March is Deep Venous Thrombosis Awareness Month and is a good time to learn about this potentially life-threatening condition. Deep venous thrombosis, more commonly known as DVT, is a leading cause of suffering and death both inside and outside of the hospital. DVT is a condition where blood clots form in the deep veins of the body, usually the legs, but can occur in other parts of the body.
Signs of DVT include swelling in the effected arms or legs, usually only one side, that occur without warning. This is usually painful and associated with increased warmth, red or blue colored skin, and sometimes enlarged veins in the effected limb.
If the clot breaks free it can move toward the heart and get stuck in the blood vessels in the lung. This is called a pulmonary embolism (PE) and it can be fatal. Sometimes this occurs without knowing that a DVT is present. In these cases, signs of PE include shortness of breath, rapid heart rate, chest pain, and coughing up blood. DVT and PE occur in 1-2/1000 people in the general population, however this risk increases in patients with risk factors
Risk factors of DVT formation can be classified into three categories, known as Virchow’s triad: alterations in blood flow, injury to the vessel lining, and alterations in the blood. Specifically, these risk factors include age (greater after age 40), bed rest, sitting for long periods of time (like long flights or car rides), pregnancy, obesity, smoking, injury, infection, inflammation, high cholesterol, serious illnesses (like cancer and heart disease), birth control pills or hormone replacement, and certain blood disorders (including genetic disorders that promote clot formation). About 80% of patients with DVTs have one of these risk factors.
Diagnosis of DVT is primarily non-invasive by a blood test called D-dimer and ultrasound of the veins. Other tests may include contrast studies, CT scans, and MRI. CT of the chest with angiography (CTA) is used to diagnose pulmonary embolism.
Treatment of DVTs is primarily anticoagulants (blood thinners). These keep the clots from growing and breaking off and prevent new clots from forming. If a patient cannot take these medications due to risk of bleeding or other reasons, or has a clot form while on these medications, then placement of a filter (a wire cage) in the large vein in the abdomen can be performed to prevent clots from going to the lungs (PE).
Aside from pulmonary embolism, complications of DVT include chronic venous insufficiency, a condition which can cause pain, swelling, varicose veins, and skin sores in the effected limb. Furthermore, patients with previous DVTs are at risk of developing them in the future.
Famous individuals who have suffered DVT or PE include Politicians like Dick Cheney, Hilary Clinton, and John Connally. Actors including Jimmy Stewart, June Allyson, Zsa Zsa Gabor, Dennis Farina, Regis Philbin, Heavy D, and Gary Shandling. Even athletes
are not immune and include Tennis star Serena Williams, NBA players Jerome Kersey and Chris Bosh, NHL player Adam McQuaid, professional golfer Joey Sindelar, and race car driver Brian Vickers.
In summary, DVT and PE are prevalent conditions both in and out of hospitals. They cause a significant amount of suffering and even death. A high index of suspicion is important and early diagnosis is imperative for the best outcomes. If you suspect these conditions, you should seek immediate medical care.
Dr. James Lee serves as the Coroner of Winn Parish. He is a General Surgeon and Surgical Oncologist who has been practicing in Winnfield for over ten years. Dr. Lee attended the University of Colorado for his medical degree. He completed his residency in Surgery at the University of Oklahoma before completing a fellowship in Surgical Oncology and Endoscopy at Roswell Park Cancer Institute in Buffalo, NY. Dr. Lee and his wife Scarlett live in Winnfield with their son and are active in the community.
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