Last week we discussed risk factors associated with the development of a Deep Venous Thrombosis (DVT). A DVT, to reiterate, is a clot in the deep venous system of the leg; the vessels responsible for carrying blood from the extremities back up to the heart for re-oxygenation and recirculation. We mentioned that a DVT can occur in anyone, but that certain risk factors such as stasis, tobacco use, estrogen use and heart conditions in addition to a history of DVT can predispose patients to development of a blockage. For a full list, including information about each risk factor, please refer back to the Blog entitled: What are My Risk Factors for a DVT?
This week, as promised we will focus on diagnostic testing that can rule-out or confirm a DVT, and if confirmed, the course of treatment that can be expected to follow.
Symptoms associated with a DVT typically present as a painful, red, swollen and hot leg. These symptoms, with or without the presence of risk factors should raise your index of suspicion for a DVT and medical attention should be sought immediately. As mentioned, should you present to your Podiatrist’s office with such symptoms you would be immediately referred to the nearest Emergency Department, therefore, starting at the Emergency Department is a wise choice!
When you arrive, it is important to explain to the admitting nurse all symptoms that you are experiencing as well as mentioning any risk factors associated with the development of a DVT. Although the process may be scary, it is important to convey all information and your suspicion of a DVT so that the Emergency Department staff takes you seriously and prompt evaluation can take place.
With suspicion of a DVT you will immediately be set up with an IV and medications given that can help break up a clot, should one be present or medications that can thin the blood to decrease the risk of additional clotting and migration of an existing clot. It should also be expected that you have blood drawn for evaluation of your base-line status in addition to looking for any imbalances in your electrolytes or blood counts. There is a specific blood test that can be conducted called a D-Dimer Test. This test looks for a specific chemical in the blood that if present can indicate the presence of a clot. It is not specific or diagnostic of a DVT but can help lead the Physicians in the right direction.
Additional tests such as a Venous Duplex Ultrasound can be conducted to look specifically at the deep veins of the lower extremity for direct visualization of a clot. The Ultrasound is completely non-invasive and consists of an Ultrasound Technician using a camera with ultrasound gel on your legs to locate a clot. Should they find one, the Technician is usually able to tell if the clot is new or if it has been present for sometime (noted by how hard the clot appears), which will help guide your treatment.
If a Deep Venous Thrombosis is detected, immediate treatment is indicated, as progression to a Pulmonary Embolism (PE) is the largest complication of a missed or under treated DVT. A PE is defined as the progression of clot from the deep veins of the leg to the lung, blocking off a section of the lung. It often becomes difficult to breath and in worst case scenarios, can be fatal!
Anticoagulation therapy is a treatment modality most of us have heard of in some form or another, usually referred to as “blood thinning.” It is the best and most effective treatment for DVT’s and helps reduce the risk of progression of your DVT to a PE. Medications that can be used in both the short and long-term include Heparin and Warfarin (Coumadin). In the hospital you will likely be started on Heparin and transitioned to Warfarin prior to being discharged home. The indication for blood thinning in patients with an acute DVT includes 3 months of therapy and in patients with recurrent episodes of DVT’s or a multitude of associated risk factors, longer.
Anticoagulation therapy requires weekly monitoring to ensure that your blood levels are thin enough, but not too thin, thus prior to any long-term treatment, you should discuss all options with your Physician. There are other options that can be explored in patients that are not candidates for anticoagulation and those should be discussed with your doctor as well.
Just remember, that if you suspect a DVT prompt recognition and treatment are a necessity, so seek medical attention immediately!