Venous Thrombosis: Causes, Symptoms, Diagnosis & Best Treatments

byBHMS.STUDENT -
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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:

  1. V – Venous Stasis (Immobility, bed rest, varicose veins)
  2. I – Injury to Vessel Wall (Surgery, trauma, IV lines)
  3. 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

  1. Sluggish blood flow (stasis) → Promotes clot formation.
  2. Endothelial injury → Platelet activation.
  3. Hypercoagulable state → Increased fibrin & thrombus formation.
  4. Clot propagation → Partial/complete vein blockage.
  5. Possible embolization → Clot breaks off & travels to lungs (PE).

Clinical Features (Mnemonic: "CLOTS")

Symptoms of DVT

  1. C – Calf pain & swelling (Unilateral)
  2. L – Localized warmth & redness
  3. O – Obstruction of venous return → Leg feels heavy
  4. T – Tenderness along deep veins
  5. S – Sudden breathlessness → Suspect Pulmonary Embolism (PE)

Symptoms of Pulmonary Embolism (PE) (Mnemonic: "PLEG")

  1. P – Pleuritic chest pain (sharp pain while breathing)
  2. L – Low oxygen saturation (Hypoxia)
  3. E – Elevated heart rate (Tachycardia)
  4. 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

  1. D-dimer test – High levels indicate clot breakdown (Sensitive but not specific).
  2. Doppler Ultrasound – Gold standard for DVT diagnosis.
  3. CT Pulmonary Angiography (CTPA) – Best test for Pulmonary Embolism.
  4. Venography – Most accurate but rarely used due to invasiveness.

Management of Venous Thrombosis

General Measures (Mnemonic: "WALK")

  1. W – Wear compression stockings.
  2. A – Avoid prolonged sitting or standing.
  3. L – Leg elevation to improve circulation.
  4. K – Keep moving (Early mobilization after surgery).

Allopathic Treatment (Mnemonic: "ABCs of DVT")

  1. A – Anticoagulants (Heparin, Warfarin, Rivaroxaban, Apixaban).
  2. B – Blood thinners (Low molecular weight heparin – LMWH).
  3. 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

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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



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