Venous Thromboembolism

Venous Thromboembolism - General Information:

Venous Thromboembolism (VTE) is a significant healthcare problem all over the world. Venous Thromboembolism is a condition of the body where a blood clot travels through the veins. VTE consists mainly of two main conditions of the body – DVT (Deep Vein Thrombosis) and PE (Pulmonary Embolism). DVT is a condition where a blood clot occurs in the veins that are deep in the leg or the pelvis region of the body and PE is a condition where the blood clot moves from some other location all the way up to the lungs and also blocking the arteries leading to lungs from the heart .There are a number of conditions and risk factors that cause poor blood circulation or thickening of the blood, thus increasing the risk of developing VTE:

When the flow of blood within the veins is disrupted, then the blood begins to clot, thus small clots are not washed away, and this increases the density of the blood.

Any damage done to the blood vessel wall either surgically or by any injury interrupts with the blood flow and thus forms a blood clot.

If there are too many factors to cause a blood-clot then this would affect the blood composition, thus increasing the tendency of developing a blood clot.

Venous thromboembolism mainly occurs in patients undergoing surgical procedures, in the hip and the knee region of the body and also in the abdominal or thoracic regions of the body. Patients with ischemic stroke have the tendency to develop DVT in the paretic or paralyzed leg.

Venous Thromboembolism -Symptoms:

Venous thromboembolism is a health problem which can mainly occur soon after an orthopedic surgery as the surgery can cause severe injury to the blood vessel, thus disrupting the blood flow and composition, leading to the formation of blood clots which results in DVT or PE which are both conditions of VTE. VTE occurs in patients due to various factors such as hereditary of VTE, high blood pressure, obesity ,being over-weight, age factor- being more than 40 years of age, thrombophilia, varicose veins, diabetes, hormones, pregnancy and smoking.

Symptoms for VTE depend on both the conditions – DVT and PE.
For DVT , the symptoms include:

Swelling of the affected leg compared to the normal leg

Pain or tenderness in the leg region can be extremely painful

Purple or bluish discoloration of the skin,

Erythema – redness of the skin

Warmth in the leg region resulting in the formation of a clot

All the above conditions occur in the leg regions such as calf, upper leg, ankle or foot and in the pelvic region,

And also there might be swelling of the veins (distended veins).

For PE the symptoms include:

If there is disruption or a block in the flow of blood to the lungs it leads to conditions such as severe chest pain during breathing, dyspnoea – a condition where there is shortness of breath , hyperventilation ,breathlessness, haemoptysis – a condition which leads to coughing of blood, increase in the heart beat rate - tachycardia, fainting or dizziness and also mild fever.

Venous Thromboembolism -Treatment:

VTE can be treated with the help of medicines, mechanical means and surgery. As there is an increase risk of VTE soon after an orthopedic surgery, these patients are given protection in the form of a treatment that is preventative, termed prophylaxis. These methods are used before or shortly after the surgery to prevent developing VTE while in the hospital. Treatment of existing deep vein thrombosis (DVT) also aims to prevent the development of a pulmonary embolism (PE) and any long-term effects.

Medicines: Anticoagulant Medicines: Anticoagulation medicines are mainly anti-clotting medicines used to prevent clotting of the blood - which is the main cause for VTE and also to avoid the clots from getting bigger. These include:

UFH - Unfractionated Heparin: which reduces the production of blood-clotting proteins?

LMWHs - low molecular weight heparins: This is the same as UFH but last longer than them. For e.g. Enoxaparin and Dalteparin.

VKAs- Vitamin K antagonists: These drugs act on Vitamin K which affects blood –clotting. For E.g. Warfarin

DTIs- Direct thrombin inhibitors : Thrombin is a blood- clotting protein which can be stopped by using DTIs.

Ximelagatran – is a drug that acts as an anticoagulant

When prophylaxis is given, these anticoagulant medicines may be continued for some time soon after the surgery as there is risk of developing blood clots.

When diagnosed with VTE (DVT) it would be necessary to take an initial course of medicines when still in the hospital, and also to continue when discharged from the hospital.

It is very necessary to take the prescribed medicines correctly and to consult and keep in touch with the doctor while taking any other medicines and also regarding the diet. Alcohol, might affect the anti-coagulants, so it is necessary to avoid it during the medicine course.

Anti-coagulants have some side-effects like, bleeding of the nose, blood in the stools and in the urine, vomiting and heavy flow of menstrual periods.

Antiplatelet medicines: These medicines prevent blood platelets from sticking together thus preventing the blood from clotting.(platelets are cells in the blood that form blood clots.) . E.g. aspirin. However, they are less effective than the anti-coagulants but are effective on patients who cannot take anti-coagulants.

Anti-thrombin Medicines: Fondaparinux , Idraparinux and Arixtra (FLEXTRA -Flexibility in Administration of Fondaparinux for Prevention of Symptomatic Venous Thromboembolism in Orthopaedic Surgery)

IPC or intermittent pneumatic compression boots: These are compression stockings which improve blood circulation and prevent VTE by increasing the speed of blood flow through the veins in the leg and the pelvic regions of the body. These stockings are basically made of plastic. These stockings act by deflating and inflating, thus increasing the speed of blood flow, increasing the circulation of blood, preventing the blood from clotting. It practically has no side-effects when fitted well and works well with the anti-coagulants.

Surgical Procedures : Surgically blood clot may need to be trapped or removed to prevent it from reaching the lungs thus preventing blocks in the lungs.

Surgical treatment can be done in two methods:

Pulmonary embolectomy : The clot can be surgically removed – the method is called- embolectomy. This is done when medicines are not effective in case of PE.

Vena caval interruption : This is a method where in a surgical device like a filter, is inserted deep into the vein and the clot is trapped and preventing it from blocking the blood to the lungs. This is also done when patients are not able to take anti-coagulants

Leg movement or exercises: This improves the blood circulation.

Graduated compression stockings: These stockings on wearing create pressure within the leg thus increase in the speed of blood flow within the leg.

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Venous Thromboembolism

Venous Thromboembolism - General Information:

Venous Thromboembolism -Symptoms:

Venous Thromboembolism -Treatment: