Blood Clots: What You
Don't Know Can Kill You
(HealthScoutNews) -- Along with the
public service signs denouncing smoking and promoting blood donations,
the corridors of the Ochsner Clinic Foundation in New Orleans
are now plastered with posters warning of two little-known dangers:
Deep vein thrombosis and pulmonary embolisms.
It's part of a new initiative by health-care
experts across the country to increase awareness about two conditions
that are responsible for 10 percent of all hospital deaths each
year.
Deep vein thrombosis (DVT) occurs
when a blood clot forms in the leg and blocks the flow of blood.
This can lead to potentially life-threatening pulmonary embolisms
(PE), which is when a clot breaks free, travels north and lodges
in a lung. If the clot is large enough, it can cause sudden death.
About 600,000 Americans develop pulmonary
embolisms every year, and 200,000 people die from them. The American
College of Chest Physicians says this may be the most preventable
cause of hospital death.
Until now, DVT and PE have fallen
through the cracks.
"Everybody assumes that someone
else is going to be taking the lead on it and because no group
'owns' the condition, it wasn't happening," says Dr. Steven
Deitelzweig, Ochsner's section head of hospital-based internal
medicine.
Deitelzweig is spearheading the initiative
at his clinic to raise the public profile of the problem, until
now overshadowed by "celebrity" conditions such as stroke
and heart attack.
However, he's not the only one. In
February, a group of medical experts formed the Council for Leadership
on Thrombosis (CLOT) Awareness and Management, which is sponsoring
free screening programs at 185 hospitals nationwide. It has also
established the ClotAlert Resource Center, which includes a Web
site that provides information and services.
"There's a lot more now in the
medical literature than ever before alerting physicians and other
health-care providers about the risk of pulmonary embolism and
deep vein thrombosis and, importantly, the effective ways that
are available to prevent these conditions from occurring in the
first place," says Dr. Samuel Goldhaber.
Goldhaber is co-chairman of CLOT,
as well as director of the Venous Thromboembolism Research Group
at Brigham and Women's Hospital in Boston and an associate professor
of medicine at Harvard University Medical School.
People hospitalized for long periods
of time are particularly at risk because blood can collect in
the legs and increase the probability of a clot forming. Air travelers
can also be prone to the condition -- in this case, dubbed "economy-class
syndrome" -- thanks to long hours spent cramped in a seat,
experts say.
Those with cancer, chronic heart
or respiratory failure, inherited or acquired predisposition to
clotting, and varicose veins also have an increased risk. So do
people who are obese, as well as women who are pregnant or are
taking birth control pills or hormone replacement therapy.
Symptoms of DVT can include leg
pain, swelling, tenderness, discoloration or redness. Often, though,
there are no symptoms.
"It's a very difficult diagnosis
to make. Half of DVTs have no symptoms or signs and PE can mimic
many other conditions such as heart attack or anxiety or pneumonia
or heart failure," Goldhaber says.
"Unless you think about it
as a diagnosis, it can be very difficult to make," he adds.
"The lay public is not really aware of PE. You rarely have
someone calling an ambulance and saying, 'I think he's having
a PE.'"
Deitelzweig and his colleagues
have developed a "clinical assessment tool" to help
identify people at risk of DVT. The various risk factors -- obesity,
heart failure, infections, lung problems, prolonged immobility
-- are put on a grid and everyone admitted to the hospital is
assessed and put in a category of low, medium or high risk.
"It's part of the intake,"
Deitelzweig says.
People with two risk factors get
treated with non-pharmacological devices, such as compression
stockings. If a person has three or more risk factors, or if he
or she has two risk factors and has also had a stroke or cancer,
they get at least one blood-thinning drug.
Ochsner also has a multidisciplinary
"thrombosis consult services" unit, which can be sent
anywhere in the hospital to provide a more specific assessment
of a patient's risk.
There's no data yet on the effectiveness
of the program, but "a member of the [services] team gets
called every day now to help manage patients," Deitelzweig
says. "Now, we have the structure and it appears to be working
for us."
In addition to encouraging hospitals
to develop programs for preventing blood clots, the CLOT group
is also focusing on outpatient practices.
"These days, many of the patients
who would traditionally be in the hospital are managed at home,"
Goldhaber says. "These patients may, ironically, be at an
even greater risk because they're not getting the intensive physical
therapy they might get in the hospital."
What To Do
For more information on the Council
for Leadership on Thrombosis, visit Thrombosis
Online or call 1-800-CLOT-FREE. For more on deep vein thrombosis,
visit the University
of Massachusetts Medical School.
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