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) definition and facts
- What is DVT?
- What does a blood clot in the leg look like?
- What causes DVT?
- Signs and symptoms of DVT
- Signs and symptoms of superficial blood clots
- Who is at risk?
- Which types of doctors treat DVT?
- What tests diagnose the condition?
- What are the treatment guidelines for DVT?
- What is the treatment of superficial blood clots?
- Medications to treat blood clots in the leg
- Warfarin (Coumadin, Jantoven)
- Side effects and risks of anticoagulation therapy
- Does DVT require surgery?
- What are the complications?
- How can blood clots in the legs be prevented?
- Deep Vein Thrombosis and Pulmonary Embolism FAQs
- Find a local Cardiologist in your town
Signs and symptoms of DVT
The signs and symptoms of DVT are related to obstruction of blood returning to the heart and causing a backup of blood in the leg. Classic symptoms include:
You may or may not have all of these symptoms, or your may have none. The symptoms of the condition may mimic an infection or cellulitis of the arm or leg.
In the past doctors and other health care professionals perform simple tests on patients to make a diagnosis of a blood clot in the leg; however, they have not been effective. For example, pulling the patient's toes toward the nose (Homans' sign), and squeezing the calf to produce pain (Pratt's sign). Today, doctors and health care professionals usually do not rely upon whether these signs and symptoms are present to make the diagnosis or decide that you have DVT.
Signs and symptoms of superficial blood clots
Blood clots in the superficial vein system (closer to the surface of the skin), 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 similar to any other type of inflammation, for example,
You often can feel the vein as a firm, thickened cord. There may be inflammation that follows the course of part of the leg vein. Although there is inflammation, there is no infection.
Varicosities can predispose to superficial thrombophlebitis and varicose veins. This occurs when the valves of the larger veins in the superficial system fail (the greater and lesser saphenous veins), which allows 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.
Who is at risk?
There are a wide variety of people who are at risk for developing blood clots. Some risk factors include:
Which types of doctors treat DVT?
People with a swollen extremity or concern that a DVT exists may be cared for by a variety of health-care professionals. Both the primary care provider (including internal medicine and family medicine specialists) and a health care professional at in an urgent care (walk in) clinic or emergency department are able to recognize and diagnose the condition. Some people go to the hospital and the diagnosis is made there.
Treatment is usually started by the doctor who makes the diagnosis, but long-term treatment decisions, risk stratification, and follow-up usually is be done by the person's primary care doctor. Depending upon the situation, a hematologist (specialist in blood disorders) may be consulted. If there is need for the clot to be removed or dissolved, an interventional radiologist may also be involved.
Depending upon the medication used to anticoagulate the blood, pharmacists and anticoagulation nurses may also be involved on your treatment team.
What tests diagnose the condition?
The diagnosis of superficial thrombophlebitis usually is made by the doctor at the bedside of the patient, based upon history, potential risk factors present, and findings from the physical examination. Further risk stratification tools may include scoring systems that can help decide whether a DVT is likely.
If the probability of a leg thrombosis is low, a D-dimer blood test may be ordered.
- If the D-dimer is negative, then it is unlikely that a DVT is the diagnosis.
- If the D-dimer is elevated, then the possibility of a DVT exists and an imaging study, usually ultrasound, is required to look for the DVT
- Ultrasound is 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 or arm, and how large it is. It also may be possible to know whether the blood clot is new or chronic. If necessary, ultrasounds may be compared over time to see whether a clot has grown or resolved.
- Ultrasound is better at "seeing" the veins above the knee as compared to the small veins below the knee joint.
- Clots in the chest or pelvis may not be identified on ultrasound.
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 in most cases 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. Any bruise or blood clot will result in a positive D-dimer result (for example, from surgery, a fall, in cancer or in pregnancy). For that reason, D-dimer testing must be used selectively.
- Venography, injecting dye into the veins to look for a thrombus, is not usually performed anymore 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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