From the Guidelines
Varicose vein patients with suspected DVT should seek immediate medical attention and be treated with anticoagulants to reduce the risk of symptomatic extension, recurrence, and progression to pulmonary embolism. Varicose veins and deep vein thrombosis (DVT) are related but distinct vascular conditions. Varicose veins are enlarged, twisted superficial veins that develop when valves in the veins become weak, allowing blood to pool rather than flow efficiently toward the heart. While varicose veins themselves are not typically dangerous, they can cause discomfort, swelling, and cosmetic concerns. DVT, on the other hand, is a serious condition involving blood clots that form in deep veins, usually in the legs, and can be life-threatening if a clot breaks loose and travels to the lungs (pulmonary embolism). According to a study published in Chest in 2021 1, superficial vein thrombosis (SVT), which often involves varicose veins, may have more serious consequences than previously thought, with 5.9% of patients experiencing symptomatic extension of SVT, and extension to DVT or PE at 77 days in the absence of anticoagulants.
Key points to consider:
- Varicose veins can increase the risk of developing DVT, but most people with varicose veins never develop DVT
- Treatment for varicose veins includes compression stockings, lifestyle changes, and procedures such as sclerotherapy or vein stripping
- If DVT is suspected, prompt treatment with blood thinners such as enoxaparin or warfarin is necessary to reduce the risk of complications
- The American Society of Hematology 2020 guidelines for management of venous thromboembolism recommend treatment of DVT and pulmonary embolism with anticoagulants 1
- A study published in Blood Advances in 2020 found that venous thromboembolism, which includes DVT and pulmonary embolism, occurs in approximately 1 to 2 individuals per 1000 each year 1
In terms of management, anticoagulant therapy is recommended to reduce acute symptoms, extension, recurrence, and progression to VTE in patients with varicose veins and suspected DVT. The choice of anticoagulant and duration of treatment will depend on individual risk factors and the cause of the clot. It is essential to seek immediate medical attention if DVT is suspected to prevent serious complications.
From the Research
Varicose Veins and DVT
- Varicose veins are a potential long-term complication of deep vein thrombosis (DVT) 2
- DVT can lead to post-thrombotic syndrome, characterized by lower-limb pain, varicose veins, oedema, and sometimes skin ulcers 2
- The risk of developing varicose veins after DVT is not directly addressed in the provided studies, but it is mentioned as a potential consequence of DVT 2
Treatment of DVT
- The treatment of DVT typically involves anticoagulation therapy, such as low molecular weight heparin (LMWH) or unfractionated heparin, followed by oral vitamin K antagonist therapy 3, 2
- The duration of anticoagulation depends on the individual patient's risk factors, such as reversible or non-reversible risk factors, and the location of the DVT 3
- Apixaban, a direct-acting oral anticoagulant, has been shown to be effective and safe in the treatment of DVT, with lower risks of recurrent VTE and major bleeding events compared to warfarin 4, 5, 6
Management of Varicose Veins
- There is no direct evidence in the provided studies on the management of varicose veins in patients with DVT
- However, the studies suggest that preventing DVT and its complications, such as post-thrombotic syndrome, is crucial in reducing the risk of developing varicose veins 2