an anticoagulant). This will keep more clots from forming or old ones from getting bigger.

Heparin is usually the first drug you will receive.

Depending on your medical history, fondaparinux may be recommended by your doctor as an alternative to heparin.

A blood-thinning drug, for example warfarin (Coumadin), is usually started along with heparin.

When you are taking warfarin, you are more likely to bleed, even from activities you have always done. If you are taking warfarin at home:

You will be given a pressure stocking to wear on your leg or legs. A pressure stocking improves blood flow in your legs and reduces your risk for complications from blood clots. It is important to wear it every day.

In rare cases, you may need surgery if medicines do not work. Surgery may involve:

Outlook (Prognosis)

Many DVTs disappear without a problem, but they can return. Some people may have long-term pain and swelling in the leg called post-phlebitic syndrome.

You may also have pain and changes in skin color. These symptoms can appear right away or you may not develop them for 1 or more years afterward. Wearing tight (compression) stockings during and after the DVT may help prevent this problem.

Blood clots in the thigh are more likely to break off and travel to the lungs (pulmonary embolus, or PE) than blood clots in the lower leg or other parts of the body.

When to Contact a Medical Professional

Call your health care provider if you have symptoms of DVT.

Go to the emergency room or call the local emergency number (such as 911) if you have DVT and you develop:

Prevention

To prevent deep vein thrombosis:

References

Dupras D, Bluhm J, Felty C, et al. Institute for Clinical Systems Improvement. Venous thromboembolism diagnosis and treatment. Updated January 2013. Accessed March 24, 2014.

Ginsberg J. Peripheral venous disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 81.

Guyatt GH, Akl EA, Crowther M, et al. Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis. 9th ed. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 suppl):7s-47s.


Review Date: 2/24/2014
Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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