Thrombosis (venous thromboembolism or deep vein thrombosis - commonly known as phlebitis) can happen at any age. However, thrombosis usually affects people in their sixties. It affects women more often than men. Sometimes thrombosis does not give any symptoms for a long time. That is the problem. Because if thrombosis is not treated in time, it can be life-threatening. Find out what causes thrombosis and how to treat it.
Thrombosis,i.e.venous thromboembolism( deep vein thrombosis ), it usually affects the veins of the shin (calves), much less often - the thighs or pelvis. Occasionally, phlebitis develops elsewhere in the venous system. The mere formation of a blood clot is not life-threatening. But breaking it off the vein wall (especially when it's large) can cause a pulmonary embolism and death within seconds. That is why thrombosis must not be taken lightly.
Thrombosis - causes
In a he althy circulatory system, blood flows rapidly through veins to the heart. The working muscles facilitate pumping blood from the legs against the force of gravity. And the downflow of blood is prevented by valves in the veins. If the blood would like to "turn back", they snap shut and close the way back.
If any part of this mechanism fails, blood remains in the veins, leading to inflammation and then damage to the epithelial lining of the vessel - the endothelium. At sites of damage, platelets "stick" to the endothelium and to each other, forming a clot (thrombus). It reduces the diameter of the blood vessels, thus hindering the outflow of peripheral blood to the heart.
The body's response to a clot varies. Sometimes it is absorbed - but then the valves within it and the inner walls of the vein are damaged and the formation of new clots is only a matter of time. Sometimes they develop a blood clot in the process of absorption, although it sometimes takes many months or years.
When the body fails to absorb the clot, it can grow so large that it clogs the vein like a plug. And although it usually plugs the deep veins of the lower leg, this situation favors the formation of new clots and the spread ofto the popliteal and femoral vein. They will surround successive valves and prevent them from working normally.
ImportantSometimes a clot breaks off the vessel wall and flows with the blood through the heart to the pulmonary artery. If the clots are small, they partially block the vessel. A large clot causes a pulmonary embolism with a risk of acute heart failure and sudden death.
A clogged pulmonary artery may be evidenced by stabbing chest pain, shortness of breath, fever, cough (sometimes with coughing up blood), imbalance, loss of consciousness. Any disorders in the respiratory system require prompt specialist intervention.
Unfortunately, the occurrence of an embolism is often not preceded by any symptoms.
Thrombosis - the onset of the disease
Blood flows smoothly "up", if:
- The heart and circulatory system are functional - the blood has the right pressure and it flows rhythmically through the blood vessels.
- The working muscles help push the blood towards the heart.
- Nothing is blocking the valves - because only then can they prevent blood from flowing back.
When a condition is not met, blood remains in the veins, inflammation occurs and the vein is damaged - this is the beginning of thrombosis.
Thrombosis - symptoms
The first is a violent pain in the calf, which is explained by muscle contraction. But unlike ordinary spasm, the pain not only persists, but also increases when you bend the foot and press against the sole. This makes it difficult to walk, stand, and make the slightest movement.
Pain is usually accompanied by swelling. Swelling is most common around the ankle, sometimes all over the lower leg or thigh, but always below the clot. The skin is warm and red - this is the result of inflammation of the vessel and increased blood flow in the capillaries.
Sometimes there is a low-grade fever, but the fever can also reach 40 degrees Celsius and be the only symptom of the disease. Some patients complain of increased heart rate (tachycardia).
We shouldn't underestimate any of the symptoms. Unfortunately, it does not occur to us to run to the doctor because of swelling or discomfort in the leg. We even disregard how painful she is or how tense she is. That is why people with advanced disease report to the doctor most often.
However, thrombosis (e.g. in pelvic vessels) may be asymptomatic. And we find out about it by accident or as a result of complications. The most common are the so-called post-thrombotic syndrome, which develops as a result of severe damage to the valves of the venous system. It can be a consequence of either asymptomatic or symptomatic, treated anduntreated deep vein inflammation of the lower leg.
Thin, tight, shiny skin with brown discoloration on the lower leg are typical symptoms. Sometimes, hard-to-heal ulcers develop on the leg, which tend to recur. They can appear even several years after the disease disappears.
Thrombosis - risk factors
People over 40 years of age who lead a less active lifestyle are at risk of thrombosis. With age, the risk of disease increases as the walls of the veins lose their elasticity and thicken, which can damage valves and cause blood clogging. Age-related diseases, especially cancer and cardiovascular diseases, have a decisive influence:
- varicose veins
- inflammation of the superficial veins
- excessive blood clotting
The tendency to too thick blood is often hereditary, but it can also be the result of aging, taking oral hormones (birth control pills and alleviating menopausal symptoms) or certain diseases, e.g. heart attack, stroke, chronic leukemia, asthma or diseases rheumatic diseases.
Thrombosis may be caused by injuries, surgical operations (e.g. orthopedic and gynecological), pregnancy, overheating of the legs, standing or sedentary lifestyle, immobilization due to illness.
Circulation may be impeded by tight clothing, crossing legs, and lumps around the groin and pelvis.
Obesity and dietary mistakes are also risk factors: eating too much animal fats and sugar, and not enough fruit and vegetables. Veins are also not used for nicotine, coffee and alcohol.
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Thrombosis - tests and diagnosis
A doctor may suspect a thrombosis on the basis of a detailed history and visual inspection of the leg. However, the diagnosis should be confirmed by specialist examinations.
The basic test is the assessment of the probability of thrombosis according to the Wells scale. The patient answers 12 questions (8 "positive" and 4 "negative") regarding general he alth and thrombosis symptoms - for each affirmative answer, he receives 1 point.
If the risk is low (0 or less) or moderate (1-2), blood D-dimer (a product of the primary constituent of the thrombus that helps to assess the clotting system) must be determined.
If the result is positive, the patient is referred for ultrasound of deep veins with a Doppler attachment. The test allows you to see exactly what is happening in the veins. Lumps on the walls and disturbances in blood flow indicate the presence of blood clots. If the Wells test result shows a high probability of thrombosis (more than 3 points), the patient fromimmediately gets a referral for an ultrasound.
The problem is that people with thrombosis symptoms go to various specialists - family doctor, dermatologist, surgeon, orthopedist, cardiologist. Such a doctor must refer the patient to a vascular surgeon or angiologist, because only he can recommend tests that can diagnose the disease.
The phlebography, which is an X-ray image after administration of a contrast agent into the veins, which has been used for many years, is an exceptionally good method of making the disease worse. In addition, a specialized blood test is performed - a coagulogram, which allows you to assess the coagulation system.
According to an expertprof. dr hab. med. Witold Tomkowski, president of the Polish Foundation for Combating Thrombosis- The Polish Foundation for Combating Thrombosis is trying to shorten this path for patients through torment - says prof. Witold Tomkowski. - We want every doctor suspecting RBB to be able to refer for an ultrasound, which would be done immediately. Sometimes a person with a very swollen leg does not have a thrombus, and the one with a slight swelling has a huge blood clot. Breaking off such a clot means sudden death, so prompt diagnosis is needed. Each of these specialists should also be able to determine D-dimer so that diagnostics is carried out in accordance with the rules applicable in the world - emphasizes prof. Tomkowski.
Read also: What are the causes and symptoms of thrombophilia?
Thrombosis - treatment
The choice of method depends on the severity of the disease and the site of the clot. In most cases, conservative therapy is used on an outpatient basis (when the disease affects the leg veins) or in a hospital setting (if the pelvic veins are affected).
Conservative therapy involves the administration of anticoagulants, which reduce the risk of pulmonary embolism, inhibit the growth of existing blood clots and prevent the formation of new ones.
First, for 10 days, low molecular weight heparin is used in the form of subcutaneous injections (the patient can do them himself). Then, oral blood thinners (acenocoumarol) and phlebotropic drugs are administered to strengthen and protect the walls of the veins.
At the beginning of the treatment, your doctor may recommend lying down with your leg elevated to prevent the clot from breaking off. It is very important in the treatment of thrombosis to wear knee socks or compression stockings (available at a pharmacy). They must also be worn after the end of the treatment to prevent relapses.
You must do it- If you sit or stand for a long time, move your feet every now and then, stand on your toes and on your heels, and walk in place. Do not cross your legs when sitting.
- When traveling by coach or plane, take off your shoes, drink plenty of water, do it occasionallya few exercises with your legs, walk between the rows. Take a break to stretch your legs while driving the car. Take care of the proper body weight. Avoid fatty foods and sweets.
- Drink plenty of fluids (minimum 2 liters a day) to prevent dehydration causing your blood to thicken.
- In case of varicose veins, prone to swelling and "heavy legs" wear compression knee socks (they are also for men) and tights. Large varicose veins must be operated on.
- Remember to take daily walks and exercise. Swimming and cycling give good results.
- Condemned to lie down for a long time, they should often tense and relax their calf muscles, bend their legs at the knees, move their feet (keep them approx. 15 cm higher than the heart), with their fingers.
- Those at risk of disease can take aspirin or its derivatives, which thin the blood (75 mg per day), e.g. Acard.
Treatment of deep vein thrombophlebitis takes time. Sometimes medication takes up to 9 months. In most cases, the treatment ends with a complete recovery, unfortunately, in the case of genetic disorders in the coagulation system, the disease may recur.
Although it is very rare to remove the thrombus surgically (the intervention promotes the formation of new clots) - in the case of long-term or recurrent thrombosis with repeated embolism, surgery is required.
A filter made of a special alloy or stainless steel, resembling an open umbrella, is permanently implanted into the inferior vena cava. It is designed to stop blood clots from flowing into the pulmonary artery.