Deep Vein Thrombosis
Definition
Clotting of blood inside the deep veins especially of the lower limbs
Pathophysiology
Blood in the deep veins clots (thrombosis) inside the veins due to slowing down of the flow of blood in the veins, hypercoagulability, inflammation of the veins, advanced age, immobilization after surgery, prolonged sitting during long flights, pregnancy, neoplastic or other types of obstruction etc.
Repetitive strenuous use of the limbs may also lead to thrombosis inside the veins
The clot formed grows longitudinally in the direction of the blood flow.
Fragmentation of a propagating venous thrombosis → a travelling clot (embolus) → embolic obstruction of pulmonary vessels
Recanalization occurs later
During recanalization valves get damaged and valvular incompetence occurs
Clinical Manifestations
Nonspecific
Swelling of the limb
Edema
Tense tissues
Pain & Tenderness
Cool to the touch
Non-healing ulcers
Complications
Chronic venous occlusion
Pulmonary infarction
Valvular incompetence leading to varicose veins
Increased venous pressure leading to edema
Venous ulcers
Venous gangrene
Prevention
Elastic compression stockings
Intermittent pneumatic compression devices
Special body positioning
Exercises
Subcutaneous unfractionated or loww molecular weight heparin
Medical Management
Anticoagulant therapy :
Indicated in prolonged immobilization in major surgery
Elderly patients undergoing surgery
Hip fracture in an elderly
Persistent leg edema from heart failure
LMWH
Warfarin
Long course or short course
Thrombolytic therapy
Surgical Management
Thrombectomy
Vena Cava Filter
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