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Deep Vein Thrombosis

Deep Vein Thrombosis (or DVT) is a blood clot most commonly found in a deep leg vein. I was recently reading on the NHS Choices website that 1 in 9 of us will develop a DVT in our lifetime and 1 in every 1,000 of us are affected in the UK every year.

A DVT itself is not necessarily life threatening. However, if a piece of the clot breaks away into the bloodstream and blocks a blood vessel in the lungs (the pulmonary artery), a Pulmonary Embolism can develop, preventing blood from reaching the lungs, which can be fatal, and therefore it seems to me that it is vital that DVTs are promptly diagnosed and treated to give the best chance of preventing this complication.

Together, DVT and Pulmonary Embolism are known as Venous Thromboembolism (VTE).

What causes a DVT to develop?

I understand from my reading that there are 3 main risk factors to be aware of:

1. Sticky blood – which can be caused by illness, old age, pregnancy and medication such as the contraceptive pill;

2. Vein damage– which can result from trauma such as surgery or an injury. This can cause the wall of a blood vessel to be damaged, narrowed or blocked;

3. Immobility – activity encourages muscle contraction and blood flow, stopping the blood from pooling and staying in the same place.  This therefore is particularly relevant to patients who spend prolonged periods of time in hospital.

DVTs are common in those who are in hospital due to the lack of activity, and have long been associated with air travel. Flight socks are becoming popular and even airlines are ‘cottoning on’ – I was interested to read that, in June this year, Qantas Airlines Limited became the first airline to introduce in-flight exercise videos to combat DVT!

Any period of immobility, however, may be harmful. A study by the Royal Society of Medicine showed that sitting for 90 minutes can reduce the blood flow in your legs by up to 50%, increasing the risk of DVT.  Experts have even coined a new term, ‘E-Thrombosis’ to reflect the growing number of DVT cases in which long periods of time sitting at a computer without leaving the desk has been a primary cause.

The ‘Redflag’ symptoms and self-diagnosis

My colleague, Simon, has recently written about the increase in self diagnosis, particularly given our modern day use of the internet as a diagnostic tool for presenting symptoms. DVTs are no exception.

The National Institute for Health and Care Excellence (NICE) published guidelines in 2012 for diagnosis and treatment if a DVT is suspected.  The guidelines state that medical professionals should use the two-level ‘Wells Score’ to estimate the clinical probability of a DVT based on what symptoms are present. The following are ‘red flag’ symptoms that you should be aware of:

• Tenderness
• Swelling. If one calf is 3cm larger than the other leg, this is a very important red flag.
• Pain or a pulled muscle sensation. Sometimes this may be the only presenting symptom.
• Redness or warmness of the skin in the area of the clot

A Wells Score of two or more points means that a DVT is likely and that treatment should be provided at the earliest possible opportunity.

How can a DVT be treated?

If you think you may have any of a combination of these symptoms then you should consult a doctor as soon as possible. The NICE guidelines suggest to medical professionals that all diagnostic investigations for suspected DVTs are completed within 24 hours to ensure prompt treatment if diagnosis if confirmed.

The guidelines then state that anti-coagulant medication is the usual treatment for DVT, unless contra-indicated. These blood-thinning medications can prevent clots from increasing in size and can stop parts of the clots from breaking off and becoming lodged in the bloodstream.

Our experience

Despite DVT being a surprisingly common medical condition, it may still be overlooked by your GP and other medical professionals, leading to more serious, and potentially life-threatening, complications such as Pulmonary Embolism.  I have been approached by patients and their families in such circumstances when they have then subsequently suffered serious injuries because of a misdiagnosis.  This includes circumstances where a client has clear risk factors, such as a previous long period of immobility in hospital.  With the clear guidelines in place, these delays should be avoidable and I hope that ongoing and increasing awareness of the guidelines will lead to fewer such cases.

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