Dr Arvind Kohli
Venous thromboembolism (VTE) is a common and potentially life threatening condition. It continues to be under diagnosed and undertreated. Awareness among Indians regarding this potentially life-threatening disease is low. Quoted as a major health problem and one of the most common preventable causes of hospital deaths in the western world, venous thromboembolism (VTE) has rarely evoked such consideration in India 1 in 4 people in world are dying because of thrombosis VTE consists of Deep vein thmbosis and Pulmonary embolism
Deep vein thrombosis (DVT) is a serious condition because blood clots in veins can break loose, travel through bloodstream and lodge in lungs, blocking blood flow (pulmonary embolism). DVTsigns and symptoms can include:Swelling and pain in the affected leg
Many factors can increase risk of developing deep vein thrombosis (DVT),:
* Inheriting a blood-clotting disorder: Some people inherit a disorder that makes their blood clot more easily. This inherited condition may not cause problems unless combined with one or more other risk factors.
* Prolonged bed rest, such as during a long hospital stay, or paralysis: When legs remain still for long periods, calf muscles don’t contract to help blood circulate, which can increase the risk of blood clots.
* Injury or surgery: Injury to veins or surgery can increase the risk of blood clots.
*Pregnancy: Pregnancy increases the pressure in the veins in your pelvis and legs. Women with an inherited clotting disorder are especially at risk.
The risk of blood clots from pregnancy can continue for up to six weeks after delivery.
* Birth control pills or hormone replacement therapy: Birth control pills (oral contraceptives) and hormone replacement therapy both can increase blood’s ability to clot.
*Being overweight or obese: Being overweight increases the pressure in the veins in pelvis and legs.
* Smoking: Smoking affects blood clotting and circulation, which can increase risk of DVT.
* Cancer: Some forms of cancer increase the amount of substances in blood that cause blood to clot. Some forms of cancer treatment also increase the risk of blood clots
* Inflammatory bowel disease: Bowel diseases, such as Crohn’s disease or ulcerative colitis, increase the risk of DVT.
Fatal PE is the most dramatic effect of VTE and remains the most common preventable cause of death in hospitalized patients. The best strategy is prevention by adequate prophylaxis for VTE. Early detection is essential for improved out come and requires a high degree of suspicion, when patients have:
Unexplained tachycardia unexplained fever chest pain dyspnoea and hemoptysis.
Treatment of PE is decided by the cardiovascular status of the patient. If the patient has circulatory collapse then he is best managed by catheter directed thrombolysis or thrombectomy. If the patient is stable than adequate anticoagulation is sufficien.
Deep vein thrombosis treatment:
* Blood thinners: Medications used to treat deep vein thrombosis include the use of anticoagulants, also sometimes called blood thinners, whenever possible. These are drugs that decrease blood’s ability to clot. While they don’t break up existing blood clots, they can prevent clots from gettingbigger or reduce risk of developing additional clots.
Treatment starts with injectable blood thinner, such as enoxaparin dalteparin or fondaparinux :
Other blood thinners can be given in pill form, such as warfarin (Coumadin,) or rivaroxaban Apixaban and dabigatran called as Newer blood thinners Blood thinners have to be taken for three months or longer :
It’s very important to take medication exactly as doctor instructs. Blood-thinning medications can have serious side effects if taken too much or too little.
‘Periodic blood tests like PTI/INR are needed to check how long it takes your blood to clots so that blood thinning medicine dose can be altered.
Pregnant women shouldn’t take certain blood-thinning medications.
* Clotbusters : If there is more serious type of deep vein thrombosis or pulmonary embolism, or if other medications aren’t working, clot busters are prescribed.
One group of medications is known as thrombolytics: These drugs, called tissue plasminogen activators (TPA), are given through an IV line to break up blood clots or may be given through a catheter placed directly into the clot. These drugs can cause serious bleeding and are generally used only in life threatening situations.
For these reasons, thrombolytic medications are only given in an intensive care ward of a hospital.
AngioJet Thrombectomy system is new device to treat DVT in a single procedure. The AngioJet uses high velocity saline jets to fracture and remove blood clots. With the Powerpulse method, the AngioJet is first used to deliver and disperse a clot-busting drug directly into the blood clot by a powerful pulse-spray injection. The drug is allowed to sit within the clot for 30 minutes, then the AngioJet is used to remove the softened thrombus fragments .
IVC Filters: If a patient can’t take medicines to thin blood, a filter may be inserted into a large vein – the vena cava. A vena cava filter prevents clots that break loose from lodging in lungs and prevents Pulmonary embolism the dreaded complication of DVT.
Graded Compression stockings: These help prevent swelling associated with deep vein thrombosis. These stockings are worn on your legs from your feet to about the level of knees. Compression stockings can help prevent postphlebitic syndrome prevented?
Prevention VTEs often are preventable, with strategies that stop the development of clots in people at-risk. Healthcare professionals discern risk by gathering information about a patient's age, weight, medical history, medications and lifestyle factors. Those at risk may take anti-clotting, or blood-thinning, medications or use mechanical devices such as compression stockings or compression devices DVT prophylaxis would reduce the incidence of VTE in India and bring down the mortality rates.
(The author is Senior consultant CTVS GMC Jammu)