Diagnosis | Thrombosis

Diagnosis

There are two ways to diagnose thrombosis safely. In addition to the symptoms that indicate a thrombosis, there are device-supported possibilities of Doppler sonography (ultrasound sonography) can be used to display the flow velocity in the vascular system. If a venous thrombosis is present, an interruption in the blood flow is detected.

The ultrasound examination is free of side effects. Contrast medium imaging of the venous system is the safest method of detecting thrombosis. With this method, the patient is administered contrast medium into a vein in the back of the foot.

Interruptions in the vascular system can be shown under X-ray control. Risks of the examination are allergic reactions and the low radiation exposure of the examination. Since the contrast medium contains iodine, this examination should not be performed in cases of known iodine allergy or hyperthyroidism.

The so-called D-dimer is available for laboratory blood tests. D-dimers are formed when thromboses are broken down and can be detected in the blood. If this value is elevated, this indicates a thrombosis.

D-dimer is always elevated after operations and is more common in tumor diseases.

  • Doppler – Sonography (Ultrasound)
  • Contrast imaging of the venous system (phlebography)

A thrombosis is a blood clot in the vascular system that clogs the blood vessel and thus obstructs blood flow. The blood eventually accumulates in the affected part of the body, causing swelling, dull, sore muscles, and a blue color or redness of the affected part of the body.

Based on these typical symptoms, affected persons can already recognize a thrombosis themselves. Other symptoms that can indicate a thrombosis are a feeling of tension, heaviness, overheating or an increased vein pattern on the affected body part. Also characteristic is an increase in complaints when standing and a decrease in complaints when lying down.

If a thrombosis is suspected, a doctor should always be consulted. With the help of various examination procedures, such as laboratory tests and Doppler sonography, a special ultrasound examination of the veins, the doctor can detect thromboses with a high degree of certainty and finally initiate treatment. Therapy goals are: The form of therapy depends on the location, size and duration of the thrombosis.

The blood clot is transformed into a scar within a short time. Therefore, thrombosis therapy should be initiated within the first 10 days in order to preserve the original vessel. The following therapy options are available: Heparin (nowadays mainly low-complication low-molecular-weight heparins) and, for the later phase, Marcumar (provided there are no contraindications) as well as thromose-resolving drugs are available as therapeutic agents.

Heparin prevents thrombus growth and reduces the risk of pulmonary embolism. Thrombosis resolving drugs (fibrinolytics) have the risk of bleeding when used. Therefore, lysis therapy must not be used after surgery, high blood pressure, pregnancy or old age.

  • Drug dissolution of the clot (thrombolysis)
  • Surgical removal of the clot (thrombectomy)
  • Bridging by surgical bypass circuit (bypass)
  • To prevent the growth of thrombosis
  • To avoid the spread of clots (embolism)
  • To restore the original blood flow.

In addition to drug therapy with heparin and rivaroxaban, physical measures such as the use of compression stockings are used to treat thrombosis. Compression stockings are specially and individually fitted stockings that are worn on the part of the body affected by the thrombosis. Compression stockings exert external pressure on the affected, blocked blood vessel, thus facilitating the drainage of blood.

This leads to a reduction in pain and swelling in the affected body part, and in the long term to the prevention of skin changes. With simultaneous moderate movement of the affected body part (activation of the muscle pump) the blood flow is further improved. Compression stockings are available in four different grades of strength (class one to four).

Grade two is usually used to treat thrombosis. Compression stockings must be re-prescribed about every six months, as they lose their strength over time and thus their effect. Depending on the location of the thrombosis, compression stockings can be used in the length of the half leg, knee or thigh, as well as for tights. Other clinical pictures in which compression stockings are used are venous thrombosis, lymphedema, varicose veins or chronic venous insufficiency. Compression stockings can also be worn prophylactically to prevent thrombosis, for example after an operation.