Hillary’s Blood Clot: What can we learn?
*by Sucharu Chris Prakash, MD*
By now, you must have heard that Hillary Clinton has a blood clot. The Secretary of State was admitted last week to a hospital in New York City after doctors discovered a blood clot. During an overseas tour, she picked up a bad stomach virus. Days later, she fainted and suffered a concussion. An MRI of the brain revealed that she had a blood clot. Her doctors said that the clot was situated in a vein that is in the space between the brain and the skull right behind the ear. The secretary did not suffer neurologic damage. Clinton has a history of blood clots. In 1998, as First Lady, she had a clot behind her right knee.
So, how common are the blood clots? Can they be life threatening? How are they treated?
DVT (Deep vein thrombosis) is often found incidentally. Symptoms often go unnoticed. DVT is a blood clot that usually starts in the leg, but like in Hillary’s case, can involve any vein in the body. It can even travel to the lungs resulting in pulmonary embolism (PE), which can be fatal.
Every year, between 400000 and 600000 Americans get DVT, and up to 100000 people die each year of DVT and its complications. Not many people are aware of its dangers. This problem is grave enough that the Surgeon General issued a “call to action” to raise awareness of this problem.
Why do people get DVT?
Several factors can put people at risk of developing blood clots, such as:
- Recent surgery or broken bone
- Immobility for long period
- Taking birth control pills or hormone replacement
- Genetic predisposition
- Risk rises with age, as well as smoking and obesity.
How is the diagnosis made?
Symptoms are not always obvious. However, these may include:
- Swelling, pain and redness in a leg.
- Unexplained shortness of breath*
- Coughing up blood*
- Chest pain*
* If any of these symptoms arise, seek immediate medical attention, since they may be indicative of pulmonary embolism (PE), the most serious complication of DVT, where part of the blood clot breaks off and travels to the lung. PE can be fatal.
The doctor will diagnose DVT based on history, physical examination, and results of tests. An ultrasound (venous Doppler) of the leg is the most common test done to diagnose DVT. Rarely, a venogram may be ordered, where dye is injected into the vein, and x-rays taken. However, a clot can even be seen on an imaging study such as an MRI or CT scan.
Testing may be necessary to check for inherited clotting disorder that can cause DVT. This may be the case if you have repeated blood clots, or if you develop blood clots in an unusual location, such as a vein in the liver, brain or kidney.
How is a DVT treated?
Patients are started on anticoagulants (blood thinners). These may be a combination of injections (heparin in different forms) and pills (warfarin). Most of the times, treatment can be done without needing to be hospitalized, but in some situations, hospital stay may be necessary. There are several newer medications approved by the FDA to treat blood clots. These medications obviate the need for injections, but may not be suitable for everyone. The decision on which blood thinner to use, and for how long, is made by the doctor based on a number of individual factors.Some patients are unable to take blood thinners due to the risk of internal bleeding. These patients may require an inferior vena cava filter (IVC filter). This is placed in the inferior vena cave (large vein that carries blood from the legs to the heart). It works by potentially trapping any clots that may break off, and prevent them from traveling to the lungs.
Prevention is the key!
There are several simple measures you can take to prevent DVT:
- During long trips: move your legs to encourage blood flow; drink plenty of fluids and avoid alcohol; if traveling by car, stop about every hour and walk; if traveling by plane, walk the aisles.
- Moving around as soon as possible after surgery or illness.
- Regular checkups with your doctor.
- Know your family history and risk factors.
This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.firstname.lastname@example.org