Deep Vein Thrombosis; Types, Causes, Symptoms, Diagnosis, Treatment

Deep vein thrombosis
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Deep vein thrombosis (DVT, also called venous thrombosis) is a blood clot that develops in a vein deep in the body. The clot may partially or completely block blood flow through the vein. Most DVTs occur in the lower leg, thigh or pelvis, although they also can occur in other parts of the body including the arm, brain, intestines, liver or kidney.

 

Deep vein thrombosis
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Causes of Deep Vein Thrombosis

Immobility which causes blood flow in the veins to be slow. Slow-flowing blood is more likely to clot than normal-flowing blood.

  • A surgical operation where you are asleep for over 1-1.5 hours – is the most common cause of a DVT. Your legs are still when you are under anaesthetic, because the muscles in your body are temporarily paralysed. Blood flow in the leg veins can become very slow, making a clot more likely to occur. Certain types of surgery (particularly operations on the pelvis or legs) increase the risk of DVT even more.
  • Any illness or injury that causes immobility – increases the risk. This includes having a leg in a hard plaster cast after a fracture. People who are admitted to intensive care units are at an increased risk of DVT. This is due to a number of reasons but partly because they are very ill and also because they are immobile (they may even be kept asleep by anaesthetic medications).
  • Long journeys by plane, train or coach/car – may cause a slightly increased risk. This is because you are mostly sitting still and not moving around very much.
  • Damage to the inside lining of the vein – increases the risk of a blood clot forming. For example, a DVT may damage the lining of the vein. So, if you have a DVT, then you have an increased risk of having another one in the future. Some conditions such as inflammation of the vein wall (vasculitis) and some medicines (for example, some chemotherapy medicines) can damage the vein and increase the risk of having a DVT.
  • Conditions that cause the blood to clot more easily than normal – (thrombophilia) can increase the risk. Some conditions can cause the blood to clot more easily than usual. Examples include nephrotic syndrome and antiphospholipid syndrome. See separate leaflets called Nephrotic Syndrome, Antiphospholipid syndrome and Thrombophilia for more details. Some rare inherited conditions can also cause the blood to clot more easily than normal.
  • The contraceptive pill and hormone replacement therapy (HRT) – which contain oestrogen can cause the blood to clot slightly more easily. Women taking the pill or HRT have a small increased risk of DVT.
  • People with cancer or heart failure – have an increased risk. Sometimes a DVT happens in a person who has not yet been diagnosed with cancer. Investigations looking for the cause of a DVT may show cancer to be the underlying cause.
  • Older people (over 60 years of age) – are more likely to have a DVT, particularly if you have poor mobility or have a serious illness such as cancer.
  • Pregnancy – increases the risk. About 1 in 1,000 pregnant women have a DVT while they are pregnant, or within about six months after they give birth.
  • Obesity – also increases the risk. If your body mass index (BMI) is more than 30 kg/m2, you are more at risk of DVT.
  • Smoking.
  • Being male – Men tend to develop a DVT more often than women.
  • Lack of fluid in the body (dehydration) – can make a DVT more likely to happen.  Related image

Injury to a vein, often caused by

  • Fractures,
  • Severe muscle injury, or
  • Major surgery (particularly involving the abdomen, pelvis, hip, or legs).

Slow blood flow, often caused by

  • Confinement to bed
    (e.g., due to a medical condition or after surgery);
  • Limited movement (e.g., a cast on a leg to help heal an injured bone);
  • Sitting for a long time, especially with crossed legs; or
  • Paralysis.

Increased estrogen, often caused by

  • Birth control pills
  • Hormone replacement therapy, sometimes used after menopause
  • Pregnancy, for up to 6 weeks after giving birth

Certain chronic medical illnesses, such as

Other factors that increase the risk of DVT include

  • Previous DVT or PE
  • Family history of DVT or PE
  • Age (risk increases as age increases)
  • Obesity
  • A catheter located in a central vein
  • Inherited clotting disorders

 Symptoms of Deep Vein Thrombosis

Symptoms of deep venous thrombosis (DVT) may include the following

  • Edema – Most specific symptom
  • Leg pain – Occurs in 50% of patients but is nonspecific
  • Tenderness – Occurs in 75% of patients
  • Warmth or erythema of the skin over the area of thrombosis
  • Clinical symptoms of pulmonary embolism (PE) as the primary manifestation
  • Calf pain on dorsiflexion of the foot (Homans sign)
  • A palpable, indurated, cordlike, tender subcutaneous venous segment
  • Variable discoloration of the lower extremity
  • Blanched appearance of the leg because of edema (relatively rare)

Potential complications of DVT include the following

  • As many as 40% of patients have silent PE when symptomatic DVT is diagnosed
  • Paradoxic emboli (rare)
  • Recurrent DVT
  • Postthrombotic syndrome (PTS)

PE symptoms include

As many as 46% with patients with classic symptoms have negative venograms, and as many as 50% of those with image-documented venous thrombosis lack specific symptoms. 

Clinical probability scoring

The Wells’ score is commonly used to evaluate the probability of DVT based on a patient’s medical history and physical examination. Clinical judgment plays a critical role because certain DVT risk factors and markers are evident early in the diagnostic process.

Wells’ score for prediction of DVT. A score of ≥2 indicates that DVT is likely and that the patient should undergo a diagnostic scan
Parameter Score
Active cancer (treatment ongoing or within previous 6 months or palliative) 1
Paralysis, paresis or recent plaster immobilization of lower extremities 1
Recently bedridden for more than 3 days or major surgery within 4 weeks 1
Localized tenderness along distribution of the deep vein system 1
Entire leg swollen 1
Calf swelling by more than 3 cm when compared with asymptomatic leg 1
Pitting oedema 1
Collateral superficial veins 1
Alternative diagnosis as likely or greater than that of DVT –2

Although a high Wells’ score indicates a clinical probability of DVT, an objective imaging technique such

Diagnosis of Deep Vein Thrombosis

The American Academy of Family Physicians (AAFP)/American College of Physicians (ACP) recommendations for workup of patients with probable DVT are as follows :

  • Validated clinical prediction rules (eg Wells) – should be used to estimate the pretest probability of venous thromboembolism (VTE) and interpret test results
  • In appropriately selected patients with low pretest probability of DVT or PE – it is reasonable to obtain a high-sensitivity D-dimer
  • In patients with intermediate to high pretest probability of lower-extremity DVT –  ultrasonography is recommended
  • In patients with intermediate or high pretest probability of PE – diagnostic imaging studies (eg, ventilation-perfusion scan, multidetector helical CT, and pulmonary angiography) are required
  • Doppler ultrasound – Using high-frequency sound waves, this system can visualize the large, proximal veins and detect a clot if one is present. Painless and without complications, this is the most commonly used method to diagnose deep vein thrombosis. However, sometimes the test can miss a clot, especially in the smaller veins.
  • Venography – A liquid dye is injected into the veins for imaging studies. It highlights blockage of blood flow by a clot. This is the most accurate test, but also the most uncomfortable and invasive. It is rarely done today because of the availability of improved ultrasound technology.
  • Impedance plethysmography – Electrodes are used to measure volume changes within veins. Because this test does not detect clots better than ultrasound and is harder to perform, it is rarely used.
  • CT scan –  This is a type of X-ray that gives a very detailed look at the leg veins in cross section and can detect clots. It is rarely used for this purpose as it is more difficult to interpret and is time consuming. The CT scan is more useful for identification of blood clots in the lung.
  • Magnetic resonance imaging (MRI) – This test uses radio frequency waves and a strong magnetic field to create detailed images of the inside of your body. You lie still on a sliding table while the test takes place. Expect to hear loud tapping or knocking sounds. If needed, you may get a fluid injected into your vein to enhance the images of your blood vessels. This imaging test is effective at finding DVT in the pelvis, as well as in the thigh. It also allows your doctor to examine both legs at once

The main laboratory studies to be considered include the following

  • D-dimer testing
  • Coagulation studies (eg, prothrombin time and activated partial thromboplastin time) to evaluate for a hypercoagulable state
  • Bleeding and Clotting time
  • Activated protein C resistant
  • Anti-prothrombin ||| level
  • Screening for disseminated intravenous coagulation (DIC)

Treatment of Deep Vein Thrombosis

Treatment options for DVT include the following

  • Anticoagulation (mainstay of therapy) – Heparins, warfarin, factor Xa inhibitors, and various emerging anticoagulants
  • Pharmacologic thrombolysis
  • Endovascular and surgical interventions
  • Physical measures (eg, elastic compression stockings and ambulation)

Heparin products used in the treatment of DVT include the following

  • Low-molecular-weight heparin (LMWH; eg, enoxaparin)
  • Unfractionated heparin (UFH)

Factor Xa inhibitors used in the treatment of DVT include the following

  • Fondaparinux – This agent appears to be comparable to enoxaparin with respect to efficacy and safety
  • Rivaroxaban – This agent appears to prevent VTE recurrence as effectively as enoxaparin followed by a vitamin K antagonist and may be associated with less bleeding , in addition, it appears to be usable in high-risk groups
  • Endovascular therapy is performed to reduce the severity and duration of lower-extremity symptoms, prevent PE, diminish the risk of recurrent VTE, and prevent PTS. Percutaneous transcatheter treatment of DVT includes the following:
  • Thrombus removal with catheter-directed thrombolysis – American College of Chest Physicians (ACCP) recommends thrombolytic therapy only for patients with massive iliofemoral vein thrombosis associated with limb ischemia or vascular compromise
  • Mechanical thrombectomy
  • Angioplasty
  • Stenting of venous obstructions

American Heart Association (AHA) recommendations for inferior vena cava filters include the following 

Confirmed acute proximal DVT or acute PE in patients contraindicated for anticoagulation

  • Recurrent thromboembolism while on anticoagulation
  • Active bleeding complications requiring termination of anticoagulation therapy

These agents prevent recurrent or ongoing thrombolytic occlusion of the vertebrobasilar circulation.

Rivaroxaban

Rivaroxaban is an oral factor Xa inhibitor that inhibits platelet activation by selectively blocking the active site of factor Xa without requiring a cofactor (eg, antithrombin III) for activity. It is indicated for treatment of DVT or PE, and to reduce risk of recurrent DVT and PE following initial treatment. It is also indicated for prophylaxis of DVT in patients undergoing knee or hip replacement surgery.

Apixaban 

 Apixaban is an oral factor Xa inhibitor that inhibits platelet activation by selectively and reversibly blocking the active site of factor Xa without requiring a cofactor (eg, antithrombin III) for activity. It inhibits free and clot-bound factor Xa, and prothrombinase activity; no direct effect on platelet aggregation, but indirectly inhibits platelet aggregation induced by thrombin. It is indicated for prophylaxis of DVT or PE in adults undergoing knee or hip replacement surgery. It is also indicated for treatment of DVT and PE and for prevention of recurrence (following the initial 6 months of the initial treatment).

Fondaparinux sodium 

Fondaparinux sodium is a synthetic anticoagulant that works by inhibiting factor Xa, a key component involved in blood clotting. It provides a highly predictable response and has a bioavailability of 100%. The drug has a rapid onset of action and a half-life of 14-16 hours, allowing for sustained antithrombotic activity over 24-hour period. Fondaparinux sodium does not affect prothrombin time or activated partial thromboplastin time, nor does it affect platelet function or aggregation.

Heparin

Heparin augments activity of antithrombin III and prevents conversion of fibrinogen to fibrin. It does not actively lyse but is able to inhibit further thrombogenesis. Heparin prevents reaccumulation of a clot after a spontaneous fibrinolysis.

Thrombin Inhibitors

These medicines interfere with the blood clotting process. They’re used to treat blood clots in patients who can’t take heparin.

Thrombolytics

Doctors prescribe these medicines to quickly dissolve large blood clots that cause severe symptoms. Because thrombolytics can cause sudden bleeding, they’re used only in life-threatening situations.

Vena Cava Filter

If you can’t take blood thinners or they’re not working well, your doctor may recommend a vena cava filter.

The filter is inserted inside a large vein called the vena cava. The filter catches blood clots before they travel to the lungs, which prevents pulmonary embolism. However, the filter doesn’t stop new blood clots from forming.

Exercise

Your healthcare team will usually advise you to walk regularly once compression stockings have been prescribed. This can help prevent symptoms of DVT returning and may help to improve or prevent complications of DVT, such as post-thrombotic syndrome.

Raising your leg

As well as wearing compression stockings, you might be advised to raise your leg whenever you’re resting. This helps to relieve the pressure in the veins of the calf and stops blood and fluid pooling in the calf itself.

When raising your leg, make sure your foot is higher than your hip. This will help the returning blood flow from your calf. Putting a cushion underneath your leg while you’re lying down should help raise your leg above the level of your hip.

Graduated Compression Stockings

Graduated compression stockings can reduce leg swelling caused by a blood clot. These stockings are worn on the legs from the arch of the foot to just above or below the knee.

Compression stockings are tight at the ankle and become looser as they go up the leg. This creates gentle pressure up the leg. The pressure keeps blood from pooling and clotting.

A DVT is often just a one-off event after a major operation.

However, some people who develop a DVT have an ongoing risk of a further DVT – for example, if you have a blood clotting problem, or continued immobility. As mentioned above, you may be advised to take anticoagulation medicine long-term. Your doctor will advise you about this.

Other things that may help to prevent a first or recurrent DVT include the following:

  • If possible avoid long periods of immobility – such as sitting in a chair for many hours. If you are able to, get up and walk around now and then. A daily brisk walk for 30-60 minutes is even better if you can do this. The aim is to stop the blood pooling and to get the circulation in the legs moving. Regular exercise of the calf muscles also helps. You can do some calf exercises even when you are sitting.
  • Major operations are a risk for a DVT – particularly operations to the hip, lower tummy (abdomen) and leg. There are a number of methods to help reduce this risk:
  • To help prevent a DVT – you may be given an anticoagulant such as a heparin injection just before an operation. This is called prophylaxis. Enoxaparin and dalteparin are the most common types of heparin given for prophylaxis against blood clots. The new drug, fondaparinux sodium, can also be given by injection in some circumstances to prevent DVT in surgical patients or immobile medical patients in hospital.
  • The newer anticoagulant medicines  – discussed above can be used to prevent DVT or PE after hip or knee replacement surgery. Rivaroxaban, apixaban and dabigatran are used in these situations, and can be given by mouth as a tablet, rather than injection.
  • An inflatable sleeve connected to a pump to compress the legs during a long operation may also be used.
  • You may also be given compression stockings to wear whilst you are in hospital.
  • It is now common practice to get you up and walking as soon as possible after an operation.
  • When you travel on long plane, train, car or coach journeys, you should have little walks up and down the aisle every now and then. Try to exercise your calf muscles whilst sitting in your seat. (You can do this by circling your ankles, getting into a ‘tiptoe’ position and lifting your toes off the floor whilst keeping your heels on the ground.) You should aim to stay well-hydrated and avoid alcohol and sleeping medications.
  • People who are overweight have an increased risk of DVT. Therefore, to reduce your risk, you should try to lose weight.

Natural Home Remedies for Deep Vein Thrombosis (DVT)

There are no specific Deep Vein Thrombosis home remedies for the removal of blood clot, but DVT should not be overlooked merely as a blood clot as in worst cases of PE (Pulmonary Embolism) the situation becomes life threatening.

For the first 15 – 20 days you have to depend upon the treatment given by doctors.

  • Usually the first drug given to the patient is HEPARIN.
  • If heparin is given through a vein (IV), you must stay in the hospital.
  • Newer forms of heparin can be given by injection once or twice a day. You may not need to stay in the hospital as long, or at all, if you are prescribed this newer form of heparin.
  • Another drug called Warfarin (Coumadin) or any anti coagulant (as suggested by the physician) is also started along with heparin. These anticoagulants keep more clots from forming or old ones from getting bigger. Generally, these drugs do not dissolve clots.
  • Most likely warfarin is administered for minimum 3 months but in some cases people have to take it for the rest of their lives.

Although no natural remedies are there which can cure DVT, but some can help in the process of blood thinning and prevention of the disease. Here our primary goal is to prevent the disease from re occurring.

Ginger

Ginger is one of the most powerful tips on how to get rid of deep vein thrombosis. It can improve the flow of blood in your arteries and veins. In addition, ginger can stop your cholesterol level from increasing too much and prevent the accumulation of plaque that limits the circulation.

Deep Vein Thrombosis

  • Cut a ginger into slices and get some slices in hot water.
  • Continue to boil the mixture in some minutes and then, have it simmered in about 10 minutes.
  • After that, it should be strained.
  • You can pour a bit honey to make it taste better.
  • Consume the mixture several times per day.

In addition, you should increase the frequency of using ginger in daily cooking.

Rosemary

Rosemary - How To Get Rid Of Deep Vein Thrombosis

In the deep vein thrombosis treatment, you should choose home remedies that are good for the blood circulation. And undeniably, rosemary is a great choice and therefore, it is a great tip on how to get rid of deep vein thrombosis. The presence of flavonoid in rosemary can enhance the flow of blood and help you escape from bruises and sprains. Furthermore, its richness of vitamin B6 is good for bringing more oxygen to tissues.

Garlic

Fibrin, one of the direct causes for deep vein thrombosis, can be broken down if you use ginger regularly. In fact, ginger is one of the best tips on how to get rid of deep vein thrombosis. It has positive effects on the flow of blood as well [10].

Garlic - How To Get Rid Of Deep Vein Thrombosis

  • Take 2-3 garlic cloves into your mouth and chew them raw.
  • Drink a cup of water after that.

You ought to follow this remedy in the morning every day to get the best result.

Turmeric

One of the most outstanding advantages of turmeric is to thin the blood effectively. Another is to enhance your flow of blood. The amount of curcumin found in turmeric can reduce the possibility of clot formation in your arteries and veins. Moreover, the anti-inflammatory quality of turmeric can help you overcome the painful feeling and swelling easily. To sum up, turmeric is a wonderful tip on how to get rid of deep vein thrombosis .

Turmeric - How To Get Rid Of Deep Vein Thrombosis

  • Get powdered turmeric combined with warm milk.
  • Before consuming it, you can pour a bit raw honey if you like..

Cayenne Pepper

Cayenne pepper is a popular natural blood thinner and a great tip on how to get rid of deep vein thrombosis. With a high content of capsaicin, cayenne pepper can help enhance the circulation of blood and reduce the formation of blood clots. It is commonly seen that cayenne pepper is used in normalizing the blood pressure and putting the level of cholesterol under control.

Cayenne Pepper - How To Get Rid Of Deep Vein Thrombosis

  • Pour half a spoon of powdered cayenne pepper in the fresh spinach juice.
  • You can pour some salt to maximize the benefits.
  • Consume the mixture 2-3 times on a daily basis.

Nevertheless, cayenne pepper is forbidden for pregnant women.

Almond

Foods that contain a considerable amount of vitamin E are strongly recommended in the attempts to get rid of deep vein thrombosis. And almond is one of the best choices for you. In 2007, the Circulation journal revealed that when the body gets vitamin E, the possibility of blood clot formation is much lower and this remedy is extremely suitable for those who suffer from this problem due to genetics

Almond - How To Get Rid Of Deep Vein Thrombosis

  • Take almonds to dip in the water before you go to bed.
  • In the next morning, you can chew them raw to get as much vitamin E as possible.

Avocado

Avocado - How To Get Rid Of Deep Vein Thrombosis

Another abundant source of vitamin E and many other essential nutrients is avocado. With anticoagulant quality, it can prevent the formation of blood clots as much as possible. You should include avocado in salad to consume every day or make the juice from it

8. Hawthorn

With a high number of antioxidant nutrients in its content, hawthorn is one of the most effective tips on how to get rid of deep vein thrombosis. It can protect your body in general and your heart in particular from many toxins. It increases the flow of blood to support every part of your body efficiently.

Apple Cider Vinegar

Another tip on how to get rid of deep vein thrombosis that has been used for years is apple cider vinegar. It can bring a quick relief for the painful feeling and swollen parts in your body. When you use this vinegar, the blood circulation will be improved significantly.

Apple Cider Vinegar - How To Get Rid Of Deep Vein Thrombosis

  • 1-2 spoons of apple cider vinegar should be poured in a cup of water.
  • You can supplement raw honey to make it taste better before consuming it twice per day.

Blackstrap Molasses

It is worth noting that blackstrap molasses is such a great tip on how to get rid of deep vein thrombosis at home. A lot of nutrients can be found in blackstrap molasses, such as iron, calcium and potassium and all of them contribute to prevent blood clots.

 

  • Get 1-2 spoons of blackstrap molasses and pour it into warm milk.
  • Consume the mixture 2-3 times on a daily basis.

Avoid Smoking

Smoking has been traditionally known to be harmful to the lungs and respiratory system at first. However, during a long period of time, smoking can even have extreme impacts on the arteries and your blood circulation. Therefore, if you want to get rid of deep vein thrombosis as soon as possible, you’d better stop smoking and stay away from smokers immediately.

Fish Oil

Fish Oil - How To Get Rid Of Deep Vein Thrombosis

The abundance of omega-3 fatty acids is the most outstanding feature of fish oil in the deep vein thrombosis treatment. These acids are antiplatelet and fibrinolytic, which means that they can limit the blood clots. Fish oil also provides you with a lot of benefits, especially in the efforts to lower the level of blood pressure and cholesterol

Some of the home remedies for DVT prevention from re occurrence are

  • Regular intake of a glass of water with 1 tbsp lemon juice and chopped slices of ginger is the easiest solution for blood clot problem.
  • Lemon and ginger is blood circulation improver.
  • Have one garlic clove daily as it has favorable effects on cardiac factors.
  • Keep your body hydrated with the intake of lots of water.
  • Cold water fish should be preferred over other animal proteins.
  • Most useful herb for improving the circulation of blood is ashvaganda. Hence, it works as one of the most effective home remedies for Deep Vein Thrombosis (DVT) natural treatment.
  • Broccoli being rich in fiber content is considered good for cardio vascular patients.
  • An aggravated stress hormone narrows down the blood vessels. Celery is an active compound and helps in reducing the stress hormone and should be included in diet.
  • Proper vascular state is maintained with the proper amount of Vitamin C in the body.
  • Banana, apricot, spinach juice help in keeping the blood pressure normal.
  • Skimmed milk should be used, as non skimmed milk offers extra fat which deposits on the walls of blood vessels thereby thinning their diameter.
  • Capsicum and pepper help in preventing the platelets to stick together, so you can also include them in your diet.
  • Prepare a juice of leaves of spinach and one part each of pepper, garlic and clove. This is one of the best herbal remedies for Deep Vein Thrombosis (DVT).
  • • Use mustard oil, canola oil instead of high fat cooking oils.

Dos and Don’ts for DVT

  • Avoid food rich in high Vitamin K.
  • Avoid smoking.
  • Avoid the intake of alcohol, as it dehydrates you.
  • Lose weight if overweight.
  • Control your blood pressure.
  • Wear compression stockings if advised by your doctor.
  • Avoid drinking too much coffee or tea.
  • Daily walk for 15 – 20 min.
  • Cut down your daily dose of margarine, processed foods.
  • Avoid long duration flights, if cannot then try walking on aisle after every 2 hours or so.
  • Don’t sit with an obstruction to the thigh muscle.
  • Elevate your leg up to 6 inches while sleeping.
  • Don’t sit idle for long time, move your legs.
  • Exercise your lower calf muscles, only after consulting your doctor.
  • Avoid doing risky things which may cause bleeding.

Additional Tips

  • Stretch your legs and feet while you are sitting to keep blood moving steadily in your calves. While sitting, avoid crossing your legs as this can limit blood flow.
  • Avoid wearing tight clothes that can restrict blood flow.
  • If traveling a long distance by car, stop every hour or so and walk around. While traveling on a plane or bus, try to stand or walk occasionally in the aisle.
  • If you are overweight, take necessary steps to lose weight.
  • Strive to keep your blood pressure and cholesterol levels under control.
  • Quit smoking as it can have a harmful effect on your arteries.
  • Avoid foods high in vitamin K, which can affect how prescribed medicines are working.
  • Limit alcohol consumption to one serving per day or avoid it entirely. Alcohol contributes to dehydration.
  • Do not forget to take the prescribed medications as directed by your doctor.
  • Get regular medical check-ups so your doctor can assess your condition.

References

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  22. Jump up^ Gould MK, Garcia DA, Wren SM, et al. (2012). “Prevention of VTE in nonorthopedic surgical patients: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines”. Chest. 141 (suppl 2): e227S–e277S. doi:10.1378/chest.11-2297. PMC 3278061Freely accessible. PMID 22315263.
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Deep Vein Thrombosis

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75 thoughts on “Deep Vein Thrombosis; Types, Causes, Symptoms, Diagnosis, Treatment”

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