Deep vein thrombosis (DVT) refers to a blood clot (or thrombosis) that develops within the deep veins located in the legs or arms. DVT tends to form due to being immobile for long periods of time—for instance, patients who are sedentary due to hospitalization, surgery, a cast, pregnancy, prolonged travel, or due to obesity at at the highest risk of developing a DVT. However, additional risk for blood clot formation include smoking, fractures to the arm or leg, a family history of blood clots, and female patients who take certain estro-oral contraceptives (i.e., Yaz and Yasmin).
The veins are at highest risk of DVT because, unlike the arteries, veins contain inadequate muscle lining so they depend upon the mobility of large muscles to squeeze, contract, and pump blood back to the heart. A DVT is considered potentially life-threatening if it embolizes. This can occur if a portion of the blood clot breaks off and as it’s transported through the circulation system (heart), becomes logged within a pulmonary artery, blocking adequate blood flow through the lungs.
Diagnosis and treatment of a DVT is meant to prevent a fatal pulmonary embolism (or the blockage of an artery in the lungs) in the following ways:
1. Physical exam
A DVT is typically diagnosed by a doctor if a patient complains of telltale symptoms such as vein swelling, redness, tenderness, and redness of the arm or leg. If the doctor suspects a blood clot, he or she will likely order a D-dimer test.
2. D-dimer
A D-dimer blood test can quickly determine the presence of a serious blood clot. This blood clot measures the levels of D-dimer protein in the blood. High levels of D-dimer in your blood indicate a potential DVT, and an ultrasound is typically ordered.
3. Ultrasound
An ultrasound can visually detect the presence and size of a DVT deep in the leg, arm, chest, or pelvis.
4. Venography
Although rarer, sometimes a doctor will order a venography, which injects dye into the veins to detect a thrombus.
5. Novel oral anticoagulants (NOACs)
The standard treatment for most DVTs is NOACs (or novel oral anticoagulant) drugs, which work immediately to thin the blood and prevent a pulmonary embolism, stroke, and systemic embolus. According to the American College of Chest Physicians, NOACs (i.e., Eliquis, Pradaxa, Xarelto, and Savaysa) are the recommended treatment for patients with no active cancers, however patients with cancer are usually treated with enoxaparin.
6. Anticoagulation therapy
Anticoagulation medications (i.e., Warfarin) are Vitamin K antagonists that block the body’s ability to blood clot and thin the blood. It can take 7 days or more for anticoagulators to be effective, so these are often combined with Enoxaparin (a low molecular weight heparin injection) to bridge the gap. Patients prescribed anticoagulation drugs should be monitored closely for risk for bleeding.
7. DVT Surgery
Surgery for DVT removal is considered a last resort, and only used in rare cases for patients with recurrent blood clots who are unable to take blood thinners. DVT surgery inserts a filter in the patient’s inferior vena cava to prevent future clots from forming in the lung. A surgical stent may also be inserted in a vein to prevent clotting.
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