Thrombosis is a condition characterised by the formation of blood clots within the deep venous system. In certain situations, it is a life-threatening condition due to the possibility of complications in the form of pulmonary embolism. Symptoms are mainly pain, swelling of the lower limb. Management consists primarily of anticoagulant medication.
The essence of the disease is the formation of thrombotic lesions in the deep venous system. Risk factors include, but are not limited to: age over 40, obesity, trauma - especially fractures, long-term immobilisation, cancer, thrombophilia, use of oral contraceptives, anticancer treatment, and additionally - major surgery in the abdomen, pelvis and lower limbs.
Symptoms typical of thrombosis are:
- swelling of the lower leg or whole limb,
- pain in the calf,
- pressure tenderness,
- excessive warming,
- the limb may be pale or bluish.
Upper limb venous thrombosis presents with pain and swelling.
Complete dissolution of the clot is rare. Deep vein thromboses may fragment and become embolic material, risking the development of pulmonary embolism. Pulmonary embolism can be massive with involvement of major vessels - a life-threatening condition. In the case of thrombosis with small fragments, symptoms are often misdiagnosed as pneumonia or asthma, for example. Very rarely, the complication is a stroke or peripheral embolism - it arises from a so-called crossed embolism, while there is a connection between the right and left atria of the heart. Another distant complication is post-thrombotic syndrome - when there is partial recanalisation of the vessel, the venous valves are damaged and hypertension and chronic venous insufficiency develop.
Usually, thrombosis has an uncharacteristic course in a large number of patients, hence the importance of diagnosis. Auxiliary tests include D-dimer level determination and ultrasound compression test (a vein that is filled with a thrombus does not collapse when compressed with a transducer). The diagnosis is, of course, based on a clinical examination of the patient.
Management of deep vein thrombosis consists primarily of anticoagulant treatment with low-molecular-weight or unfractionated heparin. The length of treatment should be adjusted according to the patient's clinical condition and concomitant additional conditions. Immobilisation is usually not necessary, but a pressure dressing should be applied.
