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Thrombosis

Thrombosis has been - and remains - a major cause of death in the United Kingdom yet astonishingly, this fact is not widely known.

Most people have little or no understanding about the causes and effects of thrombosis, and how it can be prevented. Every year, an estimated 25,000 people in England die from venous thrombosis (also called venous thrombo-embolism or VTE) contracted in hospital.

Most people affected by thrombosis are older, but anyone can suffer from thrombosis, occasionally even children and babies.

Some facts about thrombosis:

• up to one in every 1,000 are affected by venous thrombosis in the UK each year;

• up to one in ten people who suffer a pulmonary embolism will die if not treated;

• around one in every 1,000 women develops thrombosis during pregnancy, which can lead to related long-term health problems;

• one in three surgical patients can develop a DVT if no preventative measures are given;

• VTE is the most common cause of hospital deaths in the UK that can be prevented.

Thrombosis can happen to you, your family, your friends or colleagues. Thrombosis is often a 'silent' medical condition with no obvious signs or symptoms.

It doesn't discriminate and can affect people of any age or sex. It can very easily be confused with less serious conditions - a clot in the leg can be mistaken for a sore leg muscle.

But thrombosis is a leading cause of death in the United Kingdom, yet most people have little or no understanding about its causes and effects and how it can be prevented.

Questions and answers about thrombosis

1. What is a deep vein thrombosis (DVT) blood clot?

2. What is a pulmonary embolism (PE)?

3. Is a DVT the same as a varicose vein?

4. Is venous thrombosis common?

5. What are the symptoms of having a blood clot?

6. What are the complications of a DVT?

7. What are the complications of a pulmonary embolus (PE)?

8. How is thrombosis treated?

9. Can I prevent a thrombosis happening?

10. Am I at risk of DVT?

1. What is a deep vein thrombosis (DVT) blood clot?

Within our blood there is a system known as the clotting mechanism that performs two vital, but opposite functions - the first to keep the blood flowing, with the second to form a 'plug' or clot to stop us from bleeding.

This clotting mechanism is highly effective and under normal circumstances it remains inactive. When we injure ourselves - a cut to the skin for example - the second function is activated and a clot is formed to protect us from the loss of blood. But sometimes this function can go wrong and the blood becomes a solid mass within a blood vessel that has not been cut, causing what is known as a thrombosis or clot.

A deep vein thrombosis or DVT is a blood clot forming in the veins deep in the leg, usually in the calf or thigh, although occasionally DVT can occur in other veins in your body. DVT blood clots can block the flow of blood partially or completely and this causes the symptoms of DVT.

2. What is a pulmonary embolism (PE)?

An embolism is when a part of the clot 'breaks off' and travels around the body eventually blocking an artery. An example of this is a pulmonary embolism when part of the clot from a deep vein thrombosis breaks off, moves up the leg, through the heart and lodges in a lung artery or pulmonary artery. This process is known as embolisation, and the piece of clot is called an embolus.

3. Is a DVT the same as a varicose vein?

A DVT is different from a varicose vein. A DVT is a more serious problem. Varicose veins form in the superficial veins just under the skin and are caused by the superficial veins not working as well as they could. These veins are not very important as they only transport blood from the skin and from the tissue just below the skin. A DVT forms in the deep veins in your legs. These veins are much more important as they transport most of the blood back to your heart. DVT blood clots can block the flow of blood in your leg veins, which can cause swelling and pain in the leg.

4. Is venous thrombosis common?

Yes, venous thrombosis is known to occur in about one in every 1,000 of the population each year in the UK. But recent figures suggest that each year over 25,000 people in England die from venous thromboembolism (VTE) contracted in hospital. This is more than the combined total of deaths from breast cancer, AIDS and traffic accidents, and more than twenty-five times the number who die from MRSA. The figures are alarmingly high.

5. What are the symptoms of having a blood clot?

A DVT can be asymptomatic, but may be accompanied by some or all of the following symptoms: Pain, tenderness and swelling of the leg (usually the calf), sometimes accompanied by discolouration with the leg appearing a pale, blue or reddish purple colour. If thrombosis occurs in the thigh veins, the whole leg may be swollen.

The symptoms of pulmonary embolism can include: shortness of breath, either severe and sudden or gradual onset; chest pain may be worse on inhalation; sudden collapse; and the symptoms of deep vein thrombosis may also be present.

6. What are the complications of a DVT?

In addition to the serious risk of an embolus, the consequences of DVT include post-phlebitic syndrome. Normally the valves in deep veins prevent blood from travelling back down the leg. Damage to these valves higher in the leg can cause increased pressure in the veins of the lower calf and ankle and cause swelling, pigmentation skin rashes and varicose ulcers. This is known as post-phlebitic syndrome.

7. What are the complications of a pulmonary embolus (PE)?

It is important to realise that a PE is a medical emergency. Although most cases can be diagnosed quickly and effectively treated, in some cases, death can occur quickly. Guidelines for doctors recommend that patients waiting for a test to confirm the diagnosis of PE should be given treatment even before the diagnosis is confirmed because of the risk of death.

A PE is regarded as a serious condition because of other severe complications, including strain on the right ventricle of your heart (ventricular failure) and hypertension. A serious, long-term complication called chronic thromboembolic pulmonary hypertension, when most of the arteries in the lung get blocked with blood clots, occurs in around 1 in 25 patients with a PE after two years.

8. How is thrombosis treated?

If you have been diagnosed with thrombosis, it is very important to be treated immediately. Normally, DVT is first treated with two drugs - an injection of an anticoagulant called heparin and a blood thinner called warfarin, taken as a tablet. Warfarin takes several days to work and so injections of heparin are given for up to 5 days to thin the blood immediately.

After 5 days treatment with both drugs, warfarin is continued, usually for no longer than 6 months. These drugs stop blood clots from forming, so you should be aware that if you cut yourself, it will take more time for the wound to heal.

Compression stockings (also called graduated compression stockings) can also be used, and are sometimes given to relieve pain, swelling and to prevent post thrombotic syndrome. These will be fitted by your doctor and cannot be bought over the counter at the pharmacy. Your doctor may ask you to wear stockings for an extended period after a DVT.

9. Can I prevent a thrombosis happening?

Of course it is much better to prevent a DVT before it happens than have to treat a DVT. Preventing DVT is an important consideration for your doctor, most especially if you are admitted to hospital.

You can help prevent DVT by staying mobile, if this is possible. If you are undergoing surgery, or are going into hospital for an extended period because you are ill, you are at greater risk of DVT, and doctors will give you stockings to wear and may give you an anticoagulant drug.

10. Am I at risk of DVT?

Large studies have shown clearly that certain people are more likely to get thrombosis than others. For example, older people are more likely to have a DVT than a younger person, particularly if the older person is immobile or has a serious illness such as cancer.

Any illness or injury that causes immobility increases the thrombosis risk. A recent operation is a common factor in people with DVT. If you have had a DVT before, you are more likely to suffer another clot. Pregnancy increases the risk of thrombosis, with about 1 in 1000 pregnant women likely to have DVT.

Cancer markedly increases the risk of having a DVT, as does a medical illness which is severe, such as heart failure or respiratory disease. Hormone-based treatment, such as the contraceptive pill and hormone replacement therapy can cause the blood to clot more easily. Obesity increases the risk of having a DVT.

Acknowledgements

Source: Lifeblood, the Thrombosis charity

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