Deep vein thrombosis (DVT) – prevent, detect, treat

Introduction: Deep vein thrombosis

Deep vein thrombosis is a blood clot that forms in the deep veins of the body. The most common site for deep vein thrombosis is the lower leg, but it can also occur in other areas such as the arms, hips or pelvis.

Deep veins are larger and carry more deoxygenated blood back to the heart and lungs. Due to their large diameter, clots can grow there for a longer period of time and reach larger dimensions. If a thrombus of a deep vein becomes symptomatic, causes pain and swelling, then there is a life-threatening emergency that requires immediate medical attention.

Venous thrombosis and pulmonary embolism

The clot can break loose and travel through the bloodstream to other parts of the body. This can lead to serious problems such as pulmonary embolism and stroke. If a large clot gets into the lungs, it abruptly blocks the oxygen supply and causes an overload of the heart. Such a “pulmonary embolism” is life-threatening.

Not every pulmonary embolism appears as an emergency. If a small clot dissolves and only blocks a small side branch of the pulmonary circulation, an embolism usually goes unnoticed.

Superficial venous thrombosis

In addition to deep vein thrombosis and its most prominent representative, deep vein thrombosis, thrombosis also occurs in superficial vessels. In particular, the varicose veins of the calves and tibia, which increase with age, tend to thrombosis due to their enlargement and pathological changes. These thrombi are smaller and less dangerous than deep vein thrombosis. Nevertheless, they need to be treated.

thrombosis / vein thrombosis

A very unpleasant venous thrombosis is thrombosis or vein thrombosis of the anus. It manifests itself in a very painful swelling that severely hinders sitting and bowel movements. It is sometimes even confused by doctors with hemorrhoidal disease. thrombosis is usually harmless. It can be prevented by regular exercise and adequate fluid intake. Local anesthetics provide relief in the acute phase.

What are the symptoms of deep vein thrombosis?

Thick, aching legs after a long day or traveling – who doesn’t know that. In some cases, these are harbingers of venous disease or venous thrombosis!

Deep vein thrombosis (DVT) is a condition in which a blood clot forms in a deep vein and hinders the body’s supply of blood and oxygen. DVT can be either acute or chronic. Symptoms of DVT include swelling, pain, and redness of the leg, as well as calf pain or cramps.

Many thromboses remain undetected

Often, rather non-specific symptoms occur. A slightly painful calf is blamed on standing for a long time or old age. The patient does not recognize his plight and only ends up with a phlebologist with luck. In many cases, however, the diagnosis is only clear through an imaging examination of the veins, which is why doctors assume a high proportion of undetected thrombosis.

Symptoms of deep vein thrombosis vary depending on the size and location of the clot. A clot that is close to the surface of the skin may not cause any symptoms at all, while a large clot blocking blood flow through an entire leg can cause severe symptoms.

Development of thrombosis

What causes thrombosis?

Thrombosis is a blood clot. Blood clots if it stands for too long. This mechanism is useful when we hurt ourselves. The blood clot closes injuries to our vessels to prevent large blood loss.

If the blood flow to a vessel is obstructed and blood stands there for too long, the coagulation cascade begins, a complex biochemical process that leads to the solidification of the blood and the formation of a blood clot in the vessel.

For over 100 years, the three factors of the Virchow triad have been recognized as the cause of thrombosis.

The Virchow Triad – Causes of Thrombosis

A doctor named Rudolf Virchow (1821-1902) formulated three prerequisites for the formation of blood clots in vessels.

  1. Changes in the vessel walls: Clots prefer to adhere where vessels are injured, inflamed or otherwise weakened.
  2. Low flow velocity of the blood: if blood accumulates or flows too slowly, this promotes coagulation processes. This is most common in dilated vessels (e.g. varicose veins) or in branching and transitions.
  3. Low viscosity: If blood is too thick, it will clot faster.

From the Virchow triad, it can be deduced which measures lead to a reduction in the risk of thrombosis. More on that below.

Venous thrombosis: who is at risk?

The risk factors of venous thrombosis

Deep vein thrombosis (DVT) is a condition in which a blood clot forms in one of the body’s deep veins. It usually affects the legs, but can also occur in the arms.

The most common causes of DVT are:

  • Pregnancy and childbirth
  • Inactivity
  • Surgery
  • Obesity
  • Smoking and other tobacco use
  • Certain medications, such as estrogen therapy or birth control pills
  • Coagulation disorders
  • Dehydration
  • People with (undetected) cancers

Who is at increased risk of DVT?

Deep vein thrombosis is most common in people who have recently had surgery, people who are immobilized (such as people who are bedridden or people who travel long-distance), and people who have previously had a blood clot.

The latter simply results from the fact that the body of a former thrombosis patient has already shown unfavorable dispositions and behaviors; without a serious change in behavior and prevention, a thrombotic event can easily be repeated here.

So, people at particular risk for DVT are:

  • People who are immobilized (e.g. bedridden)
  • Long-distance travelers who sit still and cramped for long periods of time
  • Patients who have recently undergone surgery
  • People with a previous blood clot
  • People with certain cancers that affect blood clotting
  • Women during pregnancy and childbirth
  • Women who use contraceptives (hormonal contraceptives)

Prevention of deep vein thrombosis

How can I reduce my risk of getting a clot?

Lifestyle and habits play an important role in the formation of blood clots in the human circulation.

There are many ways to prevent blood clots in the veins. For example:

  • Get up and move every hour
  • Drink plenty of fluids
  • Wear support stockings or compression stockings
  • Control your weight

3 everyday tips to prevent thrombosis in the legs or arms

DVT stands for deep vein thrombosis, a condition in which a blood clot forms in the body’s deep veins. It is possible to get DVT in your legs or arms. You can prevent DVT by doing certain things.

  1. Stay hydrated: Drinking plenty of fluids can help keep your blood flowing freely and prevent blood clots from forming.
  2. Don’t smoke: Smoking is harmful to your health and also increases your risk of developing DVT.
  3. Exercise: Sitting or standing still for too long can make you more susceptible to developing DVT because it slows blood flow and reduces the amount of oxygen delivered to parts of your body.

Treatment of deep vein thrombosis

In the treatment of dangerous, deep vein thrombosis, two measures have proven successful. On the one hand, blood clotting is reduced, and on the other hand, the leg in question is fully or partially compressed. Why these two measures are taken, we explain in this section.

Anticoagulants: blood thinners against thrombosis and embolism

The most powerful means of treating thrombosis are so-called anticoagulants. They inhibit the clotting of the blood and thereby prevent the thrombosis from growing. Ideally, they ensure that the clot becomes smaller or even dissolves completely. Whether this succeeds depends on how old the thrombus is and how severe the blockage of the vessel has already progressed.

The latest generation of such blood thinners is taken orally (as a film-coated tablet) once or twice a day and can therefore be used very easily at home. The doctor prescribes a higher dose for a week to reduce the acute threat of embolism and more effectively dissolve the fresh blood clot. After that, the remedy is prescribed for at least three months – sometimes for life.

Blood thinners have a serious drawback: they reduce blood clotting, as a result of which bleeding in the body occurs longer and more frequently. If a patient takes blood thinners, he should always carry a patient card with him. If an emergency (of whatever kind) occurs, the attending physician knows immediately that he must expect reduced blood clotting and, if necessary, administer an antidote.

Compression therapy

Compression of the directly affected limbs has a supportive effect in thrombosis therapy in many ways. Tight pads or compression stockings exert a defined pressure on the tissue and the impaired vessels. The effect is composed of:

  1. Reduction of the venous cross-section on the thrombus: If the vessel is not yet completely occluded, the flow velocity of the blood increases and promotes the breakdown of the clot.
  2. Fixation of the thrombus: It is believed that pieces of the blood clot are less likely to detach when the vein is compressed.
  3. Reduction of the cross-section of varicose veins and collateral veins: Thrombosis creates increased pressure on collateral veins (also: secondary veins, bypass veins and warning veins). These extend to the point of pathological change. Compressions prevent this evasive process.
  4. Detoxification: Due to compression, less water is deposited in the tissue. The lymphatic system can work better.

Just like drug therapy with blood thinners, compression therapy from 3 months to lifelong prevention may be advisable.

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