What exactly is DVT and am I at risk?

Deep vein thrombosis, or deep venous thrombosis (DVT), is the formation of a blood clot (thrombus) within a deep vein,[a] most commonly the legs. Nonspecific signs may include pain, swelling, redness, warmness, and engorged superficial veins. Pulmonary embolism, a potentially life-threatening complication, is caused by the detachment (embolization) of a clot that travels to the lungs. Together, DVT and pulmonary embolism constitute a single disease process known as venous thromboembolism. Post-thrombotic syndrome, another complication, significantly contributes to the health-care cost of DVT.

In 1856, German pathologist Rudolf Virchow postulated the interplay of three processes resulting in venous thrombosis, now known as Virchow’s triad: a decreased blood flow rate (venous stasis), increased tendency to clot (hypercoagulability), and changes to the blood vessel wall. DVT formation typically begins inside the valves of the calf veins, where the blood is relatively oxygen deprived, which activates certain biochemical pathways. Several medical conditions increase the risk for DVT, including cancer, trauma, and antiphospholipid syndrome. Other risk factors include older age, surgery, immobilization (as with bed rest, orthopedic casts, and sitting on long flights), combined oral contraceptives, pregnancy, the postnatal period, and genetic factors. Those genetic factors include deficiencies with antithrombin, protein C, and protein S, the mutation of factor V Leiden, and the property of having a non-O blood type.

Individuals suspected of having DVT may be assessed using a clinical prediction rule such as the Wells score. A D-dimer test may also be used to assist with excluding the diagnosis (because of its high sensitivity) or to signal a need for further testing. Diagnosis is most commonly done with ultrasound of the suspected veins.

Prevention options for at-risk individuals include early and frequent walking, calf exercises, anticoagulants, aspirin, graduated compression stockings, and intermittent pneumatic compression. Anticoagulation is the standard treatment; typical medications include low-molecular-weight heparin or a vitamin K antagonist. Wearing graduated compression stockings appears to reduce the risk of post-thrombotic syndrome. The rate of DVTs increases from childhood to old age; in adulthood, about one in 1000 adults is affected per year.

More Awareness Needed to Prevent Blood Clots During Hospital Stays

Across the United States, 600,000 people a year experience deep vein thrombosis (DVT) and pulmonary embolisms (PE). One out of every 10 hospital deaths involves pulmonary embolisms or DVT and an estimated 100,000 people die annually due to blood clots and events onset by them. Recent surgery and other factors such as immobility, infections, cancer, and obesity increase the chances of these potentially fatal occurrences.

A new survey by the National Blood Clot Alliance (NBCA) shows gaps between patients, health care professionals, and the public’s awareness of risk factors and methods to lessen these events. The study showed that, “almost half (46 percent) of all respondents say their doctor did not provide information about blood clot risks related to hospitalization.” A total of 1,500 individuals took the survey. More than 40 percent of hospitalized patients had a family member with a history of blood clots and 15 percent had past bouts with clots as well.

“These survey findings are compelling, because they demonstrate the gaps that need to be filled to optimize use of evidence-based DVT/PE prophylaxis, as well as the need to better inform or educate our hospitalized patients about potential risk factors,” says Dr. Greg Maynard, Chief, Division of Hospital Medicine at the University of California, San Diego.

The lack of awareness and communication between patients and health care professionals leads to missed opportunities in DVT/PE prophylaxis. Mechanical compression, medicine, compression stockings, and ambulation are all preventive measures that can effectively help a patient.

Just being hospitalized with an acute medical illness causes a 10-fold increased risk of DVT or PE, notes the NBCA. The NBCA’s DVT/PE Awareness Survey was conducted in light of the U.S. Department of Health & Human Services Partnerships for Patients initiative. This includes DVT and PE prevention, which the Centers for Medicare and Medicaid Services classify as preventable and un-reimbursable “Never Events”. Unless it is documented during a patient’s hospital admission, the medical professional will not be reimbursed by Medicare for the treatment to remedy the condition nor have the ability to seek payment from the patient for the services.

Vascular PRN assists health care professionals with mechanical compression equipment rental and sales. They have a complete product offering ready for quick delivery, even overnight, to facilities throughout the United States. Their product lineup of intermittent and sequential mechanical compression devices for the foot, calf, and full leg are known for their comfort and efficacy.

Their website at www.vascularprn.com is a resource for directors of nursing, nursing home administrators, and medical professionals to find out more about compression therapy. Beyond a wealth of knowledge on prophylaxis products, the site features industry news, frequently asked questions, and director of nursing and healthcare jobs.

To learn more, visit www.vascularprn.com or call 800-886-4331.

Vascular PRN
601 S. Falkenburg Road, Suite 1-4
Tampa, FL 33619
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800-886-4331

Tall, Overweight Individuals at Higher Risk for Blood Clots and Other Complications

Tall, overweight men are five times more at risk to develop potentially dangerous blood clots, says a recent study published in the Journal of the American Heart Association. Every year in the U.S., more than 275,000 people are hospitalized for deep vein clots or pulmonary embolism. Tall, obese men are particularly at risk for venous thromboembolism (VTE), a condition that starts when a clot occurs in a deep vein – such as a leg vein – and breaks off and travels to the lungs, causing a pulmonary embolism. When the clot travels to the lungs it can cut off blood circulation, cause dizziness, shortness of breath, and sometimes death.

“In tall people the blood must be pumped a longer distance by the calf-muscle pump, which may cause reduced flow in the legs and thereby raise the risk of clotting,” said senior study author Dr. Sigrid K. Braekkan. “Understanding and preventing VTE is important because even the first occurrence may be fatal. Obesity, in combination with other VTE risk factors, has been shown to substantially increase the risk, so we wanted to assess the combined effects of tall stature and obesity.”

Tall, obese women are close to three times more at risk for VTE, the study showed. The research team collected data from more than 26,000 people from 1994 to 2007. “Obesity is also linked to a state of constant low-grade inflammation, and inflammation may render blood more susceptible to clotting,” Braekkan said. Doctors should be mindful of patients with these risk factors as obesity elevates pressure in the abdomen, thereby potentially decreasing the ability of blood to flow to the lower extremities.

The American Heart Association recently released new guidelines for complicated, serious cases involving blood clots. The guidelines will help doctors and hospitalists go after more aggressive treatment in certain populations. “For patients, the new guidelines should make a difference in outcomes,” said Dr. M. Sean McMurtry. “Ideally, it will lead to better care. While most patients don’t die from pulmonary embolism, when you start talking massive pulmonary embolism, it can have a significant mortality rate.”

The new guidelines promote aggressive treatment, such as clot-busting drugs, catheters to open up blood vessels, and surgery to remove clots and insert vein filters. Deep vein thrombosis (DVT) oftentimes is caused by extended bedrest, sitting for long periods, recent surgery, pregnancy, taking birth control pills or hormones, fractures, smoking, cancer, and obesity, the National Institutes of Health states. There are many effective treatments to lessen DVT and prevent a pulmonary embolism.

External compression devices can be a good complement to a doctor’s course of treatment against DVT, and certain machines can be used with obese patients. Compression therapy helps stimulate the venous system as it increases the volume and velocity of flow from superficial veins up through the deep veins, and decreases venous stasis, blood pooling, and venous congestion. Mechanical compression therapy decreases blood vessel distension and helps lower the risk of injury to the endothelium tissue. Overall, this therapy enhances fibrinolysis, which assists in activating anti-clotting factors.

Blood Clots Can Affect Young People and Athletes

Model Mia Amber Davis recently passed away at 36 years old. Athlete Serena Williams temporarily sidelined her tennis career at 29 years old. And many 20 and 30-somethings are now speaking up about their battle with blood clots, thanks to the National Blood Clot Alliance. Blood clots just don’t happen to the old and immobile. Young people are equally at risk for blood clots, some causing long-term issues and even death. Knowing the risk factors can go a long way to decreasing your chances of a clot occurring.

Surgery is a big risk factor in causing a blood clot. Mia Amber Davis’ death is still awaiting toxicology reports. She went to get arthroscopic surgery on her knee after years of dealing with an old sports injury that made her knee swell and caused problems when she walked. Within 24 hours of surgery a blood clot related to the procedure caused her death. In 2010, tennis star Serena Williams underwent two foot surgeries and was rushed to the hospital after a blood clot traveled to her lungs, causing a pulmonary embolism. She is still recovering and taking blood thinning medication as the world waits to see if she will return for Wimbledon.

“Usually, the high-risk surgeries are surgeries of the hip or knee, but also pelvic surgery,” said CBS News Medical Correspondent Dr. Jennifer Ashton. “Really any type of surgery can increase your risk. This is an example. Even young, elite athletes can have this happen.”

Dr. Ashton says all individuals can do things to lessen their risk. These tips include:

  • Before surgery – doctors can give medications to prevent blood clots
  • During long travel times – get up to stretch your legs, move your limbs, do small exercises
  • Keep well hydrated
  • Get tested if your family has a history of blood clots or clotting disorders
  • Wear or use compression therapy

Compression therapy can stimulate the venous system and address the factors associated with clot formation. When you’ve had a surgery, you’re not moving as much and blood starts to pool instead of circulating. Changes in skin color – particularly in the lower extremities – and increased limb warmth, pain and tenderness, and swelling are all signs to look out for. When a blood clot breaks off and travels up the body to the heart or lungs, many individuals experience shortness of breath and an increased heart rate. To learn more about other risk factors and how mechanical compression therapy can address your concern, click here.