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Γράφει ο Δρ. Θεοδόσιος Μπίσδας, Διευθυντής Γ’ Αγγειοχειρουργικής Κλινικής, Ιατρικό Κέντρο Αθηνών, Αναπληρωτής Καθηγητής Αγγειοχειρουργικής, Πανεπιστημιακή Κλινική Muenster Γερμανίας

Τι είναι εν τω βάθει φλεβοθρόμβωση;

Η εν τω βάθει φλεβοθρόμβωση είναι μια σοβαρή κατάσταση η οποία συμβαίνει όταν ένας θρόμβος αποφράσσει μια φλέβα που βρίσκεται βαθιά μέσα στο σώμα μας. Οι θρόμβοι είναι πήγματα αίματος -δηλαδή σχηματισμοί από αίμα που έχει πήξει, που μπορούν να σχηματιστούν στο εσωτερικό μιας φλέβας και να σταματήσουν τη ροή του αίματος.

Οι φλεβικοί θρόμβοι τυπικά εμφανίζονται στο πόδι αλλά μπορούν να εμφανιστούν και σε άλλα σημεία του σώματος. Το σημαντικότερο είναι όμως ότι οι θρόμβοι μπορούν να ταξιδέψουν προς την καρδιά και συγκεκριμένα προς τις πνευμονικές αρτηρίες και να προκαλέσουν την πολύ σοβαρή επιπλοκή της πνευμονικής εμβολής.

Ποια είναι τα πρώτα συμπτώματα;

Τα κύρια συμπτώματα της εν τω βάθει ή επιφανειακής φλεβοθρόμβωσης στο πόδι μπορούν να συνοψιστούν στα παρακάτω:

• του κάτω άκρου μόνο από το πόδι που έχει θρόμβωση
• και έντονος πόνος στη γάμπα του ποδιού που έχει τη θρόμβωση
• Έντονος κι ανεξήγητος πόνος στο πόδι και στον αστράγαλο
• Αίσθημα ζέστης (καύσου) με έντονο πόνο και ερυθρότητα τοπικά στο κάτω άκρο (κυρίως στην έσω πλευρά του ποδιού ή κατά μήκος της γάμπας
• Έντονος πόνος και ερυθρότητα του δέρματος τοπικά στο κάτω άκρο

Τα κύρια συμπτώματα της εν τω βάθει ή επιφανειακής φλεβοθρόμβωσης στο χέρι μπορούν να συνοψιστούν στα παρακάτω:

• Πόνος στο τράχηλο ή/και τον αυχένα
• Πόνος στον ώμο και κατά μήκος του χεριού
• Οίδημα (πρήξιμο) του βραχίονα και του χεριού
• Μπλε χρώμα του δέρματος
• Αδυναμία κίνησης του χεριού

Μερικοί ασθενείς μπορεί να μην συνειδητοποιήσουν ότι έχουν φλεβοθρόμβωση και η διάγνωση γίνεται στο νοσοκομείο με τα συμπτώματα της πνευμονικής εμβολής που μπορούν να ποικίλουν από έντονο πόθος στο στήθος, μέχρι δύσπνοια, απώλεια συνείδησης ή και ανακοπή της καρδιάς.

Τι μπορεί να προκαλέσει την εν τω βάθει φλεβοθρόμβωση;

Η εν τω βάθει φλεβοθρόμβωση προκαλείται από τη δημιουργία θρόμβου στον αυλό των φλεβών. Οι κύριες αιτίες που μπορούν να δημιουργήσουν θρόμβωση είναι:

• Τραύμα: Ο τραυματισμός ενός αγγείου μπορεί να στενέψει τον αυλό του ή να μπλοκάρει την κυκλοφορία του αίματος. Αυτό οδηγεί στη δημιουργία φλεβοθρόμβωσης.
• Χειρουργική επέμβαση: Κατά τη διάρκεια χειρουργικών επεμβάσεων είτε εξαιτίας τραυματισμού των αγγείων, είτε εξαιτίας μετεγχειρητικής ακινησίας  
• Reduced mobility or inactivity. When you sit frequently, blood can collect in your legs, especially the lower parts. If you’re unable to move for extended periods of time, the blood flow in your legs can slow down. This can cause a clot to develop.
• Certain medications. Some medications increase the chances your blood will form a clot.

DVT treatment

DVT is a serious medical condition. Tell your doctor right away if you think you’re experiencing symptoms of DVT or go to the closest emergency room. A healthcare provider can check out your symptoms.

DVT treatments focus on keeping the clot from growing. In addition, treatment may help prevent a pulmonary embolism and lower your risk of having more clots.

Medication

Your doctor might prescribe medications that thin your blood, like heparin, warfarin (Coumadin), enoxaparin (Lovenox), or fondaparinux (Arixtra). This makes it harder for your blood to clot. It also keeps existing clots as small as possible and decreases the chance that you’ll develop more clots.

If blood thinners don’t work, or if you have a severe case of DVT, your doctor might use thrombolytic drugs. People with upper extremity DVT may also benefit from this medication.

Thrombolytic drugs work by breaking up clots. You’ll receive these intravenously. Read more about these drugs and how they can help prevent and destroy blood clots.

Compression stockings

If you’re at high risk for DVT, wearing compression stockings can prevent swelling and might lower your chance of developing clots.

Compression stockings reach just below your knee or right above it. Your doctor may recommend you wear these every day.

Filters

You might need to have a filter put inside the large abdominal vein called the vena cava if you aren’t able to take blood thinners. This form of treatment helps prevent pulmonary embolisms by stopping clots from entering your lungs.

But filters do have risks. If they’re left in for too long, they can actually cause DVT. Filters should be used for a short-term period, until the risk of thromboembolism is reduced and blood thinning medications can be used.

DVT surgery

Your doctor may suggest surgery to remove a DVT clot in your arm or leg. This is typically only recommended in the case of very large blood clots or clots that are causing serious issues, like tissue damage.

During a surgical thrombectomy, or surgery to remove a blood clot, your surgeon will make an incision into a blood vessel. They’ll locate and remove the clot. Then, they’ll repair the blood vessel and tissue.

In some cases, they may use a small inflating balloon to keep the blood vessel open while they remove the clot. When the clot is found and removed, the balloon is removed with it.

Surgery isn’t without risks, so many doctors will only use this treatment in severe cases. Risks include infection, damage to the blood vessel, and excess bleeding.

DVT exercise

The longer you sit, the greater your risk of developing a blood clot. If you have to be seated for long periods, there are exercises you can do while sitting to keep your legs moving and help circulate blood.

Knee pulls

Bend your leg, and raise your knee toward your chest. Wrap your knee with your arms for a greater stretch. Hold this position for several seconds, then do the same exercise on the other side. Repeat these stretches several times.

Foot pumps

Place your feet flat on the floor. Keeping the balls of your feet on the floor, raise your heels. Hold for a few seconds, then lower the heels. Raise the balls of your feet off the floor, keeping your heels in place. Hold for a few seconds, then lower the balls of your feet.

Repeat these pumps several times.

Ankle circles

Lift both feet off the floor. Draw circles with your toes in one direction for a few seconds. Switch directions, and draw circles for a few seconds. Repeat this exercise several times.

DVT home remedies

Once a DVT blood clot is diagnosed, your doctor will likely prescribe a medication to help thin the blood or break up the clot. You can combine the prescribed medication with the following home remedies to prevent other complications and reduce the risk of future blood clots.

Move more

Take walks daily to improve blood flow. Shorter, frequent walks are better than one longer walk.

Keep your leg or arm elevated

This is especially important for legs. Blood can pool if your feet are on the ground all day. Use a stool or chair to keep your legs elevated and close to level with your hips.

Wear compression stockings

These specially designed stockings fit tightly around your feet and become gradually looser as they move up your leg to your knee. The compression helps prevent pooling and swelling, and it increases blood flow.

Most people don’t need them, but people at high risk for DVT may find them useful. Compression stockings may be beneficial when you’re traveling. Read more about how they help.

DVT risk factors

DVT occurs most commonly in people who are over 50 years of age. But they can still happen at any age. Certain conditions that alter how your blood moves through your veins can raise your risk of developing clots. These include:

• having an injury that damages your veins, like a bone fracture
• being overweight, which puts more pressure on the veins in your legs and pelvis
• having a family history of DVT
• having a catheter placed in a vein
• taking birth control pills or undergoing hormone therapy
• smoking (especially heavily)
• staying seated for a long time while you’re in a car or on a plane, especially if you already have at least one other risk factor

Some conditions can increase your risk of having blood clots. These include hereditary blood clotting disorders, especially when you have at least one other risk factor. Cancer and inflammatory bowel disease can also increase the risk of developing a blood clot.

Heart failure, a condition that makes it more difficult for your heart to pump blood, also causes an increased risk of clots.

DVT is a major risk associated with surgery. This is especially true if you’re having a surgery in the lower extremities, like joint replacement surgery.

Multiple factors can increase your risk of developing a blood clot. Learning more about each one can help you take precautions.

DVT prevention

You can lower your risk of having DVT by making a few lifestyle changes. These include keeping your blood pressure under control, giving up smoking, and losing weight if you’re overweight.

Moving your legs around when you’ve been sitting for a while also helps keep your blood flowing. Walking around after being on bed rest can prevent clots from forming.

Take any blood thinners your doctor prescribes if you’re having surgery, as this can lower your chance of developing clots afterward.

The risk of developing DVT during travel becomes higher if you’re sitting for more than four hours. Lower your risk by moving around every so often. Get out of your car and stretch at intervals during long drives. Walk in the aisles if you’re flying, taking a train, or riding a bus.

Stretch your legs and feet while you’re sitting — this keeps your blood moving steadily in your calves. Don’t wear tight clothes that can restrict blood flow. Complications of DVT are preventable. Learn how you can cut your risk.

DVT test

Your doctor will use your medical history, a thorough physical exam, as well as one or more diagnostic tests to find or rule out DVT. These tests include:

Ultrasound

This is the most commonly used test for diagnosing DVT. Ultrasound uses sound waves to create a picture of your arteries and veins in order to see how blood flows through them.

If a clot is present, your doctor will be able to see the interrupted blood flow and make the diagnosis.

Venogram

If the ultrasound is inconclusive, your doctor may order a venogram. During this test, a dye is injected into the vein in question. Then, an X-ray is taken over the area where your doctor suspects DVT is present.

The dye makes the vein more visible, so interrupted blood flow would be easily seen.

D-dimer test

A D-dimer blood test measures the presence of a substance that’s released when a blood clot breaks apart. If levels of the substance are high and you have risk factors for DVT, you likely have a clot. If levels are normal and your risk factors are low, you likely don’t.

Other tests can be used to diagnose DVT if these aren’t successful. Read more about each of them and how they can help your doctor find a blood clot.

DVT images

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DVT complications

A major complication of DVT is a pulmonary embolism. You can develop a pulmonary embolism if a blood clot moves to your lungs and blocks a blood vessel.

This can cause serious damage to your lungs and other parts of your body. Get immediate medical help if you have signs of a pulmonary embolism. These signs include:

• dizziness
• sweating
• chest pain that gets worse with coughing or inhaling deeply
• rapid breathing
• coughing up blood
• rapid heart rate

Many complications of DVT can be prevented. Read more about why they occur and what you can do to avoid them.

DVT in pregnancy

Being pregnant increases your risk of DVT. In fact, pregnant women are 5 to 10 times more likelyTrusted Source to develop DVT than women who aren’t pregnant.

While pregnant, the level of blood-clotting proteins increases, and the level of anticlotting proteins falls. Plus, increased hormone levels, and a slower blood flow as your uterus expands and restricts blood flowing back from your lower extremities, contribute to this risk.

The elevated risk continues until about six weeks after giving birth. Being on bed rest or having a cesarean delivery also increases your risk of having DVT.

Remain watchful for symptoms of DVT while you’re pregnant. Read about these symptoms and what to do if you experience them.

DVT and flying

Your risk of developing blood clots is higher when flying because sitting for long periods of time increases the chances of DVT.

The longer the flight, the greater the risk. It’s especially significant for people taking flights that last more than eight hours. Your risk also increases if you’re flying and already have other risk factors for DVT.

These measures can help you reduce your risk for a blood clot while flying:

• Sit in an exit row or bulkhead seat so you have more room to stretch and move your legs.
• Wear compression stockings, which reduce blood pooling and help maintain blood flow.
• Take any prescription blood thinners or aspirin as prescribed by your doctor.
• Do exercises with your feet and legs to keep blood flowing.
• Get up and walk around the cabin during the flight.

Symptoms of a blood clot may not develop immediately after flying. Read more about when symptoms might occur after a flight and how you should treat them.

DVT and diet

A healthy lifestyle is important for preventing DVT and helping to avoid life-threatening complications. Plus, a healthy lifestyle incorporates many of the changes that are necessary to prevent blood clots. This includes moving more, quitting smoking, and losing weight.

You can lower your risk for DVT and blood clots with a healthy diet. Fruits, vegetables, and whole grains deliver essential vitamins and minerals.

A vegan, vegetarian, or Mediterranean diet may be best for people at risk of DVT or people who’ve had DVT before, but research is needed to support this. Eating these herbs in small amounts may help you reduce your risk of DVT, too.

But some vitamins and minerals can interfere with DVT medications. For example, too much vitamin K can bypass warfarin’s ability to thin your blood and prevent a clot.

Review any vitamins or supplements you take with your doctor and ask about possible interactions with medications. It’s also important you talk with your doctor about any foods or nutrients you should avoid.