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August 13, 2012 at 10:03 PMComments: 0 Faves: 0

Worried About a Blood Clot in Your Leg?

By Jeffrey VanWingen M.D. More Blogs by This Author

A swollen leg, a little chest pain, a hard time breathing and then death - this is the dreaded scenario of an embolus (travelling blood clot) from the leg. Prior to modern preventative practices, it was responsible for a remarkable 25% of hospital deaths. I often interact with patients worried that they have a blood clot in their leg.

This blog will cover this problem toward reassuring or raising concern about a potentially dangerous situation. 

What's REALLY a Clot?

In medical school, I had an old South African pathology professor who would go off like a powder keg if a student misused the word “clot.”  As such, I feel the need to define this problem properly.

  • Clot: The solidification of blood on the outside of the body.
  • Thrombus: The solidification of blood on the inside of the body.
  • Embolus: A piece of thrombus that breaks free and travels to another part of the body through the blood vessels.
  • Deep Vein Thrombosis (DVT): A thrombus that develops in the large, deep veins of the body, usually in the leg.

Signs and Symptoms of a Deep Vein Thrombosis

One-Sided Pain and Swelling in the Leg: Cannot Be Explained By Tight Socks or Shoes * Gets Worse Over Time * Small Red Spots On Skin

A DVT in the leg is primarily characterized by pain and swelling.  Almost always this is one-sided and cannot be explained by anything else such a tight sock, pinching off the circulation through positioning etc.  The problem only worsens with time and does not wax and wan.  DVT’s get most concerning when they are above the knee.  Occasionally fine, speckled red spots can be seen on the skin. 

Deep Vein Thrombosis Risk Factors

Long Trips in a Car or Plane * Confinement to the Bed * Injury to the Legs * Family History of DVT or Embolus * Clotting Disorders

Usually a history exists which puts the person at risk for getting the DVT.  Three factors, known as Virchow’s Triad, set the stage for the formation of a thrombus.

  • Stasis: Stasis means slowing or stoppage of flow.  To remain a liquid, blood must be continually moving.  If it stops flowing, factors enact to begin the process of clot formation.  It is not uncommon for a person with a DVT to tell a story of a long plane or car ride.   Hospitals got a bad name for DVT complications due to prolonged bed confinement.  Nowadays, hospital patients are encouraged to walk as they are able.  While in bed, cuffs are placed on the legs that periodically inflate and compress the legs in order to keep blood flowing.
  • Injury: When tissue and blood vessels are injured, the clotting factors cascade to cause clotting.  A sports injury or an automobile accident can put a person at risk for developing a DVT.  The most common form of injury to cause a DVT, however, is surgery.  Add a prolonged stay in bed due to the injury and you have a recipe for DVT.
  • Hypercoagulable state: This is medical speak for a genetic pre-disposition towards clotting.  The formation of thrombus or clot in the blood is a domino effect, a cascade of many different factors.  A couple genetic conditions exist where a deficiency in a factor can make a person clot more easily.  For this reason, a family history of DVT or embolus is important.  These disorders can be diagnosed via a blood test.

Should I See a Doctor?

YES. A suspicion of a DVT should prompt a visit with a healthcare provider. 

Procrastination or delay could result in death if a piece of that thrombus breaks off!  This embolus travels predictably back through the heart and gets trapped in the lungs (a pulmonary embolus).  Pulmonary emboli (PE’s) can be fatal.  If the degree of suspicion warrants, testing will be ordered.  This would include an ultrasound of the leg to look at blood flow in the veins.  If there is concern about a PE, a CAT scan of the chest will be performed.  Once a DVT or a PE is found, medications to thin the blood are begun.  From there, progression is halted and the clots slowly dissolve, hopefully restoring normal circulation of the blood.

In Conclusion…

If you have swelling in a leg that is unexplained, a DVT should be considered.  The presence of any of Virchow’s Triad of risk factors may support the possibility of a DVT.  An ultrasound is used to diagnose DVT and therapy should be instituted urgently to prevent extension and formation of an emboli.  Emboli to the lungs, pulmonary emboli, can be fatal. 

It is best to resist the paranoia that every ache or minor swelling in the leg is a DVT.  A basic knowledge of the signs and risks, however, is important for identification of this potentially life-threatening condition.

Photo Credit: _rockinfree

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