How does Deep Vein Thrombosis (DVT) affect the heart?

From the Guidelines

Deep Vein Thrombosis (DVT) can indirectly affect the heart by leading to a potentially life-threatening complication called pulmonary embolism (PE), which increases pressure on the right side of the heart and can cause right heart failure. The main danger of DVT occurs when a piece of the clot breaks off and travels through the bloodstream to the lungs, causing a pulmonary embolism 1. This creates increased pressure on the right side of the heart, which must work harder to push blood through the partially blocked pulmonary circulation. In severe cases, this can lead to right heart failure, also called cor pulmonale, where the right ventricle becomes enlarged and weakened from the strain.

Key Points to Consider

• DVT itself is a blood clot that forms in deep veins, usually in the legs.
• The reduced blood flow through the lungs means less oxygenated blood returns to the left side of the heart, potentially causing low blood pressure and decreased oxygen supply to vital organs.
• People with existing heart conditions are at higher risk for complications from DVT.
• Prevention of DVT through early mobility after surgery, compression stockings, proper hydration, and in some cases blood thinners like enoxaparin or rivaroxaban is crucial, especially for those with heart disease or other risk factors.
• According to the American Society of Hematology 2020 guidelines, for patients with proximal DVT and significant preexisting cardiopulmonary disease, as well as for patients with PE and hemodynamic compromise, anticoagulation alone is suggested rather than anticoagulation plus insertion of an inferior vena cava (IVC) filter 1.

From the Research

Effect of DVT on the Heart

• Deep Vein Thrombosis (DVT) can affect the heart by increasing the risk of pulmonary embolism (PE), which occurs when a blood clot breaks loose and travels to the lungs, blocking blood flow 2, 3.
• The treatment of DVT focuses on preventing the clot from breaking loose and causing a PE, as well as reducing the risk of recurrence and long-term complications such as post-thrombotic syndrome 4, 5.
• Anticoagulation therapy is the cornerstone of treatment for DVT, aiming to reduce symptoms, thrombus extension, and mortality 4, 6.
• The choice of anticoagulant therapy depends on the severity of the DVT, patient comorbidities, and the risk of bleeding 2, 5.

Treatment Options

• Low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) are commonly used anticoagulants for the treatment of DVT 3, 6.
• Non-vitamin K antagonist oral anticoagulants (NOACs) such as apixaban, edoxaban, and rivaroxaban are also increasingly used for the treatment of DVT due to their convenience and efficacy 4, 5.
• The treatment of DVT should be tailored to the individual patient, taking into account their clinical presentation, comorbidities, and potential for bleeding 2, 5.

Complications

• Pulmonary embolism is a potentially life-threatening complication of DVT, and prompt treatment is essential to prevent mortality 2, 3.
• Post-thrombotic syndrome is a long-term complication of DVT, characterized by lower-limb pain, varicose veins, edema, and skin ulcers 3.
• Bleeding is a potential complication of anticoagulation therapy, and patients should be closely monitored for signs of bleeding 2, 6.