Deep Vein Thrombosis (DVT) – How to Diagnose, Treat & Prevent it

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deep-vein-thrombosis-dvt

DVT Thrombosis Definition

Deep vein thrombosis (DVT) comes from the latin term “thrombus” which means blood clot. The condition refers to a blood clot in a nonsuperficial or deep vein within the body, most commonly in the legs.  Their name implies quite obviously, deep veins are located deep within the muscles. The blood clots that form inside these deep veins are not dangerous by themselves but can become potentially fatal whenever such clots detach from the vein walls and travel through the body’s circulation system, putting vital organs at risk.  So, the treatment of a deep vein thrombosis (DVT) is meant to prevent pulmonary embolism, post-thrombotic syndrome, phlegmasia cerulea dolens, or other health complications.

 

Symptoms of Blood Clot in the Leg

Blood clot symptoms indicate a possible DVT, deep vein thrombosis, of blood clot in the legs are:

deep-vein-thrombosis-dvt

Other types of deep vein thrombosis DVT symptoms

  • Cerebral venous sinus thrombosis (CVST)

Cerebral venous sinus thrombosis (CVST) or for short cerebral vein thrombosis (CVT) is a type of deep vein thrombosis in which there’s a blood clot in the dural venous sinuses. These acute blot clots can deprive the brain of adequate blood flow and can lead to severe symptoms and fatal consequences.  Symptoms include headaches, abnormal vision, stroke symptoms such as weakness of the face and limbs on one side of the body, and seizures.  Treatment usually consists of anticoagulants and rarely thrombolysis medication. Surgical intervention is usually deployed only in cases emergencies or complications.

  • Portal vein thrombosis (Cauchois–Eppinger–Frugoni syndrome)

Portal vein thrombosis, also known as Cauchois–Eppinger–Frugoni syndrome is a form of deep vein thrombosis which affects the hepatic portal vein. The condition can lead to portal hypertension and reduction in the blood supply to the liver.  Symptoms include fever, indigestion, and worsening abdominal pain. However, the condition can also develop asymptomatically. Other symptoms can appear based on the cause. For example, if a portal vein thrombosis is caused by liver cirrhosis, then internal bleeding or other signs of liver disease may be present. If it develops due to pylephlebitis (thrombophlebitis of the portal vein), then signs of infection such as fever, colds, night sweats, and tremors may be identifiable.  Treatments include anticoagulants, shunts and other devices, bypass surgery, and transplants.

  • Cavernous sinus thrombosis (CST)

Cavernous sinus thrombosis (CST) refers to the formation of a blood clot within a cavity at the base of the brain, the the cavernous sinus, which reconducts deoxygenated blood from the brain back to the heart. It’s usually caused by an infection in the nose, sinuses, ears, or teeth. Staphylococcus aureus and Streptococcus are often the responsible bacteria.  Symptoms include partial or total loss of vision, chemosis, exophthalmos (bulging eyes), headaches, and paralysis of the cranial nerves.  This potentially deadly infection requires immediate treatment of antibiotics and sometimes surgical drainage.

Complications of DVT

The condition, deep vein thrombosis, must be treated; therefore, seek medical attention immediately. The complications include:

Pulmonary embolism

Pulmonary embolism is a potentially fatal complication which can subdue from an untreated blood clot. The blood clot can detach itself from the vein and travel to the lungs, causing the blockage of an artery. The evolution process from deep vein thrombosis to a pulmonary embolism is considered a single disease called venous thromboembolism.

Post-thrombotic syndrome

Post-thrombotic syndrome, also known as postphlebitic syndrome and venous stress disorder is a medical long-term complication of an untreated deep vein thrombosis. The complication is thought to be caused by the damaged venous valves from the thrombus (blood clot) itself. The inflammation from the pressure causes the rupture of veins and capillaries which result in subcutaneous hemorrhage, pain, swelling, discoloration, and ulceration.

Phlegmasia cerulea dolens

Phlegmasia cerulea dolens is an acute complication in which there’s a total or almost total venous occlusion of the entire extremity. The outflow is severely reduced, including the iliac and femoral veins. Such a severe blockage can cause venous or tissue gangrene (a type of necrosis). There is also a high risk of pulmonary embolism.

False positives for a DVT

Deep vein thrombosis diagnosis has to be correct put as to avoid mistreatment. A thorough examination will rule out other illnesses similar in symptomatic behavior such as:

Disease development (Rudolf Virchow’s triad)

A German pathologist named Rudolf Virchow postulated in 1856 the interaction of three processes following in deep vein thrombosis, currently known as Virchow’s triad.

  1. Venous stasis which is described as a decreased blood flow;
  2. Hypercoagulability which refers to an increased blood clot tendency;
  3. Changes to the walls of the blood vessels.

Rudolf-Virchow-triad-deep-vein-thrombosis-dvt

Diagnosis of a DVT

Your doctor will evaluate your health through visual observation, palpation, and various scans. He’ll assess your symptomology and conduct one or more exams such as:

  1. Ultrasound: A device called transducer is sending sound waves into the body, and as the wave travels through the body and reflect back, it forms a moving image of the tissues which helps identify a blood clot.ultrasound-deep-vein-thrombosis-blood-clot-dvt
  2. Blood test: A small blood sample is extracted from the patient and analyzed. If the blood has an elevated substance of a clot-dissolving substance named D-dimer, then the patient is most likely to suffer from a blood clot.
  3. Venography: A small quantity of a dye substance is injected into a large vein in the suspected area. A subsequent X-ray, CT, or MRI scan produces a higher quality image with better contrast.
  4. X-rays: An electromagnetic wave of high energy and very short wavelength passes through different tissues and forms a photographic or digital image of the internal composition of the examined body part.
  5. CT scan: A Computed Tomography or Computer Assisted Tomography combines many X-ray images from different angles to form a cross-sectional (tomographic) image, allowing the viewer to see inside the object.
  6. Magnetic resonance imaging (MRI): An MRI is an imaging technique which uses radio waves, strong magnetic fields, and field gradients to create detailed anatomic pictures. The procedure can pinpoint blood clots with high accuracy.

Risk factors for DVT

  • Lifestyle  Junk food, vices,  and lack of movement can greatly increase the risk of developing deep vein thrombosis. In the case of a sedentary lifestyle, blood circulation is reduced because the muscles aren’t contracting, thus putting you at risk fro DVT, so avoid immobilization or prolonged inactivity.
  • Aging  people (+60 years old) have a tendency to develop the disease because of both intrinsic and extrinsic factors.
  • Surgery Injury or surgery, especially to the veins, can increase the reask of blood clots. Surgeries to the knee or hip will also increase the risk of DVT. Collagen, fats, small bits of tissue, and other substances can be disturbed during these surgeries and enter the bloodstream.
  • Combined oral contraceptives or hormonal imbalances Synthetic hormones and hormonal imbalances increase the risk of developing DVT.
  • Pregnancy can increase the pressure in the veins, pelvic area, and legs.
  • Postnatal period The risk of developing deep vein thrombosis remains high even 6 weeks after pregnancy.
  • Cancer Some types of cancer treatments increase the number of substances in your blood and may cause your blood to clot.
  • Antiphospholipid syndrome sometimes known as Hughes syndrome, is a disorder of the immune system that causes an increased risk of blood clots.
  • Genetic factors such as antithrombin deficiency, protein C and S deficiency, factor V Leiden mutation, not having an O blood type. Also, a personal or family history of deep vein thrombosis or pulmonary embolism puts you at a higher risk of developing DVT.
  • Obesity and being overweight Having a high percentage of body fat (+20%) can significantly increase the risk of DVT because of the accumulated pressure in the veins of the legs and pelvis.
  • Smoking increases the chance of a deep vein thrombosis because it deprives the blood of oxygen, it raises the cholesterol levels, it raises fibrinogen levels (a protein which causes blood to clot), and it raises platelet aggregation which makes the blood more sticky.
  • Heart failure People with a heart failure history have a greater risk of developing DVT and pulmonary embolism because the heart and lungs are limited in function.
  • Inflammatory bowel disease Crohn’s disease, ulcerative colitis, and other bowel diseases increase the risk of developing deep vein thrombosis, DVT.

When to seek professional medical help

Contact your doctor or go to the ER if you experience typical symptoms of, DVT,  deep vein thrombosis. In advance, write down any relevant information about your current training, diet, medicamentation and supplementation, vices, lifestyle – basically everything. Don’t be afraid or embarrassed to disclosure information with your doctor, it’s very important that you supply him with extensive information to help him make a correct diagnosis which is vital towards your recovery. You’re always covered by the doctor-patient confidentiality clause.

  1. Organize your medical history;
  2. Prepare questions and anticipate your doctor’s informational needs;
  3. Describe in detail your symptoms and how the injury took place;
  4. Write down your medications, diet, supplements, vices;
  5. Request a verbal/written summary;
  6. If you’re looking for the fastest recovery time, then you should consider going directly to a phlebologist which is a doctor who specializes in venous diseases.

doctor-appointment.deep-vein-thrombosis-dvt

Treatment of DVT

Treatment for deep vein thrombosis consists of drugs or devices that prevent blood clots from getting bigger or getting displaced. The following drugs are used both to treat and prevent blood clots.

Diet and lifestyle

To help alleviate DVT, deep vein thrombosis symptoms, reduce rehabilitation time, and most importantly, to decrease chances deep vein thrombosis relapse, a plant-based diet is strongly advised. Better yet, a strict vegan diet is way better because you’ll keep inflammation to an absolute minimum, you’ll fuel your body with readily usable nutrients, and you’ll reduce all-cause mortality risks. A plant-based diet will also help you reach an ideal body weight. All of which will provide tangible improvements.  On top of a plant-based diet, you’ll a proper sleep pattern and adequate hydration. Alongside a reduction of harmful vices such as smoking, drinking etc.

Focus on dark, leafy greens, fruits, legumes, nuts, seeds such as broccoli, brussels sprouts, collards, mustard greens, chickpeas, spinach, tofu, fortified foods etc. You should also monitor your micro and macro nutrients to see if you’re meeting your needs. B12 is especially important on both a vegan and non-vegan diet, so monitor your intake and eat B12-fortified foods.

vegan-pyramid

Vitamin K

When taking old-generation anticoagulants such as warfarin (Coumadin), the doctor will have to regularly check your INR levels.
INR (international normalized ratio) is a measure of how quickly blood coagulates or clots. These levels have to be maintained within a neutral range as to not interfere with the drug and expose the patient to risks. INR fluctuates whenever there’s an increase or decrease in vitamin K intake.

  • If both the INR levels and warfarin dosage are too low, then the blood is too viscous and predisposed to clot in the blood vessels and affect the internal organs.
  • If both the INR levels and warfarin dosages are too high, then the blood is too watery and the coagulates slower, thus meaning that a hemorrhage will be more severe because the blood is less capable of coagulating itself and stop or reduce the hemorrhage.

Furthermore, low vitamin K levels contribute to the development of osteoporosis, bone fractures, and calcification of arteries. The patient’s INR must be ideally maintained within a therapeutic range, usually between 2 and 3, this interval is also called the therapeutic window.

  • If the INR is bellow 2, then blood is more prone to clot and the risk for a thromboembolism event is increased.
  • If the INR is over 3, then the blood is too watery and hemorrhage risk is increased.

Follow your doctor’s advice! He will calculate the drug dosages based on your usual diet.

RDA (recommended daily allowance) for Vitamin K

Age                          Male               Female           Pregnancy       Lactation
0-6 months………….2.0 mcg………..2.0 mcg
7–12 months……….2.5 mcg………..2.5 mcg
1–3 years…………….30 mcg…………30 mcg
4–8 years……………..55 mcg………..55 mcg
9–13 years……………60 mcg………..60 mcg
14–18 years………….75 mcg………..75 mcg………..75 mcg………..75 mcg
19+ years …………….120 mcg………90 mcg………..90 mcg…………90 mcg

Although vitamin K is also found in large quantities in dairy, a vegan alternative is superior because it lowers all-cause mortality factors.

Some vitamin K quantity references

1) Green Leafy Vegetables (Kale)
½ cup: 444 mcg

2) Natto (fermented soy)
2 oz: 500 mcg

3) Spring onions (Scallions)
½ cup: 103 mcg

4) Brussels Sprouts
½ cup: 78 mcg

5)Cabbage
½ cup: 82 mcg

6) Broccoli
½ cup: 46 mcg

7) Dairy (fermented)
½ cup: 10 mcg

8) Prunes
½ cup: 52 mcg

9) Cucumbers
medium one: 49 mcg

10) Dried basil
1 tbsp: 36 mcg

Calcium
Men and premenopausal women should consume at least 1000 mg of calcium. Postmenopausal women should consume 1200 mg of calcium. Don’t take more than 2000mg of calcium a day, in total.

Vitamin D
Men and women should consume between 600 and 800 international units (IU) of vitamin D per day. Don’t take more than 800 IU of vitamin D a day as high doses can be toxic, especially after long periods of time.

B12 in micrograms (μg)
Age                            RDA (μg)
0-6 months……………….0.4
7-12 months……………..0.5
1-3 years…………………..0.9
4-8 years…………………..1.2
9-13 years…………………1.8
14+ years………………….2.4
pregnant women………2.6
lactating women……….2.8

Sleep is also very important for your body to heal, so aim for 7-9 hours of sleep.

Adequate hydration is also very important because the spine fluids and lubricants are mostly made out of water and their synthesis requires water. For proper hydration, remember the 8×8 rule: drink 8 servings of 8 ounces of water a day (a total of 2L of water a day).

Sunlight
Get at least 1 hour of sunlight, every day. Continue maintaining a physically active lifestyle to encourage calcium synthesis in the body.

Blood thinners for DVT

anticoagulants-for-deep-vein-thrombosis

Anticoagulants or commonly known as blood thinners are used for both prevention and treatment of blood clots and deep vein thrombosis by reducing the viscosity of the blood. Careful to not cut yourself while on this medication because the blood’s ability to coagulate is diminished resulting in aggressive hemorrhages.  Equally important is monitoring your vitamin K levels as too much can lead to internal or external bleeding from traumas and too less won’t prevent blood clots. Usually, treatment consists of a shot or infusion of heparin, also known as unfractionated heparin (UFH) for a few days, followed by other injectable blood thinners such as enoxaparin (Lovenox), dalteparin (Fragmin) or fondaparinux (Arixtra). Sometimes, oral blood thinners are given under a pill form such as warfarin (Coumadin) or rivaroxaban (Xarelto).

Newer generation anticoagulant medicine such as Xa inhibitors work just as well and you won’t have to get regular blood tests, change your dose, or remember what foods you ate. These new-gen drugs may cause less bleeding than older generation drugs like warfarin, but there’s still a chance of it occurring. Blood thinning treatment can take anywhere from a few weeks to three months or more. Pregnant women aren’t allowed to take some forms of blood thinning medicamentations.

Anticoagulant interactions:

  • activated protein C
  • other anticoagulants (eg. warfarin)
  • dextran
  • dipyridamole
  • direct factor XA inhibitors (eg. rivaroxaban)
  • direct thrombin inhibitors (eg. dabigatran)
  • injectable cephalosporins (eg. cephazolin)
  • injectable penicillins (eg. ampicillin)
  • NSAIDs (eg. ibuprofen, ketorolac, naproxen)
  • platelet inhibitors (eg. clopidogrel, ticlopidine)
  • salicylates (eg. aspirin)
  • sulfinpyrazone or thrombolytics (eg. streptokinase)
  • nitrates (eg. nitroglycerin)
  • anabolic steroids
  • etc.

Other medications that increase the effect of anticoagulants, thus increasing the chance of bleeding:

  • Allopurinol
  • Amiodarone
  • Capecitabine
  • Cephalosporins
  • Cimetidine
  • Ciprofloxacin
  • Clofibrate
  • Clopidogrel
  • Diclofenac
  • Disulfiram
  • Erythromycin
  • Fluconazole
  • etc.

Other medications that decrease the effect of anticoagulants, thus increasing the chance of blood clots:

  • Azathoprine
  • Antithyroid medication
  • Carbamazepine
  • Dicloxacillin
  • Glutethimide
  • Griseofulvin
  • Haloperidol
  • Nafcilllin
  • Oral contraceptives
  • Phenobarbital
  • Rifampin
  • Vitamin K
  • etc.
Most common blood-thinning drug

Enoxaparin (Lovenox, Clexane, Xaparin, other)

Enoxaparin sodium is a blood thinner of the low-molecular-weight heparin (LMWH) class of drugs that’s injected into a vein or under the skin. Enoxaparin has a biological half-life of 4.5 hours. It is commonly used in the treatment of deep vein thrombosis,  DVT.

Common side effects:

  • bleeding gums
  • coughing up blood
  • difficulty with breathing or swallowing
  • dizziness
  • headache
  • increased menstrual flow or vaginal bleeding
  • nosebleeds
  • paralysis
  • prolonged bleeding from cuts
  • red or black, tarry stools
  • red or dark brown urine
  • shortness of breath

Uncommon side effects:

  • bruising
  • chest discomfort
  • collection of blood under the skin
  • confusion
  • continuing bleeding or oozing from the nose and/or mouth, or surgical wound
  • convulsions, seizures
  • fever
  • irritability
  • lightheadedness
  • lower back pain
  • pain or burning while urinating
  • swelling of the hands or feet
  • tightness in the chest
  • uncontrolled bleeding at the site of injection
  • vomiting of blood or material similar to coffee grounds
  • wheezing

Rare side effects:

  • back pain
  • burning, pricking, tickling, or tingling sensation
  • chest pain
  • chills
  • cough
  • decreased urine output
  • dilated neck veins
  • dizziness or lightheadedness when getting up suddenly from a lying or sitting position
  • extreme fatigue
  • fainting
  • fast or irregular heartbeat
  • general feeling of discomfort or illness
  • irregular breathing
  • leg weakness
  • problems with bowel or bladder function
  • skin rash or hives
  • sneezing
  • sore throat
  • sudden fainting
  • swelling of the face, fingers, feet, genitals, mouth, or tongue
  • thickening of the bronchial secretions
  • troubled breathing
  • weight gain

Side effects of unknown Incidence:

  • abdominal or stomach pain
  • deep, dark purple bruise
  • hives or welts
  • irregular heartbeat
  • itching, pain, redness, or swelling
  • large, flat, blue, or purplish patches in the skin
  • nausea or vomiting
  • nervousness
  • numbness or tingling in the hands, feet, or lips
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • redness of the skin
  • skin rash
  • unusual tiredness or weakness
  • weakness or heaviness of the legs

Medicine interaction with a total of 278 drugs (1027 brand and generic names).

Dalteparin (Fragmin)

Dalteparin is a low-molecular-weight heparin (LMWH) marketed under the name of Fragmin.  It’s administered both subcutaneous with a biological half-life of 3-5 hours and intravenously with a biological half-life of  2.1-2.3 hours. Dalteparin is generally better than warfarin in treating malignancy and acute venous thromboembolism and deep vein thrombosis, DVT.

Common side effects include, deep, dark purple bruise, pain, or swelling at the injection site.

Uncommon side effects:

  • bleeding of the gums
  • coughing up blood
  • difficulty with breathing or swallowing
  • dizziness
  • headache
  • increased menstrual flow or vaginal bleeding
  • nosebleeds
  • paralysis
  • prolonged bleeding from cuts
  • red or black, tarry stools
  • red or dark brown urine
  • unexplained pain, swelling, or discomfort, especially in the chest, abdomen or stomach, joints, or muscles
  • unusual bruising
  • vomiting of blood or material that looks like coffee grounds
  • weakness

Rare side effects:

  • back pain
  • bleeding from mucous membranes
  • bluish or black discoloration, flushing, or redness of the skin
  • burning, pricking, tickling, or tingling sensation
  • coughing
  • feeling faint
  • fever
  • leg weakness
  • numbness
  • problems with bowel or bladder function
  • skin rash (which may consist of pinpoint, purple-red spots), hives, or itching
  • sloughing of the skin at the injection site
  • swelling of the eyelids, face, or lips
  • tightness in the chest

Medicine interaction with a total of 278 drugs (1030 brand and generic names).

Apixaban (Eliquis)

Apixaban is sold under the tradename Eliquis and it’s an anticoagulant for the treatment of deep vein thrombosis and other thromboembolic events. The drug is adirect Xa factor inhibitor and it’s taken orally with a with biological half-life 9–14 h.

Common side effects include anemia, hemorrhage, and nausea.

Rare side effects:

  • Blood in the eyes
  • blood in the urine
  • bloody or black, tarry stools
  • bruising or purple areas on the skin
  • confusion
  • constipation
  • coughing up blood
  • decreased alertness
  • difficulty swallowing
  • dizziness
  • fainting
  • fast heartbeat
  • headache
  • hives, itching, skin rash
  • joint pain or swelling
  • nausea and vomiting
  • nosebleeds
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • redness of the eye
  • severe stomach pain
  • shortness of breath
  • tightness in the chest
  • unusual tiredness or weakness
  • vomiting of blood or material similar to coffee grounds

Medicine interaction with a total of 368 drugs (1467 brand and generic names).

Dabigatran (Pradaxa or Prazaxa)

Dabigatran is sold under the name of Pradaxa or Prazaxa and it’s an oral anticoagulant. The medication is a direct thrombin inhibitor. It’s a newer generation drug which doesn’t require strict blood motorization. Dabigatran also has an antidote in cases of major bleeding: idarucizumab, sold under the brand name Praxbind. The drug has a biological half-life of 12–17 hours.

Common side effects:

  • acid or sour stomach
  • belching
  • black, tarry stools
  • bloody stools
  • constipation
  • diarrhea
  • heartburn
  • indigestion
  • nausea
  • pain or burning in the throat
  • stomach discomfort, upset, burning, or pain
  • vomiting
  • vomiting of blood or material that looks like coffee grounds

Rare side effects:

  • cough
  • difficulty with swallowing
  • dizziness
  • fainting or loss of consciousness
  • fast heartbeat
  • fast or irregular breathing
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • redness of the skin
  • skin rash, hives, welts, or itching skin
  • tightness in the chest
  • trouble breathing
  • unusual tiredness or weakness

Side effects with unknown incidence:

  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs

Medicine interaction with a total of 370 drugs (1628 brand and generic names).

Edoxaban (Savaysa, Lixiana)

Edoxaban  or DU-176b i sold under the names Savaysa and Lixiana. The drug is an oral anticoagulant drug which acts as a direct Xa factor inhibitor. It has a biological half-life of 10–14 hours.

Common side effects:

  • bloody nose
  • heavy non-menstrual vaginal bleeding
  • pale skin
  • troubled breathing with exertion
  • unusual bleeding or bruising
  • unusual tiredness or weakness

Uncommon side effects:

  • bloody or black, tarry stools
  • vomiting of blood or material that looks like coffee grounds
  • rash

Rare side effects:

  • confusion
  • cough
  • difficulty with speaking
  • double vision
  • fever
  • headache, sudden, severe
  • inability to move the arms, legs, or facial muscles
  • inability to speak
  • nausea and vomiting
  • slow speech

Side effects with unknown incidence:

  • back pain
  • bowel or bladder dysfunction
  • burning, crawling, itching, numbness, prickling, or tingling feelings
  • leg weakness
  • paralysis

Medicine interaction with a total of 311 drugs (1247 brand and generic names).

Fondaparinux (Arixtra)

Fondaparinux (trade name Arixtra) is an anticoagulant medication chemically related to low molecular weight heparins. It’s a synthetic pentasaccharide Xa factor inhibitor with a biological half-life of 17-21 hours. Fondaparinux is given subcutaneously, daily.

Common side effects:

  • difficulty having a bowel movement
  • swelling
  • trouble sleeping
  • pale skin
  • troubled breathing with exertion
  • unusual bleeding or bruising
    unusual tiredness or weakness

Uncommon side effects:

  • acid or sour stomach
  • belching
  • diarrhea
  • heartburn
  • indigestion
  • pain
  • skin blisters
  • stomach discomfort, upset, or pain
  • tightness in the chest
  • unusual changes to the site of surgery
  • increased wound drainage
  • black, tarry stools
  • bladder pain
  • bleeding gums
  • blood in the urine or stools
  • blurred vision
  • chest pain
  • chills
  • collection of blood under the skin
  • confusion
  • convulsions
  • cough
  • decreased or cloudy urine
  • deep, dark purple bruise
  • difficult, burning, or painful urination
  • dizziness
  • dry mouth
  • fainting or lightheadedness when getting up from a lying or sitting position
  • fever
  • frequent urge to urinate
  • increased thirst
  • irregular heartbeat
  • itching, pain, redness, or swelling at the injection site
  • loss of appetite
  • lower back or side pain
  • muscle pain or cramps
  • nausea or vomiting
  • numbness or tingling in the hands, feet, or lips
  • pinpoint red spots on the skin
  • red, tender, or oozing skin at incision site
  • shortness of breath
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • sudden sweating

Side effects with unknown incidence:

  • back pain
  • bowel or bladder dysfunction
  • difficulty with swallowing
  • fast heartbeat
  • hives, itching, or skin rash
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • leg weakness
  • numbness
  • paralysis
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • tightness in the chest

Symptoms of overdose:

  • abdominal or stomach pain or swelling
  • bruising or purple areas on the skin
  • coughing up blood
  • decreased alertness
  • headache
  • joint pain or swelling
  • nosebleeds

Medicine interaction with a total of 224 drugs (905 brand and generic names).

Heparin (UFH)

Heparin, also known as unfractionated heparin (UFH), is an anticoagulant medication that can be delivered both intravenously and subcutaneously with a biological half-life 1.5 hours.

Uncommon side effects:

  • abdominal or stomach pain or swelling
  • back pain or backaches
  • bleeding from the gums when brushing teeth
  • blood in the urine
  • constipation
  • coughing up blood
  • dizziness
  • headaches, severe or continuing
  • heavy bleeding or oozing from cuts or wounds
  • joint pain, stiffness, or swelling
  • menstrual bleeding, unexpected or unusually heavy
  • unexplained bruising or purplish areas on the skin
  • unexplained nosebleeds
  • vomiting of blood or material that looks like coffee grounds

Rare side effects:

  • blood under the skin (blood blister) at the place of injection
  • chest pain
  • chills or fever
  • fast or irregular breathing
  • irritation, pain, redness, or ulcers at the place of injection
  • itching and burning feeling, especially on the bottom of the feet
  • nausea or vomiting
  • numbness or tingling in the hands or feet
  • pain, coldness, or blue color of the skin on the arms or legs
  • peeling of the skin
  • puffiness or swelling of the eyelids or around the eyes
  • shortness of breath
  • skin color change, especially near the place of injection or in the fingers, toes, arms, or legs
  • skin rash, hives, or itching
  • tearing of the eyes
  • tightness in the chest
  • trouble with breathing
  • wheezing

Post-treatment side effects:

  • black, tarry stools
  • bleeding gums
  • blood in the urine or stools
  • pain in the chest, groin, or legs, especially calves of legs
  • pinpoint red spots on the skin
  • severe headaches of sudden onset
  • sudden loss of coordination
  • sudden shortness of breath for no apparent reason
  • sudden slurred speech
  • sudden vision changes
  • unusual bleeding or bruising

Medicine interaction with a total of 321 drugs (1158 brand and generic names).

Rivaroxaban (Xarelto)

Rivaroxaban, sold under the brand name Xarelto among others, is a blood thinner which is taken by mouth. It is the first available active direct factor Xa inhibitor Biological half-life 5–9 hours

Common side effects:

  • back pain
  • bleeding gums
  • bloody stools
  • bowel or bladder dysfunction
  • burning, crawling, itching, numbness, prickling, tingling feelings
  • coughing up blood
  • difficulty with breathing or swallowing
  • dizziness
  • headache
  • increased menstrual flow or vaginal bleeding
  • leg weakness
  • nosebleeds
  • numbness
  • paralysis
  • prolonged bleeding from cuts
  • red or black, tarry stools
  • red or dark brown urine
  • vomiting of blood or material similar to coffee grounds

Uncommon side effects:

  • blisters
  • muscle spasm
  • fainting
  • pain in the arms or legs
  • wound secretion

Rare side effects:

  • burning while urinating
  • difficult or painful urination

Side effects of unknown incidence:

  • abdominal or stomach pain or swelling
  • blistering, peeling, or loosening of the skin
  • blurred vision
  • chills
  • clay-colored stools
  • cough or hoarseness
  • dark urine
  • diarrhea
  • fast or irregular heartbeat
  • fever with or without chills
  • general feeling of tiredness or weakness
  • hives, itching, or skin rash
  • joint or muscle pain
  • loss of appetite
  • lower back or side pain
  • nausea or vomiting
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • severe headache
  • sore throat
  • sores, ulcers, or white spots in the mouth or on the lips
  • tightness in the chest
  • unpleasant breath odor
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • yellow eyes or skin

Medicine interaction with a total of 357 drugs (1412 brand and generic names).

Warfarin (Coumadin)

Warfarin decreases blood clotting by blocking the enzyme vitamin K oxide reductase that reactivates vitamin K1.[5] Without sufficient active vitamin K1, clotting factors II, VII, IX, and X have decreased clotting ability. Biological half-life 20-60 hours

Uncommon side effects:

  • joint pain
  • muscle pain
  • abdominal or stomach pain with cramping
  • bleeding gums
  • blood in the urine
  • bloody stools
  • blurred vision
  • burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings
  • chest pain or discomfort
  • confusion
  • coughing up blood
  • difficulty with breathing or swallowing
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • excessive bruising
  • headache
  • increased menstrual flow or vaginal bleeding
  • nosebleeds
  • paralysis
  • peeling of the skin
  • prolonged bleeding from cuts
  • red or black, tarry stools
  • red or dark brown urine
  • sweating
  • unexplained swelling
  • unusual tiredness or weakness

Rare side effects:

  • bloated
  • change in taste, or bad, unusual, or unpleasant (after) taste
  • cold intolerance
  • excess air or gas in the stomach or intestines
  • full feeling
  • general feeling of discomfort or illness
  • hair loss or thinning of the hair
  • hives or welts
  • lack or loss of strength
  • pain
  • passing gas
  • red, sore, or itching skin
  • sores, welting, or blisters
  • unusual drowsiness, dullness, or feeling of sluggishness
  • arm, back, or jaw pain
  • blue-green to black skin discoloration
  • blue or purple toes
  • change in consciousness
  • chest tightness or heaviness
  • chills
  • clay-colored stools
  • diarrhea
  • dizziness
  • fainting or loss of consciousness
  • fast or irregular breathing
  • fast or irregular heartbeat
  • fever
  • itching or skin rash
  • light-colored stools
  • loss of appetite
  • nausea and vomiting
  • pain in the toes
  • pain, redness, or sloughing of the skin
  • pale skin
  • purplish red, net-like, blotchy spots on the skin
  • skin blisters
  • small red or purple spots on the skin
  • stomach pain
  • swelling of the eyes or eyelids
  • tightness in the chest
  • troubled breathing with exertion
  • unpleasant breath odor
  • unusual bleeding or bruising
  • upper right abdominal or stomach pain
  • vomiting of blood
  • yellow eyes and skin

Medicine interaction wit a total of 837 drugs (5719 brand and generic names).

Clot busters (thrombolytics)

In cases of severe deep vein thrombosis or pulmonary embolism, and if other drugs aren’t working, then your doctor might put you on thrombolytics medicine, also called tissue plasminogen activators (TPA). These enzymes are delivered through an IV line or a catheter and are generally deployed in life-threatening situations and under constant medical supervision.

Filters

In case oral or injectable drugs can’t be administered, then special filters are placed into the cava vein in the abdomen which collects dislodged blood clots, preventing them from reaching the lungs.

Inferior-vena-cava-filter-for-deep-vein-thrombosis-dvt

Compression stockings for DVT

Compression stockings or sleeves reduce swelling and help prevents further blood clots from forming through applied pressure. DVT patient may have to wear them for a couple of months or years. Compression stockings also prevent postphlebitic syndrome.

compression-stockings-for-deep-vein-thrombosis-dvt

Surgery

Surgery for blood clots, DVT,  is not usually preferred by physicians and it’s rather uncommon to remove a blood clot with surgery, although in some rare cases it might prove the best alternative. Surgery is not utilized because the problem is not the actual obstruction caused by the blood clot, but rather the damage to the vein valves are causing the swelling and other symptoms.

When can you resume physical activity?

There are no strict guidelines on sports and physical activity regarding deep vein thrombosis or pulmonary embolism. However, intense physical activity is not recommended. The patient should proceed to do non-strenuous physical activity because it doesn’t increase the chances of a blood clot being displaced because the risk of a blood clot breaking off and causing pulmonary embolism mostly exists in the first few days of it forming, up to 4 weeks while the blood clot is still fragile and fresh, and has not yet scarred. Furthermore, physical activity will also maintain a lower body fat percentage and muscle atrophy which will aid in the rehabilitation process.

  1. Refrain from intense athletic exercising for the first 10 to 14 days until the blood clot has stabilized itself.
  2. Maintain reasonable cardio activity throughout the day. You can also light weight train the non-affected parts of the body, spare the body part in which the blood clot exists.
  3. Activity can be increased after 2 to 4 weeks. Fully normal activity can be resumed by week 4, assuming adequate treatment is administered through.

Prevention of DVT

deep-vein-thrombosis-prevention

  • Adopt a plant-based diet
  • Stay hydrated
  • Stay physically active
  • Sleep 8 hours a day
  • Cut back on vices

Conclusion

Deep vein thrombosis (DVT) is a fairly common hematic disease which affects about 1 in 1000 adults worldwide. Although fatal incidents are rather low, the disease must be addressed immediately as first symptoms begin to manifest. Adapt your daily life accordingly and seek treatment immediately. Set up a doctor’s appointment or go directly to the ER upon disease or symptom realization and closely follow your doctor’s instructions. The patient should always have easy phone access and 112 on speed-dial in case of sudden disease complication. Assistance from friends and family is also recommended as physical activity must be adjusted to the doctor’s instructions. Furthermore, a pair of compression stockings are highly advised in the rehabilitation period and afterward.

 

Sources

  1. unknown, Coumadin Side Effects, Website, Apr 13, 2017
  2. unknown, Wafarin, Wikipedia, Apr 13, 2017
  3. unknown, The Effects of Smoking to Heart and Circulation, Website, Apr 13, 2017
  4. unknown, Deep Vein Thrombosis (DVT), Mayo Clinic, Apr 13, 2017
  5. unknown, Top 10 Vitamin K Rich Foods, Website, Apr 13, 2017
  6. unknown, Symptoms and Tests for Deep Vein Thrombosis (DVT), WebMD, Apr 13, 2017
  7. unknown, Pulmonary Embolism: A Complication of DVT, WebMD, Apr 13, 2017
  8. Walker, Marie and Bussey, Henry, Vitamin K and Warfarin: What You Should Know , Clot Care Online Resource, Apr 13, 2017
  9. Barclay, Laurie M.D., Vitamin K & Warfarin, Life Extension Magazine, Oct 18, 2017
  10. unknown, http://www.webmd.com/dvt/tc/warfarin-and-vitamin-k-topic-overview#2, WebMD, Apr 13, 2017
  11. unknown, When can I resume physical activities? , Clot Connect, Apr 13, 2017
  12. Bussey, Henry, Can - or should - the blood clot(s) in my leg(s) be removed surgically? , Clot Care Online Resource, Oct 18, 2017
  13. Rodriguez, Diana, Deep Vein Thrombosis Risks After Surgery, Every Day Health Website, Apr 13, 2017
  14. Wendro, Benjamine MD, Deep Vein Thrombosis (DVT, Blood Clot in the Legs), Medicine Net, Apr 13, 2017
  15. unknown, Xarelto (rivaroxaban) Drug Interactions, Drugs.com Website , Apr 13, 2017
  16. unknown, Heparin Drug Interactions, Drugs.com Website , Apr 13, 2017
  17. unknown, Arixtra (fondaparinux) Drug Interactions, Drugs.com Website , Apr 13, 2017
  18. unknown, Fragmin, Rx List.com Website, Apr 13, 2017
  19. unknown, Apixaban Side Effects, Drugs.com Website , Apr 13, 2017