Venous thrombosis is a disease due to the formation of a blood clot within the venous system. As Dr. Corrado Lodigiani, Head of the Thrombosis and Hemorrhagic Diseases Centre of Humanitas, a guest in the studio at “Il mio medico” on TV2000, explained, the formation of a clot is a physiological process that takes place whenever the body needs to stop a bleeding; however, there are situations in which its formation takes place in the veins in an inappropriate manner and in an inappropriate location and this can lead to venous thrombosis, a very serious disease that causes obstruction to the reflux of blood within our veins.
Causes of venous thrombosis
“One of the causes is the stasis or tendency of the blood to stagnate in the distal parts of our body, a condition that may be related to varicose veins or a period of entrapment or significant limitation of mobility. However, the main cause is inflammation: all chronic or acute inflammatory diseases, even pneumonia for example, cause a tendency of the blood to coagulate more. Important risk factors are obesity, the presence of a tumor (in these patients thrombosis often develops before the tumor itself), hormonal estroprogestin contraceptive therapies or substitutes after menopause, which however represent a risk factor especially in those who are predisposed, for example those who have a significant family history related to venous thrombosis.
Signals that should not be underestimated
“Venous thrombosis is a very subtle disease whose symptoms can be very variable. Generally the most affected organs (every vein of the body can have a thrombosis, even the cerebral ones) are the lower limbs and the most classical symptoms are an increase in volume and a swelling that can be limited to the foot or that can be extended to the whole calf or the whole leg. There may also be pain that ranges from barely perceptible to unbearable and a strong sense of heaviness in the leg, which may limit or even prevent limb movement or walking.
Compression ultrasound for diagnosis
“The clinical diagnosis of deep vein thrombosis is fallacious and therefore it is essential to have diagnostic confirmation by performing a safe, fast and painless ultrasound examination. The easiest variant of the ecocolordoppler with vascular probe is used, but it is considered the most effective: compression ultrasound scanning (CUS). The veins of the legs are visualized, starting from the inguinal region, based on the principle that the veins – unlike the arteries – are compressible and therefore if a vein has a normal flow and does not have a thrombus, at the pressure with the probe it compresses completely and is practically no longer visible on the monitor. The vein must be completely investigated for its whole extension because the thrombus could be present only in a part of its course, and if we limit ourselves to exploring only the more proximal parts that are more easily investigated we risk not making a diagnosis and therefore not treating a potentially fatal pathology. If the veins are compressible, the blood flows inside them in a natural way and therefore there is no presence of clots.
It is always a good idea to undergo this examination as a matter of urgency in the presence of a clinical suspicion of deep vein thrombosis, when all or even some of the symptoms described above appear, and especially if they are associated with the presence of important risk factors”.
What are the complications?
“The most feared complication is pulmonary embolism, a lung infarction that causes a major impairment of respiratory function. The veins of the lower limbs, in fact, flow at abdominal level into the hollow vein, which flows into the right heart ventricle from which the pulmonary arteries start, carrying the blood to the lungs. A clot that forms in the veins of our legs, if not treated promptly, can fragment into embolisms and following the flow of blood from the periphery to the heart, the embolisms can reach the heart itself and from there end up in the lungs, where they occlude the pulmonary arteries. Therefore, a venous pathology becomes more complicated with an arterial thrombosis in which the occlusion of a vessel that carries the blood to an organ occurs, with the consequent death of the organ itself or of a part of it, with a more or less extended infarction”.
The novelties in care
“Only anticoagulant drugs should be used to treat venous thrombosis; for about seventy years we have only had one drug available that is very effective but complicated to manage, coumadin. In the last 5-10 years, however, new drugs have become available, called new direct anticoagulants (NAO or DOAC) that have represented a real revolution in the field of therapy and prevention of both venous and arterial thrombosis (for example, stroke in the brain in patients with atrial fibrillation, a frequent arrhythmia of the heart). These drugs are easier to manage and safer; they are direct inhibitors of a single factor in coagulation and therefore require no monitoring, if not periodic blood checks, sometimes even only annually.
Watch the entire interview with Dr. Lodigiani, with in-studio demonstration of ultrasound performance and prevention tips, click here.