DVT – Everything You Need To Know

A 47-year-old healthy man, without a history of blood pressure or diabetes, came to Udai Omni Hospital. He underwent an accident a month ago and fractured his leg. However, instead of getting proper hospital care he went to a ‘Quack’ doctor, who suggested a treatment that involved only tying cotton cloth straps to his leg and assured the patient that he could walk within a month. Even after a month, the patient was unable to walk and later developed right-sided chest pain and breathing associated with palpitations. Fortunately, he was brought to Udai Omni Hospital for treatment. A Cardiologist consultation was taken and his advice was followed.

Upon arrival, the patient was in quite a distressing condition with low oxygen saturation. His heart rate was 120 beats per minute (compared to normal heart rate which is 70-80 BPM), and his fractured limb was swollen and red. Looking at the redness, swelling and pain in the fractured limb, a large blood clot was suspected in the leg vein. A doppler study of his leg was done to confirm the clot, which came out negative.

Due to his low saturations, high heart rate, right-sided chest pain and a suspicious patch in his X-ray, it was crucial to rule out the fact that the clot may have migrated to his lung, causing a Pulmonary Embolism, which could have been life-threatening.

The next step was performing a CT scan of his chest with iodinated contrast drug, because of which it was found out that there was a clot in his lung arteries that had travelled from his fractured leg.
The seriousness of this condition was explained to the attendees. The patient was not in a condition to get operated on and required initial medical stabilization.
The cause of his deadly blood clot was the prolonged bed rest, which ultimately slowed down the blood flow in the leg, resulting in the formation of a blood clot.

Following our next course of action, we put him on a treatment dose of blood thinner injections which were injected below his skin two times a day. As the blood thinners started acting up, his symptoms started to come down and his heart rate and oxygen saturation levels normalized. The treatment was continued for the next 4 days, after which he was taken for surgery.

Our expert surgeons and the anaesthetic team made sure that the surgery was a success. The patient’s post OP recovery was smooth, and he was put on oral blood thinner medications for 3 months as per recommendation. He was doing fine by the end of it.

Let us learn more about this deadly blood clot –
This blood clot is called DVT or Deep Venous Thrombosis because it develops in deep veins usually when a patient is bedridden due to a fracture or critical illness. Some patients inherit this condition, which means that their blood has the tendency to develop clots on its own, hence DVT in such patients can occur without any precipitating cause.

How does clot form in the veins?
Deep veins of legs have a one-way valve in them so that blood travels from lower extremities towards the heart and cannot go backwards, as the blood has to travel against gravity; deep veins get constantly compressed by leg muscles which make this transport of blood possible towards the heart against gravity.

If a patient gets bedridden due to any reason (the most common cause of DVT), then this flow of blood is slowed down and blood comes to stasis and clots in the vein forming a DVT (Deep Vein Thrombosis).

What are the symptoms of DVT?
Once a DVT is formed the blood circulation in the leg is compromised and the leg gets swollen and red, causing extreme pain.

Can healthy and athletic people get DVT?
As in the above case, the patient was a 47-year old healthy male. So once a person becomes bedridden for more than 3 days, he is at risk of developing a DVT.

What are risk factors and causes?
Prolonged bedridden status
Use of oral contraceptive pills
Cancer and kidney disease
Ulcerative colitis or Crohn’s disease obesity
Prolonged sitting
Presence of inherited conditions like PROTEIN C and PROTEIN S deficiency
Factor V Leiden mutation
Prothrombin gene mutation, etc, can land a patient to develop DVT

How can it be diagnosed?
DVT is diagnosed with the help of DOPPLER EVALUATION of deep veins. This is a specialised type of ultrasound imaging where each vein is traced out and compressed with an ultrasound probe to detect if it’s non-compressible. If any vein is not able to compress, then the diagnosis shows an underlying DVT.

What are the treatment options?
Once DVT is diagnosed, blood thinner injections are given below the skin twice a day, later the patient is shifted to oral medications. The duration of blood thinner medications depends upon the cause of the DVT. If it is a transient phenomenon like a bedridden status due to a fracture or any critical illness, medications are given for 3 months and later discontinued but if DVT is due to an underlying genetic issue, the patient is put on lifelong anticoagulation.

Can DVT cause a stroke or heart attack?
DVT can travel from the leg vein towards the heart and get stuck in the heart blood vessel (PULMONARY ARTERY), causing a cardiac arrest. The sudden halt of the pumping function of the heart leads to death. This is called Pulmonary Thromboembolism and it is a life-threatening condition.

Sometimes few patients have undiagnosed holes in their heart walls. DVT can clot in them; they travel to the heart and across the heart hole, lodging itself in the brain which can then trigger a stroke, this is called a paralysis attack. This phenomenon is called a Paradoxical Embolism.

What can be done before and after surgery to prevent DVT?
Once patients suffer a fracture and become bed-bound, patients are put on blood thinner injections to prevent the development of DVT. Early fixation of fracture is important to prevent DVT. Blood thinner medications are put on hold before the surgery and resumed after the surgery. Once discharged, the patient is put on oral medications, the duration of which is decided depending upon the surgery that the patient has undergone.

How can we prevent DVT during travel?
Long-duration flights or long-duration bus or car journeys can also cause stasis of blood and the formation of DVT. This can be avoided by constant movement during your travel, like for example, you can simply take a walk inside the bus or take breaks for a stroll during your drive. All these measures can help to prevent DVT formation.