PREVENTION OF BLOOD CLOT IN THE SYSTEM

A man admitted into hospital following a road traffic accident appeared to be making an excellent recovery. He was well and chatting heartily with visitors one afternoon but by dusk he had died suddenly. A doctor died suddenly while recovering at home with one leg in an orthopaedic plaster. A woman recovering smoothly from a brain operation was about to be discharged home when she suddenly died. A woman who was in labour in a Lagos hospital few years ago had developed a clot in the system, this lead to sudden death shortly before delivery, at the post mortem, the cauise of death was found to be  pulmonary embolism.  The clinical explanation for these deaths is called venous thromboembolism (VTE).The import of this story is that venous thromboembolism (VTE) is a major cause of sudden death .

Venous thromboembolism (VTE) is a condition in which blood clots form (most often) in the deep veins of the leg (known as deep vein thrombosis, DVT) and can travel in the circulation and lodge in the lungs (known as pulmonary embolism. If the dislodged clot is large enough it will cause instant death. Together, DVT and PE are known as VTE - a dangerous and potentially deadly medical condition.

VTE is a leading cause of death and disability worldwide.A survey conducted by an NGO found that global public awareness of thrombosis, DVT and PE is low, and much lower than awareness of other conditions like heart attack, stroke, hypertension, breast cancer, prostate cancer and AIDS. The first step towards reducing the number of deaths from thromboembolism is AWARENESS. Unfortunately awareness of VTE in Nigeria (as in many countries across the world) is low, among health professionals and the public at large.

There is need for continous awareness to the public. October 13 every year is declared World Thrombosis Day, I will be leading a public awareness campaign/ road walk on the condition on October 2018. Interested Members of the public can join me. The emphasis of the campaign will be on prevention from public health perspective.

Risk Factors

VTE does not discriminate. It affects people of all ages, races and ethnicities, and occurs in both men and women. Certain factors and situations can increase the risk of developing potentially deadly blood clots.

Resulting from prolonged immobilisation, it could occur after a long-distance travel (more than 4 hours by air or motor vehicle) or after a long period of bed rest in persons who are chronically ill. Being in the hospital for an extended period of time, having surgery (especially hip, knee and cancer-related surgery) , Age (60+) , Personal or family history of blood clots , Cancer/chemotherapy , Using estrogen-based medication (e.g., oral contraceptives or hormone replacement therapy) ,Obesity , Pregnancy or recent birth , Smoking , Alcohol consumption  are all risk factors.

Signs and Symptoms

VTE can occur without any warning signs or symptoms and can go unrecognized and undiagnosed by a healthcare professional. Symptoms that do appear may be associated with either DVT or PE.

Deep Vein Thrombosis (DVT):  Pain or tenderness, often starting in the calf , swelling, including the ankle or foot , Redness or noticeable discoloration ,Warmth .

Pulmonary Embolism (PE): Unexplained shortness of breath , Rapid breathing , Chest pain (may be worse upon deep breath) , Rapid heart rate , Light headedness or passing out

Prevention

Research suggests that VTEs are often largely preventable. Individuals who are deemed 'at-risk' should be given appropriate prevention (referred to as "prophylaxis"), which can include: anti-clotting medications (e.g., blood thinners, referred to as "anticoagulants") , mechanical devices (e.g., compression stockings,) Hospital patients may also be instructed to move around or do foot/leg exercises as soon and as often as possible. These measures have been shown to be very effective but under-utilised.

Treatment

DVT and PE are serious, life-threatening conditions that require immediate medical attention. Globally, The best treatment is prevention it can differ by patient but typically includes hydration, blood thinning medication to break up clots and prevent new ones from forming. Options include: anticoagulants (e.g., injectables such as heparin or low molecular weight heparin, or tablets, mechanical devices (e.g., compression stockings), thrombolytic therapy (e.g., tissue plasminogen activator)

Early diagnosis and treatment can often lead to recovery, but long-term complications, such as post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension may occur.

Economic Burden

In addition to disease burden, VTE can cause significant global economic burden. Multiple diagnostic tests and treatments, prolonged hospital stay and follow-up care - including recurrent VTE - can be extremely costly. But by focusing on VTE prevention, healthcare systems can save money, improve outcomes and ultimately save lives.

Make it a day with me next week on an enlightenment piece on management of hypertension with or without medications.