Bowing legs cause knee problems

Thrombosis: recognize warning signs in good time

Status: 04.01.2021 12:29 p.m.

Heaviness, tingling, pulling in the lower leg, swelling in the leg, a feeling of pressure or heat - these can be indications of a thrombosis.

Every year one in 1,000 people develops thrombosis, men are affected slightly more often than women. If a thrombosis is not recognized and treated in time, there is a risk of protracted problems with the leg veins (post-thrombotic syndrome) and in rare cases, especially with thrombosis in the thigh, life-threatening complications such as pulmonary embolism can occur.

Causes: How a thrombosis develops

A number of biochemical processes keep blood clotting and blood flow in balance. But sometimes the blood stalls when the circulation of the blood is hindered by a lack of exercise, such as sitting or lying down for long periods of time. Where the blood gets stuck, a blood clot (thrombus) can form, which hinders the blood supply at this point and in extreme cases completely closes the vessel. It becomes particularly dangerous if such a thrombus or even only part of it loosens and is carried away by the bloodstream. If it is flushed into the lungs and blocks a vessel there, pulmonary embolism, which is not infrequently fatal, occurs. In exceptional cases, such a thrombus can even get into the brain through a congenital hole in the heart and cause a stroke there.


Recognize signs of thrombosis

A first indication of a possible thrombosis are symptoms that only occur in one leg - in contrast to sore muscles, for example, which usually affect both legs. Typical warning signs are:

  • repeated inexplicably severe pain in the leg
  • Swelling of one leg
  • legs of different warmth
  • Sensation of heat in one leg
  • bluish discoloration on one leg
  • severe pain on occurrence

Diagnosis and therapy with Heparin syringes

Since the symptoms of a thrombosis are not clear, such symptoms must be clarified quickly by a doctor in order to avoid complications. The so-called Wells test consists of a thorough survey about possible risk factors and an examination of the legs. Is there a difference in the circumference of the lower legs of more than three centimeters? Are the legs differently warm? Can the skin on the affected leg be indented? The D-dimer test is used to determine the breakdown products in the blood that occur during coagulation processes. Thrombi can be precisely localized with a special ultrasound examination (color-coded duplex sonography). Heparin syringes ensure that the clot does not get larger and can dissolve.

Risk factors favor the formation of thrombosis

Inflammation in the body is a major factor in the development of thrombosis. If the calf pump is missing due to immobilization, the blood thickens, can clot and form a thrombus. If the foot and leg muscles work, the calf pump also works and gets the venous backflow going again. From the age of 50, the basic risk of thrombosis increases if there is an inflammation in the absence of a calf pump, for example:
• after immobility / being confined to bed, for example after a febrile infection
• after operations (abdomen, knees, hips)
• after an injury

There is also a particularly high risk of thrombosis

  • a previous history of thrombosis
  • Smoke
  • pregnancy
  • inflammatory bowel disease
  • Tumor diseases
  • pronounced varicose veins
  • diseased venous valves
  • Taking the birth control pill
  • Hereditary increased tendency to clot, for example APC resistance in the case of factor V Leiden mutation (six out of 100 people - but not all get thrombosis)

Thrombosis prophylaxis after operations

Because every injury activates blood clotting, surgery also increases the risk of thrombosis. That is why doctors prescribe heparin injections and thrombosis stockings after an operation. The duration of this thrombosis prophylaxis depends on the individual risk. Usually it should be done for two to four weeks. With a steadily increasing proportion of outpatient operations, more and more patients are only partially mobilized or are discharged from the clinic with existing risk factors for developing a thrombosis. Therefore, more and more often the doctors who continue treatment have to continue the thrombosis prophylaxis.

Thrombosis Prevent long-haul flights

Long-haul flights, on which travelers have to sit still for hours, represent a particular danger for high-risk patients. Suitable precautionary measures are also here heparin syringes and well-fitting compression stockings. Air travelers should also drink a lot to keep their blood flowing. We recommend around 250 milliliters of non-alcoholic drinks per flight hour. And you should move as often as possible and, for example, raise and lower your feet while sitting. This activates the muscle pump and reduces the risk of thrombosis.

Prevent thrombosis

Basically: Sitting and standing for long periods of time promote the development of thromboses, while walking and lying counteract them. If you have to stand a lot for professional reasons, you can reduce your risk of thrombosis by wearing compression stockings. Preventive measures are:

  • Endurance sports or walking for at least 30 minutes a day
  • If you are sitting down, take a break every two hours
  • drink at least 1.5 liters a day
  • Avoid being overweight
  • Wear compression stockings
  • Put your legs up in between

Drugs for thrombosis

Thrombosis is treated with blood thinners. They ensure that the clot does not continue to grow and thus help the body to gradually break down the clot.

The duration of therapy depends on the causes and extent of the thrombosis and is usually three to six months. Long-term blood thinning may also be necessary, depending on the individual risk of thrombosis. Patients with a known blood coagulation disorder should be examined regularly in a coagulation clinic.

Thrombosis injections and anticoagulants

The following treatment options are available in the coagulation clinic:

  • For short-term anticoagulation, heparin and low molecular weight heparins are used, which are given as a syringe under the skin.
  • So-called vitamin K antagonists such as phenprocoumon have proven themselves over many decades for long-term anticoagulation. However, it takes some time to find the right dose and it requires close coagulation control to ensure it is effective and not to risk dangerous bleeding. That is why more and more people are receiving the newer anticoagulants (NOAC, new oral anticoagulants) such as dabigatran, rivaroxaban, apixaban or edoxaban. They are taken as a tablet once a day and they work quickly. However, the anticoagulant also quickly subsides again if the intake is forgotten. Patients must therefore ensure that they are taken regularly.

Experts on the subject

Prof. Dr. Florian Langer, internist, hematologist, oncologist, hemostaseologist
Head of the haemostaseology department, coagulation clinic, ambulance center of UKE GmbH
Martinistrasse 52
20246 Hamburg
(040) 741 05 24 53

Dr. Petra Schneider, specialist in surgery, vascular surgery and phlebology
Medical care center Stade
Hohenwedeler Weg 18
21682 Stade
(04141) 786 00

Prof. Dr. Eike Sebastian Debus, director
Clinic for Vascular Medicine
University heart center
University Medical Center Hamburg-Eppendorf
Martinistrasse 52
20246 Hamburg

additional Information
German Vascular League e. V.
Mühlenstrasse 21-25
50321 Brühl
(02232) 744 12

Patient guide of the German Society for Angiology (DGA)


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