Deep Vein Thrombosis Flashcards
What is chronic deep vein thrombosis?
Chronic DVT is a chronic condition where blood clots gradually cause circulation problems, usually in the lower body. Leading to venous insufficiency (when your body has difficulty returning blood to your heart).
What is thrombosis?
A thrombosis is a clot in a blood vessel. A thromboembolism, is a clot that moves through your blood stream. In severe cases of thromboembolism’s, patients can suffer severe damage to major organs. Resulting in a pulmonary emboplism, a stroke or a heart attack.
What is acute deep vein thrombosis?
Acute DVT’s are sudden, usually resulting in urgent or emergency situations.
What is a deep vein thrombosis? Or ‘venous’ thrombosis?
A deep vein thrombosis (venous thrombosis) occurs when a blood clot forms in a vein deep inside your body. DVT’s mainly affect:
- The large veins in the lower leg and thigh
- Other deep veins, such as in the arms or pelvis
What are the risk factors for developing a DVT?
Venous thrombosis is most common in adults over 60 years of age. DVT’s are more likely if a patient has one or more of these risk factors:
- Obesity
- Being sedentary due to bed rest or during travel
- Family history of blood clots
- Having a long-term (indwelling) catheter in a blood vessel
- Polycythemia vera (a condition that causes bone marrow to make too many blood cells)
- 0 to 6 months post pregnancy
- Recent surgery or fractures in: the hips, pelvis or legs
What are some early symptoms of a possible deep vein thrombosis?
Edema in the leg or thigh with affected blood flow, or darker-coloured skin and/or redness, with skin feeling warm to the touch
How can practitioners diagnose a DVT?
Vascular testing and diagnosis is used to rule out or confirm venous thrombosis. Testing can include:
- A (CBC) complete blood count
- D-dimer blood test: looking at proteins your body makes when it tries to break down a clot. A negative result rules out the presence of a thrombus (clot).
- Doppler ultrasound exam: using sound waves to provide images of blood flow in the area of suspected blood clot
- Pelvic MRI: if the suspected clot is in the pelvis, such as after pregnancy, a pelvis MRI is ordered. Providing clear images of bones, soft tissue and blood flow in the area.
What blood tests can practitioners use to see if you have an increased chance of blood clotting?
- Antithrombin III levels (do you have enough antithrombin which prevents excess clotting?)
- Lupus-related problems: antiphospholipid antibodies, lupus anticoagulant
- Genetic testing (to look for mutations that make a pt more likely to develop blood clots: G20210A mutation and/or factor V leiden mutation)
- Levels of protein C and protein S (these proteins help your body regulate clotting)
What are the pharmacological treatment plans for deep vein thrombosis?
- IV heparin: Heparin is a powerful blood thinner that starts to work right away If you are hospitalized, your doctors may provide heparin through a vein (intravenously, through an IV).
- Injectable heparin: This type of heparin, called low molecular weight heparin, is an injection given once or twice a day. You may not need to stay in the hospital if your doctor prescribes this type of heparin.
- Warfarin: You take a warfarin (Coumadin or Jantoven) pill, often along with heparin. Warfarin takes several days to begin working.
- Direct oral anticoagulants (DOACs): These medicines begin to work right away. Your doctor may prescribe them instead of heparin. Examples of DOAC medications include apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa) and rivaroxaban (Xarelto).
- Xa inhibitors: These newer medicines work as well as warfarin and can be easier to manage. But it can be difficult to stop excess bleeding, so they are not right for everyone.
What are the surgical deep vein thrombosis treatment plans?
In rare cases a patient may need surgery in addition to anticoagulants:
- Endovascular procedures such as a thrombectomy: interventional cardiologists and interventional radiologists remove large blood clots
- Stenting: surgeons, interventional cardiologists and radiologists insert a stent to hold open the vein in the legs or pelvis (iliac veins) or manage DVT’s
- Vena cava filter placement: Vena cava filters are placed in the body’s largest vein - the vena cava - to capture blood clots a and prevent them from travelling to the lungs.
What is the first line of treatment for DVT?
Thrombolytic therapy.
This therapy uses anticoagulant (anti-clotting) medication to thin the blood. Keeping clots from growing and preventing new clots from forming. Most people take blood-thinning medicine for at least three months after experiencing a DVT
What is thrombolytic therapy or thrombolysis?
Thrombolysis - systemic thrombolysis - uses medications or a minimally invasive procedure to break up blood and prevent new clots from forming.
What is catheter-directed thrombolysis?
- A surgeon makes a tiny incision and inserts a catheter (a long, flexible tube with a camera and small tools) into your blood vessel.
- The team uses X-ray images to guide the catheter to the clot.
- The team injects dye (contrast medication) to highlight the clot in images. These images help the surgeon decide the best way to treat the clot.
- Angioplasty may also be used, stenting to reopen and support the blood vessel.
What is systemic thrombolysis?
Systemic thrombolysis uses thrombolytic drugs and medications that circulate throughout your body to dissolve clots and prevent future blockages. Penn physicians most often use systemic thrombolysis after an emergency such as a heart attack, pulmonary embolism or stroke.
Occasionally delivering clot-busting thrombotic drugs through an IV line via the arm.
