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What is deep venous thrombosis?

Deep venous thrombosis (DVT) affects mainly the veins in the lower leg and the thigh. It involves the formation of a clot (thrombus) in the larger veins of the area. This thrombus may interfere with circulation of the area, and it may break off and travel through the blood stream (embolize). The embolus thus created can lodge in the brain, lungs, heart, or other area, causing severe damage to that organ.

Risks include prolonged sitting, bedrest, or immobilization; recent surgery or trauma, especially hip surgery, gynecological surgery, heart surgery, or fractures; childbirth within the last 6 months; obesity; and the use of medications such as estrogen and birth control pills. Risks also include a history of polycythemia vera, malignant tumor, changes in the levels of blood clotting factors making the blood more likely to clot, disseminated intravascular coagulation (DIC), and dysfibrinogenia.

Deep venous thrombosis occurs in approximately 2 out of 1,000 people. The condition is most commonly seen in adults over age 60.

Prevention:

Anticoagulants may be prescribed as a preventive measure for high-risk people. Minimize immobility of the legs.

Symptoms:

• leg pain in only one leg
  
• leg tenderness in only one leg
  
• swelling of only one leg
• increased warmth of one leg
• changes in skin color of one leg, redness or bluish
• joint pain

Signs and Tests:

An examination may reveal a red, swollen, tender area of the leg. The Homans sign is positive, there is sharp pain when the foot is flexed upward.

The presence of deep venous thrombosis may be seen on:

• venography of the legs
• extremity arteriography
• blood flow studies
• Doppler ultrasound exam of an extremity
• plethysmography of the legs

Treatment:

The clot itself usually will resolve through the natural healing processes. Treatment is also aimed at relieving symptoms and preventing the clot from traveling to the lungs, heart, brain, or other areas. Treatment usually requires hospitalization, at least initially.

Anticoagulants or antiplatelet medications are prescribed to prevent further clotting. Analgesics may be needed to control pain. Thrombolytics (clot dissolving medications) are rarely needed.

Bedrest may be recommended until the symptoms are relieved. The leg may be elevated to reduce swelling. Avoid prolonged sitting. Warm, moist heat to the area may help relieve pain.

After return home, the patient may continue oral anticoagulants or antiplatelet medications for a prolonged period of time. Warm compresses may also be continued. Continue to avoid prolonged sitting or standing in one position.
Expectations:

Most DVT's disappear without difficulty. Complications may be life threatening.

Complications:

• pulmonary embolus
• stroke (rare)
• embolus in other organs (rare)

It is recommended that you call your health care provider if symptoms suggestive of DVT occur. With proper attention and care, a person with DVT can still live a long and productive life.

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