Consumer Information

Deep Venous Thrombosis

GENERAL INFORMATION:

What is deep venous thrombosis?

Deep venous thrombosis is also called DVT. It is a condition when a blood clot forms in a deep vein of the body. Veins are blood vessels that bring blood from your body back to your heart. The deep veins in the legs, thighs, and hips are the most common sites for DVT. Normally clots form when there is an injury to the wall of a blood vessel. They act as a plug to prevent too much bleeding. When the injury has healed, the clots will dissolve (break down) on their own.
When you have DVT, a large clot can form that does not break down. It can be large enough to prevent the normal flow of blood in the vein. When this happens, blood stays in the vein and causes pain and swelling in the area. The clot can also break into smaller pieces and become an embolus. An embolus is a substance, such as a clot, that travels in the blood to other body areas. An embolus can reach your heart, lungs, or brain, and decrease the blood supply to that organ. This can cause serious and life-threatening conditions, such as a heart attack, pulmonary embolism, or stroke.

What puts me at a higher risk for DVT? The risk for having another DVT is high if you have had one before. The following conditions also increase your risk:

Damage to the blood vessel wall:
- Foreign item in your body: Having a central venous catheter (large IV tube), an artificial heart valve, or a vena cava filter. These are items that may frequently cause clots to form.
- Smoking: Smoking cigarettes, cigars, or pipes can injure blood vessel walls.
- Varicose veins: These are veins that are enlarged, twisted, and swollen. Having congenital (born with) problems with your veins may also increase your risk.
Poor blood flow:
- Heart or lung conditions: Heart or lung failure will cause poor blood flow in your body.
- Increasing age: Being 50 years of age and over.
- Long periods without activity: Clots may form when you are bedridden or sitting for many hours such as on long air flights. You may not be able to move much if you have had a stroke or spinal cord injury.
- Obesity: This is when you weigh more than what your caregiver recommends.
- Pregnancy: Women are more likely to have DVT during pregnancy and in the period right after giving birth. This may also be due in part to the increased levels of hormones present in the blood during this time.
- Surgery or trauma: Having major surgery, especially on your bones, blood vessels, or brain increases your risk for DVT. Fractures (breaks) of your leg bones or hip, and injuries to your spinal cord may also put you at risk.
Increased clotting activity or thickening of the blood:
- Medicines: These include certain medicines to treat psychosis and cancer, and medicines that have the female hormone estrogen. Estrogen is found in hormone replacement therapy (HRT) for menopausal women and in oral birth control pills. Ask your caregiver for more information about these medicines that can increase clot formation.
- Medical conditions: Thrombophilia (throm-BO-feel-ee-a) refers to conditions that can cause clots to form without an injury to the blood vessel wall. These conditions can be inherited (born with) or are something you get later in life. These conditions include infections, acute myocardial infarction (heart attack), and inflammation (swelling) of the bowels. Active cancer, nephrotic syndrome (kidney disease), and certain blood disorders may cause blood clots. Autoimmune disorders, such as antiphospholipid syndrome, may also cause DVT. Autoimmune disorders can form antibodies against certain blood proteins and trigger clots to form in your vein. Ask your caregiver for more information about thrombophilia.

What are the signs and symptoms of DVT? When you have DVT, you often will have no signs or symptoms at first . Over time, you may see or feel any of the following on your hips, thighs, or legs:

Swelling of your leg.
Hard, worm-like veins that may be felt through the skin.
Painful, tender, red, or warm area on the leg.
Purplish-colored skin.

How is DVT diagnosed? Your caregiver will ask about your medical history. He will want to know about all the medicines you take. He will want to know if you have had DVT before. He will ask about your health habits. He will want to know if you have had surgery or other procedures done recently. He will want to know if you have been ill, injured, or on a trip recently. He will do a physical exam on you. You may need any of the following:

Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
Imaging tests:
- Compression ultrasound: This is a test that uses sound waves to see your veins on a TV-like screen. Caregivers look for clots in the veins near the area of your pain and redness.
- Contrast venography: This is a special x-ray of a vein after a dye has been put in. The dye makes the vein easier to see on the x-ray. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to any of these.

How is DVT treated? You may be given any of the following:

Medicines: Medicines used for DVT stop new clots from forming and prevent current clots from getting larger. Some may also speed up the break down of clots.
- Anticoagulants: These medicines, also called blood thinners, include heparin. They help stop clots from forming in your blood. Blood thinners may be given before, during, and after a surgery or procedure. They may be given to treat a clot or to prevent you from getting clots.
- Antiplatelets: These include aspirin, and they work by making your platelets less able to form blood clots. Platelets are a special type of blood cell that starts the clotting process.
- Clot busters: These are emergency medicines that work to break apart blood clots. They are given at the same time as other blood thinners. They cannot be used during pregnancy or in medical conditions where too much bleeding can be a problem.
- Vitamin K antagonists: They are used as long-term treatment to prevent clots from forming. You may need to have blood tests done while you are on these medicines. Tell your caregiver if you know or think you are pregnant. These medicines may cause damage to the growing baby.
Other treatments:
- Compression stockings: Your caregiver may instruct you to wear compression stockings. These are tight elastic stockings that put pressure on your lower legs. The pressure is highest near the toe and decreases as it goes towards the thighs. Wearing pressure stockings help push blood back up to the heart and keeps clots from forming. Ask your caregiver for more information on using compression stockings.
- Pneumatic boots: These are plastic boots or leggings put on your feet or legs over pressure stockings or ace wraps. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the pneumatic boots. This helps push the blood back up to the heart to keep clots from forming.
- Inferior vena cava filter: This is a filter that is surgically placed inside the large vein bringing blood to your heart from your lower body. It is used when you cannot be treated with blood thinners. The filter traps clots in your blood to prevent you from getting a pulmonary embolus. Ask your caregiver for more information about inferior vena cava filters.

How can DVT be prevented? Your caregiver should assess your risk for DVT during procedures or when you are in the hospital. If you are at risk, you should be given preventive treatment. Your preventive treatment will be customized for your individual situation. If you continue to be at risk, you may need on-going preventive treatment after you are discharged. Preventive treatments include:

Things that squeeze the leg veins. This will help move the blood in your legs back up into your body. Blood that stays in the leg veins too long can start to clot.
- Leg vein compression: Wearing compression stockings or using pneumatic boots. These items prevent blood from pooling in the leg veins. These may be used during and after procedures and surgery.
- Early walking: Walking and moving your legs right after having surgery or other procedures.
Medicines to decrease clot formation. You may need one or more types of medicines to prevent clots and DVT. If you cannot take the medicine you need, you may need a vena cava filter.

What things can I do to help prevent DVT? Talk to your caregiver about your medical conditions and medicines. Certain ones may increase your risk of getting blood clots. Ask your caregiver if there are other medicines you can take that have a lower risk of causing clotting problems. These are other things you can do to help prevent getting DVT:

Avoid becoming dehydrated. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Good choices for most people to drink include water, juice, and milk. If you are used to drinking liquids that contain caffeine, such as coffee, these can also be counted in your daily liquid amount. Some food items such as soup and fruit also add liquid to your diet. Ask your caregiver how much liquid you should have each day.
Change body positions often. If you are bedridden due to a chronic illness, ask other family members to help change your position regularly.
Elevate your legs. Sit or lie with your legs up. You can use a foot stool or foot rest to raise your legs while sitting. You can use pillows to raise your legs while in bed.
Maintain your ideal body weight. Exercising and eating healthy foods will give you more energy and prevent weight gain. Eat a variety of healthy foods such as fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meat and fish. Ask your caregiver what exercises you can do and if you need to be on a special diet.
Quit smoking. It is never too late to quit smoking. Smoking harms the heart, lungs, and can cause blood to thicken and form clots. You are more likely to have a heart attack, lung disease, and cancer if you smoke. You will help yourself and those around you by not smoking. Ask your caregiver for more information about how to stop smoking if you are having trouble quitting.

What precautions should I take during travel to prevent DVT?

Avoid alcohol during air travel. The combination of the dry cabin air and drinking alcohol can dehydrate you during airplane trips. Drink plenty of non-alcoholic liquids during air travel.
Change body positions and move as much as possible. Avoid long distance travels or sitting for a long period of time. If this cannot be avoided, move and stretch your feet and legs in your seat many times every hour. Get up and walk every few hours. You should also change your sitting position often.
Stretch your arms overhead and take in deep breaths. This will help improve how blood circulates (moves around) in your body.
Wear pressure stockings. These are tight elastic stockings that squeeze the lower part of your legs, such as support stockings or hose. Ask your caregiver if you should wear these stockings. Ask your caregiver if you should wear medical-grade compression stockings.
Talk to your caregiver about preventive treatment. If you are at a higher risk for getting DVT, your caregiver may want you to take medicine to prevent clots.

When should I call my caregiver? Call your caregiver if:

You have pain in your leg or trouble walking.
One of your legs has become larger than the other.
The skin on any part of your legs or hips turns purplish in color.
You have more questions or concerns regarding your condition, medicines, or care.

When should I seek immediate care? Seek immediate help or call 911 if:

You have fast breathing, trouble breathing, or are coughing up blood.
You have chest pain, loss of consciousness, or strong, fast heartbeats.
You have convulsions (seizures) or migraines (very bad headaches).
You have slurred speech, increased sleepiness, or problems seeing, talking, thinking, or remembering.
You have weakness or cannot move your arm or leg on one side of your body.

Where can I find more information? Having DVT is hard. You may have a hard time coping with your condition. You may feel angry, sad, or frightened about this. These feelings are normal. Talk to your caregiver, family, or friends about these feelings. Contact any of the following for more information:

American Academy of Family Physicians
PO Box 11210
Shawnee Mission, KS 66207-1210
Phone: 1-913-906-6000
Web Address: http://www.aafp.org

National Heart, Lung and Blood Institute
Health Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
Phone: 1-301-592-8573
Web Address: http://www.nhlbi.nih.gov/health/infoctr/index.htm

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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