Thrombosis, DVT & Pulmonary Embolism


A clot within a blood vessel is called a thrombus and the process by which it forms is known as thrombosis. It can be damaging as it might block the flow of blood. Also part of the clot might break away and block a blood vessel further along cutting off the blood supply to important organs.Thrombo means "clot." Phlebitis is inflammation of a vein.

Thrombophlebitis (throm-bo-fluh-BI-tis) occurs when a blood clot and inflammation develops in one or more of your veins, typically in your legs. On rare occasions, thrombophlebitis (often shortened to phlebitis) can affect veins in your arms.

The affected vein may be near the surface of your skin (superficial thrombophlebitis) or deep within a muscle (deep vein thrombosis).

Deep vein thrombosis (DVT)

Deep vein thrombosis (DVT) is the formation of a blood clot in one of the deep veins within the body, such as in the leg or pelvis. This kind of thrombosis can occur after surgery and may cause redness, pain and swelling.

Deep vein thrombosis commonly affects the leg veins (such as the femoral vein or the popliteal vein) or the deep veins of the pelvis. Occasionally the veins of the arm are affected.

Your risk of DVT increases if you:

  • Are inactive for a long period of time, such as sitting in a car or an airplane (economy class syndrome).
  • Are confined to bed for a prolonged time, such as after surgery, a heart attack or a leg fracture.
  • Have certain types of cancer, such as pancreatic cancer, which may result in an increase in your blood of procoagulants, substances necessary for blood clotting (coagulation).
  • Have had a stroke resulting in paralysis of your arms or legs.
  • Are pregnant or have just given birth, which may mean you have increased pressure in the veins of your pelvis and legs.
  • Use oral contraceptives or hormone replacement therapy, which may increase the clotting factors in your blood.
  • Have a family history of a tendency of blood clots.
  • Have varicose veins. Clots may develop in dilated superficial veins (varicose veins), causing superficial thrombophlebitis.

Treatment of DVT:

  • Medical treatment with anticoagulants to dissolve the clots.
  • Treatment started with intra venous anticoagulants in the hospital and continued with oral anticoagulants for six to eight months there after.
  • If patient comes within six hours of a massive DVT the clot can be surgically removed from the vein.


  • Genetic and acquired risk factors.
  • Assess risk factors of age, type of surgery, past medical history and additional risk factors like :
    • Obesity.
    • Varicose veins.
    • Estrogen use.
  • Malignancy.
  • Immobilization.
  • Paralysis.


  • Pain.
  • Warmth.
  • Redness.
  • Swelling of the lower extremity.


  • Tenderness.
  • Warmth.
  • Erythema.
  • Cyanosis.
  • Edema.
  • Palpable cord (a palpable thrombotic vein)
  • Superficial venous dilation.

Treatment recommended using low molecular weight heparin:

  • Haemorrhage less likely (40% decreased major bleeding).
  • No need to monitor activated Partial Thromboplastin Time (aPTT).
  • SC administration.
  • Lower incidence of heparin induced thrombocytopenia with thrombosis.
  • (1/3rd decreased rate of thrombocytopenia).
  • 30% decreased mortality.
  • Early discharge or outpatient treatment.

Pulmonary Embolism

Pulmonary embolism (PE) is a serious condition in which the arteries leading from the heart to the lungs becomes blocked. It can occur when a blood clot breaks away from its original location and travels to the lungs. Symptoms may include sharp chest pain, shortness of breath and coughing up blood.

The process by which blood clots occur and travel through the veins is known as venous thromboembolism (VTE), the collective term for DVT and PE.

The most serious complication of a DVT is that the clot could dislodge and travel to the lungs blocking blood flow to lung tissue which is called a pulmonary embolism (PE).

A case of acute pulmonary embolism operated as a life saving measure by Dr. Anand Somaya.

Cardiopulmonary bypass
First glimpse of the thrombus
And it kept coming
The Culprit - Worlds' Longest Anti Mortem Embolus


  • Unexplained shortness of breath.
  • Pain with deep breathing.
  • Coughing up blood.
  • Rapid breathing and a fast heart rate.


  • Lung scan.
  • Venography.
  • Venous ultrasound.
  • HRCT.
  • Pulmonary Angiography.

Treatment recommended by me:

  • Surgical removal in acute massive pulmonary embolism causing threat to life.
  • Heparin - Pro Thrombin Time (PTT) adjusted iv Infusion.
  • Streptokinase/ Urokinase.
  • Low molecular weight heparin.
  • Insertion of caval filter.
  • Oral anticoagulants for 3-6 months.

Prevention of DVT & PE During long trips, it may help to:

  • Walk up and down the aisles of the bus, train, or airplane. If travelling by car, stop about every hour and walk around.
  • Move your legs and flex and stretch your feet to encourage blood flow in your calves.
  • Wear loose and comfortable clothing.
  • Drink plenty of fluids and avoid alcohol and coffee.
  • Wear anti thrombotic stockings.