Life after a dangerous blood clot

Posted March 10, 2014, at 10:05 a.m.

You may not recognize the term “deep vein thrombosis,” or DVT, but you’ve probably heard of a blood clot. DVT is a blood clot in the deep vein system.

Most clots that embolize, or travel, start in the deep veins. A clot can travel through the circulatory system to the lungs or to the brain and result in a pulmonary embolism or stroke, respectively.

Outcomes from DVT vary, but one result that deserves more attention is post-thrombotic syndrome, or PTS. Among people who have had a DVT, approximately 30 percent develop chronic symptoms as a consequence of permanent injury to veins and vein valves. Symptoms of PTS include swelling, pain, and a rusty discoloration of the skin. In severe cases, the skin can break down, allowing an ulcer, or open sore, to form. These symptoms may not appear right away; studies have shown that after one to two years, only 10-20 percent of people experience these symptoms, but after five years, 20-30 percent do.

PTS can be expensive to treat, and the pain and discomfort it causes can make it extremely difficult for people to get around or continue to work. Unlike insufficiency in the superficial vein system (which can result in varicose veins and similar conditions), there is no FDA-approved treatment for PTS besides graduated compression stockings and supportive care.

Those who have, or have had, DVT should wear graduated compression stockings on a daily basis, as several studies strongly suggest they can significantly reduce the likelihood of developing PTS. According to the American College of Chest Physicians, wearing compression stockings for two years following DVT reduces the incidence of post-thrombotic syndrome by half.

Graduated compression stockings provide a gradient of pressure against the leg. The pressure is highest at the foot and ankle and gradually decreases as the garment rises up the leg. This pressure gradient makes it easier for the body to pump blood up toward the heart and more difficult for gravity to pull blood downward.

“TED hose,” the “anti-embolic” stockings often worn after surgery to help prevent DVT, are not the same as graduated compression stockings. TED hose work well for patients who are bed bound, but won’t offer much benefit to patients who are up and walking.

In addition to managing both acute and chronic DVT, compression can be a tool for prevention. When there are risk factors for DVT, such as long distance car or plane travel, immobility, or pregnancy, wearing compression can reduce its occurrence.

There are many benefits to using graduated compression therapy besides reduced risk factors for DVT, but be sure to consult your physician first. Compression is not appropriate for all patients and can actually have adverse effects on patients with peripheral arterial disease.

The best way to prevent PTS is to never have a blood clot in the first place. If you suspect you may have a blood clot, get to the emergency room as soon as you can. In most cases, the affected area, usually in the leg, will be painful, swollen or tender, with redness or discoloration of the skin. Even a muscle cramp that feels especially sharp and painful can be an indication of DVT.

Anyone can develop DVT, regardless of age, gender or economic background. Ask your doctor whether you are in a high-risk group for DVT. A little education can go a long way toward preserving your health and quality of life.

Dr. Cindy Asbjornsen, founder of the Vein Healthcare Center in South Portland, is certified by the American Board of Phlebology.

 

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