Thrombosis, a killer clot

Dr Harinder Singh Bedi  

You might be shocked to learn that one of the leading causes of preventable deaths is something many people have never heard of. One in four 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 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 issues cause more deaths each year in the US and Europe than breast cancer, AIDS and motor vehicle crashes combined. Yet, public awareness of the condition is extremely low. According to a 2018 survey of American office workers, only one in 10 said they are most concerned about blood clots and 62 per cent do not know what VTE is. And even though hospitalisation is a major risk factor for VTE, many hospitals around the world do not have mandatory protocols in place to help prevent thrombotic conditions. 

Every year October 13 is recognised as World Thrombosis Day (WTD). The date is in memory of the birthday of Rudolf Ludwig Carl Virchow. He was a pioneer in the understanding of the pathophysiology of thrombosis. A German physician, pathologist, biologist and anthropologist, Virchow’s birthday is dedicated to his work in the development of the concept of “thrombosis”. He elaborated on three 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. 

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Predisposing factors for venous thrombosis

Immobilisation 

Vessel wall damage

Hypercoagulability (An abnormality of blood coagulation), drugs like contraceptive pills 

Advanced age

Surgery (Usually orthopaedic surgeries, but generally any major surgery)

Heredity causes

Cancer

Pregnancy

Hormonal imbalances (Increased estrogen levels)

Obesity

Smoking

Long distance air travel

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Symptoms of venous thrombosis

Pain in the leg 

Swelling of the leg 

Soreness 

Discoloration of the leg 

Shortness of breath

Blood while coughing

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Prevention

Normal physical activity, avoid sedentary lifestyle 

Adequate hydration, especially in summers 

Abstinence from alcohol and tobacco

Maintaining normal weight 

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

Walking, stretching and moving toes every hour during a long flight

Avoiding overuse caffeinated drinks 

Complications

An established DVT can potentially produce a threat to the leg

If not treated, it can lead to chronic venous disease

The clot can migrate to the heart and cause pulmonary embolism — a potentially fatal condition

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Diagnosis   

A check-up by a vascular specialist in the case of symptoms mentioned above 

A blood test (D Dimer)  

A Duplex scan —a 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

 All of the above needs to be done by a vascular specialist and works well if instituted in time