July 3, 2020 by John Fernandez
Rule Out DVT: Miami Cardiac & Vascular Institute Expedites Diagnoses of ‘Deep Vein Thrombosis’
Deep vein thrombosis, better known as DVT, refers to a blood clot that forms in a deep vein. These blood clots are most common in the leg but can occur in the arm or other part of the body. In rare occasions, DVT can lead to a serious, life-threatening complication, most likely caused by a blood clot that partially or totally breaks away and travels to the lungs.
“Whenever a clinician considers the possibility of deep vein thrombosis, the patient’s evaluation becomes urgent,” explains Ian Del Conde, M.D., a cardiovascular specialist and director of vascular medicine at Miami Cardiac & Vascular Institute.
Because most patients with DVT require treatment with anticoagulant therapy, or blood thinners, the evaluation of patients who may have DVT has traditionally been done in the emergency room.
The Miami Cardiac & Vascular Institute created the Rule Out DVT service, which allows a patient to avoid the emergency department altogether and undergo a venous ultrasound, where a doctor at the Institute’s Ambulatory Diagnostic Center can quickly confirm a DVT diagnosis.
A physician referral is needed for the ultrasound. It can come from your cardiologist, primary care physician, specialist, surgeon or oncologist. The procedure involves placing ultrasound gel on the affected area and then moving a handheld device across it. A real-time picture of the blood flow is displayed on a screen.
“The Rule Out DVT service became particularly valuable with the COVID-19 pandemic,” said Dr. Del Conde. “Instead of patients being referred to the emergency room, which was often busy in caring for COVID 19 patients, patients were seen at the MCVI Ambulatory Diagnostic Center and a complete evaluation and treatment could be performed in less than 2 hours.”
The Rule Out DVT service has been fully operational for months, creating a less stressful, smoother experience for patients.
“If deep vein thrombosis is diagnosed, vascular specialists onsite immediately assess the patient and start anticoagulation therapy when necessary, always discussing the case with the patient’s referring doctor,” says Dr. Del Conde.
What Causes Deep Vein Thrombosis?
DVT can be caused by long periods of inactivity, like too much sitting, extended bed-rest or long trips. The deep veins of the legs, located in the muscles, help carry blood to the heart. When leg muscles contract and relax, blood is squeezed through the veins back to the heart. One-way valves inside the veins help keep the blood moving in the right direction. When blood moves too slowly or not at all, it can collect (pool) in the veins. This makes a clot more likely to form.
Blood clots are becoming a symptom of some COVID-19 patients, according to various reports. In a few cases, clots are causing patients with the coronavirus to have heart attacks and strokes; form strange rashes on their skin; and develop red, swollen wounds that look like frostbite on their fingers and toes. The big takeaway is that people with underlying health conditions, including heart disease, obesity, high blood pressure and diabetes, need to be extra cautious about protecting themselves from COVID-19.
“Patients who have chronic underlying conditions still need to make sure that these conditions remain well controlled,” says Dr. Del Conde. “Neglecting these conditions could represent a significant risk to the health and well-being in many patients.”
Make sure to take prescribed medications and keep track of hypertension at home — if at all possible.
“Use home monitoring devices, which can be as simple as an automated blood pressure cuff or a weight scale,” adds Dr. Del Conde. “Contacting a physician via telemedicine is a good way patients can stay on top of other chronic conditions and clear up any concerns or questions.”
Who is Most at Risk for DVT?
Anyone can develop a blood clot. But certain factors may raise your risk for one. Anything that slows blood flow, injures the lining of a vein, or increases blood clotting can make you more likely to have DVT. You are at risk for DVT if you:
- Are overweight or obese
- Have a blood-clotting disorder
- Are older than age 60
- Had surgery
- Have spent a long period of time not moving, such as staying in the hospital or traveling on a long trip
- Take birth control pills or hormone replacement therapy
- Are paralyzed
- Are pregnant
- Have a central venous catheter (for example, in a large vein in the chest)