Patients with deep venous thrombosis (DVT) often present with leg discomfort, commonly a fullness or tightness, in conjunction with limb swelling and discoloration. These symptoms worsen during standing and improve upon sitting or lying down.

A subgroup of patients, especially those undergoing surgical procedures such as total knee or hip replacement, may develop asymptomatic DVT.

Reference: 

White RH, Henderson MC. Risk factors for venous thromboembolism after total hip and knee replacement surgery. Curr Opin Pulm Med. 2002;8(5):365-371.

Response date: February 2008

In the general population, prevalence of DVT is about 1 in 1,000 individuals.¹ The prevalence is much higher in patients with cancer, immobility, or stroke, and in those receiving hormone therapy or undergoing certain surgical procedures.² For example, up to
60% to 80% of patients would develop a DVT following a total knee or hip replacement if they did not receive prophylaxis.² 

References:

1. Hirsch J, Lee AYY. How we diagnose and treat deep vein thrombosis. Blood. 2002;99(9):3102-3110.

2. Geerts WH et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 Suppl):338S-400S. 

Risk factors for DVT are the same as for pulmonary embolism (PE) and all venous thromboembolic disease, and include cancer, immobility (eg, hospitalization after myocardial infarction or other heart failure), spinal cord injuries, stroke, and all surgical procedures. In particular, abdominal surgery and orthopedic surgery involving long bone
fractures or total hip or knee replacement are associated with increased DVT risk. Pregnancy or hormone therapy of any type (eg, oral contraceptive pills) increase the rate of DVT, and trauma is a very strong risk factor for both DVT and PE.

References:

1. Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(suppl 3):338S-400S. 

2. Huerta C, Johansson S, Wallander MA, García Rodríguez LA. Risk factors and short-term mortality of venous thromboembolism diagnosed in the primary care setting in the United Kingdom. Arch Intern Med.
2007;167(9):935-943.

DVT can mimic a number of other different disorders, including bacterial cellulitis and arterial venous malformation in the limbs. The swelling and leg discomfort that is a common manifestation of DVT can be confused with chronic venous insufficiency, a ruptured baker’s cyst, or rupture of the medial head of the gastrocnemius tendon. 

While patients with DVT may note leg discomfort, have leg swelling, discoloration in the leg, or a palpable cord, none of these signs or symptoms is specific, and diagnosis cannot be made on physical examination alone. The physical examination may even be completely normal. Patients who have risk factors for DVT such as recent surgery or hospitalization will need an ultrasound to rule
out DVT.

Reference:

Hirsch J, Lee AYY. How we diagnose and treat deep vein thrombosis. Blood. 2002;99(9):3102-3110.

DVT, more commonly called venous thromboembolic disease or venous thromboembolism, has important cardiovascular outcomes. Patients with DVT are prone to pulmonary embolism¹ and may develop post-thrombotic syndrome² in which they have chronic persistent pain and swelling in the leg, discoloration of the limb, and ultimately, leg ulcers.

References:

1. Scarvelis D, Wells P. Diagnosis and treatment of deep-vein thrombosis. CMAJ. 2006;175(9):1087-1092.

2. Kahn SR. The post-thrombotic syndrome: progress and pitfalls. Br J Haematol. 2006;134(4):357-365.