Deep Vein Thrombosis

Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) develops in a vein deep in your body, often in your leg. This can happen because of a vein injury or slow-flowing blood. The blood clot may partially or completely block blood flow through your vein.

Most DVTs happen in your calf, thigh or pelvis. But they also can occur in other parts of your body, including your arm, brain, intestines, liver or kidney.

Deep vein thrombosis (also called venous thrombosis) is common. You need quick diagnosis and treatment to prevent life-threatening complications.

Symptoms of deep vein thrombosis

A DVT usually forms in the veins of your legs or arms. Some people have mild symptoms or none at all. DVT symptoms include:

• Swelling of your leg or arm on one side (sometimes, this happens suddenly)
• Pain or tenderness in your leg or arm (may only happen when standing or walking)
• Warmth in the area of your leg or arm that’s swollen or painful
• Discolored or red skin
• Larger-than-normal veins near your skin’s surface
• Abdominal pain or flank pain (when blood clots affect the veins deep inside your abdomen)
• Severe headache (usually sudden), vision changes, stroke-like symptoms and/or seizures (when blood clots affect the veins of your brain)

Some people don’t know they have a DVT until the clot moves from a leg or arm and travels to a lung. This is a pulmonary embolism (PE). Symptoms of this include chest pain, shortness of breath, cough with blood, lightheadedness and fainting.

It’s important to call your provider right away or go to the emergency room if you have deep vein thrombosis or PE symptoms. Don’t wait to see if your symptoms go away. Get treatment right away to prevent serious complications.

Deep vein thrombosis causes

Slow blood flow in a damaged deep vein after being inactive for a long time can cause deep vein thrombosis. This often comes after an injury, surgery or hospital stay. This is because you’re lying in bed most of the time instead of moving like you normally would. It’s also because there’s a high amount of inflammation in your body and blood vessels.

A DVT can also happen when you’re not moving for more than four hours because of travel. You may be sitting for a long time in a car, truck, bus, train or airplane.

DVT risk factors

Some people have a personal or family history of DVT or a blood-clotting disorder that increases the risk of blood clots. Others may have these risk factors for deep vein thrombosis:

• Having cancer and certain treatments for it (like chemotherapy)
• Being pregnant or having recently delivered a baby
• Being older than 40 (although a DVT can affect people of any age)
• Using tobacco products
• Having high blood pressure or diabetes
• Having varicose veins
• Taking birth control pills or hormone therapy
• Having overweight/obesity
• Having an autoimmune disease, heart failure, lung disease or kidney disease

Complications of this condition

Without prompt treatment, a DVT may lead to serious complications like:

• Pulmonary embolism (PE): This happens when blood clots that break free and travel through your blood get stuck in your lung’s blood vessels.
• Post-thrombotic syndrome: This can happen because of damage to the valves and inner lining of your veins, leading to blood “pooling” more than it should. This increases the pressure inside your veins and causes leg pain and swelling that may last months to years.

How doctors diagnose deep vein thrombosis

Your healthcare provider will do a physical exam and review your medical history. You’ll also need to have blood tests or imaging tests. These include:

• Vascular ultrasound: This is a noninvasive scan of your arm or leg to show blood flow and blood clots in your veins.
• Venogram: Your provider uses a catheter to inject a special dye (contrast material) into your veins. An X-ray can show whether any blood clots are blocking blood flow inside your veins.
• MRI or magnetic resonance venography (MRV): MRI shows pictures of organs and structures inside your body. MRV shows pictures of the veins in certain locations in your body.
• CT scan: This type of X-ray shows structures inside your body. Your provider may use a CT scan to find a DVT in your abdomen, pelvis or brain, as well as blood clots in your lung.
• D-dimer test: Abnormal results from this test can tell your provider if you might have a DVT and a blood-clotting condition.

How is it treated?

DVT treatment aims to keep the clot from getting bigger or breaking off and lessen the risk of another blood clot. Deep vein thrombosis treatment includes medications, compression stockings and elevating your affected leg(s) at different times throughout the day. In rare cases, you may need invasive treatments.

Treatments include:

• Anticoagulants: Blood thinners like warfarin, heparin and oral Xa inhibitors (like apixaban or rivaroxaban) make it harder for your blood to clot. They also stop clots from getting bigger or moving. You may have to take it for only a few months or long-term.
• Thrombolytics: For a severe deep vein thrombosis, you may receive drugs to break up blood clots. You can get this medicine through an IV or catheter that goes right into the clot.
• Compression stockings: Elastic compression stockings can improve or get rid of leg swelling. Some people need to wear these for two years or more.
• Compression devices: After surgery, your provider may put these devices on your calves. They squeeze and release around your calves while you’re lying in bed.
• Thrombectomy: Rarely, a surgeon may remove a large blood clot from a vein. They use a catheter to reach it.
• Inferior vena cava (IVC) filter: A surgeon inserts this medical device through a catheter into a large vein in your groin or neck, and then into your body’s largest vein (vena cava). The IVC filter prevents large clots in your legs from reaching your lungs.

When should I see my healthcare provider?

Tell your healthcare provider if your symptoms aren’t getting better. You should also tell them if you’re bruising too easily or having heavy periods. You should get emergency care if the blood thinners you’re taking make you bleed too much, or cause problems like bright red blood in vomit or poop.

You should have follow-up appointments while you wait for the blood clot to break up. These visits may include blood tests and ultrasounds.

Questions to ask your provider may include:

• How long will I need to take blood thinners?
• When can I travel again?
• How often do I need follow-up visits?

What can I expect if I have deep vein thrombosis?

A DVT can take several months or even over a year to come apart. You’ll need to continue with treatments until your provider tells you to stop. You may need blood tests to make sure you’re getting the right dose of blood thinners. Your provider may want to do more ultrasounds later to see whether your blood clot is still in the same place, improving or getting larger.

A deep vein thrombosis may make it harder for you to use your legs at first because of leg pain and swelling. But you’ll be able to slowly return to your normal activities.

Is there anything I can do to feel better?

If your legs feel swollen or heavy, lie in bed with your heels propped up about 5 to 6 inches. This helps improve circulation and decreases swelling. Wearing knee-high compression stockings can help, too. These can reduce your leg pain and swelling by at least half if you wear them daily.

Can this be prevented?

You can prevent deep vein thrombosis from happening (or repeating) in these ways:

• Exercise your calf muscles if you need to sit still for a long time. Stand up and walk at least every half hour if you’re on a long flight. Or get out of the car every hour if you’re on a long road trip.
• Get out of bed and move around as soon as you can after you’re sick or have surgery. The sooner you move around, the lower the chance of developing a DVT.
• Take medications or use compression stockings after surgery (if your provider prescribes them) to reduce your risk of a clot.
• Drink enough fluids at all times, especially during travel.
• Manage conditions that may lead to deep vein thrombosis.
• Keep your follow-up appointments with your provider and the lab that does blood tests. These tell your provider how well your treatment is working.

Make lifestyle changes, like eating nutritious foods, being active and avoiding tobacco products.