Deep Vein Thrombosis And Pulmonary Embolism a Guide For Practitioners | HealthInfi

A deep vein thrombosis (DVT) involves the formation of a clot in the deep veins of the lower calf. The clot generally begins very low in the leg and grows in an upward direction to extend up to and past the knee. Some DVTs can rise to the level of the upper thigh, pelvis and even the lower abdomen. DVTs are considered dangerous because a piece of the clot can break off, travel up the patient’s vena cava and enter the patient’s lungs, resulting in a pulmonary embolism (PE).

A pulmonary embolism (PE) is dangerous because it can cut off the circulation to the lung vasculature, resulting in sudden cardiovascular collapse and often, sudden death within minutes. Of the 80 out of 100,000 people in the US who have a DVT each year, fifteen percent will develop a DVT. Of cases of sudden death, 3 percent are due to a PE.

In essence, the DVT generally comes first. People prone to a DVT include travelers who travel long distances and times without the ability to get up and move one’s legs. The moving of the legs triggers increased circulation in the legs, reducing the chance of a DVT. Travelers on long haul airline flights also get dehydrated from the dry air and lack of fluid intake, and are at an even higher risk than those traveling by other mechanisms.

Individuals who are obese, pregnant or elderly put themselves at higher risk for a DVT. Women who take birth control pills or estrogen replacement therapy are also at greater risk. In addition, those who have certain types of cancer secrete prothrombic agents that increase the chances of clotting within the body.

When a person develops a DVT, he or she might be asymptomatic. Alternatively, he or she may have symptoms, including redness or discoloration of the calf, pain in the back portion of the calf and an increase in swelling of the affected lower leg. Doctors can elicit a positive Homan’s sign by dorsiflexion (tipping upward toward the head) of the foot and asking the patient if they have increased pain in the posterior calf.

Furthermore, the doctor can check a d-dimer blood test—a test that determines the breakdown products of the clotting process. This can tell the doctor if there is clotting within the body. Imaging studies that prove the clotting is coming from a DVT include a Doppler ultrasound of the legs and a deep vein venogram, which employs the use of intravenous contrast dye and x-rays to determine the contour of the deep veins.

In treating a DVT, the doctor may order an IV infusion of TPA, also called tissue plasminogen activator. It is able to break up clots effectively and efficiently. It is reserved for severe cases of DVT. Lesser cases include treating the patient with intravenous heparin and pills consisting of Coumadin. The IV heparin works immediately to thin the blood. The clot breaks up through natural processes.Read More