Thrombosis is when a blood clot travels through your vascular system and gets stuck. This reduces the flow of blood getting where it needs to go. Embolism, on the other hand, is similar in the fact that it is a blood clot (or foreign body) that gets stuck in your vascular system. this is brief study mentioning all the basic aspects of dvt , i hope this will be useful among medical professionals , scholars and students , this was made for my academic purpose , specifically for one of my friend ....... please comment thank u

1. PRSENTED BY
MARTIN SHAJI
PHARM D
DEEP VEIN THROMBOSIS

2. SUMMARY
INTRODUCTION
DEFINITION
VENOUS THROMBO EMBOLISM
PULMONARY EMBOLISM
EPIDEMOLOGY
ETIOLOGY
VIRCHOW TRIAD
SYMPTOMS
CLINICAL MANIFESTATIONS
PHARMAOLOGICAL TERAPY
NON-PHARMACOLOGICAL THERAPY
LIFE STYLE MODIFICATIONS
PREVENTION
NATURAL REMEDIES
THANK YOU
PATHOPHYSIOLOGY
DIAGNOSTIC TEST

3. INTRODUCTION :
 Venous thromboembolism (VTE) A condition in which a blood clot
(thrombus) forms in a vein, which in some cases then breaks free and enters
the circulation as an embolus, finally lodging in and completely obstructing a
blood vessel, e.g., in lungs causing a PE (PULMONARY EMBOLISM)
 The most common type of venous thromboembolism is DEEP VEIN
THROMBOSIS, which occurs in veins deep within the muscles of the
leg,arm and pelvis.
 A superficial venous thrombosis (also called phlebitis or superficial
thrombophlebitis) is a blood clot that develops in a vein close to the surface of
the skin. These types of blood clots do not usually travel to the lungs unless
they move from the superficial system into the deep venous system first.

4. DEFNITION
 Deep vein thrombosis is the formation of a blood
clot in one of the deep veins of the body, usually in
the leg

5. EPIDEMOLOGY
Venous thromboembolism (VTE) occurs for the first time in ≈100 persons per
100,000 each year in the United States, and rises exponentially from <5 cases per
100,000 persons <15 years old to ≈500 cases (0.5%) per 100,000 persons at age 80
years.
Approximately one third of patients with symptomatic VTE manifest pulmonary
embolism (PE), whereas two thirds manifest deep vein thrombosis (DVT) alone.
Despite anticoagulant therapy, VTE recurs frequently in the first few months after
the initial event, with a recurrence rate of ≈7% at 6 months. Death occurs in ≈6% of
DVT cases and 12% of PE cases within 1 month of diagnosis. The time of year may
affect the occurrence of VTE, with a higher incidence in the winter than in the
summer.

6. ETIOLOGY
Starts in
Lower
extremity calf
veins
progressing
proximally to
involve
Popliteal,
Femoral,
iliac system

7. Virchow triad
More than 100 years ago, Rudolf Virchow described a triad of factors of
-
Virchow's triad or the triad of Virchow describes the three broad categories of factors that are
thought to contribute to thrombosis.
Hypercoagulability.
Hemodynamic changes (stasis, turbulence)
Endothelial injury/dysfunction.

8. Venous stasis
Endothelial
damage
Hypercoagula
ble state

9. Venous stasis
•prolonged bed rest (4 days or
more)
•A cast on the leg
•Limb paralysis from stroke
•spinal cord injury
•extended travel in a vehicle

10. Hypercoagulability
• Surgery and trauma - 40% of all thrombo embolic disease
• Malignancy
• increased estrogen
• Inherited disorders of coagulation -Deficiencies of protein-S,
protein-C, anti-thrombin III.
• Acquired disorders of coagulation- Nephrotic syndrome, Anti-
phospholipid antibodies
•

11. Endothelial Injury
Trauma
Surgery
 Invasive procedure
Iatrogenic causes –
central venous catheters
 Subclavian
 Internal jugular lines
These lines cause of upper extremity DVT.

12. SYMPTOMS
Common symptoms include :
 swelling in your foot, ankle, or leg, usually on one
side
 cramping pain in your affected leg that usually
begins in your calf
 severe, unexplained pain in your foot and ankle
 An area of skin that feels warmer than the skin on
the surrounding areas
 skin over the affected area turning pale or a
reddish or bluish color

13. Pathophysiology
Vessel trauma stimulates the clotting cascade.
Platelets aggregate at the site particularly when venous
stasis present
Platelets and fibrin form the initial clot
RBC are trapped in the fibrin meshwork

14. The thrombus propagates in the direction of the blood flow.
Inflammation is triggered, causing tenderness, swelling, and
erythema.
Pieces of thrombus may break loose and travel through circulation-
emboli.
Fibroblasts eventually invade the thrombus, scarring vein wall and
destroying valves. Patency may be restored valve damage is
permanent, affecting directional flow.

16. Presentation and Physical Examination
•Calf pain or tenderness, or both
•Swelling with pitting oedema
•Increased skin temperature and fever
•Superficial venous dilatation
•Cyanosis can occur with severe obstruction
•Less frequent manifestations of venous thrombosis include
 Phlegmasia alba dolens,
 Phlegmasia cerulea dolens, and
 Venous gangrene. These are clinical spectrum of the same disorder.

17. P R O L O N G E D B E D R E S T, S U C H AS D U R I N G A L O N G H O S P I TA L S TAY, OR PA R A LY S I S . W H E N YO U R L E G S R E M A I N S T I
L L F O R L O N G P E R I O D S , YO U R C A L F M U S C L E S D O N ' T C O N T R A C T TO H E L P B L O O D C I R C U L AT E , W H I C H C A N I N C R
EA S E T H E R IS K OF B LO O D C LOTS .
IN J U RY OR S U RG E RY. IN J U RY TO YO U R V E IN S OR S U R G E RY C A N IN C R EA S E T H E R I S K OF B LO O D C LOTS .
B IRT H CO N T R O L P ILLS OR H O R MO N E R EP L AC E M E N T TH E RA PY. B I RT H CO N T RO L P IL LS ( O R A L
IN C R EA S E YO U R B LO O D ' S A B ILIT YCO N T R AC E P T IV ES ) AND H O R M O N E R E P LA CE M E N T T H E R A PY B OT H CAN
TO C L O T.
B E I N G OV E RW E IG H T OR O B ES E . B E ING O V E RW E I G H T IN CR EA S ES T HE P R ES S U R E IN T HE V E I N S IN YOU R
P E LV I S AND LEG S .
S M O K I N G . S M O K IN G A FF EC TS B LO O D C LOT T IN G AND C IR C U L AT IO N , W HI CH C A N IN C R EA S E YO U R R IS K OF
D VT.
C A N C E R . S O M E F O R M S OF C A N C E R I N C R E A S E T H E A M O U N T OF S U B S TA N C E S IN YO U R B L O O D T H AT C A U S E YO U
R B LO O D TO CLOT. S O M E F O R M S OF C A N CE R T R EAT M E N T A LS O IN C R EA S E T H E R IS K OF B LO O D C LOTS .
RISK FACTORS

18. H E A R T Fa I L U R E .
P E O P L E W I T H H E A R T Fa I L U R E H Av E A G R E At E R R I S K Of D V T And P U L M O N A R Y E M B O L I S M
. B E C A U S E P E O P L E W I T H H E A R T Fa I L U R E A L R E A D Y H Av E L I M I T E D H E A R T A N D L U N G F U
N C T I O N , T H E S Y M P T O M S C A U S E D By E V E N A S M A L L P U L M O N A R Y E M B O L I S M A R E M O R E
N O T I C E A B L E .
I N F L A M M At O R Y B O W E L D I S E A S E .
B O W E L D I S E A S E S , S U C H As C R O H N ' S D I S E A S E Or U L C E R At I V E C O L I T I S ,
I N C R E A S E T H E R I S K Of D V T.
A P E O N A L Or Fa M I Ly H I S T O R Y Of D E E P V E I N T H R O M B O S I S R S Or P U L M O N A R Y E M B O L I S M
( P E ) . If Yo U Or S O M E O N E In Yo U R Fa M I Ly H A S H A D D V T Or Pe B E F O R E , Yo U ' R E M O R E L I K E Ly
To D E V E L O P D V T.
A G E . B E I N G O V E R A G E 60 I N C R E A S E S Yo U R R I S K Of D V T, T H O U G H It C A N O C C U R At Any A G E .
S I T T I N G F O R L O N G P E R I O D S Of T I M E , S U C H As W H E N D R I V I N G Or F Ly I N G . W H E N Yo U R L E
G S R E M A I N S T I L L F O R M A N Y H O U R S , Yo U R C A L F M U S C L E S D O N ' T C O N T R A C T, W H I C H N O
R M A L Ly H E L P S B L O O D C I R C U L At E . B L O O D C L O T S C A N F O R M In T H E C A Lv E S Of Y O U R L E G
S If Yo U R C A L F M U S C L E S A R E N ' T M O V I N G F O R L O N G P E R I O D S .

19. Complications
Pulmonary embolism
A pulmonary embolism occurs when a blood vessel in your lung becomes blocked
by a blood clot (thrombus) that travels to your lungs from another part of your
body, usually your leg.
A pulmonary embolism can be fatal. So, it's important to be on the lookout for
signs and symptoms of a pulmonary embolism and seek medical attention if they
occur. Signs and symptoms of a pulmonary embolism include:
Unexplained sudden onset of 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
Coughing up blood

20. Postphlebitic syndrome
A common complication that can occur after deep vein thrombosis is a
condition known as postphlebitic syndrome, also called postthrombotic
syndrome. This syndrome is used to describe a collection of signs and
symptoms, including:
Swelling of your legs (edema)
Leg pain
Skin discoloration
Skin sores
This syndrome is caused by damage to your veins from the blood clot. This
damage reduces blood flow in the affected areas. The symptoms of
postphlebitic syndrome may not occur until a few years after the DVT.

21. Tests and diagnosis
•Ultrasound. A wand-like device (transducer) placed over the part of your body where there's a clot
sends sound waves into the area. As the sound waves travel through your tissue and reflect back, a
computer transforms the waves into a moving image on a video screen. A clot may be visible in the
image.
•Sometimes a series of ultrasounds are done over several days to determine whether a blood clot is
growing or to be sure a new one hasn't developed.
•Blood test. Almost all people who develop severe deep vein thrombosis have an elevated blood
level of a clot-dissolving substance called D dimer.
•Venography. A dye (contrast agent) is injected into a large vein in your foot or ankle. An X-ray
procedure creates an image of the veins in your legs and feet, to look for clots. However, less invasive
methods of diagnosis, such as ultrasound, can usually confirm the diagnosis.
•CT or MRI scans. Both computerized tomography (CT) scan and magnetic resonance imaging
(MRI) can provide visual images of your veins and may show if you have a clot. Sometimes a clot is
found when these scans are performed for other reasons.

22. Treatments and drugs-PHARMACOLOGICAL TREATMENT
•Deep vein thrombosis treatment is aimed at preventing the clot from getting any
bigger, as well as preventing the clot from breaking loose and causing a
pulmonary embolism. After that, the goal becomes reducing your chances of deep
vein thrombosis happening again.
•Deep vein thrombosis treatment options include:
•Blood thinners. Medications used to treat deep vein thrombosis include the use of
anticoagulants, also sometimes called blood thinners, whenever possible. These are
drugs that decrease your blood's ability to clot. While they don't break up existing
blood clots, they can prevent clots from getting bigger or reduce your risk of
developing additional clots.

23. •You may need to take blood thinners for three months or longer. If you're
prescribed any of these blood thinners, it's important to take your medication
exactly as your doctor instructs. Blood-thinning medications can have serious
side effects if you take too much or too little.
•You may need periodic blood tests to check how long it takes your blood to clot.
Pregnant women shouldn't take certain blood-thinning medications.
•THIS IS ONE OF THE MAIN ETIOLOGY ALSO
•Usually, you'll first be given a shot or infusion of the blood thinner heparin for a
few days. After starting heparin injections, your treatment may be followed by
another injectable blood thinner, such as enoxaparin (Lovenox), dalteparin
(Fragmin) or fondaparinux (Arixtra). Other blood thinners can be given in pill form,
such as warfarin (Coumadin, Jantoven) or rivaroxaban (Xarelto). Newer blood
thinners also may offer additional options in the near future.

24. Clot blusters.
If you have a more serious type of deep vein thrombosis or pulmonary embolism, or
if other medications aren't working, your doctor may prescribe different medications.
One group of medications is known as thrombolytics. These drugs, called tissue plasminogen
activators (TPA), are given through an IV line to break up blood clots or may be given
through a catheter placed directly into the clot. These drugs can cause serious bleeding and
are generally used only in life-threatening situations. For these reasons, thrombolytic
medications are only given in an intensive care ward of a hospital.

25. Filters.
If you can't take medicines to thin your blood, a filter may be 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 help prevent swelling associated with deep vein thrombosis. These stockings are
worn on your legs from your feet to about the level of your knees.
This pressure helps reduce the chances that your blood will pool and clot. You should
wear these stockings during the day for at least two to three years if possible.
Compression stockings can help prevent postphlebitic syndrome.
NON- PHARMACOLOGICAL TREATMENT

26. Lifestyle and home remedies
Once you receive treatment for deep vein thrombosis you need to watch your diet and look for signs of excessive
bleeding, as well as take steps to help prevent another DVT. Some things you can do include:
Check in with your doctor regularly to see if your medication or treatments need to be modified. If you're taking
warfarin (Coumadin, Jantoven), you'll need a blood test to see how well your blood is clotting.
Take your blood thinners as directed. If you've had DVT, you'll be on blood thinners for at least three to six
months.
Watch how much vitamin K you're eating if you are taking warfarin. Vitamin K can affect how warfarin works.
Green leafy vegetables are high in vitamin K. Check with your doctor or a dietitian about your diet if you're taking
warfarin.
Be on the lookout for excessive bleeding, which can be a side effect of taking medications such as blood
thinners. Talk to your doctor about activities that could cause you to bruise or get cut, as even a minor injury could
become serious if you're taking blood thinners.
Move. If you've been on bed rest, because of surgery or other factors, the sooner you get moving, the less likely blood
clots will develop.
Wear compression stockings to help prevent blood clots in the legs if your doctor recommends them.

27. Prevention
To prevent deep vein thrombosis, some common preventive measures include the following:
Take any prescribed medications as directed. If you're having surgery, such as orthopedic
surgery, you'll probably be given blood thinners while you're in the hospital. Your doctor may also
prescribe aspirin or other medications that help prevent clots to be taken for a while after surgery.
Avoid sitting still. If you've 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, try not to cross your legs because this can
limit 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, try to stand or walk occasionally. If you can't do that, at least try to exercise
your lower legs. Try raising and lowering your heels while keeping your toes on the floor, then
raising your toes while your heels are on the floor.

28. Make lifestyle changes. Lose weight and quit smoking. Obesity
and smoking increase your risk of deep vein thrombosis.
Get regular exercise. Exercise lowers your risk of blood clots,
which is especially important for people who have to sit a lot or
travel frequently.