Each year, an estimated 350,000 to 600,000 Americans suffer from Deep Vein Thrombosis, a disease in which a blood clot forms in a large vein of the leg, according to the U.S. Department of Health and Human Services. Half of those people won't experience any symptoms, leaving the disease untreated. In one-third of all people with DVT, the blood clot will break loose and travel to the lungs causing a Pulmonary Embolism, often resulting in sudden death.
However, proper screening and preventive treatment could greatly reduce the number of deaths, according to a report by the U.S. Department of Health and Human Services.
"If you get it early enough, there are ways to dissolve the clots," said Dr. James Anderson, a general and vascular surgeon at Wyoming Medical Center in Casper.
DVT occurs when a clot forms in a large vein of the leg, usually in the thigh or calf. The clot can partially or completely block circulation.
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"It's kind of like a tourniquet," said Dr. Harlen Myers, a Casper hematologist and pediatrician.
About DVT
Only half of people who have DVT experience the symptoms, which include pain or swelling in the leg, foot or ankle and redness or warmth of the affected area.
"If you develop swelling or tenderness in your leg without any injury, you should be looked at, especially if there's swelling in the foot or calf," Henshaw said.
Doctors may use ultrasound, CT or MRI scans or venography (an x-ray procedure) to look for clots. In addition, blood tests may be issued to search for blood clotting disorders. Once a blood clot is confirmed, doctors have a variety of methods for treating it.
To prevent the clot from growing, breaking loose or reoccurring, doctors may prescribe blood thinners or clotbusters, recommend the patient wear compression stockings to prevent blood from pooling and clotting, or do a procedure which involves inserting a filter in the vein to catch blood clots before they reach the lungs.
People who have DVT have a 20 to 30 percent chance of skin changes and a 5 percent chance of developing ulcers on the legs, Anderson said. Long after the clot has been absorbed, they may experience further complications.
"If you've had DVT, it damages the vein forever and you're at much higher risk (of getting a clot) in the same area," Henshaw said.
In fact, about 30 percent of people with DVT will have another episode within ten years.
Some people may experience reduced blood flow in the veins which were damaged by the blood clot, a condition called postphlebitic syndrome, or post-thrombotic syndrome. This syndrome causes swelling, pain or skin discoloration. It's treated with medication and the use of compression stockings.
The most dangerous complication to DVT is PE. During a PE, part of the blood clot breaks loose, travels through the blood stream to the lungs. There, it can partially or completely block a pulmonary artery or one of it's branches. This often causes sudden death. Those who survive rarely suffer lasting effects because the body usually absorbs the clot.
Could you be at risk for DVT?
There are many factors which can put people at risk for developing DVT including smoking, pregnancy, being overweight, experiencing a traumatic injury or having a genetic clotting disorder. It also affects up to 30 percent of surgical patients and 30 to 40 percent of cancer patients, said Dr. Diane Henshaw, a medical oncologist and hematologist at Rocky Mountain Oncology in Casper.
The risk increases with age. The elderly, especially those who live in nursing homes, are at the greatest risk for developing DVT, according to the U.S. Department of Health and Human Services. At about age 50, the risk for DVT begins to rapidly increase.
"Every decade that we age, the risk goes up," said Dr. James Altizer of the Vein Center of Charlotte, N.C. "Young people can get blood clots too, especially women on birth control pills."
The risk of developing DVT is fairly low for people under 60, but one's risk increase if they have more than one of the following risk factors.
* injury to a deep vein from a broken bone, surgery or other trauma
* obesity (People with a body mass index over 30 have a two to three-fold increase in the risk of developing a blood clot.)
* cancer, especially that which has spread to other parts of the body
* pregnancy (PE is the most common cause of maternal death in developed countries.)
* use of hormone therapy and oral contraceptives containing estrogen and progestin (Oral contraceptives containing both progestin and estrogen increase a woman's risk of a blood clot two- to eight-fold.)
* smoking (It affects blood clotting and circulation.)
* inherited blood clotting disorders which cause the blood to clot more easily
* immobility, including prolonged bed rest or sitting for long periods of time while driving or flying
* heart failure
* use of a pacemaker or catheter in a central vein
Medical facilities like hospitals and nursing homes often have DVT prevention programs. Still, Dr. Altizer said it's important to be proactive.
"You doctor may not think about it, so you may have to say, 'Hey, I'm going to have this cast on, am I at risk for a blood clot? Should I be taking a blood thinner?' "
Speaking with your doctor about your risk for DVT is the first step to preventing it.
DVT Symptoms
Only about half of people with DVT experience symptoms. Those who experience the following symptoms should contact their doctor for guidance.
* swelling of the leg, sometimes including the ankle or foot
* pain in the leg, ankle or foot which often starts in the calf and feels like cramping or a charley horse
* discoloration or redness
* warmth of the affected area
PE Symptoms
For those who experience no symptoms of DVT, the first sign of the disease can be a PE, which is often fatal. Seek immediate medical attention for the following symptoms:
* Sudden onset of shortness of breath
* sharp chest pain, especially during deep breathing
* rapid heartbeat
* sweating
* a sense of anxiety or nervousness
* feeling light-headedly or dizzy, fainting
How to prevent blood clots
The Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Resources, offers the following tips for preventing blood clots:
* Wear loose-fitting clothes, socks or stockings.
* Raise your legs six inches above your heart from time to time.
* Wear special stockings (called compression stockings) if you doctor prescribes them.
* Do exercises your doctor gives you.
* Change your position often, especially during a long trip.
* Eat less salt.
* Try not to bump or hurt your legs and try not to cross them.
* Do not use pillows under your knees.
* Raise the bottom of your bed four to six inches with blocks or books.
* Take all medicines the doctor prescribes to you.
Sources: The U.S. Department of Health and Human Services' 2008 report, "The Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism"; The Mayo Clinic; The National Heart Lung and Blood Institute.
* Contact Carol Seavey at 307-266-0544 or carol.seavey@trib.com.
