Clot Formation in Leg Veins – Deep Vein Thrombosis

Deep vein thrombosis (DVT) is the formation of clots in the veins (veins) that return blood from the body to the heart. It is a serious problem that can cause functional limitation and even death. Deep vein thrombosis most commonly occurs in the deep veins of the legs and thighs. However, it can also occur in other parts of the body, for example, in the arm veins . In this article, we mainly discussed the formation of clots in the leg veins.

Symptoms

  • Swelling and edema of the foot, ankle or leg. It usually occurs on one side (right or left). Rarely, it can be bilateral.
  • Cramping pain in the affected leg, usually starting in the calf.
  • Unexplained, severe pain in the foot and ankle.
  • An increase in temperature in a part of the skin of the legs.
  • Pale, redness, or bruising of the skin over the affected area.

About half of people with DVT may not have symptoms. Sometimes DVT is diagnosed as a result of the clot breaking off and blocking the pulmonary vessel (pulmonary thromboembolism). Pulmonary thromboembolism can be fatal and requires immediate treatment. Pulmonary thromboembolism can lead to signs and symptoms such as chest pain, rapid breathing, shortness of breath, bloody cough, increased pulse, sweating, and dizziness.

Another complication of deep vein thrombosis is postthrombotic syndrome. The damage caused by the clot in the vessels can lead to long-term deterioration of blood circulation in the affected area. Edema, pain, skin discoloration and ulcers may develop in the leg.

What Causes DVT?

Coagulation is a mechanism that normally exists to prevent excessive blood loss after vascular injury. Serious problems occur if the blood clots in the vein. The following conditions can cause blood clots in DVT:

  • Vascular damage: Damage to the vessel wall by trauma can cause blood to clot.
  • Surgery: Damage to the veins during the surgery or the person staying motionless for a long time after the surgery.
  • Staying still: If you sit still for a long time, blood accumulates in the legs. The blood flow in the leg veins slows down. Slowing blood flow increases the risk of clotting. Air travels longer than 8 hours are important in this respect.
  • smoking
  • Certain medications (eg birth control pills, hormone replacement therapy)
  • being overweight
  • Genetic conditions that increase the blood’s susceptibility to clotting (for example, factor V Leiden mutation)
  • Pregnancy: The risk of DVT in pregnant women is 5-10 times higher than in non-pregnant women. The risk continues for another 6 weeks after birth.
  • Heart failure
  • Cancer: The cancer itself or cancer treatment can increase the risk of clots.
  • Inflammatory bowel disease: Crohn’s disease, ulcerative colitis.
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The presence of more than one risk factor increases the risk of DVT.

Diagnosis

DVT can be suspected with medical history, physical examination, and questioning of risk factors. Blood flow and the presence of clots can be evaluated with Doppler ultrasonography (USG). If the D-dimer molecule, which occurs with the dissolution of the clot, is high in the blood, this is a supporting finding for DVT. Rarely, different tests such as venography, MRI, CT may be required.

Treatment

DVT is a serious disease. If DVT is suspected, emergency service should be sought without delay for treatment. Treatment aims to prevent the clot from growing and new clots from forming. For this, blood thinners (anticoagulant) drugs can be started. Low molecular weight heparin applied under the skin and warfarin taken orally in pill form are the most commonly used blood thinners.

In severe cases of DVT and pulmonary thromboembolism, clot-busting (thrombolytic) therapy may be required. Clot-dissolving drugs are administered intravenously.

If large clots are causing tissue damage, they may need to be surgically removed. A surgical approach is recommended only in the most severe cases, as it involves risks such as infection, vascular damage, and bleeding.

In high-risk people who cannot take blood thinners, a filter (vena cava filter) can be placed in the vein in the abdomen to prevent the clot in the leg from reaching the lungs.

Protection

The use of compression stockings by people who are known to be at high risk of DVT for any reason can prevent clot formation. In addition, exercises such as pumping ankles in bed, pulling knees to legs increase blood circulation and reduce the risk of clots. In cases such as orthopedic surgeries or immobility due to paralysis, anticoagulant medication can be started for preventive purposes.

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