• A major advance in the treatment of deep vein thrombosis
  

Deep vein thrombosis ( DVT) kills more people every year than AIDS, breast cancer, and motor vehicle accidents combined, and it is the most common, preventable cause of hospital death in the United States, yet few people know little if anything about it.(1, 5)

DVT is a potentially life-threatening condition involving the formation of a blood clot in a deep vein, usually in the legs. Blood clots occur when blood thickens and clumps together. A clot that forms in a deep vein is a serious condition because not only can the clot interfere with blood flow, but more importantly, it may break off and travel through the bloodstream (embolize). The traveling blood clot (embolus) can lodge in the brain, lungs, heart, or other area, severely damaging that organ. When the clot travels to the lungs and blocks blood flow, the condition is called pulmonary embolism (PE).

Thrombophlebitis: Inflammation of a vein (phlebitis) from a blood clot (thrombus)
When inflammation due to a blood clot occurs in a vein, it is called thrombophlebitis. Thrombophlebitis usually occurs in the veins of the legs, although occasionally it can occur in the veins of the arms or neck. The blood clot can develop in either the superficial or the deep veins:

• Superficial (on the surface) thrombophlebitis occurs in the veins that are visible and lie just under the skin. An important fact about superficial thrombophlebitis is that these clots won't break off and travel through the blood stream (embolize).
  
  
  • Symptoms of superficial thrombophlebitis may include one or more of the following: the affected area may be reddened, warm to the touch, swollen, tender, or painful. There may be a mild reaction of localized inflammation, or in more serious cases, the extremity may swell and fever may occur.
    
    
• Deep vein thrombosis (DVT) is when the blood clot forms deep in the vein.
  DVT is more dangerous than superficial thrombophlebitis because the clot may break off and travel through the bloodstream (embolize). Pulmonary embolism, a condition that can be fatal, results when a DVT breaks off and travels to the lungs where is blocks blood flow in the smaller arteries supplying the lungs.
  
  
  • Symptoms of DVT: Only about half of the people with DVT have symptoms and even then the symptoms may not be alarming, such as a nonpainful, mild swelling of one leg. The symptoms of DVT occur in only the leg affected by the deep vein clot. A person with a DVT may have one or more of the following symptoms:
    • Swelling of the leg or swelling along a vein in the leg
    • Pain or tenderness in the leg, which may be felt only when standing or walking
    • Increased warmth in the area of the leg that's swollen or in pain
    • Red or discolored skin on the leg
    • Pulmonary Embolism: Some people don't know they have DVT until they have signs or symptoms of a PE. A person with a PE may have one or more of the following signs or symptoms:
      • Unexplained shortness of breath
      • Pain with deep breathing
      • Coughing up blood
      • Rapid breathing and a fast heart rate (2)

• Inactivity due to recent injury, surgery, or prolonged sitting
• Flying on an airplane for 10 hours or more. This problem isn’t solely due to sitting still in tight quarters for many hours; there are other contributing factors which include: low cabin pressure, low humidity and dehydration (3).
  
• Pregnancy or recent childbirth
• Oral contraceptive use or estrogen therapy
  
• Cancer
  
• Stroke or other diseases that limit mobility
• Family history of clotting disorders
• Central venous catheters (used in hospitals for injection of medications or for dialysis)

The history and physical examination by a health care provider is helpful in the diagnosis. If the doctor or nurse practitioner suspects a DVT, the following tests may be ordered:

• Ultrasound (using sound waves to look for a blood clot in the vein),
• Magnetic resonance imaging (MRI) to visualize blood vessels, or
• Venography (using injection of a dye to trace to the course of a vein).

During long airline flights (3):

• Wear “compression stockings” to help minimize the risk of developing DVT. These stockings put pressure on leg muscles and help return blood flow from the legs to the heart. Consult with your doctor before buying compression stockings.
• Get up and walk around as often as possible.
• Drink extra water and avoid alcohol intake to prevent dehydration.
• People with cardiovascular disease and those at risk for clots in their legs should talk to their doctor about getting a single dose of heparin prior to the trip. Heparin prevents clots from forming and is effective in reducing the risk of DVT in high-risk patients.
  

After surgery or illness: Getting out of bed and moving around as soon as possible after surgery or illness lowers the chance of developing a blood clot.

See your health care provider regularly and take all medications as recommended.

1. Deep Vein Thrombosis from WebMD
2. What is Deep Vein Thrombosis? from the Nat'l Heart Lung and Blood Institute
3. Economy Class Syndrome and Deep Vein Thrombosis from the American Heart Association
4. Thrombolysis Device Effective against DVT from MedPage Today
5. Deep Vein Thrombosis, www.med-iq.com, 2008

Written by N Thompson, RN, MSN, ARNP and M Thompson, MD, Internal Medicine, Last updated January 2009