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Deep vein thrombosis TVP: causes, symptoms, diagnosis and treatment



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Deep vein thrombosis (DVT): It is a blood clot that develops in the deep vein of the body, usually in the bed. DVT usually occurs in the deep vein of the leg, the largest vein that crosses the muscles of the calf and thigh. This condition can cause pain and swelling of the leg and can cause complications such as pulmonary embolism, a serious illness that occurs when a piece of this clot breaks the bloodstream and obstructs one of the blood vessels in the lungs. Deep vein thrombosis (DVT) and pulmonary embolism are called venous thromboembolism (TEV).

Symptoms of deep vein thrombosis

In some cases, there can be no symptoms (TVP).

If symptoms appear, they may appear as:

  • Pain, swelling and irritation (ILL) in a bed (usually the calf).
  • Severe pain in the affected area.
  • The skin is warm in the area of ​​the clot.
  • Red leather, especially on the back of the leg down on the knees.

TVP usually affects (if not always) a bed. The pain is twisted as it bends the foot to the knee.

If it is not treated, about 1 in 10 people with deep vein thrombosis will experience pulmonary embolism.

Pulmonary embolism is a very serious illness, which is manifested in the form of:

  • Transpirable airspace: gradual may occur gradually.
  • Pain in the chest: it can get worse when breathing.
  • And a sudden collapse.

Both DVT and pulmonary embolism require immediate medical research and treatment.

Look for immediate medical attention if you have pain, swelling and pain in the leg and have short respiration and chest pain.

What are the causes of deep vein thrombosis?

Every year, TVP affects approximately one in every 1,000 people in the UK. Anyone may have deep vein thrombosis, but it is more common than the forty. In addition to age, there are also a number of other risk factors, such as:

  • The presence of a history of deep vein thrombosis of a person or pulmonary embolism.
  • Have a positive family history of blood clots.
  • Inactive for long periods, such as a period after the operation or during a long journey.
  • Damage to blood vessels, the wall of a damaged container may cause the formation of blood clots
  • Some cases or treatments lead to blood clotting more easily than normal, such as cancer (including chemotherapy and radiotherapy), cardiac and pulmonary disease, hyperthyroidism (coagulation) and Hughes syndrome.
  • Pregnancy, as blood is coagulated more easily during pregnancy.
  • Weight gain or obesity.

Contraceptive tablets and hormone replacement therapy contain female estrogens, which make blood clotting easier. If you make any of these options, you will increase the risk of TVP slightly.

Diagnosis of deep vein thrombosis

Consult your doctor as soon as possible if you think you have deep vein thrombosis, for example: if you have pain, swelling and pain in the bed. Your doctor will ask you about the symptoms and the medical history of the illness.

D-dimer test

It may be difficult to diagnose deep vein thrombosis only from the symptoms, so your doctor may recommend a blood test called D-dimers.

This test reveals the parts of the blood clot that have been lost and lost in the bloodstream. The more pieces you find, the more likely you will have a clot in your vein.

The D-dimer test can not always be trusted because broken fractions of the blood clot may increase after an operation, after an injury or during pregnancy. You must perform additional tests, such as ultrasound, to confirm deep vein thrombosis.

Ultrasound image

An ultrasound can be used to detect clots in the veins. A special type of ultrasound called Doppler can also be used to determine the rapid flow of blood through the blood vessels.

This helps doctors determine when the blood flow slows down and reveals the presence of a blockage, which can be caused by a blood clot.

Venogram

In this test, a fluid called intravenous dye is injected into the foot. The dye moves towards the top of the leg and can be detected by means of an x-ray, which will highlight a gap in the blood vessels, where there is a clot that stopped the flow of the bloodstream.

Treatment of deep vein thrombosis

DVT usually includes anticoagulants, which reduces blood's ability to cause clots and stops the growth of existing clots. Heparin and warfarin: two types of anticoagulants, often used to treat deep vein thrombosis. Heparin usually prescribes first; It works immediately to prevent further formation of clots.

After the initial treatment, you may need to take warfarin to prevent the formation of another blood clot. Some anticoagulants, known as direct oral anticoagulants (DOACs), can also be used to treat diseases such as deep vein thrombosis.

These drugs include rifocapan and ibexapan, and have been shown to be effective, such as heparin and the keys with less serious side effects.

Prevention of deep vein thrombosis

If you have to go to the hospital, a member of your health care team should evaluate the risk of a blood clot since you were hospitalized, regardless of your treatment.

If you have a risk of deep vein thrombosis, you can do several things to avoid a blood clot, either before going to the hospital, such as stopping temporarily taking a combination of tablets and wearing compression stockings while you are to the hospital.

When leaving the hospital, the healing team will also recommend that you help prevent recurrence of DVT or complications, such as:

  • Stay away from smoking.
  • Eat a healthy and balanced diet.
  • Regular exercise
  • Keep a healthy weight or lose weight if you are obese.

There is no evidence suggesting that taking aspirin reduces the risk of DVT.

Consult with your doctor before traveling long distances if you have a risk of developing deep vein thrombosis or if you have deep vein thrombosis in the past.

When you make a long journey (6 hours or more) by plane, train or car, you must take measures to avoid injuries, such as drinking lots of water, doing simple exercises in the bed and resting on a regular walk during a short period of time time

Risk assessment

Deep vein thrombosis TVP: causes, symptoms, diagnosis and treatment A blood clot develops in the deep vein of the body's blood vessels

Surgery and some medical treatments may increase the risk of deep vein thrombosis, with an estimated number of 25,000 people admitted to hospital for blood clots (which can be prevented every year).

Prevention of venous thrombosis is a priority of the Ministry of Health and Social Welfare in all national health services.

All patients admitted to the hospital should be evaluated for the risk of having a blood clot regardless of the type of treatment they receive and, if necessary, receive a preventative treatment.

Reasons

This thrombosis occurs sometimes for no apparent reason. However, the risk of deep vein thrombosis may increase in certain conditions.

Inactive

When you are inactive, the blood tends to meet in the lower parts of the body, especially in the lower legs. Normally do not worry, since when you begin to move the blood flow it increases and moves uniformly around the body.

To the hospital

If you go to the hospital, you are more likely to have a blood clot. The risk of venous thrombosis is more likely to be ill or inactive, or when you are less active than normal.

The risk of having deep vein thrombosis depends on the type of treatment that is applied to you. You may have more TVP risk if you apply any of the following options:

  • It is subject to a process that takes more than 90 minutes or 60 minutes, if the operation is performed in bed, hip or abdomen.
  • If you are experiencing an inflammatory process or a stomach disease, such as appendicitis.
  • If you are pregnant in your crib, you can not walk or spend almost all day in a bed or chair for at least 3 days.

It is also possible that you have a higher risk of DVT if you are less active than normal due to the operation you are suffering or severe injuries, and you have other predisposing factors for deep vein thrombosis, such as a positive family history of this condition.

When you enter the hospital, you should assess the risk of a blood clot, regardless of the type of treatment you receive and, if necessary, receive a preventative treatment.

Damages to the blood vessels

In the event of damage to the container wall, it may remain narrow or blocked, which can cause the formation of a blood clot.

Blood vessels may be damaged by injuries such as broken bones or severe muscle damage. Sometimes blood vessels can occur during surgery, causing a blood clot, especially at the lower half of the body.

Blood vessels may be damaged due to other conditions such as: vasculitis, varicose veins and some forms of medications such as chemotherapy.

Medical and genetic condition

The risk of developing deep vein thrombosis increases if you have a condition that makes blood clotting easier than normal. These conditions include:

  • Cancer: like chemotherapy and radiotherapy. This risk can increase more.
  • Diseases of the heart and lungs.
  • Infectious diseases, such as hepatitis.
  • Inflammatory conditions, such as rheumatoid arthritis.
  • Thrombosis (hyperthyroidism): a genetic condition in which blood tends to increase coagulation.
  • Phospholipid antibody syndrome: Immune system disorder that increases the risk of blood clots.

Pregnancy

During pregnancy, blood clotting is done more easily. It is a method that comes from the body to avoid too much blood loss during childbirth.

Venous thrombosis (TEV), deep vein thrombosis (DVT) and pulmonary embolism affect one in 100,000 women of childbearing age.

Deep vein thromboembolism is rare during pregnancy, although pregnant women are 10 times more likely to become infected than non-pregnant women of the same age. The clot can be formed at any stage of pregnancy and can last up to six weeks after birth.

The risk of deep vein thrombosis increases during pregnancy during hyperthyroidism (a condition in which blood is more prone to coagulation), or the presence of a father, brother or sister with a clot of blood

Other risk factors during pregnancy:

  • Age over 35 years.
  • Obesity (with IMC 30 or more).
  • Pregnancy with two or more children.
  • The section of César recently.
  • Inability to move for long periods of time.
  • To smoke.
  • The presence of dangerous functions.
  • Drying

Low molecular weight heparin (LMWH) is generally used to treat pregnant women with deep vein thrombosis. LMWH is an anticoagulant, which means that it avoids blood clotting. It is given by injection and does not affect fetal development.

Contraceptive and hormonal replacement therapy (HRT)

Both the combined tablet and the hormone replacement therapy contain female estrogens. Estrogen leads to blood clotting more easily than normal, which increases the risk of a deeper vein thrombosis. On the other hand, there is no serious risk of contraceptive pills that contain only progesterone.

Other reasons

The risk of having deep vein thrombosis increases if you or someone close to you has already experienced DVT and is associated with:

  • Weight gain or obesity.
  • To smoke.
  • You mario
  • Increase your age to 60 years, especially if you have an illness that limits your activity.

How is blood coagulation produced?

The blood contains cells called platelets and proteins known as coagulation factors. When cutting blood vessels, platelets and coagulation factors form a solid clot that acts as a stopper to stop bleeding from the wound.

Blood clotting usually occurs when the blood vessels become damaged and bleed. In the case of coagulation of the blood when there is no damage, the thrombus can be formed within the vein or the artery, which makes the blood flow difficult.

Treatment

If you have deep vein thrombosis (DVT), you should take medications called anticoagulants.

Prevention of blood clotting

Anticoagulants avoid more blood clots and can also help stop the division of a part of the thrombus and release it to another site of the bloodstream.

Although they are often called anticoagulants, blood thinners do not actually weaken, but proteins change to the inside, preventing them from forming clots.

Heparin and warfarin are two types of anticoagulants that are used to treat DVT. Heparin usually prescribes first because it works immediately to prevent further formation of clots. After this initial treatment, you may also need to take warfarin to prevent the formation of another blood clot.

Heparin

Heparin is available in two different ways:

  • Heparin is standard (undivided).
  • Heparin (LMWH) has a low molecular weight.

Standard (non-divided) heparin can occur in the following way:

  • Intravenous injection: a direct injection into the vein.
  • Intravenous infusion: by continuous distillation of heparin (through a pump) through a narrow tube in the vein of the arm (this procedure must be hospitalized).
  • Injection under the skin: by subcutaneous injection.

The low molecular weight (LMWH) is usually given under the skin.

The standard dose of heparin (not divided) varies a lot from person to person, so the dose must be monitored and adjusted with care if necessary. You may have to stay in the hospital for 5 or 10 days and repeat your blood tests to make sure you have the right dose.

LMWH acts differently than the standard heparin, which contains small molecules, which means that its effects are more effective and should not remain in the hospital and control.

Both standard heparin and LMWH can cause side effects, such as:

  • Cutaneous rash and other allergic reactions.
  • Bleeding
  • The bone weakens if it is used for a long time (although it is rare with LMWH).

In rare cases, heparin can also cause a severe reaction that causes the existing blood clots to be worse causing new clots. It is worth mentioning: this reaction and the weakness of the bones are less likely to occur when taking LMWH. In most cases, you will get (LMWH), it is easier to use and causes fewer side effects.

Varfarin

Warfarin is taken as a pill. You should take it after the initial treatment with heparin to prevent further blood clots. Your doctor may recommend taking warfarin for 3 or 6 months. In some cases, it may be that you take more time, possibly throughout your life.

As with standard heparin, the effects of warfarin vary from person to person. You will need careful follow-up through repeated blood tests to make sure you are taking the right dose.

When you start taking warfarin for the first time, you may need to do two or three blood tests a week until the doctor decides the ideal dose. After that, you will have to perform a blood test every 4 weeks at an outpatient clinic to follow anticoagulants.

Warfarin can be affected by your diet and any other medication you make and is also affected by the liver (depending on its function).

If you are taking warfarin, you should:

  • Maintain a balanced diet.
  • Reduce the amount of alcohol you drink (do not exceed 14 alcohol units per week).
  • Take warfarin at the same time each day.
  • Do not start taking any other medication without consulting a doctor, pharmacist or anticoagulant.
  • Do not use herbal medicines.

Warfarin is not recommended for pregnant women, since heparin is prescribed for the duration of the treatment.

Refroxipan

It is a recommended medication for the National Institute of Health and Care, a possible treatment for adults with deep vein thrombosis, or a treatment that helps to prevent recurrent infections and also to prevent pulmonary embolism.

They are sold as pills. This type of anticoagulant is known as direct oral anticoagulants. The formation of blood clots is inhibited by the inhibition of a substance called the tenth factor and the inhibition of thrombin formation (an enzyme that helps coagulate blood).

The treatment usually lasts for 3 months and consists of taking rifocianabine twice a day during the first 21 days and then once daily until the end of the drug program.

Apexapan

It is also recommended for the National Institute for Healthcare and Assistance, a possible way to treat and prevent the incidence of deep vein thrombosis and pulmonary embolism.

Compression stockings

If you have TVP, you do not have to carry special means called pantyhose (compression stockings) to prevent DVT or to prevent the following thrombosis syndrome (the syndrome after venous inflammation) because it is not clear if the socks help to prevent these conditions . .

Your healthcare professional will ask you to use this response to treat deep vein thrombosis or post-coagulation symptoms, as they can see that they will help you.

Exercise

Your health team often recommend walking regularly; It can help prevent TVP symptoms and can help improve the illness or prevent complications of DVT, such as post-coagulation syndrome.

Filters of inferior vena cava

Sometimes, they are using lower vena cava filters as an alternative to anticoagulants. It is usually used when anti-coagulant therapy should be discontinued, when it is inadequate or does not work.

The inferior vena cava filters are small mesh devices that can be placed in the vein. Have large chunks of blood clots and stop them not to reach the heart and lungs. It can be used to prevent blood clots in the legs of people diagnosed with:

  • Deep vein thrombosis.
  • Pulmonary embolism
  • Multiple serious injuries.

The lowest vena cava filters can be placed permanently or the newest types of filters can be temporarily placed and eliminated after reducing this risk of coagulation.

The lower vacuum filter is installed using a local anesthetic (awake, but the area is numb). A small area of ​​the skin is cut and a catheter (thin and flexible tube) is carried out in the vein in the neck or in the area.

Direct the catheter by exploration through the ultrasound. Then the lower vacuum filter enters the intravenous catheter.

Complications

The main complications of deep vein thrombosis are in two ways: pulmonary embolism and post-thrombotic syndrome.

Pulmonary embolism

Pulmonary embolism is one of the most serious complications of deep vein thrombosis. It occurs when a piece of blood clot crosses the bloodstream into the lung and blocks the blood vessels. This can be deadly in serious cases.

If the clot is small, it can not cause symptoms. If the size is medium, it can cause chest pain and respiratory difficulties. Once large it can cause a breakdown in the lungs, causing heart failure and this can be fatal.

Approximately 1 out of 10 people with untreated deep vein thrombosis have a strong pulmonary footprint.

Post-thrombosis syndrome

If you have deep vein thrombosis, you may have long-term symptoms in your calf known as post-thrombosis syndrome. This condition affects about 20-40% of people with a history of deep vein thrombosis.

If you have deep vein thrombosis, the blood clot in the vein of the rectum can turn the blood flow into other veins, which will increase the pressure. This can affect the tissues surrounding the calf, showing symptoms such as:

  • Pain in the calf.
  • Swill
  • Rash.
  • Ulcer injuries (serious cases).

عندما يتطور الخثار الوريدي العميق في وريدك الفخذي, يزداد خطر حدوث متلازمة ما بعد التخثر. منتقال على تحدث إذا كنت تعاني من زيادة الوزن أو إذا كان لديك أكثر من خثار وريدي عميق في نفس الساق.

اقرأ أيضا:

فقر الدم الانحلالي البالمناعة الذاتية: الأسباب والأعراض والتشخيص والعلاج

الكمنة العابرة أو العمى العابر

السكتة الدماغية, أسبابها وأنواعها وطرق علاجها

سعل رجل هذا الجلطة الدموية ذات الشكل المثالي فأذهل أطباءه

تشنج القدم: الأسباب والأعراض والتشخيص والعلاج

ترجمة: هلال الحميد

تدقيق: تسنيم الطيبي

مراجعة: رزان حميدة

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