Have you had blood clots in your leg veins? Let's talk about (Deep Vein Thrombosis - DVT)!

Have you ever heard of this disease called `(Deep Vein Thrombosis)` or DVT? Maybe you or someone you know has suddenly had a swollen, painful leg and gone to see a doctor. Today, let's talk about what it really is, why it happens, is it dangerous, and what to do, okay?

What exactly is DVT?

Simply put, DVT (`(Deep Vein Thrombosis)`) is the formation of a blood clot (`(thrombus)`) inside the veins, deep inside our body. Think of it like a piece of dirt getting stuck in a water pipe. There are two main reasons for these blood clots to form. One is that the veins are damaged in some way. The other is that the speed of blood flow in the veins decreases, meaning that the blood travels very slowly.

When a blood clot forms, it can completely or partially block the flow of blood through a vein. Most often, DVT occurs in the veins of the lower leg (ankle), thigh, or hip. However, DVT can also occur in other deep veins in the body, such as the arm, brain, intestines, liver, and kidneys.

How dangerous is DVT?

Now you might be thinking, it's just a blood clot, so why would it be dangerous? Well, if the DVT stays where it is, it might not cause a major accident. But the most dangerous thing is that the blood clot that forms inside these veins can break free and travel throughout the body with the blood.

Imagine if a blood clot (embolus) that breaks loose gets stuck in a blood vessel in the lungs, which is a very dangerous situation . In medicine, we call it ``Pulmonary Embolism'' or PE. Since this can be life-threatening, it is essential to recognize the symptoms, make a diagnosis, and start treatment quickly.

Not only that, but about half of people who have a DVT in their legs, or about one in two, may have occasional pain and swelling in their legs for months, or even years. This condition is called ``post-thrombotic syndrome''. This occurs when the DVT damages the delicate valves inside the veins and the inner wall of the veins, causing blood to pool in one place instead of moving upward properly. This pain and swelling are caused by increased pressure inside the veins.

Post-thrombotic syndrome may include the following symptoms:

• Blood pooling in the leg.
• The fact that the legs continue to swell.
• Increased pressure inside the veins.
• Change in skin color on the legs, sometimes turning brown.
• Venous stasis ulcers are difficult-to-heal wounds on the legs.

What is the difference between DVT and deep vein thrombosis?

You've probably heard of a vein that's swollen, blue, and painful to the touch. It's called `(Superficial Venous Thrombosis)` (some people also call it `(phlebitis)` or `(superficial thrombophlebitis)`). It's just under your skin,A blood clot forms in a nearby vein. It is very rare for a blood clot like this to break loose and travel to the lungs. However, if the blood clot travels to the deep vein system, there is a small chance that it could happen.

A doctor can usually tell if there are blood clots in the veins close to the skin by palpating and examining the body. However, to be absolutely certain about a DVT, that is, a blood clot in a deep vein, an ultrasound test is definitely needed.

How common is this DVT?

It is important to know this too. If you look at the statistics in a country like America, it is said that between one and three out of every 1,000 adults develop DVT or the resulting `(Pulmonary Embolism)` (PE) each year. It is also said that about three hundred thousand people die every year due to DVT/PE. Imagine, DVT/PE is the third most common vascular disease after heart attack and stroke.

Although DVT/PE can occur at any age, it is relatively rare in children and young adults. It is most common in people over the age of 60. Another important fact is that more than half of all DVTs occur while being treated in a hospital for an illness or after an operation. The main reason for this is that when we are in the hospital, we do not move around as much as we normally would and are confined to bed for a long time, which reduces blood flow to the legs.

What are the symptoms of a DVT?

DVT usually occurs in the veins of the legs or arms. Surprisingly, about 30% of people with DVT, or about one in three people, do not have any symptoms! Sometimes the symptoms are so mild that some people may not even notice it.

However, symptoms of a sudden (acute) DVT may include:

• Swelling of a leg or arm (sometimes this happens suddenly).
• Pain or tenderness in the leg or arm (this may only be felt when standing or walking).
• Feeling that the swollen, painful area of ​​the leg or arm is hotter than the rest.
• Redness or discoloration of the skin in that area.
• Veins that are close to the skin appear larger than normal and bulging.
• Abdominal pain or pain in the side of the abdomen (this happens if blood clots form in the deep veins inside the abdomen).
• A severe headache (usually sudden in onset) and/or seizures (this occurs if a blood clot forms in the brain).

Some people don't know they have a DVT until the clot breaks loose from their leg or arm and travels to their lungs. That's when they start to experience symptoms of a pulmonary embolism (PE), which can include sudden chest pain, shortness of breath, coughing up blood, feeling dizzy, and possibly losing consciousness.

Here's something to keep in mind: If you have one or more of the symptoms of a DVT, please don't wait for the symptoms to subside. Call a doctor immediately, or go to the emergency room of your nearest hospital. Prompt treatment can prevent serious complications.

What are the causes of DVT?

Now let's look at the most common causes, or risk factors, of DVT. If these apply to you, it's a good idea to be a little vigilant about DVT:

• Having a family history of genetic conditions that increase the risk of blood clots.
• Cancer and some of its treatments (such as chemotherapy).
• If you or someone in your family has had DVT before.
• Restriction of blood flow in a deep vein due to injury, surgery, or prolonged immobility.
• Staying in the same position, without moving, for a long time. Like when traveling on a long bus, train, or plane, or when staying in bed after surgery or a serious injury.
• Being pregnant or recently having a baby (the risk is highest within the first 6 weeks).
• Being over 40 years of age (but remember that DVT can develop at any age).
• Overweight/obesity .
• Having an autoimmune disease such as lupus, vasculitis, or inflammatory bowel disease (IBD).
• Use of tobacco products (such as cigarettes, beedis).
• People with varicose veins are also at increased risk of DVT.
• Taking birth control pills or some hormone therapy .
• Having a central venous catheter (a tube inserted into a large vein) or a pacemaker (a device that controls the heart rate) inserted into the body.
• Having recently been infected with COVID-19 also increases the risk of DVT.

How do you know if you have DVT?

When you see a doctor with symptoms of DVT, they will first ask you about your symptoms, your other medical conditions, and whether anyone in your family has had similar conditions. Then they will examine you. After that, they may do one or more of the following tests to confirm whether you have DVT:

DVT detection tests

• Duplex venous ultrasound : This is the most commonly used, painless, and easy-to-perform test to detect DVT.This uses sound waves called ultrasound to look at the blood flow in the veins and to see if there are any blood clots. The person doing this test places an ultrasound probe on your leg or arm and applies gentle pressure. If the vein does not contract properly when you press it, the doctor may suspect that there may be a blood clot there. If the results of this ultrasound are not very clear, the doctor may do another test.
• `(Venography)` : This is a test that is done inside the body. It is used very rarely these days. Here, a small incision is made in the skin of the neck or groin, a thin tube (`(catheter)`) is inserted through it into a vein, and a special liquid (contrast material) is injected into the veins. Then, X-ray images are taken to see if the blood flow in the veins is blocked due to blood clots.
• Magnetic Resonance Imaging (MRI) or Magnetic Resonance Venography (MRV) : MRI can take very clear pictures of organs and structures inside the body. MRV can take pictures of veins, especially in specific areas of the body. MRI and MRV can often provide more detailed information than an ultrasound or CT scan.
• Computed tomography (CT) scan : This is another way to take cross-sectional pictures of the inside of the body using X-ray technology. A doctor may use a CT scan to find a DVT in the abdomen, pelvis, or brain, as well as to look for blood clots in the lungs (pulmonary embolism).

Sometimes, if your doctor suspects that you have a blood clotting disorder, whether inherited or acquired, they may order special blood tests to look for it. This is especially important in cases like these:

• If you have had blood clots in the past for no other obvious reason.
• If you have a blood clot in a vein in an unusual place, such as your intestines, liver, kidneys, or brain.
• If your family has a strong history of blood clots.
• If someone in your family has already been diagnosed with a specific hereditary blood clotting disorder.

How is daily life with a DVT?

When you have a DVT, you may have some pain and swelling in your leg for the first few days, making it difficult for you to move around and do your normal activities. But don't worry, you can gradually get back to your normal activities .

If your legs are swollen and feel heavy, try lying in bed with one or two pillows under your legs and keeping your heels about 5-6 inches above your head. This will help improve blood flow from your legs to your heart and reduce swelling.

In addition, think about these things:

• If you have to sit for long periods of time (e.g., when working in an office, watching TV), do exercises that involve moving your hips back and forth at least once every half hour.
• Get up and walk around for a few minutes at least every hour you're awake. This is especially important when you're on a long flight or a long journey in a vehicle like a bus, train, or car.
• If your doctor prescribes it, wear special compression stockings that come up to your knees. Wearing these every morning and evening has been found to reduce leg pain and swelling by up to 50%.
• Avoid activities that could cause serious injury (e.g., high-impact running or jumping sports) for a while.
• Always drink plenty of water, especially when traveling, and don't let your body become dehydrated.

What are the treatments for DVT?

Some people with DVT may need to stay in the hospital for treatment, but most people can be treated at home, taking medication as prescribed by their doctor, and going to clinics (outpatient).

The main treatments for DVT are:

• Giving blood thinners (anticoagulants) to prevent blood clotting.
• The thing I mentioned earlier is to wear compression stockings.
• Elevating the affected leg(s) several times throughout the day.

Very rarely, if the DVT has spread very widely, special treatments (catheter-based procedures) may be necessary.

These treatments have several main goals:

• The goal is to stop the existing blood clot from getting bigger and spreading to other surrounding veins.
• Preventing a blood clot from breaking free from a vein and traveling with the blood to the lungs (causing a pulmonary embolism).
• Reducing the risk of developing this type of blood clot again in the future.
• Preventing long-term complications (e.g., chronic venous insufficiency, a condition that causes swelling in the legs and skin discoloration) that can be caused by this blood clot.

Remember these things about medication

If your doctor prescribes medication for DVT, be very careful about these things:

• Take your medicine exactly as your doctor prescribes, at the right time, in the right dosage. Don't miss a single day.
• Get your blood tests done exactly as your doctor tells you to, and don't miss your lab appointments. (Some blood thinners require regular blood tests to check your blood clotting ability.)
• Do not start any new medication (including over-the-counter painkillers, vitamins, and Ayurvedic medicines) or stop taking any medication you are currently taking without consulting your doctor.
• Talk to your doctor about your diet. Some blood thinners (such as warfarin) may limit the amount of certain foods you eat (such as legumes). So be aware of this.

A little more about DVT treatment

Anticoagulants (blood thinners)

This medication mainly prevents your blood from clotting easily. It also stops existing blood clots from getting bigger, and it also prevents them from breaking off and moving around.

Importantly, these anticoagulants do not "dissolve" blood clots. Your body's natural mechanisms gradually dissolve the clots. However, sometimes the clots do not dissolve completely. If they do, they shrink and remain as small "scars" inside the veins. Sometimes these "old" clots can cause persistent leg swelling, but most of the time they do not cause any major symptoms.

There are several types of anticoagulants. For example, warfarin (marketed under names such as Coumadin), heparin (given as an injection), and the newer direct oral anticoagulants (DOACs) or novel oral anticoagulants (NOACs) (e.g. rivaroxaban, apixaban, dabigatran). Your doctor will tell you which type of medication is best for you and is safest.

If you need to take an anticoagulant, how long you need to take it will depend on your condition. Some people only need to take it for a few months (usually 3-6 months), while others may need to take it for the rest of their lives. This depends on factors such as:

• Have you ever had blood clots like this before?
• Whether you are being treated for a long-term condition, such as cancer or an autoimmune disease (if so, you may need to take an anticoagulant for a long time, which increases your risk of developing a blood clot).

The most common side effect of anticoagulants is bleeding. If you experience easy bruising, excessive bleeding from your gums when brushing your teeth, nosebleeds, or black stools while taking these medications, call your doctor immediately.

`(Compression Stockings)` (Special tight socks)

Your doctor may prescribe you to wear special compression stockings to reduce or even eliminate swelling in your legs. The main cause of this swelling is damage to the delicate valves inside your veins caused by DVT. Swelling can also occur because the blood flow in your veins is blocked by DVT.

Most compression stockings come in a form that is worn below the knee. These stockings are slightly tighter at the ankle, and gradually become less tight as you move up the leg. This creates a slow, uniform pressure (compression) on the leg, reducing blood pooling and helping it move upward. Some people have to wear them for two years or more. Studies have shown that wearing these stockings every day from morning to evening (and not at night when you sleep) can reduce pain and swelling in the leg by up to 50%.

Sometimes, after major surgery, you may see people wearing special devices (`(intermittent pneumatic compression devices)`) that are placed around your leg and tightened and loosened periodically to prevent DVT while you are in the hospital. These are not recommended for use outside of the hospital. Also, these devices are not recommended for someone who already has a DVT in their leg.

Specific procedures for DVT

DVT can often be managed with medication. However, if you are unable to take blood thinners for some reason, or if you continue to develop blood clots despite taking them correctly, a surgeon may need to perform an operation to place a special device (an inferior vena cava filter or IVC filter) in the largest vein in your body (the vena cava).

This is usually done by numbing the area. The surgeon inserts this `(IVC filter)` through a thin tube (`(catheter)`) into a large vein in your groin or neck, and then takes it and places it in the `(vena cava)`, the main vein that carries blood from the lower parts of the body to the heart. The purpose of this filter is to prevent blood clots in the veins of your legs from breaking off and traveling up, and large blood clots (`(emboli)`) from traveling to your lungs and causing `(pulmonary embolism)`. But remember, while an `(IVC filter)` reduces the risk of `(pulmonary embolism)`, it does not stop new blood clots from forming in your veins.

How can I reduce my risk of developing DVT?

They say, "Prevention is better than cure." So that's true about DVT too.

If you have already had a DVT and have completed treatment, you should do the following to reduce your risk of developing another DVT/PE blood clot in the future:

• Take your medication exactly as your doctor prescribes, for the prescribed period of time.
• Don't miss your doctor's appointments and lab tests. These are the days when your doctor can determine how effective your treatment is and whether your medication dosage needs to be changed.
• Make healthy lifestyle changes, such as eating a balanced diet, exercising daily, and quitting tobacco use altogether.

If you have never had DVT, but you have one or more of the risk factors mentioned above, take care to prevent DVT by:

• If you have to sit in one place for a long time (e.g., in the office, on a long trip), do some light exercise, such as moving your hips up and down and rotating your ankles, at least once every half hour.
• If you're on a long flight, get up at least once every hour and walk around the aisle. If you're on a long car trip (bus, car), get out of the car at least once every hour or two and move around a bit, stretching your legs a little.
• After an illness or surgery, get out of bed and start walking as soon as possible. The sooner you start moving around, the less likely you are to develop DVT.
• After major surgery, if your doctor prescribes it, take the medication (e.g., small heparin injections) or wear compression stockings to reduce the risk of blood clots.
• See your doctor at the scheduled times and follow his or her instructions exactly to reduce your risk of DVT.

What can I expect if I have a DVT?

It can take months to a year for a blood clot to completely dissolve from a DVT. Therefore, it is important to continue taking your blood thinners and wearing compression stockings, if prescribed, until your doctor tells you to stop.

When taking blood thinners (especially warfarin), you will need to have regular blood tests (INR tests) to make sure you are getting the right dose. Your doctor may also want to do more ultrasounds later to check if your blood clot is still there, if it has decreased in size or is getting bigger, and how your veins are moving.

When should I see my doctor again?

If your symptoms (such as leg pain and swelling) do not improve or worsen during treatment, tell your doctor right away. Also, if you bruise more easily while taking blood thinners, or if you have heavy menstrual bleeding, tell your doctor.

When should I go to the Emergency Department (ETU) ?

This is also very important. If you experience any of the following while taking blood thinners, which means you are showing signs of excessive bleeding, go to a hospital emergency room immediately:

• If the vomit is bright red with blood, or if the vomit is black like coffee grounds.
• If the stool is bright red with blood, or if the stool is pitch black and sticky.
• If you continue to bleed unstoppably from your nose, mouth, or anywhere else.
• If you experience symptoms of a stroke, such as a sudden, severe headache, vision changes, difficulty speaking, or weakness on one side of the body.

What questions should I ask my doctor?

When you're diagnosed with DVT, it's normal to have a lot of questions on your mind. Don't be afraid to ask your doctor about things like:

• How long will I have to take this blood thinner?
• When will I be able to travel normally again (especially long trips, flights)?
• How often should I see the doctor (`(follow-up appointments)`)?
• Do I need to make any special changes to my diet?
• What activities should I avoid while taking this treatment?

So, what should we take home from this story?

DVT is not something to be afraid of, but it is not something to be taken lightly either. It is a condition that affects many people around the world and can be successfully treated.

The most important thing is,If you have symptoms, see a doctor immediately and take the treatment exactly as he or she recommends. If you are prescribed blood thinners, take them on time and get the tests your doctor recommends. Your doctor is the best person to answer any questions or concerns you may have about your health. So, talk to him or her openly and get the best treatment for your condition. Stay healthy!

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