Deep venous thrombosis
What is deep vein thrombosis
To stop external bleeding when an injury occurs, our body physiologically forms blood clots, but there are situations where thrombi appear inside superficial or deep blood vessels with disturbed blood flow. Deep vein thrombosis is caused by the intraluminal formation of a thrombus (clot) more frequently located in the lower limbs, thighs or pelvis.
What are the factors that favor the appearance of the disease
Factors involved in deep vein thrombus formation include vascular wall damage, venous stasis, and blood clotting and fibrinolysis disorders. Deep vein thrombosis is favored by:
- Contraceptive administration of estrogen-based hormone treatments;
- Intense dehydration (low fluid intake or significant losses not properly replaced);
- Lack of movement (postoperative immobilization, long air travel);
- Association of different types of neoplasms;
- Existence of autoimmune diseases;
- Surgery or accidents.
The condition is widespread, but there are several categories of people at risk for deep vein thrombosis such as: overweight people, the elderly- over 60, cancer patients or those with a history of acute ischemic episodes (acute myocardial infarction, history of stroke or diagnosed heart failure).
What are the symptoms of deep vein thrombosis
Deep vein thrombosis develops in almost half of the cases in the absence of symptoms so it can be easily reached in critical situations such as pulmonary thromboembolism (medical emergency - the most common complication of deep vein thrombosis).
Self-assessment
It is important to know some specific signs of deep vein thrombosis that will guide you to a specialist consultation as soon as possible:
- Edema of the thigh or leg (the foot swells with a visible increase in volume compared to the healthy one);
- Occurrence of pain while walking or orthostatism;
- The sensation of warmth of the affected limb;
- The appearance of skin erythema (skin reddening) or blue skin colouration (tissue hypoxia).
If the blood clots migrate from the deep veins to the lungs, pulmonary embolism occurs, which is usually manifested by: deep painful inhalation, cough with bloody sputum and accelerated heart rate.
Treatment
All the therapeutic measures applied have the role of stopping the increase in the volume of the intravenous thrombus, reducing the chance of formation of other intravascular thrombi and preventing their migration to the lungs where it causes the occurrence of pulmonary thromboembolism.
The basic drugs used in the treatment of deep vein thrombosis are low molecular weight injectable heparin (intravenous or subcutaneous) followed by coumarin anticoagulants (except for pregnant women who receive only heparin, acenocoumarol being contraindicated in pregnancy). The monitoring and adjustment of the anticoagulant doses are done periodically with the help of the INR, depending on the values of which it is possible to opt for the decrease or increase of the drug dose by the specialist doctor.
Thrombotic medication is used to "dissolve" intravascular thrombi but is not routinely used, is reserved for people with risk factors for pulmonary thromboembolism.
If a favourable response is not obtained after the drug treatment, it is possible to choose to mount a vena cava filter through a vascular catheter (minimally invasive surgery). The classic surgery remains an option, to remove the intraluminal thrombus-thrombectomy.