Tuesday, April 7, 2009

Deep Vein Thrombosis

March is (was and will be) Deep Vein Thrombosis (DVT) month. So what! My reaction exactly, until Lisa, our daughter, died of a complication of DVT on February 26, 2002. My reaction exactly, until I was diagnosed last month with the condition and one of its associated complications. Well, the “what” may surprise you as it did me.

DVT is a common but serious medical condition that occurs when a blood clot forms in one of the large veins, usually in the lower limbs. A complication of DVT, pulmonary embolism (PE), can occur when a blood clot breaks loose and moves into the lungs, where it blocks circulation to these vital organs, creating a life-threatening condition.

Up to two million Americans suffer from DVT each year; approximately 300,000 deaths annually result from PE, the majority of which result from DVT - more than breast cancer and AIDS combined. DVT-related PE is the most common cause of preventable hospital death.

So what are the signs of DVT? Symptoms of DVT may include pain, swelling, tenderness, discoloration or redness of the affected area, and skin that is warm to the touch. However, as many as half of all DVT episodes produce minimal symptoms or are completely "silent."

Because a number of other conditions - including muscle strains, skin infections, and phlebitis (inflammation of veins) - display symptoms similar to those of DVT, the condition may be difficult to diagnose without specific tests.

Quick DVT Facts:

  • DVT occurs in about 2 million Americans every year.
  • Up to 600,000 people are hospitalized in the U.S. each year for DVT.
  • Fatal PE may be the most common preventable cause of hospital death in the United States.
  • Only one-third of hospitalized patients with risk factors for blood clots received preventive treatment, according to a U.S. multi-center study.
  • Without preventive treatment, up to 60 percent of patients who undergo total hip replacement surgery may develop DVT.
  • Cancer patients undergoing surgical procedures have at least twice the risk of postoperative DVT and more than three times the risk of fatal PE than non-cancer patients undergoing similar procedures.
  • In the elderly, DVT is associated with a 21 percent one-year mortality rate, and PE is associated with a 39 percent one-year mortality rate.
  • PE is the leading cause of maternal death associated with childbirth. A woman's risk of developing VTE is six times greater when she is pregnant.

Many factors can make you more prone to DVT, including:

  • Certain cancers, especially pancreatic, brain, lymph node and lung cancers, or chemotherapy
  • Advanced age or medical circumstances that require you to be in a nursing home
  • A past incident of DVT or pulmonary embolism
  • Use of hormone replacement therapy or birth control pills
  • Pregnancy and especially recent childbirth
  • A family history of blood clots, which may indicate an inherited blood-clotting disorder
  • Lifestyle factors such as obesity

Beware of pulmonary embolism danger

From the deep veins of the legs and pelvis it's a straight shot to the heart, and only a short distance farther to the lungs. If a fragment - or, more commonly, several fragments - of a deep vein thrombosis break loose, they can be carried to the lungs, blocking blood flow. This is called a pulmonary embolism, and it can be fatal.

Signs and symptoms of pulmonary embolism vary. Sometimes, no symptoms are evident. However, seek emergency medical care if you experience:

  • Unexplained shortness of breath, which can come on gradually or suddenly
  • Sharp chest pain when you inhale or cough
  • Feeling lightheaded or dizzy or even fainting
  • Coughing up blood

In addition, anyone of several situations may be a triggering event leading to DVT. Even after the triggering event is over, risk of DVT may be heightened for up to three months. Triggering events include:

  • Hospitalization for a sudden medical problem - Trauma to the leg area or pelvis or a fracture of a leg or pelvis bone puts you at especially high risk.
  • Major surgery - This especially includes hip or knee replacement or surgery in the pelvic area.
  • Long periods of sitting - Airplane flights that are around six or more hours are the main culprits, but long car or train rides can be, too.

Stopping clots

For most healthy adults, DVT is extremely rare and not worth worrying about. If you're at elevated risk of DVT or are working to prevent a second episode, help keep your legs clot-free by:

  • Taking precautions when traveling - Stay hydrated, avoid alcohol and take hourly breaks from sitting to walk around. The extra legroom of an aisle or business-class seat may help. For those at especially high risk, a below-the-knee compression stocking or an injection of heparin prior to travel may be needed.
  • Making lifestyle changes - Losing weight if you’re obese may help reduce your risk of DVT.
  • Following instructions from your doctor or surgeon - There are well-established guidelines for preventing DVT in many medical situations, particularly with surgery. Anticoagulants feature prominently in almost every DVT prevention plan. It’s important to take anticoagulants for the length of time recommended by your doctor or surgeon - which may be for several weeks or longer - and to carefully follow any additional instructions.