Deep Venous Thrombosis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

By Kenneth Kee

Deep Venous Thrombosis (DVT) is a blood clot (thrombus) in a deep vein (venous) leading to the heart, normally in the legs.
The blood clot may either block the vein completely or partially.
Deep venous thrombosis is a blood clot that forms in a vein deep inside a part of the body.
DVT normally happens in a deep leg vein, a larger vein that extends through the muscles of the calf and the thigh.
It can cause pain and swelling in the leg and may result in complications such as pulmonary embolism.
This is when a piece of blood clot breaks off into the bloodstream and obstructs one of the blood vessels in the lungs.
DVT and pulmonary embolism together are known as venous thromboembolism (VTE).
Clots can form in superficial veins (called superficial thrombophlebitis or phlebitis) and in deep veins because of poor blood flow or stasis.
Blood clots in deep veins (Deep Venous Thrombosis) need immediate medical care.
These blood clots are dangerous because they can break loose and then travel through the bloodstream to the lungs causing a pulmonary embolism
Deaths resulting from complications of DVT are not something new.
Blood clots most often form in the calf and thigh veins, and less often in the arm or pelvic veins.
DVT does not cause heart attack or stroke.
3 major factors have a part in the development of DVT:
1. Venous stasis
2. Damage of the vein
3. Higher coagulability
In some cases of DVT there may be no symptoms.
DVT can cause:
a. Pain, swelling and tenderness in one of the legs
b. Warm skin in the area of the clot
c. Heavy ache in the leg
d. Redness of the skin particularly at the back of the leg below the knee
DVT normally affects one leg
Diagnosis:
a. The above symptoms alone and a physical exam.
The exam may show a red, swollen, or tender leg.
b. D-dimer test
A specialized blood test called the D-dimer test is used to detect pieces of blood clot that have been broken down and are loose in the bloodstream.
Treatment of DVT
a. Prevent pulmonary embolism (PE),
b. Reduce morbidity,
c. Prevent or minimize the risk of developing the post-thrombotic syndrome (PTS).
An anticoagulant will keep more clots from forming or old ones from getting bigger.
These drugs do not dissolve clots already there.
That is accomplished by the body’s natural blood system.
Other anticoagulation drugs have subsequently been added to the treatment over the years such as vitamin K antagonists and low-molecular-weight heparin (LMWH).
IV Heparin is normally prescribed first because it works immediately to prevent further clotting.
After this treatment the patient may also need to take oral warfarin to prevent another blood clot forming.
Heparin is available in two different forms:
1. Standard (unfractioned) heparin
2. Low Molecular Weight Heparin (LMWH)
LMWH is normally given as a subcutaneous injection
LMWH works differently from standard heparin.
It contains small molecules which mean its effects are more reliable and the patient will not have to stay in hospital and be monitored.
Both standard and LMWH can cause side effects including:
a. A skin rash and other allergic reactions
b. Bleeding
c. Weakening of the bones
The instant symptoms of DVT often recover with anticoagulation alone.
The reason for intervention is often reduction of the 75% long-term risk of PTS.
Lifetime anticoagulation therapy may be advised:
1. If DVT recurs,
2. If a chronic hyper-coagulability is identified
3. If PE is life threatening
Surgery
In rare cases surgery may be needed if medicines do not work.
Surgery may involve:
1. Placing a vena cava filter
2. Removing a large blood clot from the vein
Compression stockings and ambulation help prevent calf pain and swelling
TABLE OF CONTENT
Introduction
Chapter 1 Deep Venous Thrombosi

• Language: English
• Publisher: Kenneth Kee
• Release date: Sep 8, 2017
• ISBN: 9781370034406

Kenneth Kee

Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

Book preview

Deep Venous

Thrombosis,

A

Simple

Guide

To

The Condition,

Diagnosis,

Treatment

And

Related Conditions

By

Dr Kenneth Kee

M.B.,B.S. (Singapore)

Ph.D (Healthcare Administration)

Copyright Kenneth Kee 2017 Smashwords Edition

Published by Kenneth Kee at Smashwords.com

Dedication

This book is dedicated

To my wife Dorothy

And my children

Carolyn, Grace

And Kelvin

This book describes Deep Venous Thrombosis, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

(What The patient Need to Treat Deep Venous Thrombosis)

This eBook is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If the patient would like to share this book with another person, please purchase an additional copy for each reader.

If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

Thank you for respecting the hard work of this author.

Introduction

I have been writing medical articles for my blog http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.

My purpose in writing these simple guides was for the health education of my patients.

Health Education was also my dissertation for my Ph.D (Healthcare Administration).

I then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.com.

This autobiolographical account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Disorders into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

From which many free articles from the blog was taken and put together into 800 amazon kindle books and 200 into Smashwords.com eBooks.

Some people have complained that the simple guides are too simple.

For their information they are made simple in order to educate the patients.

The later books go into more details of medical disorders.

The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

Since 2013, I have tried to improve my spelling and writing.

As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

I apologize if these repetitions are irritating to some readers.

Chapter 1

Deep Venous Thrombosis

I had a patient who arrived from England 5 years ago to visit her relatives.

She had breathing difficulty and chest tightness when the plane reached the Singapore airport and was rushed to see the airport’s private clinic doctor.

However she had an ECG done and was treated as a case of mild asthma and given some medicine.

Because she did not improve and her leg started to hurt, her relative brought her to see me 2 days later.

On examination I could see a painful red warm swelling on the lower right leg together with some varicose veins.

Her lungs were congested with lower air entry on the right lung.

Her blood pressure was normal but her heart rate was 98 per minute.

I suspected Deep Venous Thrombosis based on her history of an airplane travel stasis and the swollen painful right leg.

Based on her ECG at the airport clinic, I did not think that she had a heart attack

I immediately gave her an intravenous injection of heparin together with aminophylline (a bronchodilator).

She seems to improve immediately after the injection.

The breathing was better and there was less chest tightness.

As she was reluctant to go for a venogram or to hospital, I did not want to use warfarin.

Instead I gave buffered aspirin (as an anticoagulant) and gave her a pressure stocking to wear on her leg which should be kept raised while sitting and sleeping.

She was also given a muscle relaxant together with paracetamol (a painkiller) which should help to her to sleep better.

She was told to return for review the next day.

The next day when she returned she was feeling better.

The breathing was better and the heart rate was back to 76 per minute.

She also had a good night sleep and her leg was less swollen and not so inflamed.

By the end of the second week she was much better and returned to England where she was advised to see her GP who then referred her to a UK hospital where her DVT was confirmed.

What is Deep Venous Thrombosis?

Deep Venous Thrombosis (DVT) is a blood clot (thrombus) in a deep vein (venous) leading to the heart, normally in the legs.

The blood clot may either block the vein completely or partially.

Deep venous thrombosis is a blood clot that forms in a vein deep inside a part of the body.

DVT normally happens in a deep leg vein, a larger vein that extends through the muscles of the calf and the thigh.

It can cause pain and swelling in the leg and may result in complications such as pulmonary embolism.

This is when a piece of blood clot breaks off into the bloodstream and obstructs one of the blood vessels in the lungs.

DVT and pulmonary embolism together are known as venous thromboembolism (VTE).

Incidence:

Yearly, one in every 1,000 is affected by DVT.

It is more frequent in the elderly and the obese.

Women are more vulnerable to it.

What is the danger of DVT?

Clots can form in superficial veins (called superficial thrombophlebitis or phlebitis) and in deep veins because of poor blood flow or stasis.

Blood clots in superficial veins rarely produce serious problems.

Blood clots in deep veins (Deep Venous Thrombosis) need immediate medical care.

These blood clots are dangerous because they can break loose and then travel through the bloodstream to the lungs causing a pulmonary embolism.

A pulmonary embolism is often life-threatening.

Deaths resulting from complications of DVT are not something new.

Blood clots most often form in the calf and thigh veins, and less often in the arm or pelvic veins.

DVT does not cause heart attack or stroke.

What are the causes of Deep Venous Thrombosis?

Causes:

3 major factors have a part in the development of DVT.

1. Venous stasis i.e. the pooling of blood in the veins.

This may be the effect of immobility, old age or heart failure.

2. Damage of the vein due to trauma or local pressure.

Surgery or an injury can injure the blood vessels and induce a clot to form.

3. Higher coagulability (tendency of blood to clot) of the blood which is occasionally seen in:

a. Clotting disorders,

b. Pregnancy,

c. The use of oral contraceptives,

d. Dehydration or

e. Some cancers.

Sitting for long periods without exercising the leg muscles is a main factor.

Passengers in first or economy class seats in a plane have been identified to develop DVT.

Similarly DVT has been observed in students sitting for many hours preparing for exams.

Blood clots can form in veins when the patient is inactive.

Blood clots can form if the patient is paralyzed or bedridden or must sit on a long flight or car trip.

Some people have blood that clots too easily, a disorder that may run in families.

Risk factors are:

a. Age.

DVTs are most frequent in adults over age 60.

However they can happen at any age.

b. Previous venous thromboembolism

c. Family history of blood clots

d. Inactivity and bed rest

When a person is inactive, the blood tends to collect in the lower parts of the body often in the lower legs.

This is normally nothing to worry about because when a person moves, the blood flow rises and moves evenly around the body.

If the patient is unable to move for a long period of time such as after an operation, due to an illness or injury or during a long journey, the blood flow can slow down considerably.

A slow blood flow raises the chances of a blood clot forming

Sitting for long periods when traveling can heighten the