March is National Deep Vein Thrombosis (DVT) Awareness Month. DVT indicates a blood clot in a deep vein. This not only causes obstruction of blood flow from the leg but the clot can break off and pass to the heart and lung resulting in a pulmonary embolus, which can be life threatening.
The “Silent Killer”
Why are DVT’s so important that we focus on them for an entire month? DVT is known as the “silent killer” and is the single largest cause of mortality in hospitals in patients admitted with another diagnosis; and is the greatest cause of maternal mortality in pregnancy. A clot in the leg or pelvis often occurs after an abdominal, pelvic, or orthopedic operation, trauma, or stroke. The clot can break off and pass through the heart to block the flow of blood to the lungs- pulmonary embolus- PE, resulting in shortness of breath, and/or chest pain with breathing. A pulmonary embolus can cause sudden death if the clot is large enough.
A clot can form because the blood is more prone to clotting or because the patient is sedentary or on bed rest. Also, those with cancer or long trips are vulnerable. Silent refers to the fact that the person doesn’t feel any pain or discomfort and there may be minimal to no swelling.
DVT’s Shocking Numbers
- As many as 900,000 people per year are affected by DVT (1 to 2 per 1,000) in the USA.
- Up to 100,000 Americans die each year as a result of a DVT with a pulmonary embolus. Two-thirds of these people die in the hospital, after hospitalization or after outpatient surgery.
- Half the people who develop a DVT will experience long-term consequences such as swelling, aching, discoloration, and skin changes around the ankle of the affected leg- Post-phebitic syndrome.
- One-third of those with a DVT will have a recurrence within ten years.
- COVID-19 has been found to be a cause of DVT and can cause clots in the lungs.
What Causes DVT?
Clots in the legs occur for a variety of reasons. Some people inherit a tendency to clot, referred to as thrombophilia. Several other factors can lead to blood clots in the legs (DVT).
- Prolonged Travel
- Sedentary Lifestyle
- Abdominal, pelvic, or orthopedic operations
- Trauma to the leg, especially with long bone fractures
Who Is At Risk For DVT?
People who have recently had an operation have a higher risk of developing blood clots in the legs, especially if it was an orthopedic operation, such as a back, knee, or hip procedure. Abdominal and pelvic procedures also raise the risk of blood clots, as well as people who’ve experienced physical trauma especially to the legs.
Those who have recently taken a long trip are also at an elevated risk for DVT. Long trips with little movement, especially with constricting garments or dehydration, increases the risk of developing clots.
Covid-19 can predispose to clots in veins and arteries.
Recognize the Signs and Symptoms of DVT
A blood clot in the legs may be completely asymptomatic or “silent” within the affected vein, with no symptoms and minimal signs. Sometimes there are visible signs or feelings in the leg, including:
- Sudden or unexpected leg swelling
- Pain, aching, fullness or pressure in the leg
- Warmth or coolness in the lower leg
- Skin discoloration of the lower leg
Consult your physician immediately if you have any of these symptoms listed above.
Tips for Preventing DVT
Prevention involves early mobilization after an operation, pneumatic compression of the legs during and after the operation, and use of anticoagulants, especially in those with a previous history of clots or a family history of clots, and in patients with cancer.
Compression stockings, hydration, and frequent movement or flexing the foot can help when on long trips. This is especially important in overweight or obese people and in women who are pregnant due to their elevated risk for clots.
You can reduce the risk of developing DVT by:
- Maintaining a healthy body weight
- Staying active and exercising regularly
- Avoiding smoking
- Knowing your potential risk factors and discussing them with your healthcare provider
- Avoid dehydration with long distance travel
An In-Depth Look At Blood Clots
When referring to clots in the legs, it is important to keep in mind that there are two systems of veins in the legs: a deep system and a superficial system. The deep system is surrounded by muscles and carries most of the blood from the legs. It is at the greatest risk for complications from clots. We can’t see or feel these veins, meaning a clot could be “silent” with no symptoms or signs, or it could cause dull, heavy pressure, discomfort, and swelling.
Clots in superficial veins, which lie outside the muscle tissue, can cause a lump or cord which may be tender to touch. The pain may be worse when standing and sometimes causes a pink discoloration in the overlying skin. Sometimes, this pink discoloration of the skin is mistaken by patients and doctors as infection, but it is not- it is inflammation. While these clots may be painful, they don’t lead to dangerous consequences and aren’t cause for panic. Nevertheless, an appointment should be made with a physician, particularly a vascular specialist, and a Doppler ultrasound test should be performed.
Clots in the deep veins require medical therapy. Your provider may prescribe an anticoagulant or “blood thinner” such as Heparin, Coumadin, or one of the new anticoagulants Xarelto, Eliquis, or Pradaxa. You should try to stay active, wear compression stockings, and elevate your legs when sitting.
Resolve to get up, get out, keep moving, and wear your compression for healthy, beautiful legs and decrease your chances of developing clots.