What Is the Most Effective Deep Vein Thrombosis Treatment?

Deep venous thrombosis refers to the abnormal coagulation of blood in the deep vein cavity, blocking the venous lumen, resulting in venous reflux disorders, causing clinical symptoms such as distal venous hypertension, limb swelling, pain, and superficial vein dilatation. It is more common in the lower limbs and can cause differences. The degree of chronic deep venous insufficiency can be disabling in severe cases.

Basic Information

English name: deep venous thrombosis
Visiting department: Vascular surgery

Common causes: Venous blood flow stagnation, venous wall injury, and hypercoagulability
Common symptoms: Pain, swelling, mostly purple skin on the affected limb, increased body temperature, increased pulse rate, dyspnea, chest pain, hemoptysis, etc.

Causes of deep vein thrombosis

At present, three major factors of deep venous thrombosis are recognized: venous blood flow stagnation, venous wall damage, and hypercoagulability.

Venous blood flow stagnation

Venous blood flow stagnation increases the time that activated platelets and coagulation factors come into contact with the venous wall and easily cause thrombosis. If it occurs in the damaged lining of the vein, the probability of thrombosis is greatly increased. It is caused by deep vein thrombosis of the lower limbs Prime factor.

2. Injury of venous endothelium

Vein endothelium has good anticoagulation and inhibits platelet adhesion and aggregation. If the lining of the vein is damaged, it can cause venous thrombosis. Common in chemical damage, mechanical damage, infectious damage.

3. Hypercoagulable state of blood

The hypercoagulable state of the blood makes blood coagulate easily in the venous system. In addition, endothelial damage or slow blood flow can form deep venous thrombosis.

Each of the above three factors is closely related to the occurrence of thrombosis, but a single factor cannot yet cause the disease independently. Often, the combination of two or three factors causes deep vein thrombosis.

Clinical manifestations of deep vein thrombosis

Pain

Often the earliest symptoms occur, mainly caused by thrombus-induced inflammation of the venous wall and sharp expansion of the distal vein of the thrombus, which stimulates neuroreceptors in the vessel wall. Deep venous or inferior vena cava thrombosis of the lower extremities mostly occurs in the calf gastrocnemius, thigh, and groin areas. Most are pain, painful spasms, and tension, which can be relieved by lying in bed or raising the affected limb.

2. Swelling

Is the main or only symptom. Swollen unilateral limbs are common. In the case of inferior vena cava thrombosis, bilateral limb swelling may appear.

3. Variations in superficial varicose veins and skin temperature

Because the blood flow is blocked, the skin of the affected limb is mostly purple-red, and the skin temperature increases.

4. Systemic response

Such as increased body temperature, faster pulse rate, increased white blood cell count and so on. Body temperature is generally below 38.5 ° C.

5. Pulmonary embolism

Lower extremity deep vein or inferior vena cava thrombosis can fall off, leading to pulmonary embolism, part of which can cause cardiac arrest and respiratory arrest, which is life-threatening and is the most serious complication of deep vein thrombosis of lower extremity. Often manifested as dyspnea, chest pain, and hemoptysis.

6. Postthrombotic syndrome

Mainly manifested as heavy discomfort, swelling, and aggravation after standing or exercising for a long time. May be accompanied by venous intermittent claudication, superficial varicose veins, skin pigmentation, thickening, itching, eczema-like dermatitis, persistent ulcers, or recurrent ulcers.

Deep vein thrombosis

Blood test

There may be elevated D-dimer, indicating a secondary fibrinolytic response triggered by thrombosis. May suggest that there is thrombosis in the body.

2. Doppler ultrasound

Can accurately determine whether there is a thrombus in the vein and the extent of thrombus involvement. Can be used as the preferred diagnostic test.

3. CT venography and pulmonary angiography

The condition of the deep veins of the lower limbs, the inferior vena cava and the pulmonary artery can be clarified. It is an important method for diagnosing deep vein thrombosis of lower limbs. This method is preferred when pulmonary embolism is suspected.

4. Venography

It is the "gold standard" for the diagnosis of deep vein thrombosis of the lower limbs, but it is an invasive test.

Diagnosis and differential diagnosis of deep venous thrombosis

It is not difficult to make a diagnosis based on the patient's symptoms and signs and possible risk factors, as well as the results of auxiliary examinations. Need to identify the following diseases:

Limb arterial embolism

Mainly manifested as sudden pain, paresthesia, pulse disappearance, pale skin, and decreased skin temperature.

2. Acute diffuse lymphangiitis

The onset is rapid, the limbs are swollen, there is no superficial varicose veins, and there may be high fever, redness of the skin, and elevated skin temperature.

3. Other diseases

Lymphedema, acute calf myositis, etc.

Deep vein thrombosis treatment

Acute phase treatment

(1) General treatment Rest in bed and raise the affected limb. Light movements are allowed, and medical stretch socks should be worn when getting up.

(2) Anticoagulation therapy is the most important treatment measure. For confirmed patients and highly suspected patients, if there is no contraindication, anticoagulation therapy should be started immediately. Anticoagulants include unfractionated heparin, low molecular weight heparin, warfarin, and more.

(3) Thrombolytic therapy Acute near-term DVT, within 2 weeks of onset, is generally in good condition and feasible for thrombolytic therapy. Systemic intravenous thrombolysis is generally not recommended, and catheter thrombolysis is recommended.

(4) Surgical removal of DVT is generally unnecessary. Femoral swelling, white femoral swelling, or severe symptoms of patellofemoral vein thrombosis and inferior vena cava thrombosis. The symptoms appear within one week. The general condition is good and surgery is feasible.

(5) Inferior vena cava filter placement Routine filter placement is not recommended for acute DVT. If anticoagulation is contraindicated or thrombosis or pulmonary embolism still occurs on the basis of strict anticoagulation, inferior iliac vein vena cava thrombus, and large floating thrombus at the proximal end, it is recommended to place a filter.

2. chronic phase treatment

For conservative treatment, such as compression therapy with elastic stockings, oral administration of drugs to promote venous return.