(DVT) Deep Vein Thrombsis - HVVI, La Vista, NE

Deep Vein Thombosis (DVT)

#Deep Vein Thrombosis (DVT) affects nearly 2 million Americans each year. It is a serious condition that occurs when a deep vein is partially or completely blocked by a blood clot. DVT typically appears in the leg, mostly in the lower part of the calf vein, but has been known to materialize in other parts of the body. At Heartland Vein and Vascular Institute, we recognize the importance in the early detection and treatment of this life threatening condition. As DVT is often difficult to detect, our specialists employ the most advanced medical testing to identity and diagnose DVT. The following signs and symptoms can occur:

  • • Pain, Swelling (unusual and sudden)
  • • Tenderness
  • • Cramping
  • • Aching
  • • Redness or other skin color changes
  • • Skin that is warm to the touch
  • • Fever
  • • In severe cases a bluish color of the skin
  • • No symptoms at all

DVT is a common yet serious condition that if left untreated can lead to pulmonary embolism (PE), which can be fatal. PE occurs when a blood clot travels through the veins and blocks a major blood vessel leading to the lungs. The goal for treatment is to prevent the clot from increasing in size or breaking off and floating through the blood stream to another part of the body such as the heart and lungs. For this reason, Heartland Vein and Vascular Institute pledges our center to diagnose, educate and treat patients in the proper detection and prevention of this common condition.

These FAQs were designed to answer some of the commonly asked questions from those patients and their families receiving treatment for DVT/PE.

Why can’t we use clot busters to break the clot apart?
A: Blood thinners such as heparin, lovenox, warfarin, or xarelto are the main course of treatment in patients with deep vein thrombosis (DVT) or pulmonary embolism (PE). They have been proven to prevent clots from growing and from dislodging. There are also clot busting medications (known as thrombolytics) that may be used in more serious cases of DVT when there are so many clots that it causes severe leg swelling, compromising blood flow to the leg or in cases of PE when the strain on the heart from the blood clot is significant or a patient is unstable with low blood pressure. The use of thrombolytic medications can be associated with an increased risk of serious bleeding. Furthermore, although they dissolve clots, it is not yet clear to what extent they improve patient outcome. Even if a thrombolytic/clot buster is given, a blood thinner such as heparin is also generally used.

Q: Why can’t we use a screen to prevent the clot from going to my lungs?
A: Screens that can be used to prevent clots from breaking apart from the legs and traveling to the lungs are called inferior vena cava filters (or IVC filters). Some IVC filters are placed permanently while others are left in place for a short period of time and then removed. These are used in patients who are at risk of bleeding while being on blood thinners or who have been determined by their physician to be at high risk from the clot itself. Patients are carefully selected for IVC filter placement because it requires an invasive procedure to place them. Complications of IVC filters, though uncommon, include bleeding or reaction to dye during IVC filter placement, tilting or movement of the filter, or very rarely pieces of the filter breaking off of the device. While IVC filters do decrease the risk of pulmonary embolism, they are associated with a risk of future DVT’s in the legs below the filter.

Q: Will walking, exercising, or physical therapy cause my clots to break loose?
A: If you have a DVT, getting up and moving around does not increase your risk of PE compared with bed rest. Studies have suggested that those patients with DVT who get out of bed and walk earlier have shown faster resolution of pain and swelling in the legs.

Q: What limitations do I have now that I have these clots?
A: Most patients who have had a DVT or PE are eventually able to resume their normal daily routine and may continue to participate in activities they enjoy, including massage, exercise and travel. Contact sports are generally not recommended for a fear of trauma and bleeding while on blood thinners. Having a DVT or PE should not prevent one from being at high altitudes in most cases. As always, check with your doctor as to when you may resume the activities and travel that you enjoy.

Should we check to see if the clot has dissolved?
A: Checking for resolution of a blood clot is not a great measure of success of treatment. The majority of patients who have had a PE will still have some visible clot on repeat imaging as far as six months after their event and treatment. The same is true for some patients with DVT of the legs. For leg DVT, the presence of residual clot months after treatment may be used as a marker for the risk of having another DVT. In some cases a physician may order another ultrasound study months after a DVT to assess for the presence and amount of remaining clot, to help decide whether to continue a patient on his blood thinner medication. An ultrasound performed early after the clot was diagnosed (3 – 7 days) may also be useful in determining the effectiveness of the blood thinner.

Q: Will my blood clot put me at risk for a heart attack or stroke?
A: Having a DVT or PE generally will not result in a heart attack or a stroke as the two involve different parts of the vascular system. An exception is if there is a hole in the heart to connect the two systems together, but this is highly unusual.

Q: Why do I still have some leg pain and swelling even after the clot is treated or gone?
A: Many patients will develop symptoms of the post thrombotic syndrome (PTS) after developing a DVT. The post thrombotic syndrome is a cluster of leg symptoms such as swelling, pain and discoloration of the legs that can develop after a DVT, especially if the DVT is extensive. The symptoms of PTS are generally controlled with compression stockings. Research has also shown that among patients with leg DVT, the likelihood of developing symptoms of PTS can be reduced by wearing compression hose during treatment of DVT.

Q: Will I be OK to travel?
A: In most cases, yes. Prolonged travel (thought to be greater than four hours) is associated with only a mild risk of blood clots. Most patients who have had a blood clot after a flight also have other risk factors for DVT and PE. If you have recently suffered a DVT or PE, check with your physician prior to travel. You may also need to make arrangements for monitoring your blood thinners if you are to be away for a long period of time. The general recommendations for minimizing the risk of blood clots during travel are to drink lots of fluid, avoid alcohol, and get up and walk or do calf muscle exercises frequently. Those with risk factors for DVT and PE should also wear compression hose in flight. At times, a small amount of blood thinners may be prescribed prior to travel. Aspirin is generally not recommended.

Can aspirin help my clots or prevent clots from happening?
A: Aspirin is most effective in reducing vascular events in patients with arterial disease. It does offer some protection against venous disease, and may reduce risk of a second clot in someone who is no longer taking a blood thinner such as heparin, lovenox , low-molecular-weight heparin, and Coumadin (the generic name is warfarin).

Q: Can I get another blood clot while on blood thinners?
A: It is very rare to develop another blood clot while on blood thinners if you are prescribed the right dose and are within the target range on Coumadin (warfarin).

Q: For how long do I need to be on blood thinners?
A: The duration of treatment is individualized and should be discussed carefully with your physician. The decision is mainly based on the reason why the clot occurred and if the risk factor is still present or not (for example a DVT that develops after knee surgery). Three months has been shown to be the minimal duration of treatment as it has been found that up to 20 percent of clots will worsen or recur if treatment is stopped short of this time. If there is no known reason for the clot (i.e., unprovoked DVT or PE), it is generally recommended that blood thinners be continued long term. This can be done with lower doses of blood thinners in some cases. The presence of a genetic risk factor for clotting does not automatically require one to be on blood thinners indefinitely.

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