Deep Vein Thrombosis and Pulmonary Embolism

Deep vein thrombosis (DVT) is a blood clot that develops within a deep vein in the body, usually in the leg. DVT’s usually arise within the larger veins that run through the muscles of the calf and the thigh, but they can also occur in veins of the pelvis or abdomen.

A DVT can cause pain and swelling in the leg and may lead to serious complications. The biggest risk is that a piece of the clot breaks loose, travels through your bloodstream and gets stuck in the lungs. This is called a pulmonary embolism (PE). This is a life-threatening condition and requires immediate hospital treatment.

DVT and pulmonary embolism together are known as venous thromboembolism (VTE).

It is estimated that 1 in 1000 people in the UK will develop a DVT each year. If left untreated, around 1 in 10 of these will go on to develop a PE.

Symptoms and signs

The symptoms of DVT in the leg are:

  • throbbing or cramping pain in 1 leg (rarely both legs), usually in the calf or thigh
  • swelling in 1 leg (rarely both legs)
  • warm skin around the painful area
  • red or darkened skin around the painful area
  • swollen veins that are hard or sore when you touch them

These symptoms also happen in your arm or tummy if that’s where the blood clot is.

If you think you have deep vein thrombosis, ask for an urgent GP appointment or call 111.

The symptoms of a PE include:

  • Breathlessness – which may come on gradually or suddenly
  • Chest pain – which may become worse when you breathe in
  • Coughing up fresh blood (haemoptysis)
  • Sudden collapse

If you have symptoms of a DVT, such as pain and swelling of a leg, along with either breathlessness or chest pain then you should call 999 or go to A&E.

Risk factors

A DVT is more likely to happen if you:

  • are over 60
  • are overweight
  • smoke
  • have had DVT before
  • take the contraceptive pill or HRT
  • have cancer or heart failure
  • have varicose veins

There are also some temporary situations when you’re at more risk of DVT. These include if you:

  • are staying in or recently left hospital – especially if you cannot move around much (like after an operation)
  • are confined to bed
  • go on a long journey (more than 3 hours) by plane, car or train
  • are pregnant or if you’ve had a baby in the previous 6 weeks
  • are dehydrated

Sometimes DVT can happen for no obvious reason.

Diagnosis and Treatment

If your doctor thinks that you have a DVT then you will be referred for an ultrasound scan.

Under certain circumstances your GP may initially suggest a blood test (D-dimer) to determine the likelihood of your symptoms indicating a DVT. This may be combined with a risk score called the Wells score however, neither of these investigations can definitively confirm DVT without proceeding to a scan.

The scan shows whether blood is flowing normally through the vein. You may also have an X-ray of the vein (venogram). For this, you will be injected with a dye to show where the blood clot is.

You may have an injection of an anticoagulant (blood thinning) medicine called heparin while you’re waiting for an ultrasound scan to tell if you have a DVT.

In most cases, the treatment for established DVT is to thin the blood in order to reduce the risk of complications and allow the blood clot time to settle/stabilise. This may be for several months or may involve lifelong treatment depending upon the cause of the DVT and any other risk factors that you may have.

The most common form of blood thinning treatment is in the form of tablets of an anticoagulant medicine, such as warfarin and rivaroxaban. You will probably take the tablets for at least 3 months.

If anticoagulant medicines are not suitable, you may have a filter put into a large vein – the vena cava – in your tummy. The filter traps and stops a blood clot travelling to your heart and lungs.

A newer treatment involves breaking up and sucking out the clot through a small tube in the vein. You usually need to take anticoagulant medicine for several months after this treatment.

You can read more about the treatments for DVT here.

DVT in pregnancy is treated differently. It is treated with anticoagulant injections for the rest of the pregnancy and until the baby is 6 weeks old.

 

Tips to prevent DVT

Do

Don’t
Stay a healthy weight Do not sit still for long periods of time – get up and move around every hour or so
Stay active – taking regular walks can help Do not cross your legs while you’re sitting, it can restrict blood flow
Drink plenty of fluids to avoid dehydration – DVT is more likely if you’re dehydrated Do not smoke
  Do not drink lots of alcohol
Going on a long journey:

If you’re travelling for 3 hours or more by plane, train or car, there are things you can do during the journey to reduce your risk of DVT. These include drinking plenty of water and avoiding alcohol.

Find out more tips to reduce your risk of travel-related DVT

Going into hospital:

If you go into hospital, your healthcare team should check your risks of DVT. If they think you’re more likely to get DVT, you may be given treatment to prevent it, such as medicine or compression stockings (knee-high elastic socks that help your blood circulation), while you’re in hospital.

You may continue treatment after you leave hospital because a blood clot can happen weeks later.

You can also help protect yourself against DVT while you’re in hospital by:

  • staying active and walking around if you can
  • moving your toes (up and down) and ankles (in circles) if you have to stay in bed – your healthcare team may give you some exercises to do
Recovery from DVT:

Some lifestyle measures will help you recover from DVT.

After you leave hospital, you will be encouraged to:

  • walk regularly
  • keep your affected leg raised when you’re sitting
  • delay any flights or long journeys until at least 2 weeks after you start anticoagulant medicine

Videos about DVT

What causes DVT and how can we stop it? | https://www.bhf.org.uk/

British Heart Foundation | published 30 Jun 2017

Waiting for a specialist opinion

If you have been referred for a specialist opinion your details will be reviewed and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

How long will I wait?

If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.