Deep Vein Thrombosis

Deep Vein Thrombosis is a condition characterized by the discovery of blood clots in the inner veins.

Thrombus : blood clots that form in a blood vessel.

• Thrombus can occur in superficial veins (surface veins) or in deep veins, but what is dangerous is those that form in deep veins.
• Deep vein thrombosis is very dangerous because all or part of the thrombus can rupture, follow the bloodstream and get stuck in a narrow artery in the lungs that obstructs blood flow.

Emboli : nomadic thrombus. The less inflammation around a thrombus, the looser the thrombus attaches to the venous wall and the easier it is to form an embolism. Emphasis on the calf muscles can free up the thrombus that is involved, especially when the patient is active again.

Pulmonary embolism : blood in the leg veins will flow to the heart and then to the lungs, emboli from the leg veins can clog one or more arteries in the lungs. Large pulmonary embolism can block all or almost all blood from the right heart and quickly cause death.

Cause.

3 factors causing deep vein thrombosis :

• Injury to the venous lining.
• The increased tendency for blood clots ➡ occurs in some cancers and the use of birth control pills (less frequently). A major injury or surgery can also increase the tendency for blood clots to form.
• Slowing blood flow in the vein ➡ occurs in patients who sleep for a long time because the calf muscles do not contract and pump blood to the heart. For example, deep vein thrombosis can occur in people with heart attacks who lie for several days where the limbs are moved very little or in paralytic sufferers who sit continuously and have no functioning muscles.

Some other risk factors are :

• History of trauma to the lower body, such as hip, thigh and leg fractures.
• Obesity.
• Heart failure.
• Located at an altitude of about above 14000 feet.
• In estrogen users, as in contraceptive drugs.
• Cancer.
• In patients with intravascular clotting disorders accompanied by infection or organ failure.
• Elderly. 

The symptoms.

• 50% of patients have no symptoms.
• Thrombosis causes severe inflammation.
• Blockage of blood flow.
• Calf muscles will swell and appear painful, dull pain when touched and warm.
• The ankles or thighs swell, depending on which vein is affected.
• Some thrombus heals and turns into scar tissue can damage the valves in the vein. Fluid collection (edema) occurs which causes swelling of the ankles.
• If the blockage is severe, edema can spread to the legs and even to the thighs.
• Morning to evening the edema will get worse because of the effects of gravity when sitting or standing. Throughout the night the edema will disappear because if the legs are in a horizontal position, venous emptying will take place properly.
• Brown color to the skin, usually above the ankle. This is caused by the release of red blood cells from veins that are stretched into the skin. Skin that changes color is very sensitive, even minor injuries (scratching or collision) can tear the skin and cause open sores (ulcers).

Treatment.

Swelling of the legs ➡

• Swelling can be reduced by lying down and raising the legs or by using compression bandages.
• The bandage must be fixed by a doctor or nurse and worn for several days. During the dressing, the patient must keep going.
• If the swelling does not completely disappear, the bandage must be used again.
• If the compression bandage is not used anymore, to prevent swelling the patient must use elastic stockings every day.
• Stockings do not have to be used above the knee, because swelling above the knee does not cause complications.

Skin ulcer ➡

• If an ulcer (open wound) arises in the skin that feels painful, use a compression bandage 1-2 times / week because it can improve blood flow in the vein.
• Ulcers almost always have an infection and give off smelling pus.
• If the blood flow in the vein has improved, the ulcer will heal by itself.
• To prevent recurrence, after the ulcer has healed, use elastic stockings every day.
• Ulcers that do not heal, skin grafting needs to be done.

Warfarin is an oral medication taken to thin the blood. Individual doses for each person and blood clots must be monitored regularly.

• Blood tests (USD or international normalized ratio) are carried out routinely to monitor the effects of blood thinning and help doctors choose the appropriate dose of warfarin. Blood tests are carried out a week until the INR is stable and then carried out every two weeks and every month.

Enoxaparin is low molecular weight heparin injected under the skin to thin the blood.

• This dose is usually 1 mg / kg body weight, injected 2 × a day or 1.5 mg / kg body weight injected 1 × a day.

Enoxaparin is a temporary drug to thin the blood. Warfarin can be used in the long term and in cancer patients.

Prevention.

The risk of deep vein thrombosis cannot be completely eliminated, but can be reduced in several ways :

• People who are at risk for deep vein thrombosis, should bend and stretch their ankles 10 times every 30 minutes.
• Always using elastic stockings will make the veins narrow slightly and blood flow faster, so blood clots don't form easily. But elastic stockings, if not used properly, can worsen the situation by blocking blood flow in the legs.
• More effective in reducing the formation of blood clots is the administration of anticoagulant drugs before, during and after surgery.
• Pneumatic stockings are another way to prevent the formation of blood clots. These stockings are made of plastic, automatically pumping and emptying through an electric pump, repeatedly squeezing the calf and emptying the vein. Stockings are used before, during and after surgery until the patient can walk again.