Deep Venous Thrombosis in a Young Woman

Venous thrombosis is relatively under-diagnosed condition with a potential for significant morbidity and mortality. It is under-diagnosed because in many individuals it may be asymptomatic and the signs and symptoms when present are non-specific. Most episodes of venous thrombosis occur in the deep veins of lower limbs, though venous thrombosis is known to occur at other sites. The morbidity in Deep venous thrombosis (DVT) is related to local effects that may be: (i) immediate such as pain and swelling, (ii) delayed as a result of postphlebitic syndrome (swelling, skin changes, venous stasis ulcers etc.) or recurrent DVT. However, it is the tendency of these thrombi to embolize into the pulmonary circuit that results in mortality (venous thromboembolism: VTE) as well as significant long-term morbidity in the form of chronic thromboembolic pulmonary hypertension. Treatment with anticoagulants or thrombolytics may itself rarely be the cause of morbidity. Currently DVT is thought to be a multicausal disease. Though, Virchow had proposed the role of vascular damage, stasis and hypercoagulability of the blood in causing venous thrombosis way back in 1884, our understanding of pathogenesis of these factors and interplay of the genetic and acquired factors has improved tremendously in the last 20-30 years. Moreover, improvements in imaging techniques have improved the recognition of DVT. Venous thrombosis is known to occur in association with both acquired as well as heritable risk factors (Table 1). It may occur in absence of an obvious risk factor I Idiopathic DVT/VTE). Epidemiological studies suggest that DVT occurs in approximately 1/1000 persons per year in the west. Though exact incidence of DVT in Indian context is not known, it is now being recognized to be a significant problem in our hospitals. Incidence of DVT increases with age and spontaneous DVT is relatively uncommon in the young.