Deep Vein Thrombosis
A serious condition that can quickly escalate to life threatening
As described by Dr. Trinidad-Hernandez, the treatment for DVT is generally anticoagulation, or blood thinners. "The patients who take blood thinners for life are those with a blood disorder that gives them a propensity to clot, or those who have had recurrent DVT."
The first sign that anything was amiss was when 48-year-old Colorado Springs biologist Mark Bloom noticed a soreness in a localized area of his right calf. “After a few days,” says Dr. Bloom, “it got progressively worse.”
Checking in with a physician, Bloom underwent an ultrasound procedure that confirmed the presence of a blood clot. “I was told the clot was not located in the ‘deep system’ and would resolve itself over a period of a few days.”
Over the next few days, however, the soreness increased, and Dr. Bloom returned to the doctor, where another ultrasound indicated the clot was moving. Scheduled for a venography procedure the next morning, Mark awoke early that day sweating and short of breath. The venography indicated the presence of a pulmonary embolism.
“I was instructed to immediately go to the hospital,” says Bloom, “where I was placed into intensive care and treated with a drug called TPA that is used to break up blood clots.”
Dr. Bloom’s experience is not all that uncommon. It seems we’ve all heard stories of people who developed a blood clot seemingly out of the blue and found themselves very quickly in a frightening situation.
“Deep Vein Thrombosis,” says Annette Seagraves, MD and vascular surgeon with the UCHealth/Memorial system, “is the formation of a clot in the deep veins, primarily occurring in the legs. However, it can occur in other areas. Pulmonary embolism is a potentially life-threatening complication that can occur when a clot breaks off and travels to the lung.”
Magdiel Trinidad-Hernandez, MD and vascular surgeon with the Penrose system, says once the blood clot breaks off, it will travel to the right side of the heart on its way to the lungs. “This can be deadly, depending on the size of the clot,” he says, “because it cuts off blood flow to the lungs and causes strain on the heart.”
Fortunately for Mark Bloom, treatment with the clot-busting drug was successful. “Following my release from the hospital,” he says, “I was placed on a daily dose of Warfarin.” That was 13 years ago, and the now 61-year-old says he continues to take Warfarin every day with no ill effects. His maintenance plan includes getting his blood clotting time checked every six weeks. “I have not altered my diet or physical activity, as is necessary for some patients.”
So how is it that some people suddenly develop blood clots? Are there risk factors or activities we take part in that can increase their occurence?
“Anyone can develop Deep Vein Thrombosis,” says James D. Albert, MD, Founder and Chief Physician of Albert Vein Institute. “Risk factors include any circumstance where decreased mobilization or traumatic injury occurs. Examples include general anesthesia and prolonged air or car travel. Surgical procedures, such as knee, hip or foot surgery, are also risk factors as they result in tissue injury and prolonged immobilization of the leg. Knee braces or ankle boots, used after surgery, are also frequently used after traumatic lower extremity injury that may not require surgery but need immobilization for healing. Post-surgical or posttraumatic pain from the aforementioned may mask the pain caused by the DVT, and braces or casts may visually obscure the leg swelling.” Dr. Albert says patients need to pay close attention in these situations, to watch for symptom changes and be ready to go in for an accurate venous ultrasound exam to determine the presence or absence of DVT.
“Certain patients may be at even greater risk for DVT if they have undiagnosed genetic hematologic hypercoagulable (excessive clotting) conditions,” says Albert. “These conditions are diagnosed by blood testing and are only ordered for patients who exhibit excessive clotting. Supplemental estrogen, progesterone, testosterone, birth control or hormone releasing intra-uterine devices all increase risk of DVT. Tobacco use is an additional independent risk factor.”
Mark Bloom, it turns out, learned through tests that he has an inherited mutation called the Leiden mutation in the Factor V gene that increases his risk for developing Deep Vein Thrombosis.
“Compression stockings during long flights or car rides can be helpful in prevention of DVT,” says Dr. Seagraves. “Exercise and avoiding prolonged activity are also helpful in prevention.” Seagraves says people who develop a DVT during a long trip typically don’t know there is a problem until they get up and start walking around when they reach their destination.
Since a pulmonary embolism compromises the body’s ability to oxygenate the blood, says Dr. Trinidad-Hernandez, airplane situations can be especially dangerous. “Patients require immediate hospitalization, which can be delayed by the nature of the flight. Additionally, the elevation and cabin pressure affect the lungs’ ability to oxygenate the blood.”
A different type of blood clot condition can sometimes occur in varicose veins. “Patients with varicose veins may experience episodes where their varicose veins clot, which is called phlebitis,” says Dr. Albert. “The progression from phlebitis to DVT is underappreciated. In general, patients are usually prescribed non-steroidal anti-inflammatory agents, antibiotics or steroids for symptomatic relief. The only treatment that will prevent a clot from entering the deep system resulting in DVT is blood thinners. Patients need to seek diagnostic ultrasound with a reputable vein specialist and receive appropriate treatment to prevent DVT.”
“Previously the most common treatment for DVT was Coumadin (Warfarin),” says Dr. Seagraves, “which required frequent blood testing and alteration of diet to maintain adequate blood levels of anticoagulation. More recently there are new oral anticoagulants available, such as Xarelto, Eliquis and Pradaxa that do not require frequent testing and alteration of diet. Most exciting is that Pradaxa recently received approval by the FDA for an IV medication that can reverse its effects in the event of a major bleeding episode. It is likely that soon there will also be reversal agents for Xarelto and Eliquis.”
Did You Know
• As many as 900,000 people could be affected by DVT/PE each year in the U.S
• Estimates suggest that 60,000-100,000 Americans die of DVT/PE
• 10-30% of people will die within one month of diagnosis
• Sudden death is the first symptom in about one-quarter of people who have a PE.
• Half of all people who have had a DVT will experience long-term complications such as swelling, pain, discoloration and scaling in the affected limb
• Of those with DVT/PE, one third will experience a recurrence within 10 years
• Approximately 5-8% of the U.S. population has one of several genetic risk factors