Get A Leg Up On Deep Vein Thrombosis

Overview

Deep vein thrombosis — DVT for short — happens when a blood clot forms inside a deep vein, most often in the lower leg or thigh. Veins are the tubes that carry blood back up to your heart. If blood moves too slowly, if the wall of the vein is damaged, or if your blood is more likely to clot than usual, the blood can clump together into a solid lump. That clot can partly or fully block the vein, which is why the leg may swell and ache. The main worry with DVT is that a piece of the clot can break off and travel to the lungs. That is why it needs to be checked and treated quickly — not because you have done anything wrong.

Yes, it is fairly common. Roughly 1 in 1,000 people in the general population are diagnosed each year, and it is much more common in people who are in hospital, have recently had surgery, or have been immobile for a while. Because doctors see it often, they are used to spotting it and treating it.

Anyone can get DVT, but it is more likely if you have been sitting or lying still for a long time — for example after an operation, during a long hospital stay, or on a very long journey. Risk also rises with older age, cancer and its treatment, pregnancy and the six weeks after birth, being overweight, smoking, taking some hormone medicines (such as the combined contraceptive pill or hormone replacement therapy), having a close relative who has had a clot, and some inherited conditions that make blood clot more easily.

Symptoms

Common symptoms

• Pain, cramp or tenderness in one leg — usually the calf or thigh. It can feel like a pulled muscle.
• Swelling in one leg, ankle or foot (usually only on one side).
• Skin that feels warm, or looks red, purple or darker than usual over the sore area.
• A leg that feels heavy, tight, or harder to move than usual.
• Swelling or pain that gets worse over a day or two, or when you stand and walk.
• Sometimes there are no obvious symptoms at all, and the clot is found when something else is being checked.

Symptoms in children

• DVT is rare in children. When it does happen, it is usually linked to a hospital stay, a central line (a long thin tube placed into a vein for treatment), or an inherited clotting condition.
• Children may not be able to describe the pain, so watch for a swollen arm or leg, limping, fussiness, or a limb that feels warm to the touch.
• If you notice one-sided swelling or unexplained leg pain in a child, get it checked the same day.

Symptoms in older adults

• Older adults are more likely to develop DVT, especially after a fall, an operation, or a long stretch in bed.
• Swelling is sometimes put down to 'just age' or 'poor circulation', so it is worth asking for a proper check.
• Older adults may also bruise or bleed more easily with treatment, so your doctor will look at the whole picture, including all your other medicines.

Causes

Main causes

• Blood moving too slowly — because you are sitting or lying still for a long time, or your leg is not moving normally.
• Damage to the lining of a vein — from an injury, an operation, or a tube or needle placed into a vein.
• Blood that clots more easily than usual — because of illness, hormone changes, some medicines, or traits you were born with.

Risk factors

• Being in hospital or having surgery, especially hip, knee or cancer surgery.
• Being off your feet for a long time because of illness, injury or a plaster cast.
• A long journey where you sit still for many hours.
• Cancer and some cancer treatments.
• Pregnancy and the first six weeks after giving birth.
• Taking hormone medicines such as the combined contraceptive pill or hormone replacement therapy.
• Being overweight or living with obesity.
• Smoking.
• Older age.
• A close family member who has had a blood clot.
• Some inherited conditions that make blood clot more easily.
• Having had a DVT or a clot in the lungs before.
• Some long-term conditions, such as heart failure or inflammatory bowel disease.

When to see a doctor

See a doctor urgently if:

• One leg is newly swollen, painful, warm or red — get advice the same day.
• You have recently had surgery, been in hospital, or been on a long journey and your leg starts to swell.
• You are pregnant, or taking hormone treatment, and notice new one-sided leg swelling.
• You have had a clot before and notice symptoms that feel like the last time.
• You become breathless or have chest pain — call your local emergency number straight away rather than waiting for an appointment.

Book a routine appointment if:

• You want to know what to look out for because a close relative has had a clot.
• You are planning a very long flight or drive and want advice on lowering your risk.
• You are about to start hormone treatment or have an operation booked and want to talk about clot risk.
• You had a DVT in the past and have questions about long-term swelling, exercise, or travel.
• You are unsure whether a symptom is worth worrying about — a quick check is always reasonable.

Diagnosis

Your doctor will ask when your symptoms started, what makes them better or worse, and whether you have any risk factors. They will look at both legs, compare them, and measure around your calf and thigh. If DVT seems possible, they will usually send you that day to a clinic or hospital for a scan and sometimes a blood test. You may be offered treatment while you wait for the results.

Tests that may be done

• A blood test called D-dimer. It measures a substance your body makes when a clot is breaking down. A normal result can help rule DVT out; a high result means more tests are needed.
• An ultrasound scan of the leg (sometimes called a Doppler or compression ultrasound). Sound waves show the veins and any clot inside them. This is the main test.
• A repeat ultrasound a week or so later, if the first scan was unclear.
• Blood tests to check your general health, kidney function and how your blood clots.
• Rarely, other imaging such as a CT or MRI scan, or a test that uses dye to show the veins (a venogram).

What to expect at your appointment

The ultrasound scan is painless and usually takes about 20 to 30 minutes. You will lie on a couch while a gel and a small handheld probe are moved over your leg. You can go home afterwards. Results are often available the same day, and if a clot is found, treatment usually starts straight away. Waiting for tests can feel worrying — it can help to bring someone with you, or to write down your questions beforehand.

Treatment

DVT is usually treated with blood-thinning medicine (called an anticoagulant). The aim is to stop the clot getting bigger, prevent new clots forming, and lower the chance of a piece travelling to the lungs. Treatment often starts the same day the clot is found. Your body slowly breaks down the existing clot over weeks to months.

Self-care at home

• Take your medicine exactly as prescribed, at the same time each day, and do not stop early — even if you feel completely well.
• Keep walking regularly if you can. Staying active helps blood flow, and long bed rest is usually not needed.
• When resting, prop your leg on a pillow so your ankle is higher than your hip — this helps swelling drain away.
• Wear compression stockings if you are given them, and ask for help getting the right fit.
• Keep all follow-up appointments and blood tests, even when things feel back to normal.
• Tell every doctor, nurse, dentist or pharmacist you see that you are taking a blood thinner — especially before any procedure, including dental work.
• Take care to avoid cuts and knocks. A soft toothbrush and an electric razor can help if you bruise or bleed easily.
• Avoid contact sports and activities with a high risk of falling while you are on treatment, unless your doctor says it is safe.
• Know the warning signs of a clot in the lungs, and act fast if they appear.

Medical treatments

The main treatment is blood-thinning medicine. These medicines do not melt the clot — they slow down clotting so your body can break the clot down naturally. They can be given as tablets or as injections under the skin. Most people are treated for at least three months, and some need it for longer, depending on why the clot happened and how likely it is to come back. The choice of medicine depends on your health, kidney function, other medicines you take, whether you are pregnant, and what is available where you live — your doctor will explain the options and the pros and cons. For larger clots, or if blood thinners are not suitable, treatment may be given in hospital, sometimes with stronger clot-dissolving medicine. A small number of people need a filter placed in a large vein to stop clots reaching the lungs.

When is surgery considered?

Surgery is rarely needed for DVT. It may be considered if the clot is very large, is causing severe symptoms, or if blood thinners are not safe for you. Options can include removing the clot through a thin tube, opening up a narrowed vein with a small stent, or placing a filter in a large vein. These are specialist decisions made together with a hospital team, and your doctor will explain the risks and benefits.

Living with this condition

Most people get back to their normal routine. The first few weeks can feel uncertain, and it helps to know what to expect. Swelling often improves over weeks to months, but it may not go away completely — many people find their leg is a little larger or aches after a long day. Compression stockings, movement, and raising your leg when you rest all help. Plan long journeys in advance: take breaks, move your feet, and drink plenty of water.

Lifestyle tips

• Build gentle movement into each day — walking is one of the best things you can do for your circulation.
• Break up long periods of sitting: stand up and move around every hour or so.
• On long journeys, walk up and down when you can, and circle your ankles and wiggle your toes while seated.
• Keep to a healthy weight if you can — your doctor can support you with this rather than you going it alone.
• Stopping smoking is one of the most effective ways to lower your risk of clots and heart problems. Ask about free local support.
• Limit alcohol and stay well hydrated, especially in hot weather or when travelling.
• Follow any advice about compression stockings, including how long to wear them each day.

Diet and exercise

There is no special DVT diet. Eating a balanced mix of vegetables, fruit, whole grains, beans, lean protein and healthy fats supports your circulation and general health. Some foods and supplements can interact with blood-thinning medicine — especially leafy green vegetables in large, sudden changes, and herbal products such as St John's wort — so it is worth asking your pharmacist before starting anything new. Walking, swimming and cycling are excellent choices. Build up gradually, and check with your team before high-impact or contact sports, particularly while you are on treatment.

Mental health and emotional wellbeing

It is very common to feel anxious after a clot. Many people worry about another one, or find themselves checking their leg constantly. Some feel low, frustrated by swelling, or nervous about travelling again. These feelings are understandable and they usually settle with time and information. Tell your doctor if worry is affecting your sleep, work or mood — support is available and you do not have to manage alone. If you ever have thoughts of harming yourself or feel you cannot cope, contact your local emergency number or a crisis support line in your country straight away, or reach out to someone you trust.

Prevention

Many cases can be prevented, though not all. If you are going into hospital, you should be assessed for clot risk, and you may be offered compression stockings or blood-thinning medicine around surgery. Keep moving as much as you safely can, especially after an operation or during illness. Drink plenty of water, avoid sitting still for hours on end, and on long journeys wear loose clothing, walk when possible and consider compression socks. Keeping to a healthy weight and stopping smoking lower your risk over the longer term. If you take hormone medicines, ask your doctor about your personal clot risk.

Vaccines

There is no vaccine for DVT.

Screening programmes

There is no routine screening test for DVT. Testing for inherited clotting conditions is only offered in specific situations — for example a clot at a young age, a clot with no clear cause, or a strong family history. Your doctor can advise whether testing might be useful for you.

Complications

If left untreated

• The clot can grow and block more of the vein, causing increasing pain and swelling.
• Part of the clot can break off and travel to the lungs — this is called a pulmonary embolism (PE) and can be life-threatening.
• Post-thrombotic syndrome: long-term swelling, aching, heaviness and sometimes skin changes in the affected leg.
• Reduced mobility or discomfort that affects work and daily life.
• Rarely, a very large clot can cause lasting damage to the leg.

Long-term outlook

The outlook is good for most people. With prompt treatment, the clot stops growing, your body gradually breaks it down, and the risk of serious problems drops sharply. Many people make a full recovery and return to normal activity. Some have ongoing swelling or aching in the leg, which can usually be managed with compression stockings and regular movement, and your doctor can help you with this. Having one clot does raise the chance of another, so it is worth knowing your risk factors and the warning signs. Most people go on to live full, active lives.

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