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It's Travel Time - Be wary of DVT's

385 Md

A DVT is a Deep Venous Thromboembolism, & refers to the presence of coagulated blood within the veins that return blood to the heart. The risk of an undiagnosed DVT is that the thrombus may dislodge or fragment, allowing it to travel via the heart & lodge in the small vessels of the lungs causing a pulmonary embolism – a potentially life-threatening condition.
If you experience shortness of breath, chest pain or an increased heart or
breathing rate, call an ambulance on 000 or 112 from your mobile.

DVTs commonly form in the deep veins of the legs particularly after long periods of immobilisation, leading to the common term “economy class syndrome”.

Risk factors

Risk factors for DVT include anything that increase the risk of
coagulation of the blood, and include:

  • Increased age
  • Immobilisation of a limb (plaster cast,paralysis or paresis)
  • Long periods of sitting such as plane travel, driving or in the office
  • Bedridden for longer than 3 days
  • Recent surgery, particularly in the previous 4weeks
  • Trauma
  • Stroke
  • Acute medical illness
  • Pregnancy & post-partum
  • Use of the oestrogen oral contraceptive pill or hormone replacement therapy, IVF
  • Obesity
  • A previous thromboembolism
  • Active cancer (ongoing treatment, treatment
    within the last six months or palliative care)
  • Smoking
  • Some autoimmune diseases (ie systemic lupus erythematosus)
  • Congestive heart failure

Symptoms & Diagnosis

DVTs are first suspected in any patient with leg pain & oedema
combined with any of the above risk factors. Additional findings on physical
examination include:

  • Localised tenderness along the distribution of the venous system
  • Entire leg swollen on symptomatic side
  • Calf swelling greater than 3cm when compared to the unsymptomatic leg
  • Pitting oedema (swelling which acts like bread dough if pushed into)
  • Prominent superficial veins

A combination of these findings & associated risk factors allow practitioners to categorise patients into high, moderate or low risk categories. Even patients in the low risk category should be referred for an ultrasound, though if this is clear further investigation is unwarranted. A moderate or high risk patient may require additional ultrasound scans even if the first is clear, or may require venography.

Venography is an invasive procedure involving the injection of a radioactive
dye into the veins via a catheter inserted near the groin. The veins are then
able to be seen on X-Ray, & thrombosis identified. Whilst venography is the
gold standard for identification of a DVT, such a procedure is costly, time
consuming & also comes with its own risks. Therefore venography is only
used in certain situations.

Referral for Ultrasound

You can be referred for an ultrasound from your GP, or directly from your Physiotherapist. Both methods will have the same out of pocket expense. A Physiotherapist referral doesn’t require taking a receipt to Medicare.