DVT: The Silent Killer

By Samuel P. Martin, MD, FACS

March is National Deep Vein Thrombosis (DVT) Awareness Month. DVT results from a blood clot in a deep vein, causing the dangerous obstruction of blood flow.

The “Silent Killer”

So what is it about DVT that makes it significant enough for nationally-recognized focus for an entire month? DVT is referred to as the “silent killer” and is the single largest cause of mortality in hospitals in patients admitted with another diagnosis. A clot in the leg or pelvis often occurs after an abdominal, pelvis, or orthopedic operation, trauma, or stroke. This clot then breaks off and passes through the heart to block the flow of blood to the lungs (pulmonary embolus- PE), causing shortness of breath, or chest pain. DVT could even lead to death if the clot is large enough.

DVT’s Shocking Numbers

• As many as 900,000 people could be affected by DVT (1 to 2 per 1,000) each year in the United States.
• Up to 100,000 Americans die as a result of a DVT with a pulmonary embolus. Two-thirds of these people die in the hospital or within a few weeks of hospitalization.
• Half the people who develop a DVT will experience long-term consequences such as swelling, pain, discoloration, and skin changes around the ankle of the affected leg.
• One-third of those with a DVT will have a recurrence within ten years.

What Causes DVT?

 Clots in the legs occur for a variety of reasons. Some people inherit a tendency to clot, referred to as thrombophilia, but several other factors could lead to the development of blood clots in the legs and DVT.

• Cancer
• Obesity
• Pregnancy
• Prolonged Travel
• Sedentary Lifestyle

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.

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.

Recognize the Symptoms of DVT

A blood clot in the legs may be completely asymptomatic or “silent” within the affected vein, which is extremely dangerous. However, there are visible symptoms to look for, including:

• Sudden Leg Swelling
• Pain, Aching, or Fullness and Pressure In the Leg
• Warmth or Coolness In the Area of Leg Discomfort
• 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, 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 a great deal 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

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 out of 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 it could cause dull, heavy pressure, pain, and swelling.

Clots in superficial veins, outside of the muscle tissue, can cause a lump or cord tender to the touch. This is painful, especially when standing and sometimes has a pink color in the overlying skin. Sometimes, this pink discoloration of the skin is mistaken by patients as an infection, but it is not.  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.

Treating DVT

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 like 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.