Leukemia (Blood Cancer)

Deep Venous Thrombosis (Varicose Veins)

 Hi all. In this blog, we are going to talk about deep vein thrombosis, or DVT for short which is a big issue, especially among patients post-op undergoing surgery patients who are immobile chronic illness and bed-bound DVT can lead to a common complication called pulmonary embolism which is life-threatening the signs and symptoms of DVT include asymmetrical edema asymmetrical cough swelling and asymmetrically localized pain in the cuff there can be signs and symptoms of pulmonary embolism as well which is again a common complication of DVT drawing a normal leg on the left here we have a liquid DVT the leg with DVT on the Left is swollen has edema with erythema and is warm.

So deep vein thrombosis as the name implies means thrombus forming within the deep veins so let’s look at a normal vein of the legs here a normal vein of the legs has valves that assist in the hero dynamics of the veins and helps return blood back to the heart by preventing backflow in deep vein thrombosis. There is a thrombus occurring within these veins of the leg the lower legs usually and so clotting is occurring a thrombus is made up of a network of fibrin mesh platelets and red blood cells they all clump together via a coagulation cascade and form what's known as a thrombus there are many causes of deep vein thrombosis or thrombus formation but it can all be condensed to three things and these three things are or factors make up what we call Virchow’s triad and the virtuous triad is a includes vessel injury. (1) Venous stasis (2) Hyper-coagulability (3) different diseases condition leads to one or more of these factors and this will predispose one to develop deep vein thrombosis.

So once a thrombus has occurred the thrombus itself has a few faiths including propagation which means just growing along with the vessel organization, organizing within the vessel layer recanalization forming holes within the thrombus embolism which means dislodgement of the thrombus allowing the thrombus to travel around the body via the blood and/or resolution the thrombus just gets broken down by Plasmon. My fact is that we have it in our own body but we will mainly focus on embolism because it is a common fate of thrombus in the deep veins and can be life-threatening when a thrombus dislodges and becomes an embolus it can travel up to the heart via the inferior vena cava, the heart will then pump the embolus to the pulmonary circulation, the embolus can then lodge into the pulmonary arteries causing a what's known sorry as a pulmonary embolism and this can subsequently cause pulmonary tissue, in fact, if it is big and so pulmonary embolism is a big complication of deep vein thrombosis.

Another big complication is actually the side effects of the medications people take who have deep vein thrombosis and these medications can cause acute GI bleeding because the medications are anticoagulants the risk factors for developing deep vein thrombosis essentially will fall into one or more of the virtues category the virtues tried category and these risk factors include pregnancy, now pregnancy can cause or as a risk factor to DVT because when the uterus enlarges it can press against the inferior vena cava causing stasis below also in pregnancy. There is a rise in clotting factors other risk factors for developing deep vein thrombosis include increased age obesity, malignancy having had a major surgery for the past three months having medical comorbidities being hospitalized in the past two weeks and for patients who are hospitalized 25 to 50 percent of actually surgical patients can develop DVT and also many non-surgical patients other risk factors for DVT include being on certain medications such as oral contraceptives Tamoxifen being on long distant flights genetics also plays a role in increasing the risk of DVT genetics including anti-thrombin gene mutation protein C and S deficiency and also anti-thrombin deficiency investigations for deep vein thrombosis include a full blood count, liver function test, electrolyte, urea, creatinine, INR, APTT which are both clotting studies imaging including Venous Duplex Ultrasound and imaging can also include imaging for the Chest in suspicion of pulmonary embolism there is another investigation that can be done based on the coagulation cascade let me briefly go through the coagulation cascade.

There are two pathways in the clotting cascade or a coagulation cascade which is the extrinsic pathway and the intrinsic pathway both the extrinsic pathway and the IND intrinsic pathway will lead to a common pathway which is activation of factor 10 to factor 10a, 10 a in turn activates factor 2 or Prothrombin to factor 2a which is known as thrombin, then activates fibrinogen to fibrin, that forms the basis of the fibrin mesh and is the last step in the formation of the thrombus so now the thrombus is formed however things can also break down the thrombus these things is plasminogen or plasmon and a plasma Cleaves the fibrin creating what is now called a deed during active thrombosis there is elevated d-dimer's and so the measurement of a d-dimer can give some indication of coagulation activity that is occurring in the body however saying this testing for D dimeris not very specific for deep vein thrombosis as elevated D dimer also occur in a number of other conditions including pregnancy as well as post surgery and so measuring D dimer is often not useful but sometimes it is useful in ruling out pulmonary embolism or deep vein thrombosis let's move on to management which is mainly anticoagulants and essentially the anticoagulants include heparin and there are two types of heparin that can be given low molecular weight.

Heparin which is given IV or subcutaneous un-fractionated warfarin is given orally and needs maintenance through INR measurement essentially heparin and warfarin target some pathways within the clotting cascade mainly the common pathway another important management is actually prophylaxis preventing PE from occurring and this is especially important for patients who are undergoing surgery and these prophylaxis interventions include compression stockings as well as physical activity for the people that sit down a lot to keep the blood flowing.