Unlike arteries, veins have no smooth muscle cells in the wall and therefore cannot “pump” blood. The blood in veins moves when the surrounding muscle tissue (example calf muscle in leg) contracts and pushes the unoxygenated venous blood toward the heart. Backflow of venous blood is prevented by a series of one way valves inside the vein. From the heart, the venous blood is pumped to the lungs to get oxygenated and then returns to the heart to be delivered to the body via the arterial vascular system.
Deep venous thrombosis (DVT) occurs when clot(s) form in the veins, most commonly in the legs. DVT can produce pain, swelling, tenderness, discoloration and redness, but in approximately half of cases no symptoms are present. Causes for DVT include trauma or bone fracture, surgery (especially hip, leg, abdomen), lack of movement such as people who sit down for long periods of time (truck drivers, airline pilots, judges etc), long periods of bed rest, pregnancy, cancer, varicose veins, birth control pills or hormones taken for symptoms of menopause.
Pulmonary embolism (PE) occurs when a portion of a clot in the leg may break off and travel in the venous blood stream first to the heart then to the lungs where it can block a pulmonary artery. PE is a serious life threatening situation and requires immediate treatment.
DVT and PE are commonly grouped together and referred to as “venous thromboembolism” (VTE).
TREATMENTS FOR VTE
In an emergency PE situation where the patient has unstable blood pressure (cardiogenic shock), the treatment of choice is a “clot buster” medicine like tissue plasminogen activator (tPA). This drug will break down or dissolve clots more effectively than anticoagulants.
The next line of treatment involves anticoagulants…..fast acting injection anticoagulants such as heparin or low molecular weight heparin (Lovenox)……and oral anticoagulants such as Coumadin or Coumadin substitutes (Pradaxa, Eliquis, Xarelto) for long term maintenance.
Finally, in some cases a “filter” can be placed in the inferior vena cava to prevent clots from reaching the heart/lungs. There are two types of filters….retrievable and non retrievable.
At Britt Perio, we have effective methods to reduce inflammation that contributes to VTE. We also have creative technologies to avoid invasive dental procedures that will require the patient to discontinue anticoagulant therapy, thus putting the patient at risk for recurrent VTE.