Deep Vein Thrombosis and Pulmonary Emboli

Thrombophlebitis or deep vein thrombosis (DVT) describes the formation of a blood clot in the veins of the leg. Any period of prolonged immobility such as recovering from surgery, or traveling for long periods of time in a car or an airplane decreases circulation in the legs and increases the likelihood of venous blood clot formation. Smoking, obesity, pregnancy, birth control pills, and certain genetic abnormalities that run in families increase the likelihood of venous clot formation as well.   .

Patients with deep vein thrombosis sometimes complain of swelling in the leg, pain or difficulty walking. If a deep vein thrombosis goes untreated or unrecognized, permanent swelling in the leg can result. This phenomenon is called the post-phlebitic syndrome, but the greatest risk with deep vein thrombosis is not to the leg itself. A more ominous threat is the development of a pulmonary embolism. If the blood clot detaches from the wall of a vein and travels into the lung (pulmonary embolism), it can cause difficulty breathing chest pain, anxiety, or even death.

Due to the risk of pulmonary embolism, all patients with a deep vein thrombosis extending above the knee require therapy with anticoagulants. Physicians initially use either unfractionated heparin intravenously or Lovenox (shots). These fast acting anticoagulants are administered for five to seven days, while the patient begins taking Coumadin.Physicians monitor the blood level ofCoumadin with a blood test called a prothrombin time.  Once the prothrombin time reaches the appropriate level, the intravenous heparin or the subcutaneous Lovenox is stopped, and the patient continues on heparin alone.  Patients take Coumadin to thin the blood and prevent new clots from forming in the legs or lungs for three to six months. If the venous clots in the legs and lungs are recurrent or the patient has a genetic abnormality predisposing him or her to venous clots, then physicians will prescribe Coumadin for life..

Taking Coumadin increases a person’s susceptibility to bleeding from conditions such as ulcers, hemorrhoids or trauma. While on Coumadin, patients should avoid activities with a high risk of injury such as horseback riding, working on ladders or playing contact sports. In addition, patients must adhere to scheduled doctor and lab appointments. Medication levels have to be closely monitored, and prothrombin  times must be checked every two to four weeks to avoid unwanted bleeding. If a patient has a history of internal bleeding or an intracranial hemorrhage, they may not be candidates for Coumadin. In these cases, we recommend the insertion of a titanium filter into the vena cava, which is a large vein in the abdomen. This filter catches any pieces of clot dislodging from the legs and migrating toward the lungs, thereby preventing pulmonary emboli..

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