Venous Thromboembolism - Causes, Symptoms, and Treatment

Introduction:

Venous thromboembolism refers to the formation of blood clots in the veins. Blood flow through the veins is obstructed by these blood clots. It is a disorder that results in the following two blood clotting conditions:

• Deep Vein Thrombosis (DVT): This refers to forming a blood clot in the deep veins, particularly in the legs, pelvis, and hips.

• Pulmonary Embolism: It refers to the blood clot that breaks down from the deep vein blood clot.

What Are the Causes of Pulmonary Embolism?

• Pulmonary embolism refers to the formation of emboli from the blood clot of a deep vein that breaks and reaches the lungs, resulting in blockage of the lung's artery.

• These blood clots are caused by inflammation in response to injury or infection and may develop from the injured vessels that are damaged by surgery or trauma.

What Are the Causes and Risk Factors for Deep Vein Thrombosis?

• Deep vein thrombosis affects the deep veins carrying blood to the heart. It is caused by the reduced blood flow in the body’s deep veins and changes in the blood so that blood clots are formed easily if there is any damage to the lining of the blood vessel.

• Several factors lead to an increased risk of developing deep vein thrombosis, including:

• Vein injury caused due to:

1. Severe muscle injury.

2. Fractures.

3. Major surgery involves the pelvis, abdomen, hip, or legs.

• Reduced blood flow caused due to:

  1. Limited movement.

  2. Paralysis.

  3. Prolonged periods of sitting with the legs crossed.

  4. Confinement to bed (due to surgery or medical condition).

• Certain chronic medical conditions, such as:

  1. Cancer.

  2. Lung disease.

  3. Heart disease.

  4. Inflammatory bowel diseases (IBDs) like Crohn’s disease and ulcerative colitis.

• Increased estrogen due to:

  1. Hormone replacement therapy.

  2. Birth control pills.

  3. During pregnancy, and for at least three months post-delivery.

• Some of the factors that increase the risk of developing deep vein thrombosis include:

  1. Having a family history of conditions such as pulmonary embolism or deep vein thrombosis.

  2. Age.

  3. Obesity.

  4. Inherited clotting disorders.

  5. A catheter in a central vein.

  6. Having a previous medical history of conditions like pulmonary embolism or deep vein thrombosis.

What Are the Symptoms of Deep Vein Thrombosis?

The symptoms are not the same for everyone, and they differ among individuals. The most common symptoms of deep vein thrombosis that occur in the affected part include:

• Swelling.

• Pain or tenderness.

• Cramps, pain, and increased warmth in the swollen areas.

• Redness of the skin.

Can a Deep Vein Thrombosis Cause Stroke?

A stroke happens when a blood clot dislodges and travels through the bloodstream, obstructing the arteries or veins. DVT as such does not cause a stroke or heart attack as such.

How Can Deep Vein Thrombosis Be Prevented?

The following are the tips that can help in preventing deep vein thrombosis:

• Start to move around as soon as possible after a chronic illness, surgery, or injury.

• Use of medication such as anticoagulants to prevent the risk of deep vein thrombosis.

• Use of medical compression stockings.

• Avoid tight-fitting clothes and wear loose-fitting clothes.

• In the case of long travel of more than four hours:

  1. Get up and walk every one to two hours.

  2. Raise and lower the toes while keeping heels on the floor.

  3. Raise and lower the heels while keeping the toes on the floor.

  4. Tight and release the leg muscles.

• Avoid a sedentary lifestyle.

• Maintain a healthy weight.

How Is Venous Thromboembolism Diagnosed?

• Various tests are performed to differentiate and diagnose venous thromboembolism from other conditions with the same symptoms.

• Certain medical conditions, such as cellulitis, muscle injury, and inflammation of the veins, are similar to the signs and symptoms of deep vein thrombosis.

• Some medical conditions, such as pneumonia and heart attack, may have similar symptoms to pulmonary embolism.

• Therefore, specialized tests are introduced to detect a blood clot in the veins of the lungs.

Deep Vein Thrombosis:

• An imaging test called duplex ultrasonography is used in which the waves are used to check the blood flow in the veins. It is a standard method to detect blood clots or blockages in the deep veins.

• Contrast venography is a type of X-ray in which a contrast material is injected into the large vein of the foot or ankle. It is used to view the deep veins in the hips and legs.

Pulmonary Embolism: A special type of X-ray called computed tomographic pulmonary angiography (CTPA) is performed by injecting contrast material (dye) into a vein. This is the standard method to diagnose pulmonary embolism, and it provides images of blood vessels in the lungs.

What Is the Treatment of Venous Thromboembolism?

The initial treatment step includes drug therapy; later vena cava filter is used if medicines cannot be taken.

Medicines:

• Thrombin Inhibitors (Medicines That Interfere With Clot Formation): These medicines are used as an alternative to Heparin. It is administered in the form of an injection (shot).

• Anticoagulants (Blood Thinners): These medicines prevent new clot formation and inhibit the progression of the formation of larger clots. Heparin and Warfarin have been used as anticoagulants for a long time. The common side effect is bleeding when taken alongside blood thinners such as Aspirin. Newer anticoagulants can be administered in pills, injections, or intravenously.

• Thrombolytics (Medicines To Dissolve Blood Clots): Thrombolytics are used in the case of large blood clots that can cause serious complications and severe symptoms. This medicine is administered intravenously. It is used only in serious or life-threatening conditions such as pulmonary embolism.

Catheter-Assisted Thrombus Removal:

• In a few cases, catheter-assisted thrombus removal is followed.

• In this technique, a flexible tube is used to reach a blood clot in the lungs. A tool is inserted through the tube to break the clot or deliver the medicine through the tube.

Vena Cava Filter:

• Vena cava filter is indicated in some cases that are contraindicated to blood thinners to treat deep vein thrombosis.

• The filter is placed inside the large vein called the vena cava. These filters catch up with blood clots before they reach the lungs, resulting in the prevention of pulmonary embolism.

• This filter is not indicated or recommended in patients taking blood thinners.

• One of the main disadvantages is that it does not help stop the formation of new blood clots.

Conclusion:

Venous thromboembolism is one of the common conditions which can be quite severe and lead to life-threatening situations. It is important to avoid being sedentary and move around to avoid being affected or to prevent the worsening of the condition. A proper diagnosis and timely management help in the positive outcome of this condition.