Introduction

Post-thrombotic syndrome is a possible complication of having a deep vein thrombosis (DVT) in your leg. It can affect your leg with pain, swelling, and other problems. You may not notice it right away, but it can appear weeks or months later.

DVT is a health issue where a blood clot forms in a deep vein, typically in the leg, thigh, or pelvis. They may also occur in the arm. Understanding DVT is crucial because it can affect anyone and lead to severe health problems, including disability or even death. However, DVT can be prevented and effectively treated when detected early.¹

Blood clots in your legs are serious and can happen to anyone. This article will explain why they happen, what they can lead to, how they are diagnosed and treated, and what you can do to try to prevent them. Knowing more about blood clots and what they can do will help you take care of yourself and stay well.

What you should know about DVT: common causes and risk factors of this life-threatening disorder

Here are some examples of risk factors, and potential causes,  for developing a blood clot in your veins:

• Certain health problems such as cancer, and certain interventions such as hormonal birth control, can increase the chances of getting DVT^{2, 3}
• Being overweight, pregnant, being over 60 years old, having surgery, being in intensive care, and not drinking enough water are all known to increase the risk of getting DVT³
• Slower blood movement: not moving much (like staying in bed, sitting still for long periods, being under anaesthesia, having surgery, having a stroke, or taking long flights) can make blood flow slower⁴
• Higher pressure in veins: this can be due to something pressing on, or blocking, veins. Examples can include a tumour, being pregnant, a narrowing in the veins, or a birth defect that makes it harder for blood to flow out, which can raise the pressure in the veins⁵
• Physical harm to the vein: injuries from accidents, surgeries, catheters placed in veins, a history of blood clots, or using drugs through veins can all cause damage⁶
• Differences in how veins are shaped can play a part in causing blood clots

How often does DVT occur? The statistics and causes of this blood clot disorder

blood clots in deep veins and lungs are pretty common and can happen without any symptoms, so they might not be found until after someone passes away. This means that the number of recorded cases is usually lower than the actual number of people with DVT. It's estimated that each year about 80 out of every 100,000 people get DVT, and about 1 out of every 1000 people have a blood clot in their leg. ⁷

How to spot the signs of DVT: symptoms you should never ignore

The signs and symptoms of DVT aren't specific and can be caused by the clot itself or another issue. Doctors might need to do tests like imaging scans to confirm whether a clot or something else, is causing the symptoms.⁸

DVT mostly happens in the big veins in your lower leg, thigh, or pelvis, usually on just one side of your body. It can block blood flow and cause:

• Pain or tenderness in your leg, especially in the thigh or calf
• Swelling in your leg
• Skin that feels warm
• Reddish skin colour⁹

A pulmonary embolism (PE) is a serious condition where a blood clot breaks loose from a vein and travels to the lungs, blocking the blood flow. This can cause:

• Feeling out of breath for no clear reason
• Breathing quickly
• Pain in the chest, which can get worse when you take a deep breath
• My heart beating faster than usual
• Feeling dizzy, or fainting
• Coughing, which may sometimes have blood in it
• Feeling very worried or scared

DVT diagnosis: how doctors detect this deadly condition

To find out if you have DVT or PE, you need tests that only doctors can do. That's why it is crucial to see a doctor if you have any symptoms of DVT or PE.

• A D-dimer blood test is a diagnostic tool that helps doctors identify the presence of blood clots in the body. When a blood clot forms in the body, it eventually breaks down over time. As it breaks down, it releases a substance called D-dimer into the bloodstream. Therefore, elevated levels of D-dimer in the blood indicate that there may be a blood clot present. The D-dimer blood test is often a first step for doctors to check if there might be a blood clot. If it suggests there could be a clot, more tests like scans or other blood tests might be needed to be sure.
• Duplex ultrasonography is a special test that uses sound waves to check how blood is flowing in your veins. It can find blockages or blood clots in the deep veins. This test is commonly used to diagnose DVT.
• Contrast venography is a type of X-ray where dye is put into a big vein in the foot or ankle. This helps doctors see deep veins in the leg and hip. It is the best test for finding blood clots, but it is invasive, meaning doctors have to put instruments into the body. That's why duplex ultrasonography is used more often now. Contrast venography is only used for specific cases.
• Magnetic resonance imaging (MRI) and computed tomography (CT) scans are special tests that use different techniques to create pictures showing the inside of the body. They are often used to find out what's wrong with someone's health. Although these tests can show veins and blood clots, they're not usually the first choice for diagnosing DVT.¹⁰

Post-thrombotic syndrome and DVT: how doctors manage these complications

Treatment for post-thrombotic syndrome depends on how bad your condition is. Usually, it involves raising the leg that's affected, wearing special compression stockings to squeeze the leg, doing exercises, and taking medicine. Doctors might also give you blood thinning medication to stop more clots from forming in your veins They might also prescribe you pain relief medication.

Exercise and elevation

It is best to raise your legs above your heart level, and you can use special pillows for comfortable reclining. You do not have to keep your legs up while you sleep, and it's not good to be sedentary all the time. But when you are relaxing at home, try to elevate your legs until the swelling goes down. Elevating your legs while resting or sleeping helps blood flow back to your heart because of gravity. You can also do exercises like moving your ankles and activities to make your calf muscles stronger.

Compression stockings

Appropriately sized, graduated compression clothing plays a crucial role in managing post-thrombotic syndrome. Your healthcare provider, or physical therapist, can guide you in selecting the right type of garment, which can be obtained either from a medical supply store or directly over the counter. It is essential that the compression garment fits comfortably and is easy to put on and take off. Additionally, there are various assistive devices available to assist with the process of donning and doffing.¹¹

Compression stockings play a vital role in managing post-thrombotic syndrome (PTS). Ensuring the correct fit and appropriate compression level is crucial. These stockings, made from specialised elastic fabric, exert pressure on the ankle, enhancing blood circulation while alleviating swelling and discomfort. Typically, your physician will advise you in choosing the most suitable stockings for your specific requirements.

Medication

Sometimes, people need to take blood-thinning medicine for a long time to stop more blood clots from forming in their legs. But right now, there are no specific medicines just for treating post-thrombotic syndrome (PTS). However, recent studies suggest that a natural supplement called horse chestnut extract might help with some symptoms like leg swelling and itching.¹²

How to prevent DVT with simple lifestyle changes: tips and tricks

• Keep moving. If you have been in surgery or are bedridden, try to start moving as soon as possible. Avoid crossing your legs while sitting because it can block blood flow
• Take breaks and stretch your legs during travel. Stand or walk around on a plane, and stop every hour if you're driving. If you  cannot walk, do exercises like lifting your heels or toes while seated
• Stop smoking. Smoking increases the risk of DVT.
• Control your weight. Being overweight also raises the risk of DVT. Exercise regularly for at least 30 minutes a day to lower your risk. If you're trying to lose weight or reach fitness goals, you may need to exercise more.¹³

To put it simply, deep vein thrombosis (DVT) is a serious problem that can happen when a blood clot forms in a vein deep inside the body. This can lead to long-lasting pain, swelling, and other problems in the leg where it occurs. It is important for everyone to know what causes DVT, its symptoms, how it is diagnosed, and the treatment options available to stop it from happening and to deal with it if it does.

Certain things like sitting still for a long time, being pregnant, being overweight, smoking, and having certain health conditions can make DVT more likely to happen. This shows why it's important to make changes in your lifestyle and take steps to prevent it.

Preventing DVT means taking action to keep your blood flowing well. This includes staying active, not sitting still for too long, stopping smoking, and managing your weight. When you're travelling or sitting for a long time, it's important to take breaks and move around to keep your blood moving smoothly.

By doing these things and learning about DVT, you can lower your chances of getting it and keep your blood vessels healthy. It is really important to spread the word about DVT so that everyone knows what to do to keep themselves safe and healthy.

The bottom line: what you need to remember

Post-thrombotic syndrome (PTS) arises in individuals who have previously experienced deep vein thrombosis (DVT), characterised by the formation of blood clots in deep veins, typically in the leg, leading to enduring pain and swelling. Several factors can elevate the risk of DVT, such as prolonged immobility, pregnancy, contraceptive use, obesity, smoking, and certain medical conditions, which can be identified through various diagnostic tests by healthcare professionals.

Symptoms of DVT include pain, tenderness, swelling, warmth, and redness in the affected leg. In severe cases, the clot can dislodge and travel to the lungs, posing a grave threat. Treatment for PTS may involve elevation of the leg, wearing specialised socks, engaging in exercises, medication, and the use of blood thinners. Some research suggests that horse chestnut extract might alleviate certain PTS symptoms.

Prevention of DVT entails regular movement, avoiding prolonged periods of sitting or standing, stopping smoking, and maintaining a healthy weight. During extended periods of travel or sedentary activities, it is recommended to take breaks and perform leg movements to facilitate blood circulation.

In essence, understanding the causes, symptoms, and treatment options for DVT and PTS is crucial. By adopting a healthy lifestyle and being knowledgeable about DVT, individuals can alleviate their risk of encountering these conditions and promote the health of their blood vessels.