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What is deep vein thrombosis (DVT)?Deep vein thrombosis (DVT) is a blood clot that occurs in a deep vein; that is, a vein that is not on the surface of the skin. DVT can occur anywhere, but is most often seen in the leg. Show
If you think you might have DVT, see a doctor. The most serious complication of DVT is pulmonary embolism, which is when a piece of the blood clot breaks off and lodges in the lung. This causes a serious illness and is potentially life-threatening. What are the symptoms of deep vein thrombosis (DVT)?The main signs and symptoms of DVT are pain and swelling in the affected area - usually your calf or thigh. Some people have no signs or symptoms. When to seek help?DVT is a serious condition, so if you think you may have DVT, you should see a doctor without delay. Call an ambulance on triple zero (000) if you:
 What causes DVT?Anything that slows blood flow in deep veins can cause DVT. People who have DVT may have:
Women who are pregnant or who have recently had a baby are also at increased risk of DVT. So are people who are overweight, or who smoke. DVT can also happen spontaneously, with no apparent cause. Some people with spontaneous DVTs have a genetic condition that makes their blood more likely to clot. How is a DVT diagnosed?To diagnose DVT, the doctor will need to talk to you about your symptoms and examine you to look for signs of DVT, such as swelling and pain. After this, if your doctor thinks you may have DVT, they may suggest you have an ultrasound. A blood test called a D-dimer test can also be done to help detect blood clots. If the doctor thinks there is a risk that part of the blood clot has travelled to your lungs, they may order a chest CT scan. How is DVT treated?If you have DVT, you will be treated with medicine that reduces blood clotting (called anticoagulant medication). This can be given either as tablets or via injections and you will probably need to take it for several months. In very severe cases, a medicine is used to break down the clot. The person normally needs to stay in hospital when this is given as it can cause bleeding. You may also be asked to wear compression stockings to bring down the swelling. What are the complications of a DVT?Bits of the blood clot can break off and travel around the body, affecting the heart or lungs. After having a DVT, the leg can remain swollen and ulcers may develop. How is DVT prevented?If you are travelling or are hospitalised, you can reduce your risk of developing DVT by wearing compression stockings, moving your feet and legs as much as possible, and drinking plenty of water. If you have already had a DVT, it is very important to quit smoking, keep fit and maintain a healthy weight. Some people may need to stay on low-dose anticoagulant medication long-term or use it prior to long haul flights. Last reviewed: 26 Oct 2022 Last updated: 01 Sep 2022 SummaryDeep vein thrombosis (DVT) is the development of a blood clot within a vein deep to the muscular tissue planes. DVT most commonly affects the legs, but can also affect the arms, and other sites in the body. Patients who develop DVT commonly have risk factors, such as cancer, trauma, major surgery, hospitalization, immobilization, pregnancy, or oral contraceptive use. DVT may also be unprovoked (idiopathic) and occur in the absence of any identifiable extrinsic risk factors. DVTs commonly cause asymmetrical leg swelling, unilateral leg pain, dilation or distension of superficial veins, and red or discolored skin, but can also be asymptomatic. Assessment of pretest probability (using a validated score such as Wells score) is key if DVT is suspected, and should be used in combination with an algorithmic diagnostic approach to avoid unnecessary imaging when the likelihood of DVT is low. Diagnosis requires confirmation of a blood clot in a deep vein in the leg, pelvis, or vena cava by venous duplex ultrasound imaging or computed tomography scan. DVT is usually treated with anticoagulants such as unfractionated heparin, low molecular weight heparin, fondaparinux, rivaroxaban, apixaban, edoxaban, dabigatran, and/or warfarin. Interventional therapies, including thrombolysis, are rarely indicated. Generally, anticoagulant therapy for at least 3 months is required for patients with DVT. Thereafter, continued anticoagulant therapy for secondary prevention is indicated in selected patients to reduce the risk of recurrent events. Post-thrombotic syndrome may occur with symptoms of chronic pain, swelling, skin discoloration, or venous ulcers following chronic obstruction of venous outflow and/or incompetence of venous valves. DefinitionDVT is the development of a blood clot in a major deep vein in the leg, thigh, pelvis, or abdomen. It may also occur in less common locations such as the arm veins; the portal, mesenteric, ovarian, or retinal veins; or the veins and venous sinuses of the brain. DVT can result in impaired venous blood flow and consequent swelling and pain. DVT is rarely life-threatening on its own, but has the potential to cause pulmonary embolism (PE), which can be fatal. Venous thromboembolism is the broad term that includes DVT and PE. Superficial vein thrombosis, a common related condition, affects veins superficial to the musculature. This topic focuses on lower and upper extremity DVT. History and examKey diagnostic factors
More key diagnostic factors Other diagnostic factors
Other diagnostic factors Risk factors
More risk factors Diagnostic investigations1st investigations to order
More 1st investigations to order Investigations to consider
More investigations to consider Treatment algorithminitiation-phase therapy: no active bleedinginitiation-phase therapy: active bleedingtreatment-phase therapyextended-phase therapy (3 months’ anticoagulation therapy completed): not postpartum, no recurrenceextended-phase therapy: postpartum (planning to breastfeed)extended-phase therapy: postpartum (not planning to breastfeed)extended-phase therapy: recurrent VTEContributorsAuthorsScott M. Stevens, MDDirector Thrombosis Clinic Intermountain Medical Center Murray Professor of Medicine Department of Medicine Intermountain Healthcare and University of Utah Salt Lake City UT DisclosuresSMS serves as co-chair of the American College of Chest Physicians guideline on the treatment of venous thrombotic disease. He is the author of several references cited in this topic. Scott C. Woller, MDDirector Thrombosis Clinic Intermountain Medical Center Murray Professor of Medicine Department of Medicine Intermountain Healthcare and University of Utah Salt Lake City UT DisclosuresSCW serves as co-chair of the American College of Chest Physicians guideline on the treatment of venous thrombotic disease. He is the author of several references cited in this topic. Gabriel V. Fontaine, PharmD, MBA, BCPSClinical Pharmacy Manager Critical Care and Emergency Medicine Advanced Clinical Pharmacist Neuroscience Critical Care Intermountain Medical Center Murray UT DisclosuresGVF has received consulting fees and honoraria from Alexion Pharmaceuticals. AcknowledgementsDr Scott M. Stevens, Dr Scott C. Woller, and Dr Gabriel V. Fontaine would like to gratefully acknowledge Dr Geno Merli, Dr Taki Galanis, Dr Luis Eraso, Dr Geoffrey Ouma, Dr Richard White, and Dr Windsor Ting, the previous contributors to this topic. DisclosuresGM has received grant or research support from BMS, J&J, Sanofi-Aventis, Portola, and Janssen; he has served as a Scientific Consultant for BMS, J&J, and Sanofi-Aventis. RW declares participation in numerous multicentered clinical trials sponsored by companies: Agenix, Boehringer-Ingleheim, Amgen, Bayer, Bristol-Meyer-Squibb, Novartis, Hemosense. TG, LE, GO, and WT declare that they have no competing interests. Peer reviewersBeverly Hunt, FRCP, FRCPath, MDProfessor of Thrombosis & Haemostasis King's College Consultant Departments of Haematology, Pathology & Rheumatology Lead in Blood Sciences Guy's & St Thomas' NHS Foundation Trust London UK DisclosuresBH declares that she has no competing interests. Where is DVT pain usually?DVT symptoms
pain, swelling and tenderness in one of your legs (usually your calf or thigh) a heavy ache in the affected area. warm skin in the area of the clot. red skin, particularly at the back of your leg below the knee.
What are the signs of a DVT?DVT symptoms. swelling in your calf (lower leg) or thigh – it's unlikely that your whole leg will be swollen.. pain (often a throbbing pain that's worse when you put weight on it) and tenderness in your leg.. your skin may feel warm and look red or occasionally purple.. the veins on your leg may look swollen or bulging.. |
