Venous thrombosis is the formation of a blood clot (thrombus) in a vein, which can partially or completely block blood flow. It commonly occurs in the deep veins of the legs (Deep Vein Thrombosis, DVT) and can lead to serious complications like pulmonary embolism (PE).
Incidence
- More common in hospitalized, bedridden, post-surgical, and
cancer patients.
- Higher risk in pregnancy, obesity, smokers, and
elderly individuals.
- DVT affects ~1 in 1,000 people annually.
Definition
Venous thrombosis is the abnormal
clot formation in a vein, leading to obstruction of blood flow and
possible embolization.
Types of Venous
Thrombosis
1. Superficial
Venous Thrombosis (SVT)
- Affects superficial veins, usually in the legs.
- Associated with varicose veins, trauma, or IV catheter use.
- Less serious than DVT but can cause pain and inflammation.
2. Deep Vein
Thrombosis (DVT)
- Affects deep veins, usually in the legs or pelvis.
- High risk of pulmonary embolism (PE) if the clot dislodges.
- Can cause post-thrombotic syndrome (chronic leg swelling, pain,
ulcers).
3. Pulmonary
Embolism (PE) (Complication of DVT)
- Occurs when a clot from DVT breaks off and travels to the lungs.
- Can cause sudden breathlessness, chest pain, and even death.
Etiology (Mnemonic:
"VIRCHOW's TRIAD")
Venous thrombosis occurs due to:
- V – Venous Stasis (Immobility, bed rest, varicose veins)
- I – Injury to Vessel Wall (Surgery, trauma, IV lines)
- R – Raised Coagulability (Pregnancy, cancer, smoking, oral
contraceptives)
Risk Factors
- Prolonged immobilization (bed rest, long flights)
- Surgery & trauma (especially orthopedic
surgery)
- Cancer & chemotherapy
- Pregnancy & postpartum period
- Smoking & obesity
- Hormonal therapy (estrogen, birth control pills)
- Genetic clotting disorders (Factor V Leiden, Protein C/S
deficiency)
Pathogenesis of
Venous Thrombosis
- Sluggish blood flow (stasis) → Promotes clot formation.
- Endothelial injury → Platelet activation.
- Hypercoagulable state → Increased fibrin & thrombus formation.
- Clot propagation → Partial/complete vein blockage.
- Possible embolization → Clot breaks off & travels to lungs (PE).
Clinical
Features (Mnemonic: "CLOTS")
Symptoms of DVT
- C – Calf pain & swelling (Unilateral)
- L – Localized warmth & redness
- O – Obstruction of venous return → Leg feels heavy
- T – Tenderness along deep veins
- S – Sudden breathlessness → Suspect Pulmonary Embolism (PE)
Symptoms of
Pulmonary Embolism (PE) (Mnemonic: "PLEG")
- P – Pleuritic chest pain (sharp pain while breathing)
- L – Low oxygen saturation (Hypoxia)
- E – Elevated heart rate (Tachycardia)
- G – Gasping for breath (Dyspnea, shortness of breath)
Signs
- Homan’s Sign – Pain in the calf upon
dorsiflexion of the foot (Not very specific).
- Pratt’s Sign – Tenderness on squeezing
the calf muscles.
Laboratory
Investigations
- D-dimer test – High levels indicate clot
breakdown (Sensitive but not specific).
- Doppler Ultrasound – Gold standard for DVT
diagnosis.
- CT Pulmonary Angiography (CTPA) – Best test for
Pulmonary Embolism.
- Venography – Most accurate but
rarely used due to invasiveness.
Management of
Venous Thrombosis
General
Measures (Mnemonic: "WALK")
- W – Wear compression stockings.
- A – Avoid prolonged sitting or standing.
- L – Leg elevation to improve circulation.
- K – Keep moving (Early mobilization after surgery).
Allopathic
Treatment (Mnemonic: "ABCs of DVT")
- A – Anticoagulants (Heparin, Warfarin, Rivaroxaban,
Apixaban).
- B – Blood thinners (Low molecular weight heparin – LMWH).
- C – Clot busters (Thrombolytics – Alteplase, Streptokinase)
in severe cases.
Surgical Treatment
- Inferior Vena Cava (IVC) Filter – Used in patients who
cannot take anticoagulants.
- Thrombectomy – Surgical removal of clot
(Rarely needed).
Homeopathic
Treatment
- Hamamelis Virginiana
- Engorged, painful veins with bruised
sensation.
- Varicose veins with burning pain.
- Passive venous hemorrhages (bleeding easily from
minor injury).
- Pain in legs, worse from standing long hours.
- Useful in both DVT and varicose veins.
- Lachesis
- Purplish discoloration of affected limb.
- Symptoms worsen after sleep.
- Intolerance to tight clothing.
- Highly indicated in venous congestion and
thrombosis.
- Throbbing pains with marked restlessness.
- Vipera Berus
- Severe pain and swelling of veins.
- Leg feels as if it will burst.
- Relieved by keeping legs elevated.
- Bluish, swollen veins with extreme tenderness.
- Effective in deep vein thrombosis with risk of
gangrene.
- Arnica Montana
- Painful swelling due to trauma or surgery.
- Bruised, sore feeling in limbs.
- Worse from touch, better with rest.
- Prevents clot formation after injury.
- Useful in preventing post-surgical thrombosis.
- Fluoricum Acidum
- Varicose veins with ulceration.
- Burning pain, worse in warmth.
- Weak veins that rupture easily.
- History of venous insufficiency and clot
formation.
- Useful in chronic venous congestion.
Mnemonic for
Homeopathic Treatment (HELP-V)
- H – Hamamelis (Bruised veins, hemorrhage)
- E – Elevation helps → Vipera Berus
- L – Lachesis (Purple discoloration, intolerance to tight clothing)
- P – Painful, swollen veins → Arnica
- V – Varicose veins with ulcers → Fluoricum Acidum