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Monday, 5 September 2016

Preventing Deep Vein Thrombosis (DVT)

In this article we are looking at ways in which we can prevent Deep Vein Thrombosis (DVT)

What is DVT

A DVT is a blood clot that forms deep in your veins, most often in your leg. It can partially or completely block blood flow back to the heart and damage the one-way valves in your veins. It can also break free and travel to major organs, such as your lungs, which can be very dangerous. 

Older people (over 60 years of age) are more likely to have a DVT, particularly if you have poor mobility or have a serious illness such as cancer.

How to Prevent DVT

If you're stuck in your chair/sat for long or even short periods, work the muscles in your legs often:

  • Stretch your legs.
  • Flex your feet.
  • Curl or press your toes down.

Drink plenty of fluids, but avoid coffee and alcohol. They'll dehydrate you, which makes your veins narrower and blood thicker, so you're more likely to get a clot.

Don't wear short, tight socks, and try not to cross your legs a lot. You might want to wear compression stockings. They'll help your blood flow and keep swelling down.

A DVT is often just a one-off event after a major operation.

However, some people who develop a DVT have an ongoing risk of a further DVT - for example, if you have a blood clotting problem, or continued immobility. As mentioned above, you may be advised to take anticoagulation medicine long-term. Your doctor will advise you about this.

Other things that may help to prevent a first or recurrent DVT include the following:
  • If possible, avoid long periods of immobility, such as sitting in a chair for many hours. If you are able to, get up and walk around now and then. A daily brisk walk for 30-60 minutes is even better if you can do this. The aim is to stop the blood pooling and to get the circulation in the legs moving. Regular exercise of the calf muscles also helps. You can do some calf exercises even when you are sitting.
  • Major operations are a risk for a DVT - particularly operations to the hip, lower tummy (abdomen) and leg. There are a number of methods to help reduce this risk:
    • To help prevent a DVT, you may be given an anticoagulant such as a heparin injection just before an operation. This is called prophylaxis. Enoxaparin and dalteparin are the most common types of heparin given for prophylaxis against blood clots. The new drug, fondaparinux sodium, can also be given by injection in some circumstances to prevent DVT in surgical patients or immobile medical patients in hospital.
    • The newer anticoagulant medicines discussed above can be used to prevent DVT or PE after hip or knee replacement surgery. Rivaroxaban, apixaban and dabigatran are used in these situations, and can be given by mouth as a tablet, rather than injection.
    • An inflatable sleeve connected to a pump to compress the legs during a long operation may also be used.
    • You may also be given compression stockings to wear whilst you are in hospital.
    • It is now common practice to get you up and walking as soon as possible after an operation.
  • When you travel on long plane, train, car or coach journeys, you should have little walks up and down the aisle every now and then. Try to exercise your calf muscles whilst sitting in your seat. (You can do this by circling your ankles, getting into a 'tiptoe' position and lifting your toes off the floor whilst keeping your heels on the ground.) You should aim to stay well-hydrated and avoid alcohol and sleeping medications. If you have had a previous DVT, you should see your doctor for advice before you travel on a long journey or fly.
  • People who are overweight have an increased risk of DVT. Therefore, to reduce your risk, you should try to lose weight.
  • The main cause of DVT is immobility - especially during or after surgery.
  • If you are having major surgery, you will usually be given medication with injections and/or tablets, to prevent blood clots forming. This is called thromboprophylaxis.
  • The most serious complication of DVT is a pulmonary embolus (PE), where part of the blood clot breaks off and travels to the lung. PEs can cause death.
  • Persistent calf symptoms may occur after a DVT.
  • With treatment, the risk of the above two complications is much reduced.
  • Treatment includes anticoagulation medicines, compression stockings, leg elevation when sitting, and keeping active.
  • Prevention is important if you have an increased risk of DVT - for example, during long operations or when you travel on long journeys.

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