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Frequently Asked Questions about DVT
From a presentation by Pajman Danai, MD, Pulmonary Consultants of Hagerstown
What is a DVT?
Deep vein thrombosis (DVT) is a clot that forms within a vein deep inside the body. This is different than blood clots in superficial areas: varicose veins, skin bruises, and venous stasis ulcers.
Why is DVT important?
- DVT occurs in about 2 million Americans each year
- Up to 600,000 people are hospitalized in the United States each year for DVT and its primary complication, pulmonary embolism (PE).
- About half of those are first-time cases of DVT.
- DVT can break away and float downstream from the original clot. This may cause a pulmonary embolism (PE) or a stroke.
- A DVT that does not move can cause long term leg pain, called post-phlebitic syndrome.
- More people die in the United States from PE than from breast cancer and AIDS combined.
What are the symptoms of DVT?
- Changes in skin color (redness) in one leg
- Increased warmth in one leg
- Leg pain in one leg
- Leg tenderness in one leg
- Swelling (edema) of one leg
- These symptoms can also occur with other health problems, so testing by a physician is needed to diagnose DVT.
What are the risk factors for DVT?
Anything that slows or changes the flow of blood in the veins is a risk factor
- Prolonged bed rest (the most common risk factor)
- Cigarette smoking
- Giving birth within the last six months
- Heart failure
- Obesity
- Recent surgery (especially hip, knee, or female reproductive organ surgery)
- Too many blood cells being made by the bone marrow (polycythemia vera)
- Blood that is more likely to clot (hypercoagulability)
- Cancer
- Taking estrogens or birth control pills. This risk is even higher if you smoke.
- Sitting for long periods when traveling
What tests are used to diagnose DVT?
- Duplex Doppler ultrasound, which takes pictures of blood flow through the veins
- Blood work called a D-Dimer
- Venogram, a test in which IV dye is injected into the vein and viewed using x-rays
- Blood work to test for increased clotting (hypercoagulability)
- Activated protein C resistance (checks for the Factor V Leiden mutation)
- Antithrombin III levels
- Genetic testing to look for mutations that make you more likely to develop blood clots
- Prothrombin G20210A mutation
- Lupus anticoagulant or antiphospholipid antibodies
- Protein C and protein S levels
How is DVT treated?
DVT is easily treated, usually with medication.
- Low molecular weight heparins
- Requires injection under skin
- Does not require monitoring
- Expensive
- Coumadin (warfarin)
- Very cheap
- Unpredictable --- Requires frequent monitoring
- Higher risk of bleeding
- Given as a tablet
- Heparin
- Given IV usually in acute care setting
- Requires blood work multiple times a day
- Gold standard in cases of life threatening DVT or PE
- Pradaxa
- Awaiting FDA approval for DVT
- Given by mouth twice a day
- No monitoring
- Low bleeding risk
- Surgery
- Necessary when a blood thinner cannot be used
- IVC Filter
- Placement of a filter in the body’s largest vein to prevent blood clots from traveling to the lungs
- Useful in cases where medication fails
- Mechanical removal (suction)
- Injection of clot-busting medicines
How can DVT be prevented?
DVT is easy to prevent:
- Wear elastic stockings.
- Quit smoking.
- Exercise the leg muscles.
- Take prescribed blood thinning medications as directed:
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