Deep Vein Thrombosis (DVT)
Introductions Deep Vein Thrombosis (DVT)
Arteries have a thin muscles in their walls to be able to withstand the pressure of the heart pumped blood throughout the body. Veins do not have significant muscle layer, and there is no blood is pumped back to the heart except physiology. Blood returning to the heart because the muscles of the body that press / squeeze the veins as they contract in the normal activity of body movements. The normal activities of the movement of the body return blood to the heart.
There are two types of veins in the legs, superficial veins (near surface) and deep veins (deep). Superficial veins are located just under the skin and can be seen easily on the surface. Deep veins, as their name implies, are located deep within the muscles of the leg. Blood flows from the superficial veins into the deep venous system through the perforator veins are small. Superficial veins and perforator having valves (valves) in one direction in which they allow blood to flow only from the direction of the veins of the heart when pressed.
Blood clot (thrombus) in the deep venous system of the leg is actually harmless. The situation becomes life threatening when a piece of blood clot breaks off (embolus, pleural = emboli), walking toward the estuary through the heart into the pulmonary circulation system, and concerns in the lung. Diagnosis and treatment of deep venous thrombosis (DVT) is intended to prevent pulmonary embolism.
Clots in superficial veins does not pose a danger of causing pulmonary embolism due to perforator vein valves act as a sieve to prevent clots from entering the deep venous system. They are usually not at risk of causing pulmonary embolism.
Causes of deep vein thrombosis?
Blood is meant to flow, if it becomes stagnant there is potential for it to freeze / clot. Blood in the veins continuously forming a microscopic clots that are routinely described by the body. If the balance of clot formation and resolution is altered, the freezing / significant clumping can occur. Thrombus can be formed if one, or a combination of the following situations is present:
Immobility (state No Moves)
* Travel and prolonged sitting, such as flight-long plane flights ("economy class syndrome"), car, or train travel
* Hospitalization hospital
* Operations
* Trauma to the lower leg with or without surgery or a cast
* Pregnancy, including 6-8 weeks after partum
* Obesity
Hypercoagulability (clotting of blood more quickly than usual)
* Drug-drug (eg, birth control pills, estrogen)
* Smoking
* The tendency of genetic
* Polycythemia (increased numbers of red blood cells)
* Cancer
Trauma to the vein
* Fractures leg
* The feet are bruised
* Complications of the invasive procedure of venous
Symptoms of Deep Vein Thrombosis
Superficial thrombophlebitis
Blood clots in the superficial venous system most often caused by trauma (injury) in the vein that causes small blood clots. Inflammation of the veins and the skin around it causing any symptoms of other types of inflammation:
* Redness,
* Warmth,
* Sensitivity, and
* Swelling.
Often the affected vein can be perceived as a solid thick rope. There may be inflammation that accompanies all part of the vein.
Although there is inflammation, no infection.
Varicosities can predispose to superficial thrombophlebitis. When the valves of the veins on a larger system failed superficial (saphenous veins are larger and less), blood can flow back and cause the veins to swell and become distorted or crooked. Valves failed when the veins lose their flexibility and stretching. This can be caused by age, prolonged standing, obesity, pregnancy, and genetic factors.
Deep Venous Thrombosis
The symptoms of deep vein thrombosis associated with obstruction of the blood returning to the heart and cause back flow in the legs. Classically, the symptoms include:
* Pain,
* Swollen,
* Warmth, and
* Redness.
Not all of these symptoms should occur: one, all, or none may be present with deep vein thrombosis. The symptoms may mimic infection or cellulitis of the leg.
Historically, doctors will try to create a pair of clinical findings to make a diagnosis. Dorsiflexion of foot (pull your toes toward the nose, or Homans' sign) and Pratt's sign (squeezing the calf to produce pain), have been found to be ineffective in making the diagnosis.
When should I seek medical care for deep vein thrombosis?
Diagnosis of superficial or deep thrombosis often relies on clinical skill of the physician. Diagnostic tests need to be tailored to each situation.
Leg swelling, redness, and pain may be indicators of blood clot and should not be ignored. These symptoms may be due to other causes (eg, cellulitis or infection), but it may be difficult to make a diagnosis without seeking medical advice.
If there is chest pain or shortness of breath, then further concern exists that a pulmonary embolus may be the cause. Again, seek immediate advice is appropriate.
Diagnose Deep Vein Thrombosis
The diagnosis of superficial thrombophlebitis is made clinically.
Ultrasound is now the standard method of diagnosing the presence of deep vein thrombosis. The ultrasound technician may be able to determine whether there is a clot, where it is located at the foot, and how much. Ultrasounds can be compared over time to see if the clot has to grow or disappear. Ultrasound is better to "see" the veins above the knee than in the veins below the knee.
Venography, injecting a dye (dye) into the veins to look for thrombus, is generally not done anymore and has become more of a historical footnote.
D-dimer is a blood test that may be used as a screening test (screening) to determine whether there is a blood clot. D-dimer is a chemical that is produced when a blood clot in the body gradually dissolve / decompose. The test is used as an indicator of positive or negative. If the result is negative, then there is no blood clot. If D-dimer test is positive, it does not necessarily mean that deep vein thrombosis is present since many situations will have the expected positive results (eg, from surgery, falls, or pregnancy). For that reason, D-dimer testing should be used selectively.
Other blood testing may be considered based on the potential cause for deep vein thrombosis.
Treatment To Deep Vein Thrombosis (DVT)
Superficial Thrombophlebitis
Treatment for superficial blood clots are symptomatic with:
* Warm compresses,
* Compressing the legs, and
* Drug-drug anti-inflammatory such as ibuprofen.
When thrombophlebitis occurs near the groin where the leg superficial systems and in joining together, there is potential that the thrombus may extend into the deep venous system. These patients may require anticoagulation therapy or blood thinning (see below).
Deep venous thromboses
Deep venous thromboses or thrombos-thrombos veins that occur below the knee tend to be embolization (detached). They may be observed with a series of ultrasounds to make sure they do not extend above the knee. At the same time, the cause of deep vein thrombosis may need to be addressed.
Care for above knee deep venous thrombosis is anticoagulation, unless there are contraindications. Contraindications include major surgery recently (due to anticoagulation will dilute all the blood in the body, not just those in the legs, leading to problems of significant bleeding), or abnormal reactions when previously exposed to the blood-thinning medications .
Anticoagulation to prevent further growth of blood clots and prevent them from forming an embolus that can run into the lung.
Anticoagulation is a two-step process. Warfarin (Coumadin) is the drug of choice for anticoagulation. He immediately started, but unfortunately it may take a week or more for blood mengencer appropriately. Therefore, low molecular weight heparin [enoxaparin (Lovenox)] inserted at the same time. He thins the blood through a different mechanism and is used as a therapy connector (bridge) until warfarin has achieved the level of therapeutiknya. Enoxaparin injections can be given on an outpatient basis.
For patients who have contraindications to the use of enoxaparin (eg, renal failure did not allow the medicine to metabolized), intravenous heparin may be used as the first act. This requires hospitalization.
The dose of warfarin is monitored with blood tests that measure the prothrombin time or INR (international normalized ratio). For deep vein thrombosis is not complex (difficult), duration of therapy with warfarin is recommended three to six months.
Some patients may have contraindications to warfarin therapy, for example, a patient with bleeding in the brain, major trauma, or significant operations recently. One possible alternative is to place the strainer (filter) in the inferior vena cava (major vein that collects blood from both legs) to prevent emboli reach the heart and lungs. These filters may be effective but may also be a source of new clot formation.
The complications of Deep Vein Thrombosis (DVT)
Pulmonary embolism is a major complication of deep vein thrombosis. He can present with chest pain and shortness of breath and is a life-threatening condition. More than 90% of pulmonary embolism appearance of the legs.
Post-phlebitic syndrome can occur after deep vein thrombosis. Affected leg may become swollen and chronic pain with skin color changes and the formation of ulcers (ulcers) around the legs and feet stretching.
Prevention of Deep Vein Thrombosis
As the case with most medical illnesses, prevention is of primary importance. Decrease the risk factors is key to prevention of deep vein thrombosis.
At the hospital procedures, staff work hard to minimize the potential for clot formation in patients who are paralyzed (unable to move). Compression stockings (T-suppressor feet) used routinely. Surgery patients walk out of bed early and low-dose heparin or enoxaparin is used for deep vein thrombosis prophylaxis (measures taken to prevent DVT).
For those who travel, it is recommended that they stand up and walk every few hours during a long trip.
Compression stockings may be beneficial in preventing the formation of deep vein thrombosis in the future in patients with previous history of clots.
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