Deep vein thrombosis

Off to the doctor, quickly

You must consult your doctor in case of any suspicion of a deep vein thrombosis.

Blood clots form primarily in the veins of the legs and pelvis. These blood vessels collect the blood from the feet, the legs and the pelvis and transport it back to the heart. A deep vein thrombosis must be treated by a doctor immediately.

The risk of a pulmonary embolism occurring is particularly high if the deep veins of the leg are affected. A thrombus in the affected vein becomes dislodged and is swept into the lung by the blood flow, where it can block a vessel. In contrast, if the same thing happens in one of the superficial veins in the legs, the clot first has to meander in the direction of the deep leg veins, which is less risky.

Development of a thrombus

Symptoms of a deep vein thrombosis

The most common symptoms are

• Aching, dragging pain
• Redness or blue discolouration of the skin
• Feeling of tension and swelling

A thrombosis can occur in the groin, in the thigh, in the hollow of the knee, in the calf or in the sole of the foot. Standing and walking are then especially painful.

How a deep vein thrombosis develops

A blood clot can form if

• the blood's flow rate slows down, for example, during confinement to bed or on long-haul flights
• the walls of the blood vessel have changed
• the blood has a high clotting susceptibility.

The blood flows more slowly in veins than in arteries, which is why thromboses occur above all in the veins. The deep veins in the calf and thigh are mostly affected by deep vein thrombosis (phlebothrombosis).

Diagnosis of deep vein thrombosis

Rapid diagnosis and treatment of deep vein thrombosis are required to prevent a pulmonary embolism. Examination of the painful region and measurements of a special blood parameter in the laboratory corroborate the diagnosis of suspected thrombosis. The doctor uses Doppler and duplex ultrasonography to localise a deep vein thrombosis exactly before he treats it.

Who has a higher risk of suffering a deep vein thrombosis?

Elderly men and women have about the same risk of suffering a deep vein thrombosis. In younger years, more women are affected by deep vein thrombosis than men. The reasons for this are:

How you can prevent deep vein thrombosis (thrombosis prophylaxis)

The combination of medicamentous and physical measures is standard for thrombosis prophylaxis in Germany. Your doctor decides on the type of medication, the dosage form, the dosage and the treatment period.

• The objective of all physical measures is to improve venous return flow (circulatory factor). There are various ways and means of achieving this objective:
• Medical thrombosis prophylaxis stockings (standardised compression)
• Circular bandaging (non-standardised compression)
• Lower leg wrap-around compression system

Further examples of physical prophylactic measures are early mobilisation, mobilisation treatment and elevation of the legs

Your contact in case of deep vein thrombosis

• General practitioner
• Vein specialist
• Attending physician and nursing staff if hospitalised

How is a deep vein thrombosis treated?

Many patients do not notice even severe thromboses at first. This is particularly dangerous because the blood clot that has precipitated the deep vein thrombosis can become dislodged again. If it reaches the lung, it can cause a life-threatening pulmonary embolism.

Treatment gives highest priority to:

• stopping the thrombosis growing
• removing the thrombosis
• preventing a pulmonary embolism
• preventing post-thrombotic syndrome (permanent damage to the venous valves).

The treatment strategy includes:

• Basic measures such as correct positioning or mobilisation and compression therapy
• Medication to make the blood thinner, such as heparin or Marcumar
• Thrombolysis to break down the blood clot (thrombus)
• Possibly an operation to remove the clot

Compression treatment

After a patient has been diagnosed with deep vein thrombosis, compression garments are indicated alongside the treatment with drugs. These exert mechanical pressure on the veins from the outside. They decrease the diameter of the vein and the blood flows back to the heart more quickly. The pressure on the leg follows a controlled gradient: it is strongest at the ankle and decreases up the leg. At a later date, doctors will check the extent to which return transport of the blood is still impaired. The doctor can then advise you whether the compression treatment has to be continued or whether you can stop wearing the garments.