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Deep venous thrombosis
Alternative namesDVT; Blood clot in the legs
DefinitionDeep venous thrombosis is a condition where there is a blood clot in a deep vein (a vein that accompanies an artery).
Causes, incidence, and risk factors
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.
Deep venous thrombosis is more commonly seen in adults over age 60 but can occur in any age group.
Signs and tests
An examination may reveal a red, swollen, or tender leg.
Treatment of DVT is intended to prevent the development of a pulmonary embolus and to prevent recurrent DVT.
For years the standard treatment has been an anticoagulant medication called heparin which was given through the vein. This results in relatively immediate anticoagulation and treatment of the clot. Along with heparin an oral medication called warfarin is given. Because warfarin usually takes several days to reach effectiveness (until it reaches a therapeutic level), the heparin is continued until the warfarin is therapeutic for at least 24 hours. The warfarin is usually continued for approximately six months though there is some debate about the optimal duration of therapy. In almost all circumstances warfarin should not be initiated until heparin has been started.
Because heparin is given as a continuous intravenous infusion, it requires hospitalization. However, newer forms of heparin, known as low molecular weight heparin (usually enoxaparin) can be used in some circumstances. This heparin can be given by injection once or twice a day and thus can shorten or eliminate the need for hospitalization.
Warfarin causes an increase in a blood clotting time known as the PT. The PT is monitored to determine if the blood is sufficiently anticoagulated. A measurement known as the INR standardizes PT measurements between labs. For most patients warfarin is adjusted to keep the INR between 2 and 3.
Expectations (prognosis)Most DVT's disappear without difficulty, however there is a risk of recurrence. Some patients may develop some chronic pain and swelling in the leg known as post phlebitic syndrome. Pulmonary embolus is uncommon when DVT's are treated properly but can occur and can be life threatening.
Calling your health care providerCall your health care provider if symptoms suggestive of DVT occur.
Go to the emergency room or call the local emergency number (such as 911) if chest pain , difficulty breathing , fainting , loss of consciousness , or other severe symptoms occur in a person with a DVT.
PreventionAnticoagulants may be prescribed as a preventive measure for high risk people or people undergoing high risk surgical procedures. Minimize immobility of the legs (ambulate frequently during long plane trips, car trips, etc).
Update Date: 10/28/2003Ezra E. W. Cohen, M.D., Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT