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Deep Vein Thrombosis

(DVT; Thrombophlebitis)

Definition

Deep vein thrombosis (DVT) is a blood clot in a vein deep in the body. Veins are blood vessels with valves that help prevent backward blood flow. Blood is pushed through the veins in legs and arms when muscles contract.
Deposits of red blood cells and clotting elements in the blood can build up in a vein. This build up leads to a blood clot. Clots usually occur in the legs, but can occur in other locations. As the clot grows, it blocks blood flow in the vein.
Deep Vein Thrombosis
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Causes

Several factors contribute to clot formation, including:
  • Slow blood flow, often due to lying or sitting still for a long period of time
  • Pooling of blood in a vein, often due to:
    • Immobility
    • Medical conditions
    • Damage to valves in a vein or pressure on the valves, such as during pregnancy
  • Injury to a blood vessel
  • Clotting problems, which can occur due to aging or disease
  • Catheters placed in a vein

Risk Factors

Risk factors for DVT include:

Symptoms

Symptoms occur when:
  • The clot interferes with blood flow in the vein
  • Local inflammation occurs
  • A clot breaks free and travels to the lungs
Some patients may not have any symptoms until the clot moves to the lungs. This condition is called pulmonary embolism .
Symptoms of DVT may include:
  • Pain
  • Swelling of a limb
  • Tenderness along the vein, especially near the thigh
  • Warmth
  • Redness, paleness, or blueness of the skin of the affected limb

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.
  • Your blood and blood flow may be tested. This can be done with:
    • Blood tests
    • Impedance plethysmography
    • Duplex venous ultrasound
  • You may have images taken. This can be done with venography .

Treatment

Treatment aims to:
  • Prevent pulmonary embolism
  • Stop the clot from growing
  • Dissolve the clot, if possible
Treatments include:

Supportive Care

This may include:
  • Resting in bed
  • Elevating the affected limb above the heart
  • Wearing compression stockings as advised by your doctor

Medications

You may be prescribed blood thinning medication to prevent additional clots from forming. These may be given by injection or by mouth. This treatment may be continued long-term.

Surgery

In some cases, a filter may be placed in the inferior vena cava. The vena cava is a major vein. Blood from the lower body returns to the heart through this vein. The filter may trap a clot that breaks loose before it travels to the lungs.

Prevention

General prevention measures include:
  • Having tests that monitor your use of blood thinners.
  • Do not sit for long periods. If you are in a car or airplane or at a computer, get up often and move around.
  • Do not smoke.
If you are admitted to the hospital, talk to your doctor about how to prevent blood clots, such as:
  • Get out of bed and walk as soon as possible during your recovery.
  • If you are restricted to bed:
    • Do range of motion exercises in bed.
    • Change your position at least every two hours.
  • Wear compression stockings to promote venous blood flow.
  • Use a pneumatic compression device. This device uses air to compress your legs and help improve venous blood flow.
  • If prescribed by your doctor, take medication to reduce blood clots. This medication can reduce your chance of death due to blood clots.

RESOURCES

American Heart Association http://www.heart.org

American Venous Forum http://veinforum.org

CANADIAN RESOURCES

Heart and Stroke Foundation of Canada http://ww1.heartandstroke.ca

Health Canada http://www.hc-sc.gc.ca

References

Buller HR, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(suppl 3):401S-428S.

Cecil RL, Goldman L, Bennett J. Cecil Textbook of Medicine. 21st ed. Philadelphia, PA: WB Saunders Company; 2000.

Church V. Staying on guard for DVT & PE. Nursing. 2000;30(2):34-42.

Conn HF, Rakel RE. Conn's Current Therapy 2001. 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.

Deep vein thrombosis (DVT). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated May 2, 2013. Accessed May 7, 2013.

Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(suppl 3):338S-400S.

Harrison TR, Fauci AS. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.

Hirsch J, Hoak J. Management of deep vein thrombosis and pulmonary embolism. Circulation. 1996;93(12):2212-2245.

Ramzi DW, Leeper KV. DVT and pulmonary embolism: Part I. Diagnosis. Am Fam Physician. 2004;69(12):2829-2836.

Ramzi DW, Leeper KV. DVT and pulmonary embolism: Part II. Treatment and prevention. Am Fam Physician. 2004;69(12):2841-2848.

Rosen P, Barkin RM, Danzl DF, et al. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St. Louis, MO: Mosby-Year Book, Inc; 1998.

Segal JB. Streiff MB. Hoffman LV. Thornton K. Bass EB. Management of venous thromboembolism: a systematic review for a practice guideline. Ann Intern Med. 2007;146(3):211-222.

10/27/2006 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Junger M, Diehm C, Storiko H, et al. Mobilization versus immobilization in the treatment of acute proximal deep venous thrombosis: a prospective, randomized, open, multicentre trial. Curr Med Res Opin. 2006;22:593-602.

5/11/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Bezemer ID, van der Meer FJ, Eikenboom JC, Rosendaal FR, Doggen CJ. The value of family history as a risk indicator for venous thrombosis. Arch Intern Med. 2009;169:610-615.

6/4/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Bahl V, Hu HM, Henke PK, Wakefield TW, Campbell DA Jr, Caprini JA. A validation study of a retrospective venous thromboembolism risk scoring method. Ann Surg. 2010;251(2):344-350.

10/5/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Parker C, Coupland C, Hippisley-Cox J. Antipsychotic drugs and risk of venous thromboembolism: nested case-control study. BMJ. 2010;341:c4245.

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