What is deep vein thrombosis?
Deep Vein Thrombosis (DVT) occurs when clots form in the deep veins within the muscles of the leg.1 Less commonly, clots may form in the upper extremities as well.2
Patients with DVT may experience leg swelling, leg pain and cramping, red or discolored skin on the leg, tingling, a feeling of warmth, or skin ulcers. However, about half of patients with DVT have no symptoms at all.3
This makes it important to increase awareness and education of the disease amongst patients through initiatives like World Thrombosis Day, held on October 13 of every year and often supported by Boston Scientific.
DVT is potentially life-threatening
DVT is a potentially life-threatening pathology that can lead to pulmonary embolism (PE) and/or post-thrombotic syndrome (PTS) 4.
- 50% of patients who have proximal DVT (clot in the popliteal, femoral, or iliac veins) are at risk of PE5, and
- 79% of patients presenting with PE have evidence of DVT5,6.
Post-thrombotic syndrome (PTS) is a long-term complication of DVT, manifesting as swelling, pain, edema, venous ectasia, and skin induration of the affected limb7.
Development of PTS is associated with worse physical health, mental health, and disease-specific quality of life over 1 year8.
Prevalence of DVT
DVT blood clots affect up to 684,000 Europeans each year10.
In the U.S. and Europe, VTE-related events kill more people than AIDS, breast cancer, prostate cancer, and motor vehicle crashes combined11,12.
1% of the adult population develop an acute DVT during life13.
Health economics of deep vein thrombosis
DVT not only impacts patients’ quality of life, but it also generates substantial economic burdens.
According to the European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis, treatment costs related to DVT and PE include:
- inpatient or outpatient treatment
- re-admission/recurrence
- re-admission/recurrence if PE develops
- costs related to treatment, and
- costs related to complications of treatment and long-term complications, including PTS and chronic thromboembolic pulmonary hypertension14.
A health economic modelling study using 2014 values estimated that annual total costs may range from €1.5 to €13.2 billion for the 28 member states of the European Union (EU) 14.
The same study estimated that preventable costs may range from €0.5 to €7.3 billion, implying that better prophylaxis, optimisation of outpatient treatment, and earlier hospital discharge of patients with PE and DVT may result in cost savings14.
Iliofemoral DVTs are higher risk
Different types of DVT present varying levels of risk, depending on their location in the lower extremities.
Patients with iliofemoral DVT location may have a higher risk for:
- Recurrent venous thromboembolism
- Post-thrombotic syndrome
- Pulmonary embolism
Risk of complications
| Risk of acute leg complications and pulmonary emboli | Risk of post thrombotic syndrome | |
| Iliofemoral DVT | High risk | High risk |
| Femoral popliteal DVT | Medium risk | Medium risk |
| Calf DVT | Low risk | Low risk |
Case study: Treating an IFDVT patient based on RETHRO data
Dr. Stefano Barco from the University of Zurich speaks about treating a patient with iliofemoral DVT based on clinical data from the RETHRO Zurich registry study.
Range of treatment options
Current societal DVT treatment guidelines generally recommend anticoagulation therapy and compression stockings as the first line of treatment to prevent recurrent venous thromboembolism and reduce swelling.17
Endovascular interventions – catheter-directed thrombectomy (CDT) and pharmacomechanical thrombectomy (PMT) – are currently considered for select patients who would benefit from early thrombus removal, especially those with acute iliofemoral DVT (low level of evidence)17.
References:
- Blann AD and Lip GY. BMJ 2006;332:215-219.
- Spencer FA. J Gen intern Med 2006. Jul; 21:722-727
- Centers for Disease Control and Prevention. Venous Thromboembolism (Blood Clots). https://www.cdc.gov/blood-clots/about/index.html#cdc_disease_basics_symptoms-signs-and-symptoms accessed August 23, 2024.
- http://www.acep.org/Clinical---Practice-Management/Focus-On--Emergency-Ultrasound-For-Deep-Vein-Thrombosis. Accessed January 2016.
- Tapson, V.F., “Acute pulmonary embolism.” N Engl J Med, 2008; 358(10): 1037-52.
- Sandler, D.A., et al., “Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis?” J R Soc Med, 1989; 82: 203-5.
- Ashrani AA, Heit JA. Incidence and cost burden of post-thrombotic syndrome. J Thromb Thrombolysis. 2009 Nov;28(4):465-76. doi: 10.1007/s11239-009-0309-3. Epub 2009 Feb 18. PMID: 19224134; PMCID: PMC4761436.
- Lubberts B, et al. Thromb Haemost. What is the effect of venous thromboembolism and related complications on patient reported health-related quality of life? 2016;116(3).
- The Postthrombotic Syndrome: Evidence-Based Prevention, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association. https://doi.org/10.1161/CIR.0000000000000130
- Cohen AT et al. VTE Impact Assessment Group in Europe (VITAE). Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost. 2007;98:756-64.
- Cohen AT, Agnelli G, Anderson FA, et al. Venous thromboembolism (VTE) in Europe. Thromb Haemost. 2007;98:756-764.
- Cohen, A. et al. (2007). Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thrombosis and haemostasias. 98. 756-64. 10.1160/TH07-03-0212.
- SOX: Kahn SR, Shapiro S, Wells PS, et al. Compression stockings to prevent post-thrombotic syndrome: a randomized placebo-controlled trial. Lancet. 2014;383(9920):880-8.
- Barco S, Woersching AL, Spyropoulos AC, Piovella F, Mahan CE. European Union-28: An annualised cost-of-illness model for venous thromboembolism. Thromb Haemost. 2016 Apr;115(4):800-8.
- DE Maeseneer MG, Boctanen N. Analysis of 1338 patients with acute lower limb deep venous thrombosis (DVT) supports the inadequacy of the term ‘ proximal DVT ‘ Eur J Vasc Endovasc Surg. 2016: 51: 415 – 420.
- Engelberger RP, Fahrni J, Willenberg T, et al. Fixed low-dose ultrasound-assisted catheter-directed thrombolysis followed by routine stenting of residual stenosis for acute ilio-femoral deep-vein thrombosis. Thromb Haemost. 2014;111(6):1153-60.
- Lucia Mazzolai, et al. Second consensus document on diagnosis and management of acute deep vein thrombosis: updated document elaborated by the ESC Working Group on aorta and peripheral vascular diseases and the ESC Working Group on pulmonary circulation and right ventricular function, European Journal of Preventive Cardiology, Volume 29, Issue 8, May 2022, Pages 1248–1263, https://doi.org/10.1093/eurjpc/zwab088
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