Deep vein thrombosis (DVT) is a condition in which a blood clot forms in one of your deep veins, usually in your leg. DVT can cause pain and swelling and may lead to complications, such as pulmonary embolism.
Deep veins pass through the centre of your leg and are surrounded by layers of muscle. DVT happens when a blood clot forms in a deep vein.
It affects about one in 1,000 people every year in the UK. DVT is most common in the deep veins of your lower leg (calf). It can also develop in the deep veins in your thigh and, more rarely, in other deep veins, such as the ones in your arm or pelvis.
Sometimes blood clots can form in your superficial veins, which lie just under your skin. This is known as superficial thrombophlebitis. The condition is different to DVT and much less serious, but it can occasionally spread to your deep veins.
Many blood clots are small and don't cause any symptoms. Your body will often be able to gradually break down a blood clot with no long-term effects.
Larger clots can partly or completely block the blood flow in your vein and cause symptoms in your affected leg or arm, such as:
Although these symptoms may not be caused by DVT, if you have them, you should see your GP urgently for advice.
DVT may not cause you any further problems, but possible complications can include the following.
This is the most serious complication of DVT. A pulmonary embolism happens when the blood clot (or a piece of it that has broken off) travels in your blood to your lungs, where it blocks one of your blood vessels. This is serious and can be fatal.
This happens if DVT damages the valves in your veins and permanently reduces the ability of your veins to efficiently return blood from your lower leg to your heart. This can lead to ongoing high pressure in the veins in your legs and can eventually cause long-term pain and swelling. If the condition becomes severe, you may develop ulcers on your leg.
This is a rare complication that only happens with severe DVT. The blood clot can cause the pressure in your vein to rise. This can block the flow of blood through your arteries, so less oxygen is carried to your affected leg. This can be painful and lead to skin ulcers, infection and even gangrene.
Anyone can get DVT but many things may increase your risk of the condition. Often, more than one factor will contribute to its development – some of these include:
There is evidence that long-haul travel (lasting over four hours) can increase your risk of developing DVT. Although you usually hear about DVT in relation to flying, this is confusing because the risk is mainly the result of being inactive for long periods of time. This can happen during any form of long-distance travel, whether by car, bus, train or air. Therefore, you may hear the phrase ‘travel-related DVT’ being used.
Generally, your risk of developing DVT when travelling is small unless you have one or more of the risk factors mentioned previously. If you do, talk to your GP before you travel for four hours or more.
Your GP will ask about your symptoms and examine you. If he or she thinks that you might have a DVT, you may be referred to a specialist in a hospital or clinic for further tests. These may include the following.
The main aim of treatment for DVT is to reduce the risk of and, if possible, prevent complications including pulmonary embolism. It will also try to relieve any symptoms you have, such as pain and swelling.
Try to start walking as soon as possible after DVT. This has been found to be safe and it may help circulation of blood in your leg. It may also help to ease your symptoms and reduce your risk of developing complications.
You will be given anticlotting (anticoagulant) medicines, such as low molecular weight heparin injections or warfarin tablets, to treat DVT. These change chemicals, known as clotting factors, in your blood and so reduce its ability to clot and can also stop new blood clots from forming. There are a number of new medicines available, for example rivaroxaban, that may be more suitable for some people. However, because they are new, there isn’t much evidence about their long-term effectiveness. You will probably need to take anticlotting medicines for at least three months and possibly longer.
These are also called graduated compression stockings. Your doctor may recommend that you wear them as they may help to reduce pain and swelling. They can also help to prevent post-thrombotic syndrome. You will need to have these fitted for you by a nurse or pharmacist and may need to wear them for at least two years after developing DVT.
If there is a reason why you can’t take anticlotting medicines, your doctor may recommend having a filter fitted in your inferior vena cava. This may be because you’re pregnant or you have recently had major surgery. Your vena cava is a large vein in your abdomen (tummy) and blood travels in it from your lower body back to your heart. Placing a filter in it means that if a blood clot (or a piece of it) moves from your leg, it will be prevented from travelling to your heart or lungs where it could cause pulmonary embolism.
Ask your GP for advice if you think you're at risk of developing DVT.
There are things you can do to reduce your risk, such as stopping smoking if you smoke, or losing weight if you're overweight. Regular walking can help to improve the circulation in your legs and help to prevent another DVT from developing. If you have had a DVT, you can usually start walking once you get home from the hospital, unless your doctor has told you otherwise.
There isn't enough evidence to show that taking aspirin reduces your risk of developing DVT.
Surgery and some medical treatments can increase your risk of developing DVT. So if you're going to hospital for an operation, you will usually have an assessment to check your risk of developing DVT during surgery. There are many things that can be done to try to keep this risk as low as possible.
You may be given anticlotting medicines before and after surgery, or be asked to wear compression stockings. You may also be given a mechanical pump to use on your feet and legs in the first few days after the operation. This is called an intermittent compression device. The pump automatically squeezes your feet and lower legs to help your blood circulate.
If you have recently been treated for DVT, you will need to wait two weeks before making journeys that will be longer than four hours.
Although it's unlikely that you will develop DVT when you're travelling, there are some steps you can take to reduce your risk of developing a blood clot on journeys of over three hours.
If your GP has told you that you're at high risk for DVT, you may also need low molecular weight heparin injections for long journeys. Talk to your GP for more information.
If you develop swelling or pain in your calf or thigh during or a few hours or days after your flight, or if you have breathing problems or chest pain after travelling, you should seek urgent medical attention.
Produced by Polly Kerr, Bupa Health Information Team, April 2013.
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