Deep vein thrombosis (DVT) occurs when blood clots form in a deep vein in the leg or the pelvis. Image Credit: Vijith Pulikkal/Gulf News

Deep vein thrombosis or DVT is generally associated with people travelling on long-haul flights, but beware it can happen to anyone. Here is all you need to know about DVT.

My encounter with DVT: A post-flight experience

DVT can strike you like a bolt out of the blue, especially the first time around when you have no clue what you are dealing with.

My first, and hopefully only, experience dates back to 2016 when I returned to Dubai from a three-week holiday to the US and the UK. No sooner had I landed than I developed a sharp pain in the calf muscles of my left leg. I put it down to the long walks I had undertaken over the last couple of days as I explored London on foot. I promptly returned to work, even though the pain was progressively getting worse. On the fourth day, when I was out on a field assignment, I found myself grabbing a chair to sit down as I was unable to stand at a stretch.

Back home, I still tried dismissing the pain, but on the insistence of my husband, agreed to see a doctor the next morning.

It was a Friday, a weekly holiday at the time, so we went to the Emergency of a private hospital in Dubai Health Care City. Without much ado, I was asked to give a blood test and my leg was put through a scan. Subsequently, I was told I had DVT with a tiny clot lodged in my leg. I was lucky it had not travelled to my heart or lungs, causing a blockage or pulmonary embolism, which could even turn fatal in some cases.

I was then referred to a hematologist, who after further investigations, put me on an anticoagulant. The pain subsided in a day or so, but the treatment was prolonged. I had to continue with the medication, with weekly blood tests being conducted to check for the D-Dimer (protein fragments indicating the presence of a clot) levels. Finally, eight months later, I was told I could stop the anticoagulant. However, I was asked to take the medicine as a precaution if I went on a long-haul flight. To date, I continue to follow the advice.

Of course, like anyone else who may be at risk of developing DVT after a long flight, I also make it a point to take a seat with more legroom, exercise my calf muscles and feet and walk around a bit. I also ensure I drink lots of water. After all, it is always better to be safe than sorry.

Sharmila Dhal, UAE Editor

What is deep vein thrombosis (DVT)?

Deep vein thrombosis (DVT) occurs when blood clots form in a deep vein in the leg or the pelvis. The clots can occur in other parts of your body, including the arm, brain, intestines, liver or kidney.

A pulmonary embolism (PE) can occur if a clot breaks off and travels to the lungs. It can be life-threatening. DVT and PE are two parts of the disease known as venous thromboembolism.

Image Credit: Vijith Pulikkal/Gulf News

Watch: UAE-based surgeon explains how he treated a DVT patient

A Sharjah-based cardiologist explains how he treated a DVT patient

A 48-year-old man came to me with swelling in his left leg, said Dr Fekry ElDeeb, Consultant, Interventional Cardiology, NMC Royal Hospital, Sharjah.

He also complained of shortness of breath and chest pain. The expat was diabetic and was having a high fever for 3 days, along with a dry cough, the cardiologist said.

Dr Fekry ElDeeb, Interventional Cardiology

"I examined the patient and found out that his oxygen saturation was low and his left leg was swollen and tender," Dr Fekry said.

After tests, it was found that the patient was COVID-19 positive. The patient was admitted and treatment started but didn't show much improvement. The patient was then moved to the cardiac catheterisation lab (a specialised area in the hospital where doctors perform minimally invasive tests and advanced cardiac procedures), and the clot was removed, the Sharjah-based doctor said.

It was a case of acute DVT and once the procedure was done, the patient started to recover. He was discharged after a week and was kept on oral anticoagulants. He is perfectly well now and leads a normal life, Dr Fekry said.

UAE-based doctor on DVT preventive measures

DVT preventive steps
Image Credit: Vijith Pulikkal/Gulf News

What are the causes of deep vein thrombosis (DVT)?

Blood clots may form when blood flow in your veins slows down or becomes blocked. Anything that prevents the blood from flowing or properly clotting can cause a blood clot. The main causes of deep vein thrombosis (DVT) are damage to a vein from surgery or inflammation and damage from infection or injury.

Who is at risk of DVT?

DVT can strike at any age, but the incidence is greater in older ages. DVT is extremely rare in children, and according to the US National Heart, Lung, and Blood Institute in Maryland, the risk of DVT doubles every 10 years after people reach 40 years of age.

People older than 60 are at a higher risk of developing DVT. The chances of women experiencing DVT are high around childbearing age, but it dwindles after menopause.

Only 1 in 10,000 people younger than 20 get DVT, but among those older than 80, it is 1 in 100, a report in Healthline said.

DVT is a medical urgency, a Medical News Today report said. According to the US Centers for Disease Control and Prevention (CDC), 10-30 per cent of people who develop DVT in the leg can develop fatal complications within a month of diagnosis.

What are the symptoms of DVT?

Up to 30 per cent of people with DVT don’t have symptoms, and in some cases, the symptoms are very mild and may not raise concern. According to the Cleveland Clinic in Ohio, US, the symptoms associated with an acute DVT include:

• Swelling of your leg or arm (can happen suddenly).
• Pain, cramping or soreness in your leg or arm when standing or walking.
• A feeling of warmth in the affected area.
• Change in skin colour: red or discoloured.
• Veins near your skin’s surface may be enlarged.
• Abdominal or side pain (if blood clots are in the abdomen).
• Severe and sudden headaches or seizures (when blood clots affect veins in the brain).
• Symptoms of acute PE (clot in the lungs) include chest pain, racing pulse, breathlessness, coughing up blood, dizziness and fainting.

How is DVT diagnosed?

According to Penn Medicine of the University of Pennsylvania Health System in Philadelphia, US, the testing may include:

Complete blood count (CBC): This test can identify signs of infections or problems related to clotting.
D-Dimer blood test: The blood test looks for a protein the body makes to break down a clot. A negative result is required to rule out a clot.
Doppler ultrasound: Sound waves are used to provide images of blood flow in the area where there is a clot.
Pelvic MRI: If a blood clot in the pelvis is suspected, an MRI is used to get clear images of bones, soft tissue and blood flow in the area.
Other blood tests: To check Antithrombin III levels, lupus-related problems, genetic testing (for mutations), and levels of proteins that help regulate clotting.

What is the danger of DVT?

DVT is not life-threatening, but the clots have the potential to break free and travel through the bloodstream. A life-threatening condition known as pulmonary embolism (PE) occurs if it lodges in the lungs.

Around 50 per cent of people who get a DVT in their legs develop symptoms of intermittent leg pain and swelling that may last months to years, a Cleveland Clinic report said. Called post-thrombotic syndrome, this happens due to damage to the valves and inner lining of veins.

Characteristics of this condition include:

• Pooling of blood.
• Chronic leg swelling.
• Increased pressure within your veins.
• Increased pigmentation or discolouration of your skin.
• Leg ulcers are known as venous stasis ulcers.

How common is DVT?

Each year, approximately 1 to 3 in every 1,000 adults develop a DVT or pulmonary embolism in the United States, and up to 300,000 people die each year due to DVT/PE, a Cleveland Clinic report said.

It’s the third most common vascular disease, behind heart attacks and strokes.

More than half of all DVTs happen after a hospital stay due to illness or following surgery. That’s because the patient would lie in bed most of the time instead of moving around.

What are the risk factors?

Several factors can increase the risk of developing DVT. According to Mayo Clinic, the main risk factors include:

Lack of movement: When legs are not moved for a long time, the calf muscles don’t contract enough to keep the blood flowing. Long-distance driving or flying raises the risk, as does long-term bed rest, including a lengthy hospital stay.
Injury or surgery: Injury to veins can increase the risk of blood clots. Blood vessels can be damaged during surgery.
Pregnancy: Pregnancy increases risk by 5-10 times due to the pressure in the veins in the pelvis and legs. The risk of blood clots can continue for up to six weeks after delivery.
Medications: Some medications, such as birth control pills, hormone therapy drugs, glucocorticoids, and antidepressants, can increase the chances of blood clots.
Obesity: Higher body weight increases the pressure in the veins in the pelvis and legs.
Smoking: It affects blood flow and clots, raising the risk of DVT.
Cancer: Certain types of cancer increase substances in the blood that causes clots. Some cancer therapy also increases the risk of blood clots.
Some health conditions: Inflammatory bowel disease (Crohn’s disease or ulcerative colitis), cardiac problems, Covid-19, tuberculosis and other viral or bacterial illnesses, asthma, sleep apnea, polycystic ovary syndrome (PCOS), varicose veins and diabetes increase the risk of DVT.
Genetics and family history: If someone in the family has had DVT one PE, the risk is higher as the disorder (Factor V Leiden thrombophilia) could be inherited. An inherited disorder may not cause blood clots unless combined with other risk factors.
Unknown factors: A blood clot in a vein can occur with no identifiable risk factor. It’s called unprovoked venous thromboembolism (VTE).

What are the treatment options for DVT?

The first line of treatment is thrombolytic therapy: it uses anticoagulant medication to thin blood. It can inhibit the clots from growing and help prevent new clots from forming, a report in Penn Medicine said.

In rare cases, surgery is recommended. It includes endovascular procedures to remove a large blood clot, stenting (inserting tiny metal tubes to hold open the vein and vena cava filter placement to prevent clots from travelling to the lungs.

How can you prevent DVT?

Lifestyle changes may help prevent DVT. Here are some recommendations from Penn Medicine and Johns Hopkins Medical School.

Move your legs: If you’ve had surgery or have been on bed rest, try to move as soon as possible. Don’t cross your legs while sitting. If you have to sit for a long time, lift your legs, move or rotate the ankles and wiggle the toes.
Travelling: Take frequent breaks to stretch your legs. Stop the car every hour or so and walk around. On a plane or bus, stand or walk up and down the aisles occasionally.
Smoking: Avoid it.
Manage weight: Regular exercise helps fight obesity and lowers the risk of blood clots.
Clothing: Wear loose clothing
Hydration: Drink a lot of water and other healthy drinks
Stockings: Elastic or compression stockings are needed only for people at high risk of DVT. They are beneficial while travelling. Use them only if a doctor prescribes them.

Don’t let that happen

DVT is often linked to long-distance air travel. That’s not entirely true. It can strike anyone, anytime. So, if you have unexplained pain in your leg, it’s better to seek medical attention. A travelling blood clot can kill. Don’t let that happen.