thrombosis

Venous Thrombosis. This occurs most often in the legs or pelvis; it may be a complication of phlebitis, result from injury to a vein, or occur with prolonged bed rest. The symptoms—a feeling of heaviness, pain, warmth, or swelling in the affected part, and sometimes chills and fever—do not necessarily indicate its severity. Immediate medical attention is necessary in any case. Under no circumstances should the affected limb be massaged.



In thrombosis of superficial veins, bed rest with legs elevated and application of heat to the affected area may be all that is necessary. In thrombosis of deep veins, the affected part must be immobilized to prevent the clot from spreading or turning into an embolus, and anticoagulant drugs may be given. With proper treatment, recovery occurs within a short time unless an embolism develops. Practice management guidelines for venous thromboembolism in trauma patients note that a vena cava filter should be considered in patients at high risk who are not candidates for anticoagulants.

Prevention of Venous Thrombosis. Immobility is a prime factor in the development of thrombosis; hence, all patients should be mobilized as soon as possible after surgery or an illness that requires bed rest or produces paralysis. Those who cannot get out of bed should follow an exercise routine involving either active or passive motion of the extremities.  dehydration also plays a role in the development of thrombosis, and the patient should be kept well hydrated. The use of sequential compression devices, such as graded elastic stockings or automated devices providing intermittent compression to the legs, are widely used and accepted, but there are few clinical studies related to their use. They probably play a role in the prevention of stasis and should be combined with other methods to prevent thromboembolism. Clinical guidelines also support the use of low molecular weight heparin for patients at high risk when the bleeding risk is not considered a problem.

Arterial Thrombosis. The main types of arterial thrombosis are related to arteriosclerosis, although thrombosis can also result from infection or from injury to an artery. Arteriosclerosis may be hereditary or may be brought on by diabetes mellitus. Coronary thrombosis, arterial thrombosis in a coronary artery, is a complication of coronary atherosclerosis. A thrombus in one of these arteries will block part of the blood supply to the heart muscle and cause severe myocardial infarction, which is a medical emergency. Cerebral thrombosis is arterial thrombosis in one of the cerebral arteries; the thrombus obstructs the supply of blood to the brain and results in stroke syndrome. Causes include hardening of the cerebral arteries, hypertension, complications of syphilis or other infections, dehydration, diabetes mellitus, or a violent injury.



In advanced cases of arteriosclerosis, a thrombus may fill up whatever channel remains through a vessel, completely blocking off circulation and causing gangrene. This occurs most frequently in arteries of the legs and is called peripheral thrombosis. The onset, often sudden, is characterized by either a tingling feeling or numbness and coldness in the limb. Pain is not always present. Immediate treatment with anticoagulants is necessary to discourage clotting. If this is not effective, surgery may be required. This condition is most common in the elderly and in diabetics. There are now methods of treatment that may save the limb, such as surgical removal of a thrombus or embolus, or surgery of blood vessels to remove old, narrowed, or deteriorated vessels and replace them with grafts.