Blood Clots Can Kill You by Dr. Chris Prakash, MD
Deep vein thrombus (DVT) is a blood clot that forms in the deep veins, usually in the legs. DVT affects an estimated 300,000-600,000 individuals in the U.S. each year, causing considerable morbidity and mortality. It is an equal opportunity disorder affecting all races and age groups. It is an important and growing public health problem. The blood clot can travel to the lung resulting in pulmonary embolism (PE). Up to 100,000 people die each year of DVT and PE (according to the CDC). Not many people are aware of its dangers.
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 a long period
- Taking birth control pills or hormone replacement
- Genetic predisposition (Approximately 5 to 8% of the U.S. population has one of several genetic risk factors, also known as inherited thrombophilias in which a genetic defect can be identified that increases the risk for thrombosis.)
- Risk rises with age, as well as smoking and obesity.
What are the symptoms?
Symptoms are not always obvious. 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 this may be indicative of pulmonary embolism (PE). PE can be fatal.
How is the diagnosis made?
The doctor will diagnose DVT based on history, physical examination, and results of tests. An ultrasound (venous Doppler) is the most common test done to diagnose DVT. A CT Angiogram is done to diagnose PE.
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. The blood thinners may be needed for 3-6 months, or longer (depending upon risk factors). A blood test called Prothrombin time (PT or INR) is done periodically to ensure that the dose of warfarin is correct. Since warfarin works by inhibiting Vitamin K dependent clotting factors, you will be advised to avoid diet containing Vitamin K (such as salads and green leafy vegetables).
Several new drugs have become available for the treatment of DVT over the past couple of years. These drugs are oral and do not require concurrent administration of heparin. Most prominent among these are Rivaroxaban (Xarelto) which is a factor 10 inhibitor, and Dabigatran (Pradaxa), a direct thrombin inhibitor. Your doctor will decide if you are a candidate for either of these new treatments.
What is Inferior Vena Cava filter?
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