Deep Vein Thrombosis

Early treatment reduces the risk of clot extension, pulmonary embolism and long-term venous damage.

A DVT typically causes one-sided leg swelling, pain, warmth, redness or heaviness, though some clots cause few or no symptoms and are found on scans done for other reasons. Risk increases with:

• Major surgery or hospitalisation
• Prolonged immobility or long-distance travel
• Cancer and its treatment
• Pregnancy and the weeks after delivery
• Oestrogen-containing medication
• Previous thrombosis or an inherited clotting disorder
• Significant acute illness

Many patients have more than one contributing factor, and identifying them shapes both treatment duration and future prevention.

When to seek urgent care

• New swelling, pain, warmth, heaviness or discolouration in one leg should be medically assessed the same day. Do not wait for a routine appointment.
• Sudden breathlessness, chest pain, coughing blood, fainting or a racing heartbeat may indicate pulmonary embolism. Call Triple Zero (000) or go to the nearest emergency department immediately.

Compression duplex ultrasound is the main investigation for suspected leg DVT. A D-dimer blood test can help exclude thrombosis in selected low-risk patients but is not specific, and repeat ultrasound is sometimes used within a structured pathway.

CT or MR venography may be required when pelvic thrombosis is suspected, and CT pulmonary angiography when pulmonary embolism is the concern.

Anticoagulation

Anticoagulant medication is the mainstay of treatment. It stops the clot growing while the body gradually breaks it down. Duration depends on where the clot is, what caused it, and the balance between recurrence risk and bleeding risk; taking the medication exactly as prescribed is essential.

Compression and mobility

Early walking is generally encouraged once treatment has started and symptoms allow. Compression can reduce swelling for some patients and is prescribed individually rather than routinely.

Thrombolysis and thrombectomy

Patients with extensive recent iliofemoral DVT, severe symptoms or threatened circulation may be considered for catheter-directed thrombolysis or mechanical thrombectomy. These procedures carry bleeding and procedural risks and are reserved for carefully selected cases; most DVTs do not need them.

Post-thrombotic syndrome

Valve damage or residual obstruction after a DVT can leave persistent swelling, aching, skin changes and sometimes ulceration, known as post-thrombotic syndrome. Specialist review can identify treatable contributors such as iliac vein compression, superficial reflux or chronic deep venous obstruction, some of which respond to intervention.

The immediate danger of DVT is pulmonary embolism; the longer-term concerns are post-thrombotic syndrome, chronic swelling, skin change, venous ulcers and recurrent clots. Follow-up typically involves clinical review, sometimes repeat ultrasound, and a clear plan for anticoagulation duration. Tell your doctor promptly about new leg symptoms, breathlessness or unusual bleeding while on anticoagulants.

Preventing recurrence

After the acute episode, management may include addressing temporary risk factors, reviewing hormonal medications, cancer assessment where clinically appropriate, and planning clot prevention around future surgery, pregnancy or long-haul travel.

After a DVT, the treatment plan depends on where the clot is located, how extensive it is, whether there was a temporary trigger and the balance between future clotting and bleeding risk. These factors determine the type and duration of anticoagulation, so two patients with apparently similar scans may appropriately receive different advice.

Further testing is not automatically required for every person. Investigation for an inherited clotting tendency, cancer or pelvic venous obstruction is guided by age, family history, recurrence, clot location and whether the event was provoked. Your clinician can also explain when repeat ultrasound is useful and whether compression is likely to help persistent swelling.

Patients should know which symptoms require urgent review, including new one-sided swelling, chest pain, breathlessness, coughing blood or collapse. It is also important to plan clot prevention around future surgery, pregnancy, hormonal medication and long-distance travel. Keep a written record of the anticoagulant, dose and intended duration, and share it with every clinician involved in your care.

Yarra Vascular Surgeons manages acute, extensive and recurrent DVT, including assessment for iliofemoral obstruction, selected catheter-based clot treatment and the long-term care of post-thrombotic complications.

New one-sided leg swelling, pain or discolouration requires prompt medical assessment for deep vein thrombosis. Yarra Vascular Surgeons provides specialist review of extensive, recurrent and post-thrombotic disease, including assessment for iliofemoral obstruction and selected catheter-based treatment. Chest pain, breathlessness, coughing blood or collapse may indicate pulmonary embolism and requires immediate care through Triple Zero (000).