Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs. Deep vein thrombosis can cause leg pain or swelling, but it can also occur without symptoms. Deep vein thrombosis can develop if you have certain medical conditions that affect how your blood clots. It can also happen when you do not move for a long time, such as after surgery or an accident, or when you are confined to the bed. Deep vein thrombosis can be very serious because blood clots in your veins can loosen, travel through your bloodstream and lodge in your lungs, blocking blood flow (pulmonary embolism). Deep Vein Thrombosis most likely happens in your lower leg, thigh, or pelvis. But it can also occur in other parts of your body. Most deep vein thrombus start in the legs.

Deep vein thrombosis (DVT) is defined as a blood clot in the deep venous system most commonly found in the legs. The clot can cause damage to the venous valves, causing a condition known as reflux and post-thrombotic syndrome (PTS). A blood clot or a component of it can go to the lungs, resulting in a pulmonary embolism (PE). Both PTS and PE can result in significant morbidity, while PE can be fatal. These three conditions together (DVT, PTS, and PE) are known as venous thromboembolism (VTE). It has been reported that VTE is the third most common vascular disease after coronary artery disease and stroke.

What Are the Symptoms ?

Deep vein thrombosis can have the same symptoms as many other health problems. The clinical presentation of individuals with DVT is inconsistent because many patients are asymptomatic. Those with symptoms may exhibit the following features in the affected extremity:

• Swelling of the legs or arms
• Pain or pain when standing or walking
• Temperature in the painful area
• Enlarged veins
• Skin that looks red or blue,pale skin
• Pain or tenderness in your leg, ankle, foot, or arm.
• Intense and painful cramping that will not go away.

Pulmonary Embolism

A pulmonary embolism occurs when a blood vessel in your lung is blocked by a blood clot (thrombus) that travels from another part of your body, usually your leg, to your lung. A pulmonary embolism can be life-threatening. It is important to monitor the signs and symptoms of pulmonary embolism and seek medical attention if they occur. The greatest risk of deep vein thrombosis is the possibility of developing Pulmonary Embolism. Warning signs and symptoms for pulmonary embolism include:

• Sudden shortness of breath
• Chest pain or discomfort that worsens when you take a deep breath or cough
• Dizziness or fainting
• Rapid pulse
• Spitting out blood

Causes of Deep Vein Thrombosis

Many factors can increase your risk of developing deep vein thrombosis (DVT). The more you have, the greater your risk of DVT. Risk factors include:

Genetic Transmission of Blood Clotting Disorder: Some people may have a genetic disorder that makes blood clots easier. This condition on its own may not cause blood clots unless combined with one or more risk factors.

Prolonged bed rest, such as a long hospital stay or a stroke: When your legs are immobilized for long periods of time, your calf muscles don’t contract to help circulate blood, which can increase the risk of blood clots.

Pregnancy: Pregnancy increases the pressure in the veins in your pelvis and legs. Women with inherited coagulation disorders are particularly at risk. The risk of blood clots from pregnancy may persist for up to six weeks after delivery.

Being overweight or obese: Being overweight increases the pressure in the veins in your pelvis and legs.

Smoking: Smoking affects blood clotting and circulation, which can increase your risk of DVT.

Cancer: Some types of cancer increase substances in your blood that cause blood clots. Some forms of cancer treatment also increase the risk of blood clots.

Heart failure: This increases your risk of DVT and pulmonary embolism. Since the heart and lung functions of people with heart failure are limited, the symptoms are more pronounced even due to a small pulmonary embolism.

Inflammatory bowel disease: Bowel diseases such as Crohn’s disease or ulcerative colitis increase the risk of DVT.

Age: Being over 60 increases your risk of DVT, but it can occur at any age.

Sitting for a long time: When your legs are inactive for hours, your calf muscles do not contract, which normally helps blood circulation. If your calf muscles do not move for a long time, blood clots november form in the calves of your legs.

Deep Vein Thrombosis and Covid-19

in a recent observational study of 184 patients, Klok and his colleagues determined that the cumulative incidence of venous thrombotic complications during their admission to intensive care units for COVID-19 patients was as much as 31 percent.
This means at least a two-fold increase in the median rate of DVT formation in patients admitted to the intensive care unit.

DVT Treatment Methods

Treatment for deep vein thrombosis (DVT) aims to prevent the clot from growing and loosening and creating a pulmonary embolism. The goal is then to reduce the posibility of deep vein thrombosis again.

Deep vein thrombosis is most commonly treated with anticoagulants. These drugs, which can be injectable or taken as a pill, reduce your blood’s ability to clot. They don’t break up existing blood clots, but they can prevent clots from growing and reduce your risk of developing more clots.

Compression stockings: To help prevent swelling associated with deep vein thrombosis, these are worn on your legs from your feet to the level of your knees.

Deep Vein Thrombosis And Physiotherapy

Physiotherapists often see patients diagnosed with DVT. Conservative management of DVTs using solid immobilization is based on the theoretical assumption that early ambulation and active range of motion will result in proximal exit of the thrombus, migration into the pulmonary circulation, and a PE with significant morbidity and mortality potential.

Physiotherapists work with patients who are diagnosed and at risk of DVT throughout the continuum of care. Therefore, the American Physical Therapy Association (APTA) has developed clinical practice guidelines to facilitate decision-making in the prevention and treatment of DVT in adults.

1) Prevention of VTE

• Promote patient mobility and physical activity at the individual and institutional level.
• How to recommend / use mechanical compression for people at moderate or high risk for DVT
• Consult a doctor about medications for individuals with moderate or high risk for DVT
• DVT prevention training (leg exercises, ambulation, hydration, etc.)
• Provide training on the risk factors, signs and symptoms of DVT and their consequences.

2) DVT Scan

• Screening for DVT risk using the preferred risk assessment model.
• Communicate screening results and related clinical signs and symptoms to the medical team.
• Provide training on the importance of seeking medical attention for suspected DVT.

3) Deciding for Safe Movement with the Health Team

• Support diagnostic testing and wait for results before acting on patients with suspected DVT
• Fall risk screening while a patient is on anticoagulation therapy
• Involve patients with known DVT in early mobilization. Recommendations on how and when it would be safe to reassure a patient with known DVT depend on the risk of falls of the medical treatment used.

4) Prevention of Long-Term Consequences of DVT

• Involve patients with known DVT in safe mobilization.
• Recommend / use mechanical compression.
• Provide training on the risks and benefits of mobilization following DVT.

5) Patient Education

• Patient education should be provided during the DVT prevention and management process.
• Patients should have the autonomy to decide whether they want to participate in the recommended prevention and treatment measures.

After Surgery

After surgery to remove a blood clot in the leg, your doctor may recommend physical therapy to improve movement after surgery. A physical therapist may visit you in the hospital to help you move your leg in your hospital bed, such as ankle pumps that help promote blood circulation. You may also benefit from physical therapy after surgery. Your therapist can perform exercises that help you improve range of motion, walk with proper form, and engage in muscle-strengthening exercises.

Walking / Compression Therapy

If you are experiencing DVT, your physical therapist may recommend compression therapy to improve your circulation. This includes wearing compression stockings that encourage circulation in your veins. According to a study published in the “Journal of Pediatric Oncology Nursing” in 2007, patients who engage in walking combined with compression therapy have been shown to have better outcomes following a DVT diagnosis. If you have DVT, you may need to take them for 48 to 72 hours before starting physical therapy walking exercises.

References

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2) Kearon C. Natural history of venous thromboembolism. Seminars in Vascular Medicine 2001; 01(1): 027-038
3) Douketis JD. Treatment of deep vein thrombosis: what factors determine appropriate treatment? Can Fam Physician. 2005;51:217–23
4)Silverstein MD, Heit JA, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ. Trends in the incidence of deep vein thrombosis and pulmonary embolism. Arch Intern Med. 1998;158:585–93
5) Hillegass E, Puthoff M, Frese EM, Thigpen M, Sobush DC, Auten B. Role of Physical Therapists in the Management of Individuals at Risk for or Diagnosed With Venous Thromboembolism: Evidence-Based Clinical Practice Guideline. Phys Ther 2016; 96(2):143-66
6)Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020.
7)Boddi M, Peris A. Deep vein thrombosis in intensive care. Adv Exp Med Biol. 2017;906:167–181.