Is your leg suddenly swollen and painful? It could be DVT (Deep Vein Thrombosis)

Has one of your legs suddenly become swollen and hot to the touch? Does it hurt when you walk or stand? Maybe the skin on your leg is red? Many people think it's just a sprain or a sprained ankle. But sometimes it can be something much more serious and needs immediate attention. Today we're talking about a blood clot in a deep vein, or what's medically known as Deep Vein Thrombosis (DVT) .

Simply put, what is DVT?

There are two types of blood vessels in our body. One is the superficial veins that are visible under the skin. The other is the large veins that run deep inside the body. Deep Vein Thrombosis (DVT) is when a blood clot (thrombus) forms in these deep veins. Think of it like a piece of dirt getting stuck in a water pipe, blocking the flow of water. This blood clot can completely or partially block the flow of blood in the vein. This condition is most common in the veins of the legs (especially the thighs or buttocks), and the pelvis. However, rarely, blood clots can form in the veins of the arms, brain, intestines, liver , or kidneys.

Why can DVT be dangerous?

If the DVT condition remains as it is, it is not life-threatening. However, the main danger is if the blood clot that has formed inside this vein breaks away from there and starts traveling through the bloodstream. Imagine, what happens if a blood clot that breaks away (we call this `emboli`) goes straight to a blood vessel in the lungs and gets stuck? That is what we call Pulmonary Embolism (PE) . This is a very dangerous, life-threatening emergency. Therefore, it is essential to diagnose and treat the disease as soon as you suspect that you have DVT. Additionally, about half of people who have DVT may develop long-term problems called Post-Thrombotic Syndrome .This is when a blood clot damages the delicate valves inside the veins, causing blood to pool in the legs instead of pumping properly. This can cause swelling, pain, discoloration (browning) of the skin, and wounds that are difficult to heal (venous stasis ulcers) for months or even years.

How do you know if you have DVT? What are the symptoms?

Not everyone with DVT will have symptoms. About 30% of people may have DVT without any symptoms. Some people may have symptoms so mild that they don't even notice them. However, there are some common symptoms. If you have these symptoms, especially if they only occur in one leg, you should be concerned.

Be aware of the symptoms of Pulmonary Embolism (PE)!

Some people only find out they have a DVT after the blood clot breaks loose and gets stuck in their lungs. So be very aware of the following symptoms.

• Sudden chest pain
• Difficulty breathing
• Coughing up blood
• Dizziness (vertigo)
• To cast a spell

What are the risk factors for DVT?

Anyone can get DVT, but some people are at higher risk. Let's take a look at what they are.

• Sitting still for long periods of time: Imagine you're taking a bus from Colombo to Jaffna, Sri Lanka, or taking a plane for hours to get to the country. During such long journeys, keeping your legs in the same position can slow down blood circulation and lead to blood clots. The same goes for after major surgery, or if you have to stay in bed for days due to illness.
• Surgery or accidents: If the veins are damaged due to surgery or an accident, the risk of blood clots increases.
• Over 40 years of age: The risk gradually increases with age.
• Pregnancy and postpartum: The risk of DVT is highest during pregnancy and for about 6 weeks after delivery.
• Overweight/Obesity: People who are overweight are at higher risk.
• Smoking: Smoking increases the risk of blood clotting.
• Cancer and cancer treatments: Some types of cancer and cancer treatments (e.g. chemotherapy) increase the risk of DVT.
• Birth control pills or hormone therapy: Birth control pills and hormone therapy that contain the hormone estrogen may slightly increase the risk of blood clots.
• Family history: If someone in your family (mother, father, siblings) has had DVT, you are also at risk.
• Genetic causes: Some people may be born with conditions that cause their blood to clot easily.
• Other medical conditions: Autoimmune diseases such as lupus, inflammatory bowel disease, varicose veins (varicose veins in the legs), and COVID-19 infection can also increase the risk of DVT.

Doctor, how do you accurately diagnose DVT?

If you have symptoms of DVT, your doctor will first examine you, ask about your medical history and risk factors, and then order several tests to confirm the diagnosis.

• Duplex Venous Ultrasound: This is the main and most commonly used test to detect DVT. It is similar to a baby scan. It is painless. It can clearly see the blood flow in the veins and whether there are any blood clots.
• Venography: This is not used much anymore. This involves injecting a special liquid (dye) into a vein and taking an X-ray.
• MRI or CT scan: Sometimes these tests may be done if there is a suspicion of blood clots in deep veins, such as the stomach or brain.
• Special blood tests: If you have developed DVT for no apparent reason, or if you have a family history, your doctor may decide to do special blood tests to check for genetic conditions that affect blood clotting.

What are the treatments for DVT?

There are a few main goals in treating DVT.

• Stopping a blood clot from getting bigger.
• Preventing that blood clot from breaking loose and going to the lungs.
• Stopping the formation of new blood clots.
• Reducing the risk of long-term complications (Post-Thrombotic Syndrome).

There are several main treatment methods to achieve these goals.

1. Blood thinners (Anticoagulants)

This is called `Anticoagulants` in English. These medications work by reducing the ability of the blood to clot. The most important thing is that these medications do not ``dissolve'' a blood clot that has already formed. Instead, they stop it from getting bigger and new clots from forming. Over time, the body's natural processes can gradually dissolve the blood clot. Medications such as ``Warfarin`` and ``Heparin`` are used for this. Your doctor will decide which medication is right for you and how long you need to take it. Usually, you will need to take this medication for 3-6 months, or for some people, for the rest of your life.

2. Compression Stockings

These are not like regular socks. These are specially designed socks that fit snugly around the ankles. They are made to be very tight around the ankles and gradually become less tight towards the knees. This helps the blood flow up the legs without stagnating. Wearing these throughout the day can reduce swelling and pain in the legs by about 50%.

3. IVC Filter

This is not a treatment for everyone. It is recommended for people who cannot take blood thinners, or who develop blood clots while taking them. Here, a small mesh-like device (a `filter`) is inserted into the body's main vein, the `Vena Cava`. This is to catch a blood clot that has broken off in the leg before it can travel to the lungs.

How can I prevent DVT from recurring?

Once you have a DVT, it's important to prevent it from happening again. Also, if you're at risk for DVT, you need to take steps to prevent it from happening again.

If you have already had DVT:

• Take the medicine prescribed by the doctor exactly and on time. Don't miss a single day.
• Attend clinics and blood tests on scheduled dates.
• Adopt a healthy lifestyle (good diet, exercise, and avoiding smoking).

If you are at risk for DVT, to prevent it:

• On long journeys: Get up and walk around at least once an hour. While sitting, do small exercises like rotating your ankles and moving your toes up and down.
• After surgery: Get out of bed and start walking as soon as possible. Do as your doctor tells you.
• Always drink enough water.
• Talk to your doctor and get advice on ways to reduce your risk.

DVT, Deep Vein Thrombosis, Blood Clots, Blood Clots in Veins, Leg Swelling, Pulmonary Embolism, Blood Thinners, Anticoagulants, Blood Thinning Medications, Leg Pain