On September 15, 2008, the Surgeon General’s office issued a Call to Action to reduce the number of cases of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) in the United States. DVT is known as the ‘silent epidemic’ and affects an estimated 350,000 to 600,000 Americans annually. Together, DVT and PE contribute to at least 100,000 deaths each year. You can read the full Call to Action at http://www.surgeongeneral.gov/library/calls/index.html.
As you read this section, you will understand the role that graduated compression therapy plays in the prevention, treatment and management of DVT and PE.
DVT is often known as ‘the silent epidemic’ because its symptoms don’t stand out in a crowd.
What is a DVT?
Deep Vein Thrombosis (DVT) is a common, but under-diagnosed medical condition that occurs when a thrombus (blood clot) forms in one of the large veins leading to either partially or completely blocked circulation. Blood clots may form after an injury, surgery or any prolonged sitting or cramped position which obstructs blood flow. This obstruction causes blood to reflux (reverse flow) which increases the venous pressure. This pressure results in edema (swelling). In the second article in this series, we briefly discussed DVT as one of the chronic venous insufficiency conditions.What are the symptoms of a DVT?
Nearly half of reported DVT’s presented with no recognized symptoms. Most common, however, include:
- leg pain and tenderness;
- swelling in the calf muscle, ankle, foot or thigh;
- increased redness and warmth of the leg (many times in the back of the knee area).
DVTs may occur suddenly or over a short time period.
BupaHealth has created a wonderful animated video that shows how a DVT is formed in the body.
Visit http://www.youtube.com/watch?v=CETfozL0cQg to see the video.
Pregnancy and DVT
Women who are pregnant are at a high risk for the development of DVT. One reason is due to the increased blood volume at full term which can be as much as 45-50%. Source: Maternal Physiology Changes During Pregnancy, Priscilla Moreira Sodre’ MD, Obstetrics and Gynecology).
Additionally, pregnancy causes hormonal changes that increase blood coagulability, a measure of how easily blood clots. The expanding uterus puts pressure on blood vessels, restricting blood flow from the legs and pelvis back to the heart. Slower blood flow increases the risk of Deep Vein Thrombosis. The risk continues during the post-partum period until the woman’s hormonal levels return to their pre-pregnancy state. Source: http://www.PregnancyFacts.com.
How do you diagnose DVT?
The diagnostic process consists of a physical exam which takes into account the medical history and risk factors. Confirmation of a clot is determined by a Duplex ultrasound scan which is highly accurate, non-invasive and painless. With Duplex scanning, blood clots and the flow of blood are displayed on the monitor. Once the diagnosis is made, a treatment plan is decided.
DVT Treatments
Treatment for DVT begins right away to prevent the blood clot from growing larger or breaking loose and traveling to the lungs. Individuals are now being treated both in hospital and as ambulatory outpatients according to their diagnosis, their preference, and according to the facility guidelines.
Treatment starts with blood-thinner medications such as low-molecular heparins and a warafin (such as Coumadin). Compression therapy (30-40 mmHg) may be used to reduce pain and swelling as well as help stabilize the blood clot with the hope that it will adhere
to the vein wall while the body’s natural mechanisms dissolve the clot.
Physical activity is important in the treatment process. A patient should:
- walk (no jumping or jarring motions),
- wear compression stockings daily,
- avoid deep calf muscle massage and
- watch for bleeding as a result of being on an anti-coagulant.
Effective treatment prevents the DVT from complicating in more than 95% of cases.
Source: American Venous Forum. What you need to know about Venous Thromboembolism.Complications of a DVT
There are two major complications of a DVT: (1) a chronic condition known as Post Thrombotic Syndrome (PTS); and (2) an acute complication known as Pulmonary Embolism. Let’s look at both of these in further detail.
Post Thrombotic Syndrome (PTS)
Nearly 30% of DVT patients will have a recurrent event within 10 years and the greatest risk is within the first 6 to 12 months. Source: Heit J, et Al. Arch Internal Medicine 2000.160: 761-768.
Due to this high risk, patients are more closely monitored. A patient is prescribed to wear 30-40 mmHg graduated compression stockings or socks to help blood flow and prevent the development of another clot formation.
Pulmonary Embolism
A Pulmonary Embolism is a serious, potentially life threatening condition that is not easily detected by examination. If the DVT becomes loosened and travels through the veins to the lungs, it may block a pulmonary artery or one of its branches. The size and resting place of
this clot may cause chest pain, sweating and shortness of breath. These symptoms are similar to a heart attack and, as a result, the Pulmonary Embolism may not be diagnosed in time.
If the clot is large enough to completely block one or more of the vessels that supply the lungs with blood, it could cause a cardiac arrest and may result in death.
The Role of Graduated Compression Therapy
Compression therapy is the application of controlled graduated external pressure to the limb to reduce venous pressure within the limb. This external pressure acts as a layer of muscle by gently squeezing the stretched vein walls together allowing the valves to close. The cavity of the vein is reduced, thereby restoring blood flow to a normal state and aiding overall circulation.
SIGVARIS medical compression stockings provide relief from pain and swelling caused by a DVT. Physicians recommend wearing 30-40 mmHg compression for at least 2 years after the initial DVT diagnosis. By doing so, the risk of developing another clot is reduced by as much as 50%. Source: Brandjes DP, et. Al. Lancet 1997.
There may be confusion between TEDS (Anti-Embolic Stockings) and graduated compression stocking among many healthcare
providers. TEDS are designed to prevent DVT in people who are in a recumbent (horizontal) position for a long period of time. Remember, one of the risk factors for DVT is long periods of immobilization following surgery.
For ambulatory patients, graduated compression stockings should be worn.
If you suspect that you are developing a DVT, seek immediate medical attention. Following an initial DVT, be especially aware of the high risk you have of developing another DVT. Wear SIGVARIS graduated compression stockings or socks daily to lower this risk.
Note: Only your physician will be able to assess your condition and prescribe the most effective treatment.
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