Deep Vein Thrombosis (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Deep vein thrombosis (DVT) facts
- Introduction to deep vein thrombosis (DVT)
- What are the causes of deep vein thrombosis (DVT)?
- What are the symptoms of deep vein thrombosis (DVT)?
- When should I seek medical care for deep vein thrombosis (DVT)?
- How is deep vein thrombosis diagnosed (DVT)?
- What is the treatment for deep vein thrombosis (DVT)?
- Deep vein thrombosis (DVT) medications
- Surgery for deep vein thrombosis (DVT)
- What are the complications of deep vein thrombosis (DVT)?
- Can deep vein thrombosis (DVT) be prevented?
- Deep Vein Thrombosis - Slideshow
- Deep Vein Thrombosis and Pulmonary Embolism
- Spider & Varicose Veins - Slideshow
- Find a local Cardiologist in your town
What are the symptoms of deep vein thrombosis (DVT)?
Superficial thrombophlebitis symptoms
Blood clots in the superficial vein system most often occur due to trauma to the vein which causes a small blood clot to form. Inflammation of the vein and surrounding skin causes the symptoms of any other type of inflammation including:
- tenderness, and
Often the affected vein can be palpated (felt) as a firm, thickened cord. There may be inflammation that follows the course of part of the vein.
Although there is inflammation, there is no infection.
Varicosities can predispose to superficial thrombophlebitis. This occurs when the valves of the larger veins in the superficial system fail (the greater and lesser saphenous veins), allowing blood to back up and cause the veins to swell and become distorted or tortuous. The valves fail when veins lose their elasticity and stretch. This can be due to age, prolonged standing, obesity, pregnancy, and genetic factors.
Deep venous thrombosis symptoms
The symptoms of deep vein thrombosis are related to obstruction of blood returning to the heart and causing a backup of blood in the leg. Classically, symptoms include:
- warmth, and
Not all of these symptoms have to occur. One, all, or none may be present with a deep vein thrombosis. The symptoms may mimic an infection or cellulitis of the leg.
Historically, healthcare professionals would try to elicit a couple of clinical findings to make a diagnosis. Dorsiflexion of the foot (pulling the toes towards the nose, or Homans' sign) and Pratt's sign (squeezing the calf to produce pain), have not been found effective in making a diagnosis.
When should I seek medical care for deep vein thrombosis (DVT)?
- The diagnosis of a superficial or deep thrombosis often relies on the clinical skill of the healthcare professional. Diagnostic tests need to be tailored to each situation.
- Leg swelling, redness, and pain may be indicators of a blood clot and should not be ignored. These symptoms may be due to other causes (for example, cellulitis or infection), but it may be difficult to make the diagnosis without seeking medical advice.
- If there is associated chest pain or shortness of breath, further concern exists that a pulmonary embolus may be the cause. Once again, seeking immediate advice is appropriate.
How is deep vein thrombosis diagnosed (DVT)?
The diagnosis of superficial thrombophlebitis is often made by the health care professional at the bedside of the patient, based upon the physical examination.
- Ultrasound is now the standard method of diagnosing the presence of a deep vein thrombosis.
- The ultrasound technician may be able to determine whether a clot exists, where it is located in the leg, and how large it is. Ultrasounds can be compared over time to see whether a clot has grown or resolved.
- Ultrasound is better at "seeing" veins above the knee as compared to the veins below it.
D-dimer is a blood test that may be used as a screening test to determine if a blood clot exists. D-dimer is a chemical that is produced when a blood clot in the body gradually dissolves. The test is used as a positive or negative indicator. If the result is negative, then no blood clot exists. If the D-dimer test is positive, it does not necessarily mean that a deep vein thrombosis is present since many situations will have an expected positive result (for example, from surgery, a fall, or pregnancy). For that reason, D-dimer testing must be used selectively.
Other tests for DVT
- Venography, injecting dye into the veins to look for a thrombus, is not usually performed any more and has become more of a historical footnote.
- Other blood testing may be considered based on the potential cause for the deep vein thrombosis.
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