What is thrombosis pain like?

Leg Pain: Causes, Diagnosis, and Treatment for Deep Vein Thrombosis

Deep vein thrombosis (DVT) is a serious condition in which a blood clot forms in one of the deep veins inside the body, usually in the leg or legs. This can occur any time a medical condition or some other factor prevents the blood from circulating through the body properly, such as prolonged immobility or injury to a vein. A blood clot in the deep veins is a serious concern because it can cause life-threatening complications, one of the most notable being pulmonary embolism. Diagnosis and treatment of a DVT are meant to prevent a potentially fatal pulmonary embolism.

Causes of Deep Vein Thrombosis

Blood is meant to flow freely through the body, and if it moves too slowly through the veins or becomes stagnant, a clump of blood cells called a clot may form. There are several situations in which dangerous clotting can occur in a vein deep inside the body. For instance, limited movement due to surgery, obesity, prolonged travel, bed rest or hospitalization; a clotting condition; injury to a vein; pregnancy; and other serious health issues like cancer or heart disease can all increase the risk of deep vein thrombosis.

If you are at high-risk for deep vein thrombosis, there are certain steps you can take to lower your odds of a DVT. You can get regular checkups, maintain a healthy weight, drink plenty of water, and exercise more. You can also avoid sitting for too long on flights or long car rides and, if you are having surgery, you can make a plan for your after-care to prevent DVT.

DVT Diagnosis

Doctors diagnose deep vein thrombosis using special tests designed to detect blood clots or blockages in the veins. Duplex ultrasonography is one common example of an imaging test that can be used to diagnose DVT. This test uses sound waves to look at the flow of blood through the patient’s veins. Another tool doctors can use to diagnose deep vein thrombosis is a D-dimer test. Blood clots typically start to break down after they are formed, releasing a protein fragment into the blood called D-dimer. A D-dimer test is a special blood test that can be used to rule out a harmful blood clot.

Deep Vein Thrombosis Symptoms

In some cases, patients experiencing a deep vein thrombosis may not find out about the condition until they have undergone emergency treatment for a pulmonary embolism. A pulmonary embolism is a life-threatening condition that occurs when a DVT clot breaks loose and moves from the leg into the lungs. A small pulmonary embolism may cause no symptoms, but a large embolism can be fatal. You should seek immediate medical attention if you experience any symptoms of a DVT. Some common deep vein thrombosis symptoms include the following:

Severe, unexplained pain in the foot and ankle
Swelling in the foot, ankle, or leg
Cramping pain in the leg, usually beginning in the calf
The skin over the affected area becoming pale or turning a reddish or bluish color

Deep Vein Thrombosis Treatment

The main goal of deep vein thrombosis treatment is to prevent a clot from becoming lodged in the lungs and causing a pulmonary embolism. Patients with a DVT typically take blood thinner medications, or anticoagulants, to reduce the blood’s ability to clot. For some patients, anticoagulant therapy is not appropriate or successful, in which case treatment with an inferior vena cava (IVC) filter maybe considered. Other DVT patients benefit from using compression stockings, which are designed to squeeze blood up the legs to prevent swelling and blood clots.

Deep Vein Thrombosis is a serious condition. We are dedicated to providing the highest level of vascular care to the residents of the Southern San Joaquin Valley and surrounding areas. If you have concerns about developing this condition, call (559) 625-4118 or visit South Valley Vascular online to schedule an appointment today.

Deep vein thrombosis

Deep vein thrombosis (DVT) is a condition that occurs when a blood clot forms in a vein deep inside a part of the body. It mainly affects the large veins in the lower leg and thigh, but can occur in other deep veins, such as in the arms and pelvis.

This picture shows a red and swollen thigh and leg caused by a blood clot (thrombus) in the deep veins in the groin (iliofemoral veins) which prevents normal return of blood from the leg to the heart.

Veins in the extremities carry blood to the heart and lungs, where the blood is oxygenated. As the blood returns to the heart from the lungs, the arteries carry the oxygen-rich blood out to the body.

Deep venous thrombosis (DVT) affects mainly the veins in the lower leg and the thigh. It involves the formation of a clot (thrombus) in the larger veins of the area.

Veins in the extremities carry blood to the heart and lungs, where the blood is oxygenated. As the blood returns to the heart from the lungs, the arteries carry the oxygen-rich blood out to the body.

Veins carry blood back to the heart from the tissues. Blood flowing in the veins is under lower pressure and moves more slowly than blood flowing in the arteries. Blood is therefore more likely to clot in the veins, thus blocking the flow through the veins.

Causes

DVT is most common in adults over age 60. But it can occur at any age. When a clot breaks off and moves through the bloodstream, it is called an embolism. An embolism can get stuck in the blood vessels in the brain, lungs, heart, or another area, leading to severe damage.

Blood clots may form when something slows or changes the flow of blood in the veins. Risk factors include:

A pacemaker catheter that has been passed through the vein in the groin
Bed rest or sitting in one position for too long, such as plane travel
Family history of blood clots
Fractures in the pelvis or legs
Giving birth within the last 6 months
Pregnancy
Obesity
Recent surgery (most commonly hip, knee, or female pelvic surgery)
Too many blood cells being made by the bone marrow, causing the blood to be thicker than normal (polycythemia vera)
Having an indwelling (long-term) catheter in a blood vessel

Blood is more likely to clot in someone who has certain problems or disorders, such as:

Cancer
Certain autoimmune disorders, such as lupus
Cigarette smoking
Conditions that make it more likely to develop blood clots
Taking estrogens or birth control pills (this risk is even higher with smoking)

Sitting for long periods when traveling can increase the risk for DVT. This is most likely when you also have one or more of the risk factors listed above.

Symptoms

DVT mainly affects the large veins in the lower leg and thigh, most often on one side of the body. The clot can block blood flow and cause:

Changes in skin color (redness)
Leg pain
Leg swelling (edema)
Skin that feels warm to the touch

Exams and Tests

Your health care provider will perform a physical exam. The exam may show a red, swollen, or tender leg.

The two tests that are often done first to diagnose a DVT are:

D-dimer blood test
Doppler ultrasound exam of the area of concern

A pelvic MRI may be done if the blood clot is in the pelvis, such as after pregnancy.

Blood tests may be done to check if you have an increased chance of blood clotting, including:

Activated protein C resistance (checks for the Factor V Leiden mutation)
Antithrombin III levels
Antiphospholipid antibodies
Complete blood count (CBC)
Genetic testing to look for mutations that make you more likely to develop blood clots, such as the prothrombin G20210A mutation
Lupus anticoagulant
Protein C and protein S levels

Treatment

Your provider will give you medicine to thin your blood (called an anticoagulant). This will keep more clots from forming or old ones from getting bigger.

Heparin is often the first medicine you will receive.

If heparin is given through a vein (IV), you must stay in the hospital. However, most people can be treated without staying in the hospital.
Low molecular weight heparin can be given by injection under your skin once or twice a day. You may not need to stay in the hospital as long, or at all, if you are prescribed this type of heparin.

One type of blood-thinning medicine called warfarin (Coumadin or Jantoven) may be started along with heparin. Warfarin is taken by mouth. It takes several days to fully work.

Another class of blood thinners works differently than warfarin. Examples of this class of medicines, called direct oral anticoagulants (DOAC), include:

Rivaroxaban (Xarelto)
Apixaban (Eliquis)
Dabigatran (Pradaxa)
Edoxaban (Savaysa)

These drugs work in a similar way to heparin and can be used right away in place of heparin. Your provider will decide which medicine is right for you.

You will most likely take a blood thinner for at least 3 months. Some people take it longer, or even for the rest of their lives, depending on their risk for another clot.

When you are taking a blood thinning medicine, you are more likely to bleed, even from activities you have always done. If you are taking a blood thinner at home:

Take the medicine just the way your provider prescribed it.
Ask the provider what to do if you miss a dose.
Get blood tests as advised by your provider to make sure you are taking the right dose. These tests are usually needed with people who are taking warfarin.
Learn how to take other medicines and when to eat.
Find out how to watch for problems caused by the medicine.

In rare cases, you may need surgery instead of or in addition to anticoagulants. Surgery may involve:

Placing a filter in the body’s largest vein to prevent blood clots from traveling to the lungs
Removing a large blood clot from the vein or injecting clot-busting medicines

Follow any other instructions you are given to treat your DVT.

Outlook (Prognosis)

DVT often goes away without a problem, but the condition can return. The symptoms can appear right away or you may not develop them for 1 or more years afterward. Wearing compression stockings during and after the DVT may help prevent this problem.

Possible Complications

Complications of DVT may include:

Fatal pulmonary embolism (blood clots in the thigh are more likely to break off and travel to the lungs than blood clots in the lower leg or other parts of the body)
Constant pain and swelling (post-phlebitic or post-thrombotic syndrome)
Varicose veins
Non-healing ulcers (less common)
Changes in skin color

When to Contact a Medical Professional

Contact your provider if you have symptoms of DVT.

Go to the emergency room or call the local emergency number (such as 911) if you have DVT and you develop:

Chest pain
Coughing up blood
Difficulty breathing
Fainting
Loss of consciousness
Other severe symptoms

Prevention

Move your legs often during long plane trips, car trips, and other situations in which you are sitting or lying down for long periods.
Take blood-thinning medicines your provider prescribes.
DO NOT smoke. Talk to your provider if you need help quitting.

References

Kabrhel C. Pulmonary embolism and deep vein thrombosis. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 74.

Lockhart ME, Umphrey HR, Weber TM, Robbin ML. Peripheral vessels. In: Rumack CM, Levine D, eds. Diagnostic Ultrasound. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 27.

Siegal D, Lim W. Venous thromboembolism. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 142.

Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest. 2021 Dec;160(6):e545-e608. Epub 2021 Aug 2. PMID: 34352278. https://

Version Info

Last reviewed on: 1/25/2022

Reviewed by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

How to Spot and Prevent Deep Vein Thrombosis

Lots of things can cause pain and swelling in your leg. But if your symptoms stem from a blood clot deep in your leg, it can be dangerous. Blood clots can happen to anyone, anytime. But some people are at increased risk. Taking steps to reduce your chances of a blood clot forming in your veins can help you avoid potentially serious problems.

Blood clots can arise anywhere in your body. They develop when blood thickens and clumps together. When a clot forms in a vein deep in the body, it’s called deep vein thrombosis. Deep vein blood clots typically occur in the lower leg or thigh.

“Deep vein thrombosis has classic symptoms—for example swelling, pain, warmth, and redness on the leg,” says Dr. Andrei Kindzelski, an NIH blood disease expert. “But about 30–40% of cases go unnoticed, since they don’t have typical symptoms.” In fact, some people don’t realize they have a deep vein clot until it causes a more serious condition.

Deep vein clots—especially those in the thigh—can break off and travel through the bloodstream. If a clot lodges in an artery in the lungs, it can block blood flow and lead to a sometimes-deadly condition called pulmonary embolism. This disorder can damage the lungs and reduce blood oxygen levels, which can harm other organs as well.

Some people are more at risk for deep vein thrombosis than others. “Usually people who develop deep vein thrombosis have some level of thrombophilia, which means their blood clots more rapidly or easily,” Kindzelski says. Getting a blood clot is usually the first sign of this condition because it’s hard to notice otherwise. In these cases, lifestyle can contribute to a blood clot forming—if you don’t move enough, for example. Your risk is higher if you’ve recently had surgery or broken a bone, if you’re ill and in bed for a long time, or if you’re traveling for a long time (such as during long car or airplane rides).

Having other diseases or conditions can also raise your chances of a blood clot. These include a stroke, paralysis (an inability to move), chronic heart disease, high blood pressure, surgical procedure, or having been recently treated for cancer. Women who take hormone therapy pills or birth control pills, are pregnant, or within the first 6 weeks after giving birth are also at higher risk. So are those who smoke or who are older than 60. But deep vein thrombosis can happen at any age.

You can take simple steps to lower your chances for a blood clot. Exercise your lower leg muscles if you’re sitting for a long time while traveling. Get out of bed and move around as soon as you’re able after having surgery or being ill. The more active you are, the better your chance of avoiding a blood clot. Take any medicines your doctor prescribes to prevent clots after some types of surgery.

A prompt diagnosis and proper treatment can help prevent the complications of blood clots. See your doctor immediately if you have any signs or symptoms of deep vein thrombosis or pulmonary embolism (see the Wise Choices box). A physical exam and other tests can help doctors determine whether you’ve got a blood clot.

There are many ways to treat deep vein thrombosis. Therapies aim to stop the blood clot from getting bigger, prevent the clot from breaking off and moving to your lungs, or reduce your chance of having another blood clot. NIH scientists continue to research new medicines and better treatment options.

If you think you may be at risk for deep vein thrombosis, talk with your doctor.