Formation of a blood clot secondary to an external injury on skin can be a life saver, as it controls loss of blood, but the same happening inside the body amongst the deep veins and arteries can be limb threatening or life threatening. Deep vein thrombosis (DVT) is one such condition, where blood clots in the deep veins of the body.
Theoretically, it can happen in any vein, but the most common site is the leg veins. DVT can have serious consequences. The most dangerous is, if the clot dislodges, gets into the blood stream and blocks the blood flow to the lungs. This is known as pulmonary embolism and if not detected in a timely fashion can lead to death. The less fatal, but significant local complications include, pain, chronic swelling and non healing ulcers in the leg.
This begs the question: Who develops DVT and why?
Sluggish blood flow, hypercoagulable state (increased clotting risk) and injury to the veins is a triad that leads to DVT.
There are a number of risk factors for the development of DVT, the two most common being: firstly Injury to lower body and secondly pelvic, hip and knee surgery.
The other risk factors include –
- Recent surgery, abdominal surgeries, fracture fixation.
- Major diseases like cancer, AIDS etc.
- Advanced age
- Lack of movement, being bedridden for a long period of time
- Overweight or Obesity
- Birth control pills
- Certain autoimmune diseases
- Inherited blood clotting disorder
Symptoms of Deep Vein Thrombosis:
The symptoms of deep vein thrombosis are very subtle or silent in nature.
- Pain in the area
- Warmth in the affected area
- Red discoloration of skin.
In many instances, symptoms of pulmonary embolism can be the first sign of DVT. We need to have an high index of suspiscion to diagnose pulmonary embolism. some warning signs post surgery can be
Management of DVT:
Most patients at risk of DVT are already in the hospital either for the injury per se or for surgery. This allows for us to start preventive modalities to avoid the occurance of DVT. Once a patient is diagnosed with DVT, the treatment is usually non surgical and very rarely surgical intervention is needed.
Medicine: Anti-coagulants are blood thinners which prevents the blood from clotting. These medicines cannot dissolve the existing clot but can prevent the clot from getting bigger. It is very important to titrate the dose. Its a delicate balance between maintaining the anticoagulation effect, while avoiding excessive bleeding tendency.
Early postoperative mobilisation: When indicated, patients should be mobilised in bed or out of bed. The leg muscles act like a pump in pushing blood back into the circulation. Its imperative that the patients follow the phyisotherapy protocol given to them.
Compression stockings: Compression stockings are worn from ankle to above the level of knees. They help to balance the blood flow, reducing the chances of blood clot in your legs. Mechanical compression devices can be used when ever available.
Surgical Management: If anti-coagulants cannot prevent the clot size from increasing or medicines are contraindicated, placement of an Inferior vena caval filter (IVC filter) in the main vein which directs the blood back to the heart can be done. This acts as a mesh and prevents the clots from reaching the heart and lungs.
Other Measures: Some modifiable risk factors like quitting smoking, avoiding use of contraceptive pills, and weight reduction can decrease the incidence of DVT. Previous cases of DVT and patients with hereditary risk factors may need life long anti-coagulation or an IVC filter.
With the ever increasing number of orthopaedic surgeries being performed these days, especially total hips and knees, the incidence of DVT will only be on the rise. This is were acute post operative care becomes very important. Getting operated at an high volume center equipped with well trained staff and infrastructure, will help in diagnosing and treating DVT at the earliest, thus avoiding any undue fatality.
About the Doctor
Dr A.B Suhas Masilamani is one of the few surgeons who has trained in USA and has come back to work in India. He finished his MBBS and MS Orthopaedics from Christian Medical College, Ludhiana. He then went on to clear his DNB Orthopaedics. He further pursued advanced fellowship training in United States. His first fellowship was in Paediatric Orthopaedics at Montefiore Medical Centre, Albert Einstein School of Medicine, New York, USA. This was followed by a second fellowship in Adult Hip and knee Joint Replacement Surgery at Bronx Lebanon Hospital, Icahn School of Medicine at Mount Sinai, New York, USA.
He is one of the very few surgeons from the city to become a member of American Academy of Hip and Knee Surgeons (AAHKS). He is also a member of American Academy of Orthopaedic Surgeons (AAOS) and International Congress for Joint Replacement (ICJR).
About Sunshine Hospitals
A Multi Super Speciality Institution, 500+ bedded Sunshine Hospitals is promoted by globally reputed Joint Replacement Surgeon Dr. AV Gurava Reddy (Orthopedic Doctor) and like-minded associates who share the objective of making world-standard healthcare available, affordable and accessible to the common man.