Deep Vein Thrombosis (DVT)


What is DVT ?

This is a serious condition where blood clot has developed in a vein, usually in the leg(s) but sometimes in the pelvis. Calf veins are commonly affected.
Sometimes blood clot from the leg(s) may migrate to lungs. The presence of blood clots in the lung ie pulmonary embolism (PE) is .

How does DVT manifest ?

Usually symptoms occur in one leg though occasionally DVT may occur in both legs. Occasionally there are no symptoms and is found in course of investigation of PE.

Typical symptoms include pain, tenderness and swelling of the calf.

What causes DVT ?

Risk factors for DVT include

    • Past history of clot (DVT)
    • Prolonged immobilization
    • Pregnancy
    • Obesity
    • Recent major surgeries such as pelvic operations, hip or knee replacement surgeries
    • Hypercoagulable states ie conditions associated with increased tendency to clot such as cancer, inherited conditions such as Protein C/S/Antithrombin III deficiencies, Polycythemia

Sometimes there may be no apparent reason why DVT develops.

How Should We Evaluate Patients with DVT?

A thorough evaluation of your medical history and physical examination including tests to evaluate for risk factors for DVT, bleeding tendencies, site of DVT is important
Confirmation of DVT will require ultrasound scan of the leg. Additional tests are required to assess and evaluate risks of bleeding and any possible underlying causes, as well as to monitor therapy.

Management of DVT

Once diagnosis of DVT is confirmed, anticoagulation therapy should be instituted promptly. This is to prevent extension of the clot and lower risk of pulmonary embolism. In addition, this will lower risk of post thrombotic syndrome – a condition whereby there is long term pain and swelling of the calf.

Options for anticoagulation therapy include low molecular weight heparin, warfarin or new oral anticoagulant agents such as rivaroxaban, apixaban. Choice of therapy depends on the needs and concerns of individual as well as assessment of bleeding risk by your doctor.

Compression stockings are helpful to lower risk of developing post thrombotic syndrome. These should be professionally fitted based on accurate measurement and assessment by trained individuals such as physiotherapists.