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The Cardiovascular SystemVenous Thrombosis Synonyms : Clinical features, Diagnosis, Management, Prognosis, Nutrition, Herbs, Thrombosis
is formation of a blood clot (thrombus) within the non-interrupted vascular
system, and can be understood as inappropriate activation
of normal haemostatic processes. Thrombotic disease of peripheral veins
may present as:
Superficial
thrombophlebitis,
which is characterised by thrombosis accompanied by reactive inflammation of a
superficial vein (phlebitis) that becomes tender and painful. This condition
is usually found in patients with varicose veins.
Deep
vein thrombosis
that affects particularly the venous sinuses of the muscles in the calf and
the femoral and iliac veins. The thrombus is a loose,
jelly-like mass of platelets, fibrin and red cells that can after a few days
undergo lysis or organisation (be replaced by fibrous tissue) or sometimes be
a source of emboli which are free-flowing parts of a thrombus. Emboli formed
from venous thrombi ultimately end up in the pulmonary circulation (pulmonary
embolism) which can, depending on their size and number, be silent, cause
minor discomfort or even be life-threatening. Several factors may predispose to deep venous thrombosis: venous stasis (prolonged immobility, right
ventricular failure) venous injury (trauma, intravenous
cannulation) increased coagulability of the blood (malignant diseases, oral contraceptives, dehydration) increasing age Clinical features: < BACK TO TOP >
In
superficial thrombosis a thrombosed superficial vein can be palpated as a
linear, indurated cord, associated with variable inflammation presenting as
pain, tenderness, erythema and warmth.
Deep
vein thrombosis may be asymptomatic, present with similar but less obvious
symptoms as superficial thrombosis, or the patient may only complain of
soreness or pain on standing and walking that is usually relieved by rest with
the leg elevated.
Prolonged
deep vein thrombosis may lead to chronic venous insufficiency in which there
is oedema, aching pain, skin pigmentation, cyanotic discolouration and stasis
ulceration of the affected limb, that worsen on standing or walking. In deep vein thrombosis there is a high risk for pulmonary embolism that can occur without any warning sign, and present with chest pain, breathlessness, tachypnoea, coughing and increased temperature (superficial thrombophlebitis extremely rarely causes pulmonary embolism presumably due to early activation of inflammation that breaks down the thrombus or causes its organisation). Diagnosis: < BACK TO TOP >
Superficial
thrombophlebitis is diagnosed by the symptoms and clinical examination.
Clinical
diagnosis of deep vein thrombosis is notoriously unreliable due to very
variable clinical features.
Ascending
venography (X-ray of the veins after the injection of the contrast medium
into the peripheral veins) is the definitive investigation and will help to
define the extent and site of thrombus. Ultrasound examination may reveal the site of thrombosis, especially if coupled with Doppler flow studies to measure blood flow through larger veins. Management < BACK TO TOP >
Superficial
thrombophlebitis requires no specific therapy other than relief of discomfort
(warm packs, NSAIDs); alternatively topical anticoagulant and thrombolytic
cream Hirudoid can be rubbed in.
For
deep vein thrombosis treatment is aimed at preventing the propagation of the
thrombus, pulmonary embolism, and damage to the valves of the vein leading to
chronic venous insufficiency.
A
short period of bed-rest with the legs elevated to 15o,
followed by mobilisation and physiotherapy; elastic stockings are helpful
because they prevent pooling of blood and may reduce oedema.
Initially
anticoagulant drug heparin is given by injection for 7-10 days, carefully
monitoring the blood coagulation status and adjusting the dose if necessary.
Thrombolysis
with tissue plasminogen activators (e.g., streptokinase [Kabikinase,
Streptase], reteplase [Rapilysin], alteplase [Actilyse] or urokinase [Ukidan])
can be tried if thrombosis is detected in the early stage.
Oral
anticoagulant drug warfarin [Marevan, Coumadin] is continued after heparin
for three months (indefinite therapy may be indicated in patients with
persisting risk factors). Thrombectomy (surgical removal of the thrombus) may occasionally be required, when conservative treatment has failed. Prognosis < BACK TO TOP >
Nutrition < BACK TO TOP > Nutrition that alleviate or prevent Venous Thrombosis :- Herbs < BACK TO TOP > Herbs that alleviate or prevent Venous Thrombosis :- (source : -) |
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