Thrombus formation can be attributed to three factors: venous stasis, endothelial damage, and blood hypercoagulability. When valves in the veins of the leg(s) do not function properly or when muscles of the leg are inactive for extended periods of time, pooling of blood in the lower legs can occur. This is called venous stasis. Direct or indirect injury a vessel, called endothelial damage, can stimulate the activation of platelets and clotting factors, which when combined with existing hypercoagulability of blood can lead to platelet aggregation. As clotting factors continue to make fibrin, more platelets and red and white blood cells will stick to the wall of the vein forming a clot.
Patients with a VTE will typically present with tenderness of the affected extremity.
Edema of the affected extremity can occur. If edema or swelling is present, the skin covering the extremity will appear tight, smooth, and shiny.
A patient presenting with a VTE may also notice warmth of the affected area due to inflammation.
Because a VTE typically affects one limb at a time, the patient’s extremities will appear asymmetrical. For example, if the patient was experiencing a VTE in the lower left leg, tenderness, swelling and warmth would be present in that area, while the lower right leg would appear unaffected.
Keep in mind that although tenderness, swelling, and warmth are common signs of a VTE, patients with this condition may be asymptomatic.
Patients with a VTE should be placed on bedrest to prevent the thrombus from dislodging and becoming an embolus. If embolization does occur, the clot could travel to the pulmonary vasculature and become a pulmonary embolism (PE). Patients should be monitored closely for symptoms of a PE including dyspnea, tachycardia, and chest pain.
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