Deep venous thrombosis is a blood clot that forms in a vein deep inside a part of the body. It mainly affects the large veins in the lower leg and thigh.
DVT; Blood clot in the legs; Thromboembolism; Post-phlebitic syndrome; Post-thrombotic syndrome
DVTs are most common in adults over age 60. However, they can occur at any age. When a clot breaks off and moves through the bloodstream, this is called an embolism. An embolism can get stuck in the brain, lungs, heart, or other area, leading to severe damage.
Blood clots may form when something slows or changes the flow of blood in the veins. Risk factors include:
· A pacemaker catheter that has been passed through the vein in the groin
· Bed rest
· Family history of blood clots
· Fractures in the pelvis or legs
· Giving birth within the last 6 months
· Recent surgery (most commonly hip, knee, or female pelvic surgery)
· Too many blood cells being made by the bone marrow, causing the blood to be thicker than normal
Blood is more likely to clot in someone who has certain problems or disorders, such as:
Your doctor will give you medicine to thin your blood (called an anticoagulant). This will keep more clots from forming or old ones from getting bigger. These drugs do not dissolve clots you already have—that is accomplished by your body’s natural blood system.
Heparin is usually the first drug you will receive.
If heparin is given through a vein (IV), you must stay in the hospital.
Newer forms of heparin can be given by injection under your skin once or twice a day. You may not need to stay in the hospital as long, or at all, if you are prescribed this newer form of heparin.
Depending on your medical history, fondaparinux may be recommended by your doctor as an alternative to heparin.
A drug called warfarin (Coumadin) is usually started along with heparin.
Warfarin is taken by mouth. It takes several days to fully work.
Heparin is not stopped until the warfarin has been at the right dose for at least 2 days.
You will most likely take warfarin for at least 3 months. Some people must take it longer, or even for the rest of their lives, depending on their risk for another clot.
Take the medicine just the way your doctor prescribed it
Ask the doctor what to do if you miss a dose
Get blood tests as advised by your doctor to make sure you are taking the right dose
Learn how to take other medicines and when to eat
Find out how to watch for problems caused by warfarin
Newer blood thinning medicines that are taken by mouth are being developed. Your doctor may recommend one of these for you.
You will be given a pressure stocking to wear on your leg or legs, along with other discharge instructions. A pressure stocking improves blood flow in your legs, and reduces your risk for complications from blood clots. It is important to wear it every day.
In rare cases, you may need surgery if medicines do not work.
Surgery may involve:
Placing a filter in the body's largest vein to prevent blood clots from traveling to the lungs
Removing a large blood clot from the vein or injecting clot-busting medicines
Many DVTs disappear without a problem, but they can return. Some people may have long-term pain and swelling in the leg called post-phlebitic syndrome.
You may also have pain and changes in skin color. These symptoms can appear right away, or you may not develop them for 1 or more years afterward. Wearing tight (compression) stockings during and after the DVT may help prevent this problem.
Blood clots in the thigh are more likely to break off and travel to the lungs (pulmonary embolus, or PE) than blood clots in the lower leg or other parts of the body.
When to Contact a Medical Professional
Call your health care provider if you have symptoms of DVT.
Go to the emergency room or call the local emergency number (such as 911) if you have DVT and you develop:
Guyatt GH, Akl EA, Crowther M, et al. Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis. 9th ed. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 suppl):7s-47s.Â
Snow V, Qaseem A, Barry P, et al. Management of venous thromboembolism: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2007;146(3):204-210.
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, and Nissi Wang.