Thrombosis – A Killer – Especially In The Current Pandemic

It is a killer – a silent killer.

You might be shocked to learn that one of the leading causes of preventable death is something many people have never heard of — and often don't know they have. 1 in 4 people worldwide are dying from conditions caused by thrombosis, making it a leading global cause of death and disability. When a blood clot forms in an artery or vein – it is called a thrombus. It can lead to heart attack, stroke, or a life-threatening clot in the lungs or leg, causing venous thromboembolism (VTE).

In fact, VTE-related events cause more deaths each year in the U.S. and Europe than breast cancer, AIDS, and motor vehicle crashes — combined. Even though hospitalization is a major risk factor for VTE, many hospitals around the world do not have mandatory protocols in place to help prevent thrombotic conditions. Air travel is one of the risk factors.

Every year October 13 is recognized as World Thrombosis Day (WTD). The date is in memory of the birthday of Dr. Virchow. It is celebrated today dedicating it to his work in the development of the concept of "thrombosis". He elaborated on the 3 causes of thrombosis – stasis, hypercoagulability, and endothelial injury - known as Virchow's triad. The day is dedicated to Deep Vein Thrombosis (DVT) and draws attention to the often misunderstood condition of thrombosis.

Predisposing factors for Venous Thrombosis

• Covid-19 infection: This is today a major risk factor and contributes greatly to the fatality of the disease. All Covid-19 patients are put on blood thinners

•Immobilization

• Vessel wall damage

• Hypercoagulability (is an abnormality of blood coagulation ), drugs like contraceptive pills

• Increased Age

• Surgery (usually orthopedic surgeries – but any major surgery )

• Heredity causes

• Cancer

• Pregnancy

• Hormonal imbalances (Increased estrogen levels)

• Obesity

• Smoking

• Long-distance air travel

Symptoms of Venous Thrombosis

• Pain in the leg

• Swelling of the leg

• Soreness

• Discoloration of the leg

• Shortness of breath

• Blood while coughing – implies a complication called Pulmonary Embolism (PE)

Complications :

• An established DVT can potentially produce a threat to the leg

• If not treated in time it can lead to chronic venous disease

• The clot can migrate to the heart and cause PE – a potentially fatal condition

Prevention :

• Exercising your legs regularly – take a brisk walk every day

• Maintaining a healthy body weight

• Avoiding sitting or lying in bed for long periods of time

• Avoid tobacco and caffeinated drinks

• Avoid tight-fitting clothes

• If driving long distances - exercise your legs at least every 2 hours - try to take regular breaks from driving. If on a long flight or train journey - walk up and down the aisle. Exercise even while sitting - pull your toes towards your knees then relax, or press the balls of your feet down while raising your heel

• Adequate hydration especially in summers

• Prophylaxis during major surgery (your surgeon will take care of this

Diagnosis :

• A checkup by a vascular specialist in case of symptoms mentioned above

• A blood test (D Dimer) when in doubt

• A Duplex scan – non-invasive test to look for clots in the leg veins

• Cardiac echo

• CT scan in selected cases

Therapy:

• Anticoagulants in early diagnosed cases

• Intervention in selected cases – potent clot busters given systemically or locally in the clot, aspiration of the clot in some cases, rarely a filter to prevent the clot from entering the heart and again rarely a major emergency open-heart surgery. All the above needs to be done by a vascular specialist and work well if instituted in time.

• Catheter Directed Thrombolysis (CDT) and aspiration with special pumps is an advanced therapy being used successfully in selected cases. The author has a wide experience with these advanced modalities of therapy and in fact, has successfully treated the very first documented case of massive DVT and massive PE (Pulmonary Embolism) occurring simultaneously. He has also used a specialized device called Penumbra Indigo which sucks out the clots without any surgery. All above are being in specialized centers all over India.

In addition to these medical treatment options, lifestyle changes are important to reduce the risk of DVT. Simple lifestyle changes like losing weight, quitting smoking, and doing some exercise every day will all help prevent DVT.