Prevention of blood clot in the system

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A man who was admitted to the hospital, following a road traffic accident appeared to be making an excellent recovery. He was well and chatting heartily with visitors at the clinic one afternoon, but by dusk, he had died.

Another woman who was recovering smoothly from a brain operation died a day before she was to be discharged.

The clinical explanation for these deaths is called venous thromboembolism. The import of this story is that VTE is a major cause of sudden death.

What to know about thrombosis

It’s a startling fact that one in four people worldwide are dying from conditions caused by thrombosis.

Thrombosis, also known as blood clot, is the formation of potentially deadly blood clots in the artery (arterial thrombosis) or vein (venous thrombosis).

Once formed, a clot can slow or block normal blood flow, and even break loose and travel to an organ. A clot that travels to the circulation is called an embolism.

Thrombosis is the often preventable underlying pathology of heart attack. Thromboembolic stroke and venous thromboembolism, the top cardiovascular killers.

Thrombosis does not discriminate. They can affect anyone regardless of age, ethnicity or race. Up to 900,000 people in the United States alone are affected by blood clots each year and about 100,000 of those people will die, which is greater than the total number of people who lose their lives each year to AIDS, breast cancer, and motor vehicle crashes combined.

The most important thing you can do to protect yourself from a life-threatening blood clot is to learn if you are at risk. Know the signs and symptoms and contact your health care professional immediately if needed.

Deep vein thrombosis

It is a condition in which blood clots form in the deep veins of the leg known as deep vein thrombosis and can travel in the circulation and lodge in the lungs known as pulmonary embolism.

If the dislodged clot is large enough it will cause instant death. Together, DVT and PE are known as VTE – a dangerous and potentially deadly medical condition.

VTE is a leading cause of death and disability worldwide. A survey found that global public awareness of thrombosis, DVT and PE is low, and much lower than awareness of other conditions.

The first step towards reducing the number of deaths from thromboembolism is awareness. Unfortunately awareness of VTE in Nigeria (as in many countries across the world) is low, among health professionals and the public at large.

Risk factors

VTE does not discriminate. It affects people of all ages, races and ethnicities, and occurs in both men and women. Certain factors and situations can increase the risk of developing potentially deadly blood clots.

Resulting from prolonged immobilisation, it could occur after a long-distance travel (more than four hours by air or motor vehicle) or after a long period of bed rest in persons who are chronically ill.

Being in the hospital for an extended period of time, having surgery (especially hip, knee and cancer-related surgery), age , personal or family history of blood clots, cancer/chemotherapy, using estrogen-based medication (e.g., oral contraceptives or hormone replacement therapy) ,obesity , pregnancy or recent birth , smoking , alcohol consumption  are all risk factors.

Signs and symptoms

VTE can occur without any warning signs or symptoms and can go unrecognised and undiagnosed by a healthcare professional. Symptoms that do appear may be associated with either DVT or PE.

Deep vein thrombosis:  Pain or tenderness, often starting in the calf , swelling, including the ankle or foot , redness or noticeable discolouration Pulmonary embolism: Unexplained shortness of breath , rapid breathing , chest pain (may be worse upon deep breath) , rapid heart rate , light headedness or fainting.

Prevention

Research suggests that VTEs are often largely preventable. Individuals who are deemed ‘at-risk’ should be given appropriate prevention (referred to as “prophylaxis”) therapy, which can include the use of anti-clotting medications like blood thinners, often referred to as anticoagulants and mechanical devices such as compression stockings.

Patients on admission should be told to move around or do foot and leg exercises as soon and as often as possible. These measures have been shown to be very effective but under-utilised.

Treatment

DVT and PE are serious, life-threatening conditions that require immediate medical attention. Globally, the best treatment is prevention and it can differ by patient.

It typically includes hydration, use of blood thinning medication to break up clots and prevent new ones from forming.  The individuals can use anticoagulants and injectables such as heparin or low molecular weight heparin, or tablets.

Early diagnosis and treatment can often lead to recovery, but long-term complications, such as post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension may occur.

Economic burden

In addition to disease burden, VTE can cause significant global economic burden. Multiple diagnostic tests and treatments, prolonged hospital stay and follow-up care – including recurrent VTE – can be extremely costly. But by focusing on VTE prevention, health care systems can save money, improve outcomes and ultimately save lives.

Make it a day with me next week on an enlightenment piece on management of hypertension with or without medications. Punch

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