Vein Disorders

DVT

What is DVT “Deep Vein Thrombosis”?

  • Most common symptom: new onset leg pain or leg swelling in one leg
  • leg may turn more red or purple than the other leg
  • a blood clot in a deep vein
  • deep veins are inside the muscle layer and run alongside the arteries
  • you can’t see a DVT and cannot  feel it with your hands
  • doctors have high index of suspicion…If there is any doubt as to the cause of leg pain or swelling, an ultrasound is likely to be ordered

3 Things Cause Blood to Clot
(Virchow’s Triad)

Stasis – This is medical speak for slow blood flow

  • Sudden inactivity-long car ride, long plane trip, prolonged bedrest
  • Restriction of blood flow in a vein from internal or external obstruction

Injury

  • Directly to the inner vein inning, getting hit or kicked
  • to the body in general,   ‘the body’s clotting mechanism gets geared up”

Hypercoagulability  – Conditions that chemically make the blood clot easier than normal

  • Inherited problems: Factor V Leiden, Protein C deficiency, Protein S deficiency, Antithrombin III deficiency, Prothrombin Gene mutation.   
  • Acquired factors:  dehydration (less fluid in the blood), long periods of inactivity (hospitalization, surgery, long trips), polycythemia (body making too many red blood cells), thrombocythemia (too many platelets), and cancer. Antiphospholipid antibody

Diagnosis of DVT

  • Leg ultrasound is the standard of care
  • CT scans are also effective especially for looking at pelvic veins and for clots in the lungs
  • Venogram  non filling area when dye is put into vein used infrequently for legs, more often used for pelvic veins.

DVT Treatment

Anticoagulation

  • slows or stops bloods ability to make clot
  • keeps clot from growing
  • does not dissolve clot
    • IV Heparin – used in patients in hospital who may need its effect stopped quickly
    • Lovenox – subcutaneous injection once or twice daily
    • Coumadin – oral medication
      • Blocks effects of vitamin K
      • Affected by amt of Vit K in diet
      • Hard to regulate proper dosage
      • Blood work required to adjust dosage
      • Once therapeutic, takes three days to wear off
      • Reverse by Vitamin K or replacement of affected blood components
      • Blood more prone to clotting than normal until proper therapeutic dose achieved
      • Heparin or Lovenox also required while starting and stopping it (Bridging)
    • NOACs—New Oral Anticoagulants
      • Don’t require blood monitoring
      • Don’t require bridging
      • Not affected by diet
      • Short acting don’t need reversal agent
      • Xarelto, Eliquis

Thrombolysis

  • Dissolves acute clot, < 2-3 weeks old
  • Tissue Plasminogen Activator (TPA) Alteplase™
    • Systemic- drug goes into arm vein and throughout whole body. Higher risk of bleeding
    • Catheter Directed—drug goes into multi side hole catheter placed directly into clot
    • PharmacoMechanical—drug  and mechanical energy used simultaneously  to disrupt and evacuate clot
    • Mechanical—open surgical removal of clot

Inferior Vena Cava Filter

  • An implanted device that traps blood clots before they can get to the heart
  • Used when anticoagulation can’t be used
  • Or patient unable to withstand any further heart or lung dysfunction
  • Ideally should be removed after no longer needed
  • Dissolvable filters are being tested

What happens after DVT?

No complications — A doctor orders an ultrasound that shows a blood clot. A blood thinner is given for 3-6 months, the symptoms go away, and that’s the end of it for a majority of patients.

The most common complication of a DVT is “PTS” (Post Thrombotic Syndrome):

  • This happens in 20-30% of people that have had a DVT.
  • Usually occurs Within a few years
  • chronic swelling , pain, and discoloration of the leg
  • Results in non-healing venous leg ulcers in 5-10%.
  • Compression garments after DVT may reduce PTS occurrence by 50%
  • Most doctors that treat DVT who are not vein specialists

    • Don’t follow patients for PTS
    • Don’t prescribe compression.
    • Don’t recognize PTS as a result of DVT
    • Don’t refer patients to a Vein Specialist
    • Don’t recognize leg ulcers are part of the same process

Most Feared, LEAST common complication of DVT:

  • PE (pulmonary embolism)
  • Blood clot travels from a vein through the right side of the heart and out into the lungs
  • May be totally silent if small
  • May cause shortness of breath, chest pain or both. Chest pain that is worse with breathing is more likely from PE than MI
  • May cause coughing up blood
  • Death usually not from loss of lung function, but from overload of the right side of the heart
  • If caught in time the clot can be dissolved or removed
  • May be suddenly fatal
    • When this happens many times the patient and doctor never knew there was a clot present. Doctors and hospitals go to great lengths to try to prevent this from happening to patients. They also order lots of tests, mostly leg ultrasounds and CAT scans of the lungs, to try to find them.

Schedule a Consultation

If you suffer from Deep Vein Thrombosis, call 704-544-5245 to schedule a consultation.

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