Deep Vein Embolism: Did You Know?
Doctor Tran Hoang Nhat Linh's article on deep vein thrombosis, with proper treatment, can prevent blood clots from bursting, causing dangerous complications.
Today, deep vein thrombosis is increasingly recognized. The right treatment can prevent the clot from growing in size and breaking off, causing dangerous complications such as a pulmonary embolism. The following article will provide all the necessary information about this disease.
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1. What is Deep Vein Thrombosis?
Deep vein thrombosis is a blood clot in a vein located deep inside, not close to the skin. From there, the thrombus causes a complete or partial blockage of blood flow in the vein.
Deep vein thrombosis is most common in the veins of the lower extremities. Nevertheless, embolism of the arm, portal, spleen, and mesentery has occasionally been reported.
2. Mechanism of formation and risk factors for deep vein thrombosis
2.1 Mechanism of formation
Venous thrombosis is caused by a combination of 3 factors:
These three factors form the Virchow triangle, which is the basis for determining risk factors.
2.2 Key risk factors
Acquired risk factors:
Risk factors for deep vein thrombosis
Hereditary risk factors are those that cause congenital hypercoagulability:
3. What symptoms do deep vein thrombosis usually cause?
3.1 Clinical Manifestations
Deep vein thrombosis of the lower extremities is usually unilateral
3.2 Differential diagnosis
Clinical manifestations of deep vein thrombosis are sometimes similar to those of a number of other conditions:
Common in people with venous insufficiency of the lower extremities, lymphatic occlusion, diabetic foot ulcers.
Common after infusion, or in people with venous insufficiency of the lower extremities.
Swelling, sudden pain on one side of the calf.
Common after trauma, or coagulation disorders due to cirrhosis, anticoagulants.
Side effects of antihypertensive drugs of calcium channel blocker group: amlodipine…
Therefore, clinical symptoms have low specificity and are not reliable enough to make diagnostic decisions. Therefore, doctors will use the scale to assess the risk of deep vein thrombosis. On the basis of the assessment of the risk of embolism, the doctor will choose the laboratory investigation to approach the diagnosis.
4. Diagnosis of deep vein thrombosis
4.1 The first clinical examination
In low-risk patients, D-dimer to rule out lower extremity deep vein thrombosis. D-dimer can be increased in some diseases such as cancer, infection, pregnancy, advanced age, etc.
In patients with intermediate-high risk, ultrasound is definitive. Doppler ultrasound is also the “gold standard” because of its high sensitivity and specificity. This probe is simple, safe, and can be performed many times. However, it depends on the person doing it. The conclusions you may see on the ultrasound paper include thrombus filling the venous lumen, preventing the venous pressure from collapsing or only partially collapsing and/or having a color defect on color Doppler, spectral Doppler does not change with respiratory rate.
4.2 Subclinical finding the cause
Next, the patient will be assigned to do more laboratory tests to screen for the cause of inherited blood clotting disorders in the following cases:
In-depth tests to do include
Time to do Protein C, Protein S, Antithrombine III tests:
4.3 Care should be taken in the diagnosis of cancer
In patients with venous thromboembolism with unknown predisposing factors and no cancer detected, appropriate diagnostic investigations for cancer are indicated, depending on the clinical findings suggestive of the disease.
5. Treatment of deep vein thrombosis
Consists of:
5.1 Treatment of the acute phase
Antifreeze
Indications for treatment:
Thrombosis of unknown predisposing factor.
– D-dimer > 500 mg/mL.
- Thrombosis occurs in many veins with length > 5 cm, diameter > 7 mm.
– Cancer is active.
- History of venous thrombosis.
- Prolonged immobility.
Anticoagulation can be started immediately in cases of high clinical probability of deep vein thrombosis pending a definitive diagnosis.
Other therapeutic measures in the acute phase:
In the acute phase, how does the patient note activity?
5.2 Maintenance treatment and prolonged maintenance
Duration of anticoagulation: At least 3 months, depending mainly on the underlying medical condition and predisposing factors, weighing the risk of recurrent venous thrombosis against the risk of bleeding with anticoagulation:
Should not be used for more than 3 months in cases of:
Prolonged treatment is recommended if:
6. How to prevent venous thrombosis?
6.1 General principles
6.2 Preventive measures
Used in patients with high bleeding risk or contraindications to anticoagulation
7. What are the complications of deep vein thrombosis?
Deep vein thrombosis has an acute complication such as a pulmonary embolism with a high mortality rate, and a chronic complication is a post-thrombotic syndrome.
7.1 Pulmonary embolism
Up to 79% of patients with acute pulmonary embolism present with deep vein thrombosis. In contrast, more than 50% of patients with deep vein thrombosis have pulmonary embolism complications.
Pulmonary embolism is extremely dangerous because it can suddenly cause chest pain, shortness of breath, low blood pressure, shock and death.
Pulmonary embolism is a dangerous complication of deep vein thrombosis
7.2 Postthrombotic syndrome
This is the leading complication with chronic venous disease (pain, edema, dystrophy, ulceration), occurring secondary to venous thromboembolism.
Treatment of this syndrome includes:
Although it takes 3-6 months to completely resolve a blood clot, deep vein thrombosis always needs to be treated thoroughly to avoid serious complications such as pulmonary embolism. If you have risk factors for this disease, you should see a doctor early for appropriate advice and treatment.
Doctor Tran Hoang Nhat Linh
Doctor Tran Hoang Nhat Linh's article on deep vein thrombosis, with proper treatment, can prevent blood clots from bursting, causing dangerous complications.
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