Thrombosis or deep vein thrombosis is a term we are becoming familiar with. The word thrombosis entered our language from the Latin word "Thrombos". The word means plug. Therefore, thrombosis means blockage of the vein with a clot, and deep vein thrombosis means blockage of the vein. Thrombosis can occur in arteries, superficial veins, or deep veins. Superficial veins are found all over the body and are located under the skin. Although thrombosis of these veins is common, it is usually corrected with simpler medical treatment. As the name suggests, the deep vein is among the muscle structures in the deep parts of the body. Veins are called veins and arteries are called arteries. The deep veins of the body undertake most of the return of blood to the heart. For this reason, deep vein thrombosis is a disease that requires extreme caution. The incidence of deep vein thrombosis is thought to be 1-2 per 1000 per year in our country.
What causes Deep Vein Thrombosis (DVT)?
The triad (three factors) defined by the German scientist pathologist Rudolf Virchow in the early 1900s is still valid. These are damage to the inner wall of the veins, genetic predisposition to clotting (thrombophilia) and slowdown in blood flow, which we call stasis. If we explain these three concepts:
Vein damage. The inner surface of the vein has an extremely regular structure to prevent clotting. Causes of deterioration in this internal structure we call endothelium;
-Infections, especially coronavirus (covid-19) infection
-Intravenous drug treatments, sometimes long-term antibiotic applications, chemotherapeutic drugs used in cancer treatment.
-Direct damage caused by injection into the vein
-Receiving serum from the vein for a long time
-Intravenous drug use addiction
-Intravenous drug use catheter placement or direct trauma
These situations create vascular wall damage and prepare the ground for thrombosis.
Stasis Blood pooling in the leg veins, slowing down or stagnation of blood flow in the vein is very important in the development of thrombosis. plays a role. To briefly summarize the causes of stasis:
-Long-lasting abdominal and pelvic area operations
-Leg traumas and immobilization Traumas with severe fractures that end with immobility of the leg, which we call cation
-Orthopedic surgeries, putting the leg in a cast
-Hip fracture
-Especially those that cause a slowdown in blood flow due to immobility. Travels exceeding 10-12 hours
-Staying in the intensive care unit
-Masses that put pressure on the veins and the development of deep varicose veins, which we see very commonly
Genetic predisposition to clotting (thrombophilia ) These are conditions that create an inherited tendency to clot. Factor 5 Leiden mutation in the blood, the presence of antiphospholipid antibodies, antithrombin 3, protein C and protein S deficiency predispose to clotting. DVT usually occurs in older ages and is triggered by risk factors. For this reason, atypically located thrombosis, young patients, thrombosis developing without any obvious cause, and the presence of DVT in other members of the family are warnings in terms of heritability. Other conditions that cause thrombophilia (proneness to clotting); cancer, chronic infections, pregnancy, hormone replacement therapy, birth control pills, male gender, decreased body water content and obesity.
Deep Vein Thrombosis Findings
DVT causes symptoms depending on the affected area. It can affect any part of the body, including legs, arms, internal organs, abdomen, lungs and brain. 90% of DVTs occur in the leg area. Therefore, when DVT is mentioned, if the region is not specified, the leg region should come to mind. Since leg (lower extremity) DVTs usually begin in the lower leg regions, in the calf area, the first symptoms appear here and progress to the upper regions within hours and days.
These findings;
-Rapidly progressing and severe in the calf region. tension, pain and swelling
-As deep-seated venous vessels are blocked, blood is forced to flow through superficial veins to return to the heart, therefore color changes such as temperature increase, skin darkening and redness occur.
-Rarely. Lung clot symptoms, which we call pulmonary embolism, occur when a large clot breaks off and travels to the lungs without any symptoms in the leg. This condition is a feared complication that endangers the patient's life.
Pulmonary embolism symptoms
It is manifested as a sharp stinging pain in the lungs, respiratory distress, bleeding from the mouth and cough.
How is DVT Diagnosed?
Today, in modern centers, DVT diagnosis begins with listening to the patient's complaint and examination, and can be made very simply with the available imaging methods. . With the color Doppler ultrasonography ultrasound device, not only deep vein thrombosis, which we call venous thrombosis, can be diagnosed within a few minutes, but also its location and vein map can be determined. It is the gold standard today because it does not contain radiation, is low-cost, is extremely practical and provides real-time images. Usually alone is sufficient. However, it may not be sufficient to detect some overweight patients and intra-abdominal vascular occlusions. In these rare cases, magnetic resonance (MRI), Computed Tomography (CT) and venography are diagnostic methods that can be applied. CT angiography is a very valuable examination method in the diagnosis of pulmonary embolism (lung clot) due to DVT.
DVT Complications
It has two important complications. These are pulmonary embolism and postthrombotic syndrome.
Pulmonary Embolism (Lung clot) occurs when a large piece of DVT breaks off and blocks the lung vessel in the acute period, that is, in the early period, while the clot is still soft (the first 2-3 weeks). Unless there is a congenital hole in the heart, the clot that breaks off from the veins and reaches the heart will travel directly to the lungs and cannot pass into the arterial system. However, if there is a defect between the right and the left, which we call a hole in the heart, a large clot may progress to the more vital brain. Pulmonary embolism presents with sudden onset of respiratory distress, sudden onset of sharp pain and bloody cough. Mild cases recover with some decrease in lung capacity. In moderate cases, respiratory distress may become permanent. In severe cases, it can cause death. The incidence of pulmonary embolism in deep vein thrombosis is close to 50%. However, the serious embolism rate is between 10%.
Postthrombotic syndrome: If patients with DVT do not receive appropriate treatment, postthrombotic syndrome begins to develop within 2 years. After DVT occurs, most of the clot in the vessel will not dissolve and will harden within the vessel and turn into scar tissue. This will cause irregularities, stenosis and blockages in the veins to continue throughout life. forward says Since narrowed and blocked veins cannot carry blood to the heart, side branches, which we call collaterals, will develop and begin to carry blood to the heart. Since collateral veins can never drain properly and adequately like normal veins, blood pooling in the legs, increased intravascular pressure and deterioration in tissue nutrition will occur. These patients develop leg swelling, skin thickening, permanent hyperpigmentation and deep ulcerated wounds. At this stage, treatment enters a difficult phase for both the patient and the physician. In these patients, whom we call postthrombotic syndrome, the leg becomes incapacitated within 5-10 years and permanent disability occurs. Since the vascular structure is completely irregular and damaged in postthrombotic syndrome, many varicose veins develop in the surrounding area, which triggers recurrent vascular occlusions. In recent years, closed system angiographic operations have been developed that will significantly improve the complaints of these patients.
Reasons to Prevent the Development of Thrombosis
Individuals in the risk group, especially on long journeys, use the vehicle corridors every hour if possible. They should take short walks, or if not possible, they can do leg exercises. These leg exercises can be done to exercise the lower leg muscles, especially in the calf area, such as stepping on the tip of the foot, pressing on the heel of the foot, turning the foot left and right, and creating circular movements of the foot. In daily life, walks of 15 to 60 minutes should be taken above the routine pace. In major and long-lasting surgeries, heparin (blood thinner) can be applied before the operation. Compression stockings (compression stockings) can be used after abdominal surgery and early mobilization is important. New generation oral anticoagulants (blood thinners) can be used after hip and leg operations. Once DVT develops, the risk of new thrombi forming again and again is very high. For this reason, oral blood thinners, which we call oral anticoagulants, should be used to prevent new thrombus development. The risk of recurrent DVT is highest in the first 3 months. After the development of DVT, protective anticoagulants may be required for at least 3-6 months, sometimes much longer depending on the cause, to prevent relapses.
Read: 0
