Deep Vein Thrombosis (DVT)

Deep Vein Thrombosis (DVT) is a disorder where blood clots are formed deep in the veins. This condition can be serious but preventable. According to Beckman, Craig Hooper, Critchley, and Ortel (2010), the condition affects an estimated 300,000–600,000 individuals in the U.S. each year. It can occur in all races and ethnicities, all age groups, and both genders. DVTs usually occur when a person is immobile, bedridden, after a serious trauma or major surgery. A person can also develop a DVT with certain medications such as hormone replacement therapy or birth control pills, and diseases such as cancer. Pregnancy and genetics can also contribute to the formation of clots. According to Stone, Hangge, Albadawi, Wallace, Shamoun, Knuttien, Naidu, and Oklu (2017), venous thrombosis tends to occur in areas with decreased or mechanically altered blood flow such as the pockets adjacent to valves in the deep veins of the leg. While valves help to promote blood flow through the venous circulation, they are also potential locations for venous stasis and hypoxia. Knowing this allows us to understand why clots usually form in the lower portion of the body, the legs, thighs, and even the pelvic region.

A patient may not always exhibit symptoms. According to The Centers for Disease Control and Prevention (CDC, 2020), the following symptoms are considered red flags and should be taken seriously. When a person has asymmetrical swelling, warmth, pain in the extremities, tenderness and redness of the skin they should contact their physician immediately. Once at the MDs office, the patient will undergo a physical exam and will have an ultrasound of the extremity. According to Govind (2019), the gold-standard practice for diagnosis of DVT includes ascending venography and duplex ultrasound scanning. A D-Dimer blood test may also be completed to test a specific substance in the blood that is released when a clot breaks up. Once all tests are run and the provider receives confirmation a treatment plan will be put together for the patient. Compression stockings are encouraged to prevent swelling and pain. Medications such as anticoagulants are given to dissolve clots or keep the blood from forming clots and flowing. Anticoagulants according to Govind (2019) include unfractionated heparin (UFH), low molecular heparin (LMWH), vitamin K antagonists, such as warfarin, and direct oral anticoagulants (Dabigatran, Rivaroxaban, and Apixaban). Patient education should include several things depending on the situation. After surgery, a patient should be encouraged to walk around or move their limbs to prevent clots from forming. If a patient is at risk for DVT, compression stockings and anticoagulation therapy should be started. According to The CDC (2020) when sitting for long periods (ex. on a long flight) the patient should be encouraged to walk around every 2 to 3 hours, wear loose-fitting clothes, and perform leg exercises. Patients should also be taught what to expect while on anticoagulants such as warfarin. Patients are also encouraged to maintain a healthy lifestyle. While DVT can be managed, complications can arise. A traveling clot which then becomes an embolism can travel to the lungs, heart, or brain causing a stroke, pulmonary embolism or a heart attack. A patient should follow up based on their treatment regimen. According to Epocrates (2020), patients on heparin should be monitored closely. Their activated partial thromboplastin time (aPTT) should be measured before starting heparin to obtain a baseline, should be measured 6 hours after starting the infusion, 6 hours after every dose adjustments, and at least once daily after therapeutic levels are reached.

References

Beckman, G. M., Craig Hooper, W., Critchley, E. S., & Ortel, L. T. (2010). Venous Thromboembolism: A public health concern. American Journal of Preventive Medicine, 38(4), S495-S501. https://doi.org/10.1016/j.amepre.2009.12.017

Centers for Disease Control and Prevention. (2020). Venous thromboembolism (blood clots). Retrieved from https://www.cdc.gov/ncbddd/dvt/diagnosis-treatment.html

DVT. (2020). In Epocrates Essential for Apple iOS (Version 20.2) [Mobile Application Software]. Retrieved from http://www.epocrates.com/mobile/iphone/essentials

Govind, N. (2019). Home versus in-patient treatment for deep vein thrombosis. British Journal of Community Nursing, 24(8), 397–398. https://doi-org.libauth.purdueglobal.edu/10.12968/bjcn.2019.24.8.397

Stone, J., Hangge, P., Albadawi, H., Wallace, A., Shamoun, F., Knuttien, M. G., Naidu, S., & Oklu, R. (2017). Deep vein thrombosis: Pathogenesis, diagnosis, and medical management. Cardiovascular diagnosis and therapy, 7(3), S276–S284. https://doi.org/10.21037/cdt.2017.09.01

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