Deep Vein Thrombosis (DVT)

Diagnosis

To diagnose deep vein thrombosis (DVT), a healthcare provider performs a physical examination and reviews your symptoms. The provider checks the legs for signs such as swelling, tenderness, and changes in skin color. Based on your symptoms and medical history, additional tests may be ordered to confirm or rule out DVT.

Tests

Several diagnostic tests help detect or exclude DVT:

• D-dimer blood test: Measures a protein fragment released by blood clots. Elevated levels may indicate the presence of a clot and can help rule out pulmonary embolism (PE).

• Duplex ultrasound: A noninvasive test using sound waves to create images of blood flow in veins. It is the standard method for diagnosing DVT. The test may be repeated over several days to monitor clot growth or detect new clots.

• Venography: An X-ray test that uses contrast dye injected into a vein in the foot or ankle to visualize veins in the legs and feet. Because it is invasive, it is rarely performed and typically replaced by ultrasound.

• Magnetic resonance imaging (MRI): Used when DVT is suspected in veins located in the abdomen or pelvis.

Treatment

The main goals of DVT treatment are to prevent the existing clot from getting larger, to stop it from breaking loose and reaching the lungs, and to reduce the risk of another clot forming in the future.

Treatment options include:

• Blood thinners (anticoagulants): These medications help prevent clots from enlarging and reduce the chance of new clots forming. They can be taken orally, by injection under the skin, or through an intravenous (IV) line. The duration of treatment usually lasts for three months or longer. Regular monitoring may be required, especially for those taking warfarin, to ensure safe dosage levels. Some anticoagulants are not suitable during pregnancy.

• Clot busters (thrombolytics): Used for severe DVT or pulmonary embolism cases, or when other treatments are ineffective. These medications dissolve clots quickly but can cause serious bleeding, so they are reserved for emergency or high-risk situations.

• Filters: If blood thinners cannot be used, a vena cava filter may be placed in a large vein in the abdomen to prevent clots from traveling to the lungs.

• Support stockings (compression stockings): These tight-fitting socks improve blood circulation, prevent blood pooling, and reduce swelling in the legs. They should be worn from the foot up to the knee during the day, often for several years, to reduce complications and improve comfort.

Summary

Deep vein thrombosis is a serious condition that requires prompt diagnosis and treatment to prevent life-threatening complications. Early medical care, adherence to prescribed medications, and the use of compression stockings can significantly lower risks and improve long-term outcomes.