Deep vein thrombosis is a blood clotting disorder. causes of this is age above 60 yrs. cancer , obesity, prolonged standing etc. diagnostic evaluation of this doppler study, CT, MRI, etc. medical management of this blood thinner, like aspirin, stockings etc

1. DEEP VEIN THROMBOSIS
PRESENTED BY
R.PRIYA

2. INTRODUCTION
DVT is not uncommon in India. By having a high index of suspicion and following a
simple protocol we could make a difference in the lives of our patients by reducing the
morbidity and mortality associated with DVT. DVT and pulmonary embolism (PE) are
the two main manifestations of VTE .Even though Indians may be at an equal risk, the
exact incidence of DVT is not known for the Indian population. There are only a
handful of studies, mainly orthopedic, in which the rate of DVT varies from 3.7 to 17%.

3. DEFINITION
Deep vein thrombosis (DVT) is a medical condition that occurs when a
blood clot forms in a deep vein. These clots usually develop in the lower leg, thigh, or
pelvis, but they can also occur in the arm.

4. UNDERSTANDING ABOUT DVT

5. CAUSES/RISK FACTOR
•Increasing age. Being older than 60 increases your risk of DVT, though it can occur at any age.
•Personal or family history of DVT or pulmonary embolism
•Having cancer(Some experts suggest this is because of tissue damage some cancers can cause that might trigger
the blood clotting process. Any person with cancer can develop a blood clot. Some forms of cancer treatment
also increase the risk of blood clots).
•Having a vein disease, such as varicose veins
•Smoking(Smoking affects blood clotting and circulation, which can increase your risk of DVT) .
•Using birth control pills or hormone therapy (Estrogen, like many lipophilic hormones, affects the gene
transcription of various proteins. Thus, estrogen increases plasma concentrations of these clotting factors by
increasing gene transcription. Higher doses of estrogen appear to confer a greater risk of venous
thrombus formation).
•Pregnancy (during pregnancy may include an enlarged uterus, which increases pressure on the veins that return
the blood to the heart from the lower body, as well as lack of movement due to bed rest.)
•Being overweight or obese(Obesity promotes a state of chronic inflammation that activates prothrombotic signaling
pathways in platelets and other vascular cells.
Impaired fibrinolysis, mediated largely by increased production of PAI-1, is a major contributing factor to thrombotic risk in
obesity.)
•Inheriting a blood-clotting disorder
A broken hip or leg, or having major surgery on your hip, knee or lower leg can affect normal blood flow and clotting.
In these situations, three primary factors contribute to the formation of blood clots in veins: slow blood flow, hyper
coagulator Thopaediction, and damage to the veins.

6. CAUSES/RISK FACTOR
• Blood that Flows Slowly through Veins (Stasis)
The walls of the veins are smooth. This helps blood flow freely and mix with naturally occurring agents
(anticoagulants) in the blood that keep the blood cells from clotting. Blood that does not flow freely and does not mix
with anticoagulants may be more likely to clot. This is why it is important to watch for signs of DVT in people who are
on bed rest, immobilized in a splint or cast, or not able to move for long periods of time.
• Hypercoagulation
Blood thickens, or coagulates, around matter that does not belong in the veins. During surgery, matter such as
tissue debris, collagen, or fat may be released into the blood system and can cause the blood to coagulate. In
addition, during total hip replacement, preparing the bone to receive the prosthesis may cause the body to release
chemical substances called antigens into the blood system. These antigens can also stimulate clot formation.
• Damage to the Vein Walls
During surgery, the doctor must move, or retract, soft tissues such as ligaments, muscles, and tendons to reach the
area being operated on. In some cases, this can release naturally occurring substances that promote blood clotting.

7. •Sitting for long periods of time, such as when driving or flying. When your legs remain still
for hours, your calf muscles don't contract. Muscle contractions normally help blood circulate.
•Prolonged bed rest, such as during a long hospital stay, or paralysis. Blood clots can form in
the calves of your legs if your calf muscles don't move for long periods.
•Injury or surgery. Injury to your veins or surgery can increase the risk of blood clots.
•. Heart failure. This increases your risk of DVT and pulmonary embolism. Because people with
heart failure have limited heart and lung function, the symptoms caused by even a small
pulmonary embolism are more noticeable.
•Inflammatory bowel disease. Bowel diseases, such as Crohn's disease or ulcerative colitis,
increase the risk of DVT.
•A personal or family history of DVT or PE. If you or someone in your family has had one or
both of these, you might be at greater risk of developing DVT.
•Genetics. Some people inherit genetic risk factors or disorders, such as factor V Leiden, that
make their blood clot more easily. An inherited disorder on its own might not cause blood clots
unless combined with one or more other risk factors.
•No known risk factor. Sometimes, a blood clot in a vein can occur with no apparent underlying
risk factor. This is called an unprovoked VTE.
CAUSES/RISK FACTOR

9. SIGNS AND SYMPTOMS
Symptoms of DVT occur in the leg affected by the blood clot and include:
•Swelling
•Pain or tenderness
•Distended veins
•Red or discolored skin
•A firmness or thickening of the vein called a "cord"
Many patients, however, experience no symptoms at all.
The warning signs and symptoms of a pulmonary embolism include:
•Sudden shortness of breath
•Chest pain or discomfort that worsens when you take a deep breath or when you cough
•Feeling lightheaded or dizzy, or fainting
•Rapid pulse
•Rapid breathing
•Coughing up blood

10. DIAGNOSTIC EVALUATION
•D-dimer blood test. D dimer is a type of protein produced by blood clots. Almost all people
with severe DVT have increased blood levels of D dimer. A normal result on a D-dimer test
often can help rule out PE.
•Duplex ultrasound. This noninvasive test uses sound waves to create pictures of how
blood flows through your veins. It's the standard test for diagnosing DVT. For the test, a
technician gently moves a small hand-held device (transducer) on your skin over the body
area being studied. Sometimes a series of ultrasounds are done over several days to
determine whether a blood clot is growing or to check for a new one.
•Venography. A dye is injected into a large vein in your foot or ankle. An X-ray creates an
image of the veins in your legs and feet, to look for clots. The test is invasive, so it's rarely
performed. Other tests, such as ultrasound, often are done first.
•Magnetic resonance imaging (MRI) scan. This test may be done to diagnose DVT in veins
of the abdomen.

11. MANAGEMENT
•Blood thinners. DVT is most commonly treated with anticoagulants, also called blood thinners.
These drugs don't break up existing blood clots, but they can prevent clots from getting bigger and
reduce your risk of developing more clots.
Blood thinners may be taken by mouth or given by IV or an injection under the skin. Heparin is
typically given by IV. The most commonly used injectable blood thinners for DVT are enoxaparin
(Lovenox) and fondaparinux (Arixtra).
After taking an injectable blood thinner for a few days, your doctor may switch you to a pill.
Examples of blood thinners that you swallow include warfarin (Jantoven) and dabigatran (Pradaxa).
Certain blood thinners do not need to be given first with IV or injection. These drugs are rivaroxaban
(Xarelto), apixaban (Eliquis) or edoxaban (Savaysa). They can be started immediately after
diagnosis.
You might need to take blood thinner pills for three months or longer. It's important to take them exactly as
prescribed to prevent serious side effects.
If you take warfarin, you'll need regular blood tests to check how long it takes your blood to clot.
Pregnant women shouldn't take certain blood-thinning medications.
•

12. MANAGEMENT
•Clot busters. Also called thrombolytics, these drugs might be prescribed if you have a more
serious type of DVT or PE, or if other medications aren't working.
These drugs are given either by IV or through a tube (catheter) placed directly into the clot. Clot
busters can cause serious bleeding, so they're usually only used for people with severe blood
clots.
•Filters. If you can't take medicines to thin your blood, you might have a filter inserted into a
large vein — the vena cava — in your abdomen. A vena cava filter prevents clots that break
loose from lodging in your lungs.
•Compression stockings. These special knee socks reduce the chances that your blood will
pool and clot. To help prevent swelling associated with deep vein thrombosis, wear them on your
legs from your feet to about the level of your knees. You should wear these stockings during the
day for at least two years, if possible.

13. COMPLICATION
•Pulmonary embolism (PE). PE is a potentially life-threatening complication
associated with DVT. It occurs when a blood vessel in your lung becomes blocked by a
blood clot (thrombus) that travels to your lung from another part of your body, usually
your leg.
It's important to get immediate medical help if you have signs and symptoms of PE.
Sudden shortness of breath, chest pain while inhaling or coughing, rapid breathing,
rapid pulse, feeling faint or fainting, and coughing up blood may occur with a PE.
•Postphlebitic syndrome. Damage to your veins from the blood clot reduces blood
flow in the affected areas, causing leg pain and swelling, skin discoloration and skin
sores.
•Treatment complications. Complications may result from blood thinners used to
treat DVTs. Bleeding (hemorrhage) is a worrisome side effect of blood thinners. It's
important to have regular blood tests while taking such medications.

14. PREVENTION
•Avoid sitting still. If you have had surgery or have been on bed rest for other reasons, try to get
moving as soon as possible. If you're sitting for a while, don't cross your legs, which can block
blood flow. If you're traveling a long distance by car, stop every hour or so and walk around.
If you're on a plane, stand or walk occasionally. If you can't do that, exercise your lower legs. Try
raising and lowering your heels while keeping your toes on the floor, then raising your toes with
your heels on the floor.
•Don't smoke. Smoking increases your risk of getting DVT.
•Exercise and manage your weight. Obesity is a risk factor for DVT. Regular exercise lowers
your risk of blood clots, which is especially important for people who sit a lot or travel frequently.

15. THANK YOU