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Deep Vein Thrombosis during Pregnancy – Causes and Treatment

Deep vein thrombosis (DVT) is a blood clot that forms in a deep vein of the leg, calf or pelvis. During pregnancy, swelling and discomfort in both legs is common and does not always mean there is a problem. The blood in the veins is in constant formation of tiny clots that usually breaks down in the body. If the balance of clot formation and resolution changes, significant clotting can occur. A thrombus may form if one or a combination of the following situations exists.

Causes of Deep Vein Thrombosis

Immobility
– Prolonged sitting and travel such as long airplane flights, car or train.
– Hospitalization.
– Surgery.
– Trauma in the leg with or without surgery or casting.
– Pregnancy, including 6-8 weeks after birth.
– Obesity.

Hypercoagulability
– Smoking
– Genetic predisposition
– Polycythemia (increased number of red blood cells)
– Cancer

Trauma to the vein
– Fracture of the leg
– Leg contusion
– Complication of an invasive procedure, the vein

Other causes include:
– The damage occurs to the inner lining of a vein. This damage can result from injuries caused by physical, chemical or biological factors. Such factors include surgery, serious injury, inflammation and immune response.
– Blood flow is sluggish or slow. Lack of movement can cause slow or sluggish blood flow. This can occur after surgery, if you are sick and in bed for a long time, or if you are travelling for a long time.
– Your blood is thicker or more likely to clot than normal. Certain hereditary conditions (such as factor V Leiden) increase the tendency for blood to clot. This is also true for treatment with hormone therapy or birth control pills.

Treatment for Deep Vein Thrombosis

As soon as the doctor suspects a venous thrombosis, you are advised to start treatment with an injection of heparin (an anticoagulant) to “thin the blood.” There are different types of heparin. The most commonly used in pregnancy is “low molecular weight heparin (LMWH).

Superficial Thrombophlebitis:
The treatment of superficial blood clot is symptomatic:
– Hot towels
– Leg compression and
– An anti-inflammatory drug like ibuprofen.

Deep venous Thromboses
Treatment of DVT above the knee is anticoagulation, unless there is a contraindication.Contraindications include recent major surgery (from anticoagulation would be thin all the blood in the body, not just in the leg, leading to serious bleeding problems), or abnormal reactions when previously exposed to anticoagulant medications.

Anticoagulation prevents further growth of blood clotting and prevents the formation of a clot that can travel to the lungs. Anticoagulation is a two-step process. Warfarin is the drug of choice for anticoagulation. It should be started immediately, but unfortunately it may take a week or more for blood to get properly diluted. Therefore, the molecular weight heparin is administered at the same time. It thins the blood through a different mechanism and is used as bridge therapy until the warfarin has reached the therapeutic level. Enoxaparin injections can be given on an outpatient basis.

Surgery
Surgery is a rare option in the treatment of deep vein thrombosis large leg in patients who can not take blood thinners or who have recurrent clots while on anticoagulant medications. Surgery is often accompanied by placement of a vena cava (IVC) filter to prevent future clots embolization to the lung.

Cerulea dolens Phlegmasia describes a situation in which a blood clot in the iliac vein of the pelvis and the femoral vein in the leg, blocking almost all of the blood return and jeopardizing the blood supply to the leg. In this case surgery may be considered to remove the clot, but the patient also required anticoagulant medications.

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