Blood clots in the leg and varicose veins.
Blood clots in the leg can be very serious if they become dislodged and flow up into the lungs causing a pulmonary embolus - potentially a life threatening condition.
However there are two different types of blood clots in the leg and both have different patterns of risk.
Deep vein thrombosis (DVT)
Superficial vein thrombosis (SVT)
DVT occurs in veins inside the muscles of the leg whereas SVT occurs outside the muscles and in the veins inside the fat layer between the skin and the muscles.
DVT will most often require treatment with anti-coagulation drugs, such as intra-venous heparin, low molecular weight heparin (“Clexane”), Warfarin ( a vitamin K antagonist ) or the new generation direct oral anticoagulant drugs such as rivaroxaban (Xarelto), apixaban (Eliquis) or dabigatran (Pradaxa).
SVT most often occurs in the presence of varicose veins and usually does not require anticoagulation, except in certain circumstances - such as when the clot is close to a major junction with the deep veins. The affected vein becomes swollen, red and tender with a palpable cord like feel along the course of the vein.
Treatment of SVT in association with varicose veins usually only requires
a short course of non-steroidal anti inflammatory drugs such as ibuprofen 400mgs x3/day
wearing a class 2 (20-30mg Hg) compression stocking
mobilization - walking 30 minutes twice a day
However if SVT does occur when varicose veins are NOT present then further investigation in required.
An ultrasound investigation of the deep veins is necessary in SVT if varicose veins are not present because DVT can be present in up to 30% of cases.
Also further investigation is necessary to exclude potentially serious underlying medical conditions.
Underlying cancers. Pancreas, liver, bowel, lung, leukaemias and lymphomas.
Underlying medical disorders.
Underlying Thrombophilias