The diagnosis and management of deep vein thrombosis

Deep vein thrombosis (DVT) is a blood clot within the vein, usually the legs. Blood clots are not always obvious when they happen, as they can remain asymptomatic for some time, but without treatment, the consequences can be life-threatening. Professor Vassilis Hadjianastassiou, an expert surgeon, shares with us in this article how DVT is diagnosed, and how it can be treated.

What causes deep vein thrombosis?

DVT can occur due to many factors — anything that obstructs blood flow (the “circulation” of blood) or something which makes the blood too sticky, and the formation of blood clots can cause it, such as:

• Thrombophilia, a condition where blood clots form too frequently in the body. This can be acquired (due to a “disease”) or genetic (born with a predilection).
• Pregnancy, which increases the pressure in the veins of the legs and pelvis
• Smoking, which affects blood flow
• Heart failure, where the heart cannot pump blood efficiently throughout the body
• Sitting down or lying down for too long periods at a time (being sedentary), which prevents normal blood flow
• Wearing tight clothing for too long
• Obesity

What are the symptoms of deep vein thrombosis?

The onset of DVT can be accompanied by symptoms such as swelling of the legs (usually just one, but it can rarely happen in both), pain or tenderness in the legs, skin that reddens or changes colour, a visible increase in the size of the veins, abdominal or flank pain. If you notice these symptoms, you should see a doctor as soon as possible.

How is deep vein thrombosis diagnosed?

If a doctor suspects that you have DVT, you may have a blood test and/or undergo a Doppler ultrasound so they can examine the flow of blood through the vein in real time and in colour; these are the standard tests for diagnosing DVT. If there are still doubts, further imaging tests might include a CT or MRI venogram, where dye is injected into the vein which is then “x-rayed” to check on the blood flow. You may be asked about your family medical history and lifestyle to assess if you have a tendency for blood clots.

How is deep vein thrombosis treated?

Treatment is focused on preventing the blood clot from getting bigger, trying to improve the flow of blood, and preventing the clot from migrating to your lungs, heart, or brain.

Blood-thinning medication (anticoagulants) – such as the newest DOACs, blood thinning injections or the traditional warfarin, in certain cases – can be prescribed to prevent more clots from forming and facilitate blood flow. The prescription is usually for three to six months, but it will depend on how the body reacts to the medication (if the clot “clears”) and if the body is at risk of more, serious blood clots in the future. Not everyone is suitable to take blood thinners, such as pregnant women or people with stomach ulcers (or any active sources of bleeding).

A thrombectomy is a surgical procedure to remove a blood clot, where an incision is made to the vein and the clot is manually removed; however, this has been abandoned for the minimally invasive version of this procedure called percutaneous thrombectomy, in which catheters are used to access the blood clot and destroy or suction out the clot from within the vein.

Supportive treatment for leg DVT may also include the need to wear knee-high compression stockings, exercise and engage in more physical activity, and cease smoking tobacco products, but your doctor or haematologist will advise on the best course of action to treat your DVT.

 If you believe you may have deep vein thrombosis, or are struggling with blood clot issues, book an appointment with Professor Hadjianastassiou via his Top Doctors profile.