Deep Vein Thrombosis and Pulmonary Embolism

Far too many Americans are dying of dangerous blood clots that can masquerade as simple leg pain, according to a major new government effort to get patients and their doctors to recognize this important cause of significant morbidity and mortality. 

A deep vein thrombosis, or DVT, forms in large veins, usually a leg or the groin. It can quickly kill if it moves up to the lungs, where it goes by the name pulmonary embolism, or PE.  

The surgeon general’s campaign estimates that every year, between 350,000 and 600,000 Americans get one of these clots, and at least 100,000 of them die.   The Surgeon General has issued a "Call to Action" to address the issue of lack of recognition and early treatment of DVT and people at risk for this condition. 

Who Is At Risk?

Risk factors and triggers include recent surgery or a broken bone, a fall or car accident, pregnancy or taking birth control pills or menopause hormones,  and being immobile for long periods. The risk rises with age, especially over 65, and among people who smoke or are overweight.

Since some people have genetic conditions that cause no other symptoms but increase their risk, telling your doctor if a relative has ever suffered any type of  blood clot is vital.

What are the Symptoms?

Deep Vein Thrombosis

Only about half of the people with DVT have symptoms. These symptoms occur in the leg affected by the deep vein clot. They include:

• Swelling of the leg or along a vein in the leg
• Pain or tenderness in the leg, which you may feel only when standing or walking
• Increased warmth in the area of the leg that's swollen or in pain
• Red or discolored skin on the leg

Pulmonary Embolism

Some people don't know they have DVT until they have signs or symptoms of PE. Symptoms of PE include:

• Unexplained shortness of breath
• Pain with deep breathing
• Coughing up blood

Rapid breathing and a fast heart rate also may be signs of PE.

How Is Deep Vein Thrombosis Diagnosed?

Your doctor will diagnose deep vein thrombosis based on your medical history, a physical exam, and the results from tests. He or she will identify your risk factors and rule out other causes for your symptoms.

Medical History

To learn about your medical history, your doctor may ask about:

• Your overall health
• Any prescription medicines you're taking
• Any recent surgeries or injuries you've had
• Whether you've been treated for cancer
• Family history of unexplained blood clots or strokes

Physical Exam

During the physical exam, your doctor will check your legs for signs of DVT. He or she also will check your blood pressure and your heart and lungs.

Diagnostic Tests

You may need one or more tests to find out whether you have DVT. The most common tests used to diagnose DVT are:

• Ultrasound. This is the most common test for diagnosing deep vein blood clots. It uses sound waves to create pictures of blood flowing through the arteries and veins in the affected leg.
• A D-dimer test. This test measures a substance in the blood that's released when a blood clot dissolves. If the test shows high levels of the substance, you may have a deep vein blood clot. If your test is normal and you have few risk factors, DVT isn't likely.
• Venography. This test is used if ultrasound doesn't provide a clear diagnosis. Dye is injected into a vein, and then an x ray is taken of the leg. The dye makes the vein visible on the x ray. The x ray will show whether blood flow is slow in the vein. This may indicate a blood clot.

Other less common tests used to diagnose DVT include magnetic resonance imaging (MRI) and computed tomography (CT) scanning. These tests provide pictures of the inside of the body.

You may need blood tests to check whether you have an inherited blood clotting disorder that can cause DVT. You may have this type of disorder if you have repeated blood clots that can't be linked to another cause, or if you develop a blood clot in an unusual location, such as a vein in the liver, kidney, or brain.

How Is Deep Vein Thrombosis Treated?

Anticoagulants

Anticoagulants are the most common medicines for treating DVT. They're also known as blood thinners.

These medicines decrease your blood's ability to clot. They also stop existing blood clots from getting bigger. However, blood thinners can't break up blood clots that have already formed.

Blood thinners can be taken as either a pill, an injection under the skin, or through a needle or tube inserted into a vein.

Warfarin and heparin are two blood thinners used to treat DVT. Warfarin is given in pill form. (Coumadin^® is a common brand name for warfarin.) Heparin is given as an injection or through an IV tube. There are different types of heparin.

Your doctor may treat you with both heparin and warfarin at the same time. Heparin acts quickly. Warfarin takes 2 to 3 days before it starts to work. Once the warfarin starts to work, the heparin is stopped.

Pregnant women usually are treated with heparin only, because warfarin is dangerous during pregnancy.

Treatment for DVT with blood thinners usually lasts from 3 to 6 months. The following situations may change the length of treatment.

• If your blood clot occurred after a short-term risk (for example, surgery), your treatment time may be shorter.
• If you've had blood clots before, your treatment time may last longer.
• If you have certain other illnesses, such as cancer, you may need to take blood thinners for as long as you have the illness.

The most common side effect of blood thinners is bleeding. This happens if the medicine thins your blood too much. This side effect can be life threatening.

Sometimes, the bleeding is internal (inside your body). People treated with blood thinners usually receive regular blood tests to measure their blood's ability to clot. These blood tests are called PT and PTT tests.

Thrombolytics

These medicines are given to quickly dissolve a blood clot. They're used to treat large blood clots that cause severe symptoms.

Because thrombolytics can cause sudden bleeding, they're used only in life-threatening situations.

Other Types of Treatment

Vena Cava Filter

A vena cava filter is used if you can't take blood thinners or if you're taking blood thinners and still developing blood clots.

The filter is inserted inside a large vein called the vena cava. The filter catches blood clots that break off in a vein before they move to the lungs.

Graduated Compression Stockings

These stockings can reduce the swelling that may occur after a blood clot has developed in your leg. Graduated compression stockings are worn on the legs from the arch of the foot to just above or below the knee.

The stockings are tight at the ankle and become looser as they go up the leg. This creates gentle pressure up the leg. The pressure keeps blood from pooling and clotting.

Preventing DVT and PE

If you're at risk for DVT or PE, you can help prevent the conditions by:

• Seeing your doctor for regular checkups.
• Taking all medicines your doctor prescribes.
• Getting out of bed and moving around as soon as possible after surgery or illness. This lowers your chance of developing a blood clot.
• Exercising your lower leg muscles during long trips. This helps prevent a blood clot from forming.

Travel Tips to Help Prevent DVT and PE

Your risk of developing DVT while traveling is small. The risk increases if the travel time is longer than 4 hours, or if you have other risk factors for DVT.

During long trips, it may help to:

• Walk up and down the aisles of the bus, train, or airplane. If traveling by car, stop about every hour and walk around.
• Move your legs and flex and stretch your feet to encourage blood flow in your calves.
• Wear loose and comfortable clothing.
• Drink plenty of fluids and avoid alcohol.

If you're at increased risk for DVT, your doctor may recommend wearing compression stockings during travel or taking a blood-thinning medicine before traveling.