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Thrombosis

Article Published May 2010

Thrombosis

It is well and truly spring now and many of us will be looking forward to summer holidays. Most people who have booked a longhaul trip will be aware of the dangers of deep vein thrombosis, but it isn’t just long plane journeys that can increase the risk.

A main cause of deep vein thrombosis is immobility, and this can be from any long journey in a car or train as well as in a plane, and also from any injury or illness that stops you getting around as normal.

Aircraft travelDeep vein thrombosis (DVT) is a blood clot formed in a vein – these are the blood vessels that take blood in towards the heart. DVT is common in the larger veins that go through the muscles in the calf and thigh and less common in other veins.

Normally, blood flows quite quickly through the veins and this stops it from clotting. Leg movements help pump the blood around because the muscle action squeezes the vein. For whatever reason, if you are immobile the blood flow will slow and then becomes more likely to clot. There are other factors that can contribute towards higher risk of DVT; hormone replacement therapy that contains oestrogen can cause blood to clot slightly more easily; people with cancer or heart failure can have increased risk, and obesity can also be a contributing factor.

The problem with a DVT is that part of the blood clot can break off. When this happens, the clot is called an embolus. This can travel in the bloodstream until it becomes stuck, and a clot in a leg vein will be carried up the larger leg and body veins to the heart. Here it can get stuck in a blood vessel going to the lung (known as a pulmonary embolus) which can cause breathing problems and chest pain. A large pulmonary embolus can cause collapse and sudden death.

DVT is not uncommon – it is estimated that around one in 1000 people develop DVT every year in the UK.

Early symptoms can be varied and may include:

  • pain, tenderness and swelling on the leg where the clot is sited
  • a pale blue or red tinge to the skin
  • a deep ache in the affected area
  • warm skin in the area of the clot
  • an itchy skin rash in the area of the clot
  • a mild fever
  • prominent veins standing out from your skin

Sometimes there are no symptoms and it can be difficult for a doctor to diagnose DVT. When a DVT is suspected, further tests may be recommended, including a D-dimer blood test which detects fragments of breakdown products of a blood clot; and an ultrasound scan which can detect a clot in a vein.

Treatment can include anticoagulation medication to prevent the clot from getting larger and breaking off. Anticoagulation is often called “thinning of the blood” but this isn’t really what it does. Anticoagulation medication such as Warfarin alters certain chemicals in the blood to stop clots forming so easily and to prevent a DVT from getting any larger.

Medication is not a simple matter as it has to be monitored carefully until just the right level is obtained to ensure your blood will clot enough to stop bleeding problems but not too easily.

Compression stockings are usually part of a treatment plan these days as they reduce the risk of a recurrent DVT.

But prevention is far the best option and being aware of being immobile for long periods is key. Regular exercise of course is important, but this is not always possibly if you have had an injury or operation. Do start walking as soon as you can though to get those leg muscles working again; and when you are resting, it can help to raise the leg. This reduces the pressure in the leg veins and if your foot is higher than your hip, gravity will help with the blood flow returning from the calf and thigh. There are some calf exercises you can do even when you are sitting down.

If you are going on a long journey, do try and get up and walk around every so often and even exercise your leg muscles while sitting in your seat.

There is quite a lot of information available on the internet about DVT; one good source is:

hcd2.bupa.co.uk/fact_sheets/html/Deep_Vein_Thrombosis.html

 


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