Deep vein thrombosis (DVT)

Deep vein thrombosis (DVT) is a serious medical condition where a blood clot forms in a major vein, most commonly in the legs. A DVT is a concern because the clot can break away and travel through the bloodstream to the lungs, causing a potentially life-threatening blockage called a pulmonary embolism (PE). 

Common causes

A DVT occurs when blood flow slows down or blood becomes more prone to clotting. Risk factors for this include: 

  • Prolonged immobility: Long periods of inactivity—such as being on bed rest after surgery, sitting on a long flight or drive, or having a cast on a limb—can cause blood to pool in the legs and form clots.

  • Recent surgery or injury: Damage to the veins during major surgery (especially to the hips, pelvis, or legs) or from serious muscle injuries and fractures increases the risk of clot formation.

  • Certain medical conditions: People with cancer, heart disease, inflammatory bowel disease, and inherited blood clotting disorders are at higher risk.

  • Pregnancy and childbirth: Increased pressure on the pelvic veins and hormonal changes during and after pregnancy can raise the risk of DVT.

  • Lifestyle factors: Smoking and being overweight or obese can also contribute to DVT. 

Signs and symptoms

DVT symptoms often occur in the affected leg and can be mild or absent in up to 30% of cases. When symptoms are present, they typically include: 

  • Swelling: The affected leg, ankle, or foot may swell, sometimes suddenly.

  • Pain or tenderness: This can feel like a cramp or soreness, especially when standing or walking.

  • Warmth: The skin over the affected area may feel warm to the touch.

  • Skin discoloration: The skin may appear reddish or bluish.

  • Visible veins: Surface veins might become more prominent. 

It is crucial to be aware of the signs of a pulmonary embolism (PE), a life-threatening complication of DVT. If a DVT clot breaks off and travels to the lungs, it can cause: 

  • Sudden shortness of breath

  • Chest pain that worsens with deep breathing

  • Rapid heart rate

  • Lightheadedness or fainting

  • Coughing up blood 

If you experience any of these signs, seek emergency medical help immediately. 

Diagnosis

To diagnose a DVT, a doctor will perform a physical exam and ask about your medical history. They will then confirm the diagnosis with specific tests: 

  • D-dimer blood test: This test measures a substance released when a blood clot dissolves. High levels of D-dimer in the blood can indicate a clot.

  • Duplex ultrasound: The most common diagnostic tool, this non-invasive test uses sound waves to create images of blood flow in your veins. The doctor can press on the veins to see if they compress properly or are blocked by a clot.

  • Venography or MRI: These tests may be used in rare cases when an ultrasound is inconclusive. 

Treatment

The primary goals of DVT treatment are to prevent the clot from getting bigger, stop new clots from forming, and prevent a pulmonary embolism. 

Medications

  • Blood thinners (anticoagulants): These are the most common treatments. While they don't dissolve the existing clot, they prevent it from growing and help the body absorb it over time. Medications like warfarin or newer drugs such as rivaroxaban are taken for several months or longer.

  • Clot-busting medications (thrombolytics): For severe cases, these potent drugs can be injected directly into the clot to dissolve it quickly. This is typically reserved for more serious clots due to a higher risk of bleeding. 

Supportive measures

  • Compression stockings: These special stockings apply pressure to the legs to improve blood flow, reduce swelling, and prevent blood from pooling.

  • Movement: After the initial treatment, doctors often recommend a walking regimen to encourage blood circulation. 

Other procedures

  • Filters: If a person cannot take blood thinners, a filter can be temporarily placed in the body's largest vein (the vena cava) to catch clots before they reach the lungs.

  • Thrombectomy: In some cases, a catheter-based procedure can be used to mechanically break up and remove a large clot.

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