THINGS TO KNOW  ABOUT Deep Vein Thrombosis (DVT)


What is Deep Vein Thrombosis?

Deep vein thrombosis or DVT is a blood clot that forms in a deep vein in the body. Blood clots occur when blood thickens or clumps together. Most deep vein blood clots occur in the lower leg or thigh. It can also occur in other parts of the body. If the vein swells, the condition is called thrombophlebitis. A deep vein thrombosis can break loose and cause a serious problem in the lung. And when the clot travels to the lungs and blocks blood flow, this condition is called pulmonary embolism. PE is a very serious condition. It can cause damage to the lungs and other parts of the body and can result in death. Blood clots in the thigh break down more than in the lower leg or other parts of the body, causing pulmonary embolism. Blood clots in the thigh break down more than clots in the lower leg or other parts of the body, and they are more likely to cause the pulmonary embolism. Blood clots can also form in veins closer to the skin surface. However, these clots do not break up and do not cause pulmonary embolism.

What Causes Deep Vein Thrombosis?

Blood clots can form in the deep veins of your body if:

- If damage occurs to the inner surface of a vein. This damage can occur from injury caused by physical, chemical or biological factors. These factors include surgery, severe injury, inflammation, and an immune response.

-Inactivity can cause heavy or slow blood flow. This can occur after surgery if you are sick and have been in bed for a long time or have traveled for a long time.

-Your blood may thicken or clot more easily than usual. Certain inherited conditions (such as factor V Leiden) can increase the tendency of the blood to clot. This is also the case with treatments such as hormone therapy or birth control pills.

Who is at Risk for Deep Vein Thrombosis?

Various factors increase your risk of deep vein thrombosis (DVT). Some of these are:
-DVT history.
-Disorders or factors that make your blood thicker or clot more easily than usual. Some inherited blood disorders (such as factor V Leiden) do this. This is also the case with treatments such as hormone therapy or birth control pills.
-Injury to a deep vein by surgery, a broken bone, or other trauma.
- Slowing of blood flow in a deep vein due to inactivity. This can occur after surgery if you are sick and have been in bed for a long time or have traveled for a long time. -The first 6 weeks after pregnancy and delivery.
-Cancer treatment that has been applied recently or is ongoing.
-A central venous catheter. This is a tube placed in a vein to provide easy access to medical treatments to the bloodstream.
-Being over 60 years old (although DVT can occur at any age).
-Being overweight or obese.
Your risk of DVT increases if you have more than one of the risk factors listed above.

What are the Signs and Symptoms of Deep Vein Thrombosis?

Signs and symptoms of deep vein thrombosis (DVT) may be associated with deep vein thrombosis itself or pulmonary embolism (PE). If you have signs and symptoms of either condition, see your doctor straight away. Both DVT and PE can cause serious and potentially life-threatening complications if left untreated.

Deep Vein Thrombosis
Only half of DVT patients have signs or symptoms. These signs and symptoms occur in the leg affected by a deep vein clot. Some of these are:
-Swelling in the leg or along the vein in the leg
-Pain or tenderness in the leg only when walking or walking
-Increased temperature in the swollen or painful part of the leg
-Red or discoloration of the leg
Pulmonary Embolism
Some people do not know they have deep vein thrombosis until the signs and symptoms of PE appear. PE signs and symptoms: -Inexplicable shortness of breath -Pain with deep breathing -A bloody cough Rapid breathing and rapid heart rate can also be signs of PE.

How Is Deep Vein Thrombosis Diagnosed?

Your doctor will diagnose deep vein thrombosis (DVT) based on your medical history, physical examination, and test results. It will identify your risk factors and rule out other causes of your symptoms.

Medical History
To find out your medical history, your doctor may ask:
- Your general health.
- All prescription drugs you take
- Your recent surgery or injuries
- Whether you are being treated for cancer

Physical Exam
During the physical exam, your doctor will check your legs for DVT symptoms. It will also check your blood pressure, heart and lungs.

Diagnostic Tests
Your doctor may recommend tests to find out if you have DVT. The most commonly used tests for DVT are:

-Ultrasound. It is the most widely used test in the diagnosis of deep vein blood clots. Ultrasound uses sound waves to obtain pictures of blood flow in the arteries and veins in the affected leg.

-A D-dimer test. This test measures a substance released in the blood as the blood clot dissolves. If the test shows that the level of this substance is high, you may have a deep vein blood clot. If your test is normal and your risk factors are low, DVT is unlikely.

-Venography. This test is used if the ultrasound does not provide a clear diagnosis. Dye is injected into a vein and then an x-ray examination of the leg is done. The dye allows the vein to be seen by x-ray. The x-ray will show whether the blood flow in the vein is slow. This could indicate a blood clot.

Other tests that are less commonly used to diagnose DVT are magnetic resonance imaging (MRI) and computerized tomography (CT) scanning. These tests provide a picture of your organs and tissues.

You may need blood tests to check if you have an genetic predisposition of clotting disorder as the cause of DVT. These tests may be needed if you have repeated blood clots for no other reason, or if you have developed an unusually located blood clot, such as veins in the liver, kidney or brain.

If your doctor thinks you have pulmonary embolism (PE), he or she may recommend other tests such as a lung ventilation perfusion scan (VQ scan). The lung VQ scan uses a radioactive material to control oxygen and blood circulation in all lung areas.

How is Deep Vein Thrombosis Treated?

Deep vein thrombosis (DVT) is treated with medications and other tools and therapies. The main goals of DVT treatment are:
-Stopping the growth of blood clots
-Preventing the blood clot from breaking down and moving to your lungs
-Reducing the likelihood of another blood clot forming

Medicines
Below are the medications used in DVT prevention and treatment.
-Anticoagulants
Anticoagulants are the most commonly used drugs in the treatment of DVT. They are also known as blood thinners.

These medications decrease your blood's ability to clot. It also stops the growth of existing blood clots. However, blood thinners cannot break up clots that have formed. (The body dissolves most blood clots over time.)

Blood thinners are administered as a pill, as a subcutaneous injection or through a needle or tube inserted into a vein (called an intravenous or IV injection).

Warfarin and heparin are two blood thinners used in the treatment of DVT. Warfarin is given as a pill. (Heparin is given by injection or by an IV tube. There are different types of heparin. Your doctor will tell you the options.)

Your doctor can treat you with both heparin and warfarin at the same time. Heparin acts quickly. Warfarin takes 2-3 days to take effect. When warfarin starts to take effect, heparin is stopped.

Because warfarin is dangerous during pregnancy, pregnant women are usually treated with heparin alone.

DVT treatment with blood thinners usually takes 3-6 months. The following situations may change the duration of treatment.

When the blood clot occurs after short-term risk (for example, surgery), your treatment may take less time.

If you have had blood clots before, your treatment may take longer.

If you have certain diseases such as cancer, you may need to take blood thinners for the duration of your illness.

The most common side effect of blood thinners is bleeding. This condition occurs when the medicine thins your blood too much. This side effect can be life threatening.

Occasionally, there may be internal bleeding (inside your body). People treated with blood thinners usually have blood tests to measure their blood's ability to clot. These blood tests are called PT and PTT tests.

These tests also help the doctor make sure you are taking the correct amount of medication. If you have easy bruising or bleeding, call your doctor right away. These could be signs that your medications are making your blood too thin.

Thrombin Inhibitors
These drugs interact with the blood coagulation process. Used in the treatment of blood clots in people who cannot use heparin.

Thrombolytics
These medications are given to help a blood clot dissolve quickly. It is used to treat large blood clots that cause severe symptoms.
Because thrombolytics can cause sudden bleeding, they are used only in life-threatening situations.
Other Types of Treatment

Living With Deep Vein Thrombosis

If you are living with DVT, there are some things you can do to manage your condition:
• Check in with your doctor regularly and have regular blood tests.
• Diet – Maintain consistent intake of leafy green vegetables as they have high vitamin K content, which can interfere with your anticoagulant treatment. Examples of foods and drinks that have high vitamin K content include spinach, Brussel sprouts, parsley, green tea, mustard greens. Always ask your doctor or pharmacist if you are unsure.
• Exercise – Stay active, regular exercise is a great way to avoid getting another deep-vein clot. Unless you doctor advises against this. You should walk regularly after you are discharged from hospital. Walking improves circulation in the affected leg and may help to reduce your risk of further DVT.

When resting, try to raise your foot higher than your hip so gravity helps with blood flow returning from the calf. This reduces pressure in the calf veins and helps to prevent blood and fluid pooling in the calves. The easiest way to raise your leg is to recline on a sofa with your leg up on a cushion


INCA - Vena Cava Filter

The vena cava filter is used when you cannot take blood thinners or if you develop a blood clot despite taking blood thinners.
This filter is placed in a large vein called the vena cava. The filter catches blood clots that break down in a vein before the lungs leave. This prevents pulmonary embolism. However, it does not stop new blood clots from forming.

"Primum non nocere is a Latin phrase that means "first, to do no harm."

That is why INVAMED Thrombolysis Protection System catheter provides pulmonary embolism protection in peripheral thrombus patients and in patients with risk of pulmonary embolism by filtering in the inferior vena cava.

•There are ports for fibrinolytic and thrombolytic drug administration and aspiration. Hence, systemic thrombolysis can be performed from these ports. There is a nitinol protective cage that reaches 30 mm in body temperature. This mechanism opens in the vascular lumen and minimizes the incidence of complications of permanent filters such as fracture, penetration, migration, rupture.

DOVI - Aspiration Catheter

-The aspiration process eliminates the first heavy thrombus burden before the aggressive treatment.
-Reduces the VTE (Venous thromboembolism) risk.
-Opens the lumen for aggressive treatment and provides direct intervention to thrombus attached to the wall.
-It cleans the suspended resuscitation thrombus using during and after the treatment.
-Side aspiration windows provide efficient aspiration.

MANTIS – PHARMACOMECHANICAL TREATMENT

Invamed Thrombectomy System is used in the acute, sub-acute phase in venous peripheral obstructions (also present in the pulmonary artery and vena cava inferior uses) and is used for opening and lumen thrombosis in acute congestion melting occurs in chronic phase. The system consists of an active tip, motor unit and infusion port specially designed to dissolve the thrombus. The active tip rotates inside the vein and breaks apart the thrombus. An anti-thrombolytic drug can also be delivered from the infusion port. In this way, thrombus and drug are macerated and a fast result can be obtained.

VIPER – PHARMACOMECHANICAL THROMBOLYSIS CATHETER

Viper Pharmacomechanical Thrombolysis catheter is designed for controlled infusion of tPA along with mechanical vibrations.
It increases the effect of tPA by thinning the fibrin.
tPA can be pushed deeper inside the thrombus, with mechanical effect thus increasing the drugs effectively.
OTW system and 200 cm catheter length allow safe access to the clotted vessel including pulmonary artery in PE cases.