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Patient education: Deep vein thrombosis (blood clot in the leg) (The Basics)

Patient education: Deep vein thrombosis (blood clot in the leg) (The Basics)

What is deep vein thrombosis? — Deep vein thrombosis ("DVT") is the medical term for a blood clot in the deep veins of the leg (figure 1). DVT can be dangerous.

Sometimes, DVT can happen in an arm instead of a leg. But this is much less common.

Why are blood clots dangerous? — If a blood clot forms inside a blood vessel, it can clog the vessel and keep blood from getting where it needs to go. When that happens to 1 of the veins deep within the leg, blood can back up and cause swelling and pain.

Blood clots in veins can also travel to other parts of the body and clog blood vessels there. For example, a clot that forms in the leg could end up blocking a blood vessel in the lung. This can make it hard to breathe and sometimes, if the clot is large, can lead to death. When a blood clot travels to the lungs, doctors call it "pulmonary embolism" ("PE").

What are the symptoms of DVT? — DVT can cause the following symptoms in the involved leg:

Swelling

Pain

Warmth and redness

Sometimes, clots form in the veins that are closer to the surface of the skin, called the "superficial veins." Those blood clots cause a different set of symptoms. Blood clots in the veins near the surface of the skin are more painful and cause redness or infection. These clots sometimes also cause the veins to harden and bulge into ridges that look like cords. This is most common with the veins below the knee.

If you think that you have a blood clot in your leg, call your doctor or nurse right away. Blood clots in the veins near the surface of the skin are less dangerous. But blood clots in the deep veins of the leg are more serious. Your doctor or nurse can do tests to find out if you do have a clot that needs to be treated.

What are the symptoms of a blood clot in the lungs? — Blood clots in the lungs can cause:

Panting, shortness of breath, or trouble breathing

Sharp, knife-like chest pain when you breathe in or strain

Coughing or coughing up blood

Rapid heartbeat

If you get any of these symptoms, especially if they happen over a short period of time (hours or days) or get worse quickly, call for an ambulance (in the US and Canada, call 9-1-1). At the hospital, doctors can do tests to find out if you do have a clot. Blood clots in the lungs can lead to death. That's why it's important to act fast and find out if there is a clot.

How is DVT treated? — DVT is treated with medicines that keep the clot from getting bigger and traveling to the lung. These medicines are called "anticoagulants." They are also sometimes called "blood thinners," although they do not actually thin the blood. Some come in shots, and others come in pills. DVT is usually treated first in the hospital.

If you have had a clot, your doctor will prescribe an anticoagulant medicine to lower your risk of getting more clots in the future. You will need to take the medicine for at least 3 months (and sometimes longer). Some people are first put on a medicine that comes as a shot, called heparin. This might be for a few days, or longer if for some reason you can't take pills.

The medicines do not dissolve existing blood clots, but they do keep them from getting bigger. They also help keep new blood clots from forming. Taking the medicine for a few months is important because it gives your body time to dissolve the old clot. It's also important because people who have a clot are at risk of developing another clot, especially in the first few months.

There are different oral medicines (pills) used to prevent and treat blood clots. They include apixaban (brand name: Eliquis), dabigatran (brand name: Pradaxa), edoxaban (brand names: Savaysa, Lixiana), rivaroxaban (brand name: Xarelto), and warfarin (brand name: Jantoven). Each medicine is different in terms of the dose, how often you take it, the cost, and how your diet or other medicines might affect it (table 1). Your doctor can talk to you about your options and preferences.

If your doctor prescribes 1 of these medicines:

Take it exactly as your doctor tells you to – If you forget or miss a dose, call your doctor to find out what to do. When you start taking the medicine, you will need to have your blood tested. If you take warfarin, you will need regular blood tests to check how your blood is clotting. This is important to make sure that you get the correct dose of warfarin for you.

Follow your doctor's instructions about diet and medicines – Depending on which medicine you take, you might need to pay special attention to what you eat. Also, certain other medicines can affect the way these medicines work.

Watch for signs of bleeding – Abnormal bleeding is a risk with any of the medicines used to prevent and treat blood clots. These medicines help prevent dangerous blood clots, but they also make it harder for your body to control bleeding after an injury. Try to avoid getting injured, and tell your doctor right away if you do have signs of bleeding.

People who cannot take medicines to prevent and treat blood clots, or who do not get enough benefit from the medicines, can get a different treatment. This is called an "inferior vena cava filter" ("IVC filter"). The inferior vena cava is the large vein that carries blood from your legs and the lower half of your body back up to your heart. IVC filters go inside the inferior vena cava. They filter and trap any large clots that form below the location of the filter. Your doctor might suggest this if:

You cannot safely take a medicine for blood clots.

You form clots even while taking a medicine for blood clots.

You have a dangerous bleeding problem while taking a medicine for blood clots.

You are so sick that if a blood clot that travels from your legs to your lungs it could kill you.

In some cases, severe clots can cut off the blood supply to your leg. This is called "gangrene." If this happens, doctors can give medicine to dissolve the clot. This is sometimes called "clot-busting" medicine, and is given through a catheter (a small tube inserted into a vein). In some cases, doctors will do surgery to remove the clot.

Can I do anything on my own to prevent blood clots? — Yes. People sometimes form clots because they have been sitting still for too long. People who travel on long airplane flights, for example, are at increased risk of blood clots. Some things that you can do to help prevent a clot during a long flight include:

Stand up and walk around every 1 to 2 hours.

Do not smoke just before your trip.

Wear loose, comfortable clothes.

Change your position while seated, and move your legs and feet often.

Wear knee-high compression stockings.

Avoid alcohol and medicines that make you sleepy, because they can impair your ability to move around.

More on this topic

Patient education: Choosing an oral medicine for blood clots (The Basics)
Patient education: Taking oral medicines for blood clots (The Basics)
Patient education: Staying healthy when you travel (The Basics)
Patient education: What can go wrong after a heart attack? (The Basics)
Patient education: Duplex ultrasound (The Basics)
Patient education: Factor V Leiden (The Basics)
Patient education: Superficial vein phlebitis and thrombosis (The Basics)
Patient education: Pulmonary embolism (blood clot in the lung) (The Basics)
Patient education: How to give an anticoagulant shot (The Basics)
Patient education: D-dimer test (The Basics)
Patient education: Lowering the risk of a blood clot (The Basics)
Patient education: Clot-dissolving medicines for heart attack or stroke (The Basics)
Patient education: Deep vein thrombosis – Discharge instructions (The Basics)

Patient education: Lower extremity chronic venous disease (Beyond the Basics)
Patient education: Deep vein thrombosis (DVT) (Beyond the Basics)
Patient education: Pulmonary embolism (Beyond the Basics)
Patient education: Warfarin (Beyond the Basics)

This topic retrieved from UpToDate on: Feb 02, 2024.
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