Emergency: Sudden breathlessness, chest pain, coughing up blood, a racing heart or fainting can be signs of a pulmonary embolism. Call the emergency number at once (112 in Germany and the EU), not the out-of-hours GP service (116117). This article does not replace a medical examination.
Typical signs of a deep vein thrombosis (DVT) in the leg are new swelling, mostly on one side, of the calf, ankle or whole leg, a pulling pain like sore muscles, a feeling of tension, and bluish, shiny, warmer skin. Even one of these signs in one leg is enough for a suspected DVT that you should have checked by a doctor the same day. A DVT can also cause no symptoms at all. It can only be proven with an ultrasound of the leg veins, not by feeling the leg or with a self-test.
As of October 2026. Sources are linked below. They are German: the S2k guideline on venous thrombosis, the German Federal Ministry of Health and the German Society of Phlebology and Lymphology (DGPL).
Key Takeaways
- What is a DVT? A blood clot in one of the deep veins inside the muscles, mostly in the leg.
- Most common signs: one-sided swelling, pain mainly in the calf, a feeling of tension, bluish, warm skin, more visible surface veins.
- Can be silent: some DVTs are only noticed because of a pulmonary embolism.
- Diagnosis: assessing the probability (for example with the Wells score), a D-dimer blood test, ultrasound of the leg veins.
- Treatment: anticoagulant medicines, usually for at least 3 months, mostly as an outpatient, plus compression for a swollen leg and movement.
- Emergency: breathlessness or chest pain together with leg symptoms? Call 112 at once.
What Are the Signs of a DVT in the Leg?
The German Society of Phlebology and Lymphology (DGPL) lists these signs of a deep vein thrombosis in the leg:
- Sudden swelling of the calf, the ankle area or the whole leg
- A feeling of heaviness and tension that eases when the leg is raised
- Bluish, shiny skin that feels warmer than on the other leg
- More visible surface veins, so-called warning veins: the blood looks for detours because the deep vein is blocked
- Pain, mainly in the calf, that gets worse when you bend your foot or press on it. It is often described as pulling and can feel like sore muscles
- A slight fever and a faster pulse
The German Federal Ministry of Health's health portal (gesund.bund.de) also names pain in the hip and reddened skin. How strong the symptoms are depends on which vein is affected, how big the clot is and how quickly it forms.
Important: if some of these signs are missing, a DVT is not ruled out. According to the DGPL, a DVT should already be suspected if only one of them appears newly in one leg. On the other hand, the signs are not specific: superficial thrombophlebitis, varicose veins, erysipelas (a skin infection) or peripheral artery disease can also cause pain, swelling and redness. That is why any suspicion belongs in a doctor's hands.
Signs of a pulmonary embolism
If part of the clot breaks off, it can be carried through the heart into the lungs and block vessels there. Signs are:
- sudden breathlessness
- chest pain, especially when breathing in or coughing
- coughing, especially with bloody sputum
- dizziness, light-headedness or fainting
- a racing heart
- a strong sense of fear
Then: call 112 at once, even if the leg itself hardly hurts. A pulmonary embolism is an emergency and can be life-threatening. According to the German guideline, of people treated in hospital for a pulmonary embolism, about 14 in 100 died in the period it describes, down from about 20 in 100 in 2005. Do not wait to see whether it gets better.
How Is a DVT Diagnosed?
According to the German guideline (AWMF S2k 065-002, recommendation 2.1), history and physical examination alone are not enough to confirm or rule out a DVT. Three building blocks are typically used:
- Clinical probability: your doctor estimates how likely a DVT is from your symptoms, history and findings, often using the Wells score.
- D-dimer blood test: D-dimers are produced when the body breaks down a clot. The test can only rule a DVT out, not prove it. According to the guideline, normal values rule out a leg vein thrombosis with more than 95 percent probability; together with a low clinical probability, a DVT is considered ruled out. Raised values do not prove a DVT: they also rise after operations, with infections or inflammation, for example.
- Ultrasound: in compression ultrasound, the doctor presses on the veins with the probe. A free vein can be fully compressed, a vein with a clot cannot. According to the guideline, ultrasound is the method of first choice to prove or rule out a DVT. Where it is available, the scan should be done straight away, according to the guideline (recommendation 2.4).
The Wells score
This is the points list printed in the guideline (table 2.1). It is a tool for the examination, not a self-test: several points can only be judged by someone examining the leg.
| Criterion | Points |
|---|---|
| Active cancer (diagnosis less than 6 months ago, ongoing treatment or palliative care) | 1 |
| Immobilisation of a leg by a cast across a joint or by paralysis | 1 |
| Bed rest for 3 or more days or major surgery in the last 3 months | 1 |
| Tenderness along the deep veins | 1 |
| Swelling of the whole leg | 1 |
| Calf circumference at least 3 cm greater than on the other side | 1 |
| One-sided oedema in the affected leg | 1 |
| Clearly visible superficial collateral veins that are not varicose veins | 1 |
| Previous deep vein thrombosis | 1 |
| Another cause is at least as likely | -2 |
Scoring: 2 points or more means a high, 0 to 1 point a low probability of a DVT. With a low probability, a normal D-dimer test can rule out a DVT, but often the scan is done straight away. The score alone decides nothing.
Who Is at Risk?
About one in 1,000 people develops a deep vein thrombosis with symptoms each year. The risk rises sharply with age: for thrombosis and pulmonary embolism together (venous thromboembolism), the guideline puts it at about 1 in 1,000 per year at age 50 to 60 and about 1 in 100 per year over age 80. The guideline groups risk factors by strength:
| Strength | Examples |
|---|---|
| Strong | leg fracture, hip or knee replacement, severe injury, previous thrombosis or pulmonary embolism, hospital stay for heart failure or atrial fibrillation in the last 3 months, heart attack in the last 3 months |
| Moderate | cancer and chemotherapy, the contraceptive pill, hormone replacement therapy, the weeks after giving birth, inherited or acquired clotting disorders, superficial vein thrombosis, stroke with paralysis, infections, autoimmune diseases, chronic inflammatory bowel disease |
| Weak | bed rest over 3 days, long periods of sitting on car or plane journeys, older age, obesity, pregnancy, varicose veins, diabetes, high blood pressure |
How strongly a factor acts varies a lot, and usually several come together. About two thirds of all thromboses occur in connection with a temporary risk situation such as surgery, an injury or being bedridden. In up to 30 percent no trigger is found.
Treatment
Mostly as an outpatient. According to the guideline, most DVTs can be treated by experienced doctors in practice. Hospital treatment is for severe symptoms, a high risk of complications or serious other illnesses. If a pulmonary embolism is suspected: always call 112.
Anticoagulant medicines. They stop the clot from growing and new clots from forming. The body itself has to dissolve the clot. A short initial phase is followed by maintenance treatment, usually for at least 3 months, sometimes longer. Which medicine and for how long is your doctor's decision.
Compression for a swollen leg. If the leg is swollen and heavy from blocked blood flow, compression shall start within 24 hours of diagnosis according to the guideline (recommendation 2.15). If the lower leg is swollen, a knee-length medical compression stocking in compression class 2 shall be the standard. A thigh-length stocking should be prescribed if the thigh is swollen, and a compression bandage should be applied first if the leg is very swollen (recommendation 2.16). According to the guideline, white anti-embolism stockings from hospital should not be used for this; their pressure is too low. After 3 to 6 months, your symptoms shall be used to check whether you still need the stocking (recommendation 2.17).
Movement instead of bed rest. According to the DGPL, strict bed rest is now only intended for people whose thrombosis developed while lying down, for example after surgery. Everyone else may get up once medicines and compression have started. Walking eases the symptoms.
Long-term effect: post-thrombotic syndrome. About 30 percent of people develop a post-thrombotic syndrome: the vein stays damaged, with swelling, pain, heaviness and skin changes. In 2 to 3 percent it becomes severe, up to an open wound (leg ulcer). It resembles chronic venous insufficiency.
Prevention: What You Can Do
- Get up early after surgery or bed rest. Even pumping your foot up and down in bed gets the calf muscles working.
- Break up long periods of sitting, including when travelling: stand up and walk a few steps.
- Stop smoking, lose excess weight, move regularly. The DGPL names these as prevention.
- Get medical advice if your risk is higher. Whether compression stockings or anticoagulant medicines make sense for you, for example before a long journey or after surgery, depends on your risk factors.
Frequently Asked Questions
How can I test whether I have a DVT? Not reliably at home. The classic signs found by examination, for example calf pain when the foot is pulled up, are non-specific according to the guideline and on their own lead to many false alarms. A DVT is proven with ultrasound; a normal D-dimer blood test can rule it out when the probability is low. If you have one of the signs in one leg, go to a practice or emergency department the same day. For breathlessness or chest pain, call 112.
What should you not do with a DVT? Do not wait to see whether it gets better, and for breathlessness or chest pain do not call the out-of-hours GP service but 112. After diagnosis, strict bed rest is usually no longer necessary; movement helps. Do not stop anticoagulant treatment on your own; your doctor decides how long it lasts.
What are early DVT symptoms in the leg? Early signs are new swelling in one calf or ankle, a pulling pain like sore muscles, a feeling of tension, or warm, bluish skin. There is no fixed warning period. Some DVTs cause clear symptoms, others none, and some are only noticed through a pulmonary embolism. Watch your leg especially at times of higher risk: in the weeks after surgery, after longer bed rest, a cast or a long journey. The Wells score counts major surgery up to 3 months back.
Can a DVT go away on its own? According to gesund.bund.de, many deep vein thromboses go unnoticed and dissolve by themselves. But you cannot tell yourself whether a clot is harmless, so any suspicion belongs in a doctor's hands. A diagnosed DVT must be treated because of the risk of a pulmonary embolism. The medicines stop the clot from growing, and the body breaks it down: according to the guideline, 50 to 80 percent of affected veins open up again.
Can you have a DVT without feeling anything? Yes. Especially in bedridden or seriously ill people, a DVT can cause few symptoms, according to the guideline. That is why many people receive preventive treatment after surgery.
How long does treatment take? You usually take anticoagulant medicines for at least 3 months, sometimes longer. Compression is reviewed after 3 to 6 months, depending on whether the leg still swells or hurts.
Does the contraceptive pill increase the risk? Yes, pills containing oestrogen, that is, combined pills, increase it. The guideline counts taking oral contraceptives as a moderate risk factor. If other factors add to it, such as a family history of thrombosis, talk to your gynaecologist about alternatives.
When to See a Doctor
| Situation | What to do |
|---|---|
| Breathlessness, chest pain, coughing up blood, racing heart or fainting | Call 112 at once |
| Sudden one-sided leg swelling with pain, warmth or bluish skin | See a doctor at once: practice or emergency department, do not wait |
| A single new sign in one leg, especially after surgery, a cast, bed rest or a long journey | The same day at a practice |
| After a DVT: the leg keeps swelling, hurts or feels heavy | Contact your treating practice |
How LEVANA Can Help
LEVANA is not an emergency service, and the LEVANA Leg Check™ does not make a diagnosis. If you have signs of a DVT or pulmonary embolism, only a medical assessment counts. After a treated DVT, the app can support you in daily life with reminders for compression and movement and with exercises for the calf muscles.
Sources
All accessed on 6 October 2026.
- AWMF S2k guideline on the diagnosis and treatment of venous thrombosis and pulmonary embolism (065-002), version 5.0, 2023: epidemiology including pulmonary embolism mortality, risk factors (table 1.1), Wells score (table 2.1), recommendations 2.1 to 2.17
- German Federal Ministry of Health, gesund.bund.de: Tiefe Venenthrombose (TVT)
- German Federal Ministry of Health, gesund.bund.de: Lungenembolie
- German Society of Phlebology and Lymphology (DGPL): Thrombose
Related Articles
- Swollen leg: causes and what really helps
- Varicose veins
- Chronic venous insufficiency
- How your veins work
Disclaimer
This article is for general information only and does not replace medical advice, diagnosis or treatment. If you suspect a DVT, see a doctor at once; for breathlessness or chest pain, call 112.
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