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DEEP VEIN THROMBOSIS (known as 'DVT') "Clots in the Deep Veins"

What is DVT ?
DVT, is a condition in which a blood clot ("thrombus") forms inside a deep vein.
The clot then either partially blocks or completely blocks the flow of blood in the vein. Veins are the blood vessels that take blood towards the heart. Deep veins are those such as found inside the calf, thigh or arm muscles, and are not those which you can see just below the skin.

WHAT CAUSES DVT?
There are several possible factors that can contribute to DVT.
The leading medical factors that cause DVT are: injury, immobility, surgery and/or illnesses that may include cancer, clotting disorders, and inflammatory diseases. Prolonged periods of inactivity or sitting still can slow down the blood flow and lead to blood "pooling," or accumulating in the extremities.
The leading medical factors that cause DVT are: injury, immobility, surgery and/or illnesses that may include cancer, clotting disorders, and inflammatory diseases.

Prolonged periods of inactivity or sitting still can slow down the blood flow and lead to blood "pooling," or accumulating in the extremities.

IN WHAT PARTS OF THE BODY DOES DVT OCCUR?
DVT usually occurs in the extremities, most often in the lower limbs, including the thigh or the calf.
However, occasionally the veins of the arm can be affected.

WHAT CAUSES BLOOD CLOTS TO FORM IN LEG VEINS?
Mainly, Poor blood circulation.
Blood normally flows quickly through veins, and does not usually clot.
Blood flow in leg veins is helped along by leg movements, because muscle action squeezes the veins.
Sometimes however, a DVT can occur for no apparent reason.

HOW COMMON IS A DEEP VEIN THROMBOSIS?
It is estimated that about 1 in 1000 people have a DVT each year in the UK.
About 5% will die from the complications (i.e. pulmonary embolism). If fact, complications from DVT blood clots kill over 200,000 people world-wide, each year. That is more than AIDS and breast cancer combined.

IS A DEEP VEIN THROMBOSIS SERIOUS?
When a blood clot forms in a leg vein it usually remains stuck to the vein wall and the symptoms tend to settle gradually, but there are two main possible serious complications.

1.   Pulmonary embolism
Occasionally, a part of the blood clot breaks off. This travels in the bloodstream and is called an embolus. An embolus will travel in the bloodstream until it becomes stuck.

l   A small size embolus may not cause any symptoms.
l   A medium size embolus can cause breathing problems and chest pain.
l   A large embolus can be carried up the larger leg and body veins to the heart,
     pass through the large heart chambers and get stuck in
     a blood vessel going to a lung.

This is called a pulmonary embolism. This is serious, and can sometimes be fatal. A pulmonary embolism may happen many hours or days after the formation of the clot.

2.   Post-thrombotic syndrome
Without treatment, up to 6 in 10 people who have a DVT develop long-term symptoms in the calf. This is called 'post-thrombotic syndrome'. Symptoms occur because the increased flow and pressure of the diverted blood in other veins can affect the tissues of the calf. Symptoms can range from mild to severe and include: calf pain, discomfort, swelling, and rashes. An ulcer on the skin of the calf may develop in severe cases. This is a common occurrence in people who are overweight, or those who have had more than one DVT in the same leg.

DVT SYMPTOMS - WHAT ARE THE SYMPTOMS OF A DEEP VEIN THROMBOSIS?
Some deep vein thromboses are "silent" and may be present with no symptoms at all.

Under these circumstances, DVT is only diagnosed when a complication occurs such as a pulmonary embolus. Patients with pulmonary embolism may experience shortness of breath, an apprehensive feeling, chest pain, rapid pulse, sweating, or a bloody cough.

The general symptoms, where they do occur, may include pain, tenderness, swelling and discolouration of the affected area, which is caused by dilation of the surface veins. The limb may also feel warm to touch, as blood that would normally go through the blocked vein is diverted to outer veins. The calf may then become warm and red.

WHO IS AT RISK OF HAVING A DVT?
Anyone may develop a DVT, however the following factors can cause an increased risk.

l   Major surgery - particularly operations to the hip, lower abdomen, or leg.
l   Any sort of immobility which causes blood flow in the veins to be slow,
     e.g. illness or injury.
l   (Many doctors advise if you have had hip or knee replacements then you
     should not go on a long-haul flight for at least three months
     after the operation.)
l   Immobility on long journeys by plane, train, etc.
l   Pregnant women are 5 times more at risk than non-pregnant women.
l   Women immediately following childbirth.
l   A previous history or currently suffering from malignant disease.
l   Hormone treatment such as the oral contraceptive pill or
     hormone replacement therapy (HRT).
l   Heart failure or cardiac disease or having had heart problems in the past.
l   Cancer, or having had treatment for cancer in the past.
l   Medical conditions that cause the blood to clot more easily than normal.
l   Clotting factors may also be affected as a result of an infection or injury
     to a blood vessel.
l   Previous personal or family history of clotting conditions,
     pulmonary embolism or DVT.
l   Any abnormality of blood clotting factors.
l   Some drugs (for example, some chemotherapy drugs) which can
     cause vein damage.
l   Older people are more likely to have a DVT, particularly if they have
     poor mobility.
l   If you have suffered from a stroke.
l   Vasculitis (inflammation of the vein wall).
l   Broken or fractured leg.
l   Varicose veins.
l   Obesity.
l   Smoking.

WHAT IS TRAVELLER’S THROMBOSIS (DVT)
This has become known in the press as "economy class syndrome" but the term is misleading. Individuals seated in cars, buses and trains may all be at equal risk, and cases of DVT occurring in flight have been reported in travellers in premium cabins as well as economy. The term 'travel related DVT' is much more accurate.

WHAT IS TRAVEL-RELATED DVT?
Long journeys by plane, train, etc, are thought to cause an increased risk of DVT.
This is probably due to sitting immobile and cramped for long periods of time. In plane journeys, in addition to the immobility, other factors which may possibly play a part (but are not proven) include: the reduced cabin pressure; reduced oxygen levels in the plane; slight dehydration caused by not drinking much water, and drinking too many alcoholic drinks which are often freely available.

DOES RESEARCH BACK THIS UP?
Yes - It is indicated from the studies of which we are aware, that there is indeed an association between long journeys and the occurrence of DVT. However, thromboses can occur after car, bus, rail or air travel and there is no conclusive evidence that flying in itself is a specific risk factor.

It has to be stressed that the vast majority of travellers have no problems. The increased risk of DVT from travel is small. Research studies suggest that there is about one DVT for every 6000 journeys that last four hours or more. Also, it is difficult to rule out that the people who have a DVT after a journey would have had one anyway and the journey was a coincidence. (DVT is quite a common condition in the general population anyway.) Nevertheless, it is wise to try and reduce the risk, particularly if you are in any of the other 'at risk' groups listed above.

DVT PREVENTION - WHAT CAN I DO TO REDUCE THE RISK OF TRAVEL-RELATED DVT?
Because a DVT can occur with little or no warning, it is advisable to take proper precautions to reduce the risk.

Don’t let cramped conditions put you at risk of DVT.
Keep your blood circulation moving – even when travelling by aeroplane.
Whilst travelling on a long journey, particularly on a long-haul plane trip:

l   Wear loose fitting comfortable clothes when travelling.
l   Exercise your leg, calf and foot muscles frequently – even whilst
     sitting in your seat.
l   Use Nukkles to frequently refresh your legs.
l   Elevate your feet and legs when possible.
l   Drink plenty of fluids, preferably water, to avoid dehydration.
l   Avoid drinks which contain alcohol and/or caffeine both before and
     during the flight. ( Alcohol can cause both dehydration and immobility. )
l   Do not take sleeping tablets, which cause immobility.
l   Avoid smoking.
l   Don't cross your legs or sit in a manner that restricts circulation.
l   Take all opportunities to get off and walk about if your transport
     or aeroplane stops for refuelling etc..
l   Walk up and down the cabin or aisle as frequently as you are able.
l   If possible, stand up in your seat area and stretch your arms and legs.
l   Walk for 30 minutes before starting your journey particularly
     before boarding an aeroplane.

AFTER THE JOURNEY
Have a little walk straight after the journey to 'get the circulation going'. The vast majority of travellers have no problems. However, if you develop a swollen painful calf or breathing difficulties shortly after a long journey, then see a doctor urgently. (But note: slight painless puffiness of feet and ankles is common after a long journey and is not due to a DVT.)

AM I AT RISK IF I AM NOT TRAVELLING?
Yes - If you are inactive for long Periods of time! or have a sedentary occupation. or have a sedentary occupation.

HOW CAN I REDUCE THE RISK?
If possible, avoid long periods of immobility such as sitting in a chair for many hours without moving about. (e.g. using a PC!). If you are able, get up and walk around now and then. A daily brisk walk for 30-60 minutes is even better if you can do this. Regular exercise of the calf muscles also helps. You can do some leg exercises or use a Nukkles massager even when you are sitting. such as sitting in a chair for many hours without moving about. (e.g. using a PC!). If you are able, get up and walk around now and then. A daily brisk walk for 30-60 minutes is even better if you can do this. Regular exercise of the calf muscles also helps. You can do some leg exercises or use a Nukkles massager even when you are sitting.

ELASTIC COMPRESSION STOCKINGS
There is some evidence to suggest that compression stockings may help to prevent travel related DVT. Many doctors recommend that you wear them if you are in any of the 'at risk' groups listed above. Some doctors advise that all adults should wear them on long-haul flights. Stockings however, do not replace the need for regular measures to improve circulation, but should be considered to be in addition to this. There is some evidence to suggest that compression stockings may help to prevent travel related DVT. Many doctors recommend that you wear them if you are in any of the 'at risk' groups listed above. Some doctors advise that all adults should wear them on long-haul flights. Stockings however, do not replace the need for regular measures to improve circulation, but should be considered to be in addition to this.

IMPORTANT NOTES:
A compression stocking used following a DVT should be fitted professionally after an assessment and accurate measurement. Do not just buy 'over the counter' support stockings that may be the wrong class or size which may potentially cause more damage. used following a DVT should be fitted professionally after an assessment and accurate measurement. Do not just buy 'over the counter' support stockings that may be the wrong class or size which may potentially cause more damage.

Aspirin is not used to prevent DVT. (Aspirin is widely used to help prevent blood clots in arteries which can cause strokes and heart attacks. However, aspirin does not seem to be very effective at preventing clots in veins.)

If you believe you may be experiencing DVT symptoms, talk to a doctor immediately. Patients who receive early treatment may reduce their chances of developing pulmonary embolism to less than 1%.

If you feel that you may be at particular risk of DVT or if you have any of the additional risk factors listed previously, you should seek medical advice before travelling.

NUKKLES
In addition to the measures mentioned above, why not improve blood circulation in your legs using the Nukkles massager. Nukkles is considered to be one of the best devices available for leg massage.

FURTHER ADVICE:
For further advice regarding Travel Related DVT,
Click here to visit the NHS DVT information web page

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