DVT is a severe condition that happens when a blood clot develops in a vein located deep inside the body. A clot is a mass of blood in a viscous solid form. Deep vein blood clots evolve in the thigh or lower leg, although they can also develop in other tissues of the body. Mainly, this ailment has other names such as thromboembolism, post-phebitic syndrome, and post-thrombotic syndrome (Patel, Chun & Brenner, 2014). Deep vein thrombosis frequently occurs in individuals who are over 50 years of age. Nevertheless, some afflictions that change how the blood moves through the veins can increase the risk of developing clots.
According to Patel, Chun and Brenner (2014), such problems include an injury that damages the veins, having a catheter placed in a vein, family history of DVT, being obese, which lays more pressure on the veins in the legs and pelvis, and sitting for a long time mostly if one has at least one other risk element. Similarly, certain ailments and disorders can raise the risk of developing blood clots. For example, hereditary blood clotting afflictions, chiefly when one has at least one other risk aspect. Additionally, cancer and inflammatory bowel ailment can raise the risk. Heart failure, a condition that makes it difficult for the heart to pump blood, also leads to a high risk of clots. Other instances include surgery, especially in the lower extremities, pregnancy, and rheumatoid arthritis.
Symptoms of Deep Vein Thrombosis
Notably, signs and symptoms of DVT can be non-specific, which calls for additional diagnostic testing on patients, as the repercussion of missing a deeply rooted problem such as pulmonary embolism can be fatal. According to recent research, the extent of DVT in suspected patients was approximately 10-15% implying that doctors have a little verge for diagnostic testing (Geersing et al., 2014). Consequently, different clinical decision rules have been made to enhance the clinical examinations for suspected DVT such as the Wells rule and the Geneva score. These rules integrate various clinical aspects to produce a score that doctors then utilize to estimate the chance of DVT being present.
According to Geersing et al. (2014), the most commonly used clinical decision rule is the Wells rule, which uses information from a patients medical history and physical examination with pre-test probability tools, D-dimer testing and selective usage of confirmatory imaging. Nevertheless, Wells rules validity in some clinically essential subgroups is uncertain. The most prevalent symptoms of DVT include swelling of the foot, ankle, or leg, usually on either side, cramping pain in the affected leg that commonly starts in the calf, and grave and unexplained pain in the foot or ankle. Additionally, patients may have a region of skin that feels warmer than the skin of the neighboring areas and the skin over the affected area turning pale or a bluish color (Patel, Chun & Brenner, 2014).
Treatment Options
Lauw and Buller (2014) opine that once DVT is diagnosed, the goals of treatment are relief of the symptoms and prevention of embolization and recurrence. Mainly, doctors adopt anticoagulation options such as unfractioned heparin, fondaparinux, low molecular weight heparin, and the direct oral anticoagulants (DOACs). Unfractioned heparin is typically administered intravenously by continuous infusion after the administration of a loading dose. Notably, the anticoagulant response differs among patients because the drug binds nonspecifically to plasma and cellular proteins. Therefore, laboratory monitoring, with analysis of the activated partial thromboplastin time is necessary, with adjustment of the dose to attain the target therapeutic range. Mainly, this range depends on the type of reagent and coagulometer used to measure the activated partial thromboplastin time.
Lauw and Buller (2014) add that low molecular weight heparins are as efficient as unfractioned heparin in preventing the recurrence of DVT, but they cause less bleeding than unfractioned heparin. Similarly, they show less nonspecific binding, have enhanced bioavailability, and generate more foreseeable dose response than unfractioned heparin. Therefore, doctors administer low molecular weight heparins once or twice per day although in weight-adjusted doses normally without monitoring. Nevertheless, the agents often cross-react with a patients antibodies, which lead to heparin-induced thrombocytopenia, and are therefore, contraindicated in individuals with a history of this disorder. Outpatient therapy with low molecular weight heparins is efficient and safe for most patients. However, it is unrecompensed for patients with acute thrombosis or a high risk of hemorrhage such in old patients, individuals who have undergone surgery recently or have a history of bleeding.
On the other hand, thrombolytic therapy is recommended for extensive DVT. The thrombolytic agents dissolve new blood clots and reinstate venous patency faster than anticoagulants. There are administered by local catheter-directed infusion that results in is a higher local concentration of the drug than does the systemic administration. Nevertheless, this route causes considerably more bleeding than heparin. Therefore, this therapy is reserved for patients with limb-threatening thrombosis, with a small risk of bleeding and has had the symptoms for less than a week. Lastly, doctors put inferior vena cava filters in the large abdominal vein, which aid prevent pulmonary embolisms by ceasing clots from traveling to the lungs (Lauw & Buller, 2014). Notably, this treatment method is reserved for patients with acute DVT and contraindications to anticoagulation.
Conclusion
To conclude, it is clear that deep vein thrombosis is life threatening if not treated timely. Furthermore, it can lead to significant complications such as pulmonary embolism when the blood clot travels to the lungs. Consequently, it is essential that doctors apply effective diagnostics techniques to identify the often non-specific DVT signs and symptoms. Once the symptoms are evident, doctors can use various short-term and long-term treatment strategies to restore venous patency. Nevertheless, it is crucial to pay attention to the patients medical history to ensure the administration of the most efficient treatment. However, individuals can lower the risk of contracting DVT by making various lifestyle changes such keeping the blood pressure under control, losing weight, and exercising regularly to maintain the blood flowing.
References
Geersing, G. J., Zuithoff, N. P. A., Kearon, C., Anderson, D. R., Ten Cate-Hoek, A. J., Elf, J. L., ... & Schutgens, R. E. G. (2014). Exclusion of deep vein thrombosis using the Wells rule in clinically important subgroups: individual patient data meta-analysis. BMJ, 348, g1340.
Lauw, M. N., & Buller, H. R. (2014). Treatment of deep vein thrombosis. Future Medicine Ltd. Current Approaches to Deep Vein Thrombosis, 136-160.
Patel, K., Chun, L. J., & Brenner, B. E. (2014). Deep venous thrombosis. Medscape, emedicine. medscape. com.
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