Venous thrombosis occurs by thrombus clot (blood clot) in the vein. They can be affected by surface veins, which is called superficial thrombophlebitis, or deep veins, which is called deep vein thrombosis.
Thrombosis is always accompanied by phlebitis (inflammation of a vein), and the terms thrombosis and thrombophlebitis are also used. Thrombosis may result from coagulation disorders (disturbances in blood clotting) or may indicate a yet undiscovered malignant disease.
Factors that may contribute to the occurrence of thrombosis are: damaged endothelium, (inner layer of the wall of blood vessels) catheter, blood stasis after surgery, oral contraceptives, prolonged sitting with your legs down during a journey (e.g. Plane flight), which represents a risk to healthy people.
Acute disease symptoms can develop during several hours or up to 1 or 2 days. The course of the disease is usually limited, it takes 1 to 2 weeks, and after that the acute process soothes, and the pain decreases. In the case of superficial thrombophlebitis, the affected vein can be felt under the fingers as thickened, hard, ribbon-like formation. This is a reflection of the inflammatory reaction and it is accompanied by pain, tenderness, erythema and warmth.
Deep venous thrombosis may be asymptomatic or can also be revealed by varying degrees of sensitivity, pain, erythema, swelling, heat, changes in skin color or prominent superficial veins. The sensitivity and pain occur while standing and walking, and facilitate by resting with a raised foot. Maximum pain occurs in bending the hock, with a stretched knee, or when standing up with a stretched foot, which is called Homans’ sign and it is essential to distinguish from ordinary muscle pain.
Surface thrombosis is diagnosed based on clinical symptoms and physical examination, in fact acute arterial and deep venous obstruction (blockage)can usually be distinguished. In more than 50% of the cases, acute deep thrombosis cannot be diagnosed only on the basis of clinical symptoms, nor can Homan’s sign or edema be reliable. The diagnosis is confirmed by non-invasive tests, or venography (see the flow of blood through the veins using contrast). If thrombosis affects the veins in the groin or pelvis, duplex ultrasonography helps in the diagnosis. If not diagnosed, deep vein thrombosis (DVT) can lead to death due to pulmonary embolism.
DVT is a benign disease, but can cause pulmonary embolism, which can result in death or chronic venous insufficiency (insufficient function of the flow in the veins). Surface thrombosis can also cause the formation of pulmonary embolism but they will not be fatal.
Surface thrombosis requires no special treatment other than relief of symptoms, placing warm compresses over the affected vein and taking NSAIDs (nonsteroidal anti-inflammatory drugs) for pain and to calm inflammation. Antibiotics are not necessary, andhospitalization alsois not required. In DVT, patients must immediately be hospitalized because it is necessary to prevent pulmonary embolism and chronic venous insufficiency. Heparin is given and the patient lies with an elevated leg and possible compresses if there is no arterial insufficiency.
Antibiotics are given only if the infection is present. After heparin, it is proceeded to oral warfarin therapy, and the length of using them depends on each patient, typically lasts for 2 to 6 months. When you reduce the edema, the patient should wear elastic stockings while walking, to control edema that can occur during walking.