Blood Clot Dangers

http://sciencedaily.healthology.com/healthy-aging/article160.htm

Blood Clot Dangers: More Common Than You Think

Medically Reviewed On: August 20, 2002

by Erica Heilman

Millions of Americans suffer from blood clots, and though most cases are preventable and treatable, 60,000 people die each year from pulmonary embolism, or blood clots that have traveled to the lung.

Deep vein thrombosis (DVT) is one of the more common clotting conditions, and occurs when blood pools in one of the body's major veins, most commonly deep in the legs. There are a number of factors that increase the risk for DVT, including long, immobilizing air flights, commonly referred to as "economy class syndrome." But many people are often not aware that simple preventive measures could save them from serious complications, or even death.

Below, Dr. Steven Deitelzweig Section Head of Hospital-Based Internal Medicine at Ochsner Clinic Foundation, offers some practical advice about recognizing and treating DVT.

What is deep vein thrombosis, and what makes it dangerous?
Deep vein thrombosis, or DVT, are blood clots that form in large veins-usually in the legs, but sometimes in the pelvic area. If these clots leave the legs, go through the blood system, and land in the lung, then it's called a pulmonary embolus (PE).

DVT can lead to swelling, discoloration and pain to the legs. It's not life-threatening, but it's uncomfortable and sometimes disabling. What becomes life-threatening is the pulmonary embolism, which 600,000 Americans develop each year.

How many people die from pulmonary embolism?
60,000 people die from pulmonary embolism every year. More people die of PE than of breast cancer, or AIDS or in highway accidents. In fact, if you add them all up together, those conditions cause fewer deaths than PE causes each year.

What are the signs and symptoms of DVT?
Fewer than half of people with DVT have symptoms such as swelling, discoloration and pain to the legs. Many times it's actually silent, and patients don't even know it's there. More than half of people have symptoms when it reaches the lungs, however, and the typical symptoms might be chest pain, shortness of breath, rapid pulse, or a cough. Sometimes a cough will produce bloody sputum. They may just black out.

Does a pulmonary embolism represent an emergent, life-threatening situation?
It can have different manifestations and different time courses. The most urgent time is the first hour or two. That's when many of the deaths occur from a pulmonary embolus. But longer-term complications can occur in subsequent hours, days and weeks.

Who is most at risk of developing blood clots?
People over the age of 40, predominantly, because the risk goes up incrementally with years. People who are obese are at greater risk. People with chronic medical conditions that may cause prolonged immobility, like heart failure or chronic obstructive pulmonary disease. People with cancer-are also at greater risk. Smokers are at higher risk. Women taking hormone replacement therapy or birth control pills are at a higher risk as well. Pregnant women are at a very high risk, and interestingly, the highest risk is right after delivery. Some of it has to do with anatomy. They had a large fetus compressing the veins, and preventing optimal blood flow. Pregnant women also undergo alterations in their blood clotting, or thinning ability. They make less of the proteins that prevent blood clotting.

Some people have what is called thrombophilia, which is a propensity for clotting. We now know that up to 1 in 10 people will have one of these genetic markers.

There's been a lot written about the risk of blood clots in airplanes, referred to as "economy class syndrome." How significant is this risk?
The economy class syndrome only becomes an issue in those who are at particularly high risk-those who have a prior personal or family history, typically. And the real risk usually involves transatlantic-type flights, typically more than seven hours. Otherwise, just being well-hydrated, and walking frequently from the front to the back of the plane, is more than adequate.

Are there effective ways to prevent clots from forming in the first place?
Yes. Almost 99% of all blood clots are preventable. If people are at risk, they should get a work up from their doctor, and find out how high their risk is. Then they can be given a drug or a nonpharmacologic agent. Things like compression devices or compression stockings can be very effective, but you need to be thinking about it and acting on it early.

For instance, the highest risk population is the orthopedic hip fracture population. If you don't do anything to help them prevent a clot, there's a 50 to 80% chance they'll develop a clot. If, however, you give them appropriate prophylaxis, you don't bring that number down to zero, but you bring it down to probably about 10 to 15% risk.

What sort of lifestyle changes can you recommend to people to reduce their chances of developing clots?
Just having one risk factor by itself is really not of any consequence. But when you start having two or three together, the risk becomes quite impressive, and reducing the number of risks becomes essential.

For instance, if you had a stroke, or if you have heart failure, and you're 65 years old, it may not be wise to start taking hormone replacement therapy, which is another risk factor for DVT. If you have a pretty immobile lifestyle, you may want to be much more proactive about getting active. You don't have to run a marathon, but you could do some exercise, certainly, that uses the calf muscles to prevent the blood from pooling in the legs.

What about DVT prevention for pregnant women?
Exercise. They should exercise, and if they have a family history or personal history of DVT, then they need to be evaluated by a vascular medicine specialist.

How is DVT diagnosed?
The diagnosis is noninvasive. All they have to do is an ultrasound. It's very accurate, cost-effective and noninvasive.

Why is this diagnosis so often overlooked?
When a patient gets hospitalized with some other condition, or a patient is pregnant, a DVT screening is not the first thing on anyone's mind. No one group of doctors typically "owns" this process. After all, there's no field called thrombology.

Dr. Steven Deitelzweig is the Section Head of Hospital-Based Internal Medicine at the Ochsner Clinic Foundation in New Orleans.