The Basics of a Deep Venous Thrombosis

One of the more serious forms of venous disease that we treat in our office is called a deep venous thrombosis (DVT) or, in layman’s terms, a “blood clot.” The formation of a DVT can be precipitated by numerous factors, including long periods of immobilization (ex. a long flight or after a major surgery), smoking, estrogen substitution (ex. birth control or hormone replacement therapy), trauma, a genetic tendency for your blood to clot, or even cancer. Sometimes, the cause is unknown. As clinicians, we combine the patient’s history, physical exam, and lab tests to identify the underlying cause. Most commonly, patients present with a sudden onset of severe swelling and pain in one leg, most often in the calf.

Deep Vein ThrombosisThe diagnosis is easily made using a Doppler ultrasound in the office, which uses sound waves to reconstruct an image of the veins in the affected extremity (see picture). Because veins function to return blood to the heart, there is a risk that a portion of the blood clot will dislodge from the vein and travel through the heart and into the lungs. When this occurs, it is called a pulmonary embolism (PE). A pulmonary embolism can result in chest pain, shortness of breath, a new cough, and even death. If suspected, your healthcare provider may order a CT scan of the chest with IV contrast. Depending on the extent of the DVT, you may be admitted to the hospital for further work up and treatment. The main treatment is to start a medication that will thin the blood (anticoagulation). These medications will not dissolve a clot, but they will make the blood thin enough to maneuver around the clot until the body has time to dissolve it. An anticoagulant called coumadin (Warfarin) is the most common medication used to both treat both DVT’s and PE’s. The length of treatment ranges from three months to lifetime, depending on the precipitating cause. Coumadin can be a dangerous drug because of the risk of hemorrhage if the blood becomes too thin. Therefore, close monitoring of blood work by your healthcare provider is essential for safe, successful treatment of a DVT/PE.

By Jessica Alison, PA-C

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