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Deep vein thrombosis

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"venous thrombosis"[MeSH Terms]

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deep vein thrombosis symptoms diagnosis treatment CDC

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https://www.cdc.gov/blood-clots/testing-diagnosis/index.html

Deep vein thrombosis (DVT) is a blood clot in a deep vein, most often in the calf or thigh. The main concern is that part of the clot can travel to the lungs and cause a life-threatening pulmonary embolism (PE).

Typical symptoms

Usually on one side of the body:
  • Leg or calf swelling
  • Pain, cramping, or tenderness
  • Warmth, redness, or darker skin color
  • Enlarged surface veins
DVT can also cause few or no symptoms. Homans' sign, pain on dorsiflexing the foot, is not reliable for diagnosis. Bailey and Love's Short Practice of Surgery, 28th ed., p. 5653-5674.

Seek emergency care now if you have possible DVT plus:

  • Sudden shortness of breath
  • Chest pain, especially worse with breathing
  • Coughing blood
  • Fainting, severe dizziness, or a very fast heartbeat
These may signal PE. The CDC overview of DVT and PE describes these as urgent symptoms.

Common risk factors

  • Recent surgery, hospitalization, injury, or plaster cast
  • Prolonged immobility, including long journeys
  • Pregnancy or recent delivery
  • Estrogen-containing contraception or hormone therapy
  • Cancer
  • Previous DVT/PE or inherited clotting tendency
  • Older age, obesity, smoking, and severe illness
The underlying contributors are venous blood stasis, vessel-wall injury, and increased tendency to clot, known as Virchow's triad. Gray's Anatomy for Students, p. 785.

Diagnosis

Clinicians estimate probability with a Wells score and then commonly use:
  • Duplex compression ultrasound of the leg, the standard test
  • D-dimer blood test in selected lower-risk cases
  • CT pulmonary angiography or V/Q scan if PE is suspected
Imaging is needed because muscle injury, cellulitis, and other conditions can resemble DVT, as explained by the CDC diagnostic guidance.

Treatment

Confirmed DVT is generally treated with an anticoagulant such as a direct oral anticoagulant, low-molecular-weight heparin, or warfarin in selected situations. These prevent extension and new clots while the body clears the existing clot. Treatment length and drug choice depend on the clot location, trigger, bleeding risk, pregnancy, kidney function, cancer status, and prior clots. Thrombolysis, clot removal, or an IVC filter is reserved for specific severe situations or when anticoagulation cannot be used.
Do not massage a painful swollen leg or self-treat a suspected DVT. Arrange same-day urgent medical assessment if you have new one-sided leg swelling or pain.
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