Don't get thrombosis

Deep vein thrombosis is a very serious but still neglected problem. Most often it develops without any symptoms. However, when it attacks, it may be too late to be rescued. Find out about the causes, symptoms and dangers of thrombosis.

It is the third most common disease of the circulatory system. Thrombosis kills one person in the world every 37 seconds. In Poland, 40-50 thousand people lose their lives due to this disease every year. people, i.e. a medium-sized city in our country.

However, knowledge about the symptomsthrombosis , its causes and dangers is still too little. We are talking about thrombosis with prof. Witold Tomkowski, president of the Polish Foundation for Combating Thrombosis "Thrombosis", founder of the Coalition Against Thrombosis.

• Let's start by organizing the knowledge. Do frequently repeated names of diseases, e.g. varicose veins, thrombosis, thromboembolism, have a common cause?

PROF. WITOLD TOMKOWSKI: You can find a common denominator for these diseases, for example obesity and low physical activity, but that would be a big simplification. Varicose veins are a disease of the superficial veins. Venous thromboembolism affects the deep veins and covers two conditions. One isdeep veinthrombosis (ZZG) and the other ispulmonary embolism(PE). The basis for the development of thrombosis is the formation of deep clots in the veins, which gradually fill the inside of the vein, so that blood cannot flow freely through them.

• Why do doctors call DVT "silent killer"?

W.T .: Thrombosis is an insidious disease. In half of the cases it develops asymptomatically, but sometimes causes death within seconds. This is no exaggeration, these are the facts. The correct diagnosis of deep vein thrombosis is made in Poland several times less frequently than in Western European countries.

• What happens in the veins when they become ill?

W.T .: The natural course of ZZG is different. Less than 20 percent patients develop endogenous fibrinolysis. This means that the body itself produces the substance that dissolves the clot, and nothing bad happens. But about 50-70 percent. in patients, the thrombus fills the venous vessel to a varying degree. It is made of red blood cells and fibrin, which is formed by the activation of the coagulation cascade,that is, causing an avalanche of processes that accelerate blood clotting. It creates a network in which the red blood cells are trapped. To stimulate the imagination of readers, I would like to say that the thrombus resembles a greasy earthworm with a diameter of 1 mm to 2 cm and a length of several to several dozen centimeters.

• And what causes blood clots in the veins?

W.T .: Several conditions must exist, which are known as the Virchow triad. It includes: blood flow disorders that occur when the patient is immobilized after surgery; damage to blood vessels by injections, drip, catheter; excessive coagulation caused by changes in the blood composition, e.g. as a result of cancer, thrombophilia, the use of contraception or hormone therapy. When 2 of the 3 elements of this triad are present in the body, the tendency to clot formation is high. Thrombs form mainly above the valves of the veins.

• But the formation of a thrombus in itself is not life-threatening

W.T .: When a part of this structure breaks away from the vein wall, it will flow with the blood to the right atrium of the heart, then to the right ventricle and pulmonary artery. Then the pulmonary artery will become clogged. Shock or sudden cardiac arrest and respiratory arrest can be the result, often resulting in immediate death. Therefore, thrombosis must not be taken lightly. In addition, the untreated disease leads to further problems - post-thrombotic syndrome, which manifests itself in brown discoloration on the calves or leg ulcers. A complication of PE is chronic thromboembolic pulmonary hypertension.

• Who is most at risk of thrombosis?

W.T .: Thrombosis can develop at any age, but usually occurs after the age of 60. More often women than men. It affects the veins of the calves (lower legs), less often the veins of the thighs or pelvis. But while it is rare, it can develop anywhere in the venous system. The disease is favored by immobilization after injuries and surgeries, especially orthopedic and oncological surgeries. Risk factors also include infections, pregnancy and puerperium, dehydration, hormone therapy, varicose veins, obesity, stroke, heart failure, etc. The tendency to disease may be due to congenital or acquired thrombophilia - a disorder of the clotting system that promotes blood clots.

• What symptoms should draw our attention to?

W.T .: Deep vein thrombosis can manifest itself in a rather uncharacteristic way. This means that the same symptoms may occur with other diseases, e.g. lymphoedema, superficial thrombophlebitis, fracture.bones, dislocation or failure of the right ventricle, etc. But the following should be of concern: severe pain, reddening of the skin, swelling of the thigh or calf, pain when touching the calves, palpable lumps, difference in leg circumference greater than 3 cm, limb warmth, pain in the calf when bending the foot (Homan's symptom) and leg swelling with visible skin tightness (Mozes's symptom).

• Long immobilization promotes thrombosis. What injuries and treatments pose the greatest risk?

W.T .: The greatest risk of thrombosis occurs in fractures of the femoral neck, femur or pelvis, replacement of the hip or knee joint, spinal cord injuries, extensive surgical procedures, especially due to malignant tumors or extensive injuries. People who need arthroscopic surgery are at moderate risk. Patients with heart and respiratory failure are at risk. There is a slight risk of immobilization during an airplane flight for more than 6 hours.

Important

How to find out about pulmonary embolism?The most common symptoms include exercise and resting dyspnea. It can be paroxysmal with no cause, suggesting neurosis. There is pain in various places of the chest. Cough, rales, fever, rapid heartbeat, atrial fibrillation, and fainting are less common (but if they do occur, prognosis is poor). It is worth knowing these symptoms, because pulmonary embolism can be effectively treated.

StatisticsIn the EU-25, around 1.5 million people suffer from venous thromboembolism each year, and around 500,000 die from pulmonary embolism. people. This number is greater than the sum of deaths from breast cancer, prostate cancer, HIV infection and road traffic accidents. In Poland, about 40-50 thousand die from pulmonary embolism each year. people. Every year, about 60 thousand people should be diagnosed. cases of deep vein thrombosis and 30-40 thousand. pulmonary embolism. It proves great negligence in diagnosis and treatment.

• But knowing about the risks is not enough. After all, a sick person in a hospital depends on doctors

W.T .: I am not saying that the patient has to dictate the method of treatment to the doctor. But he can inform about his ailments and ask if adequate antithrombotic prophylaxis has been applied to him. The physician is obliged to follow the therapeutic standards that are developed for the various surgical speci alties. For example, if patients undergoing hip replacement surgery had not received thromboembolism prophylaxis, more than half of them would have developed venous thromboembolism.Therefore, before surgery, they are given drugs (low molecular weight heparins), which increase the risk of heavy bleeding during surgery and several hours after it, but protect against thrombosis. After surgery, the patient should receive injections in the abdomen for at least 35 days.

• Is heparin sufficient to minimize the risk?

W.T .: Antithrombotic prophylaxis also means combating obesity, increasing physical activity, and encouraging getting out of bed. You can also offer the patient to wear special stockings or use devices to help tighten the muscles, exercise the feet. Medicines prevent blood clots from forming, and drugs that formed earlier are more likely to dissolve. The effect is that the blood flow in the veins improves.

• And what is the treatment of deep vein thrombosis?

W.T .: Treatment of thrombosis and pulmonary embolism is a long and tedious process. It consists of two phases. In the acute phase of the disease, low molecular weight heparins are administered subcutaneously for 5-7 days. The next stage is the many months of anticoagulant treatment. The shortest therapy lasts 3 months, and sometimes even the whole life. Treatment effectiveness is assessed on the basis of the INR index, which should be measured at least every 3-4 weeks. It is burdensome for the patient, because not all laboratories perform this test. And it is important because the selection of the dose of the anticoagulant and the daily diet depend on it. The higher the INR values, the "less blood clotting" is. Many products (e.g. cabbage, lettuce, cauliflower, broccoli, spinach) contain vitamin K, which may reduce the effectiveness of the anticoagulant, especially when it is an older generation drug. Drinking alcohol is also forbidden.

• And innovative anticoagulant drugs?

W.T .: They simplify the treatment because they do not require INR determination. They are safer because they do not enter into as many food and drug interactions as previously used. Innovative therapeutics are still waiting to be registered in the European Union, we hope that all related procedures will be completed this year and we will be able to prescribe them to patients.

• You mentioned insufficient diagnostics. What follows from this?

W.T .: Deep vein ultrasound is the basic test that allows to assess the risk of thrombosis. The primary he alth care physician to whom the patient has been exposed cannot refer him for such an examination, because the National He alth Fund did not anticipate it. He may refer you to an angiologist or vascular surgeon. Time flies, there is no diagnosis, and the dangergrows. It also happens that without tests, the patient undergoes unnecessary and ineffective therapy. In our country, the determination of D-dimer in the blood (concentration of stabilized fibrin breakdown products) is not routinely performed, which is extremely useful in the process of excluding venous thromboembolism.

• Difficulty in accessing diagnostics, insufficient knowledge and neglecting slight pain symptoms often lead to tragedy

W.T .: It's true. Latent RCD can become a source of a pulmonary embolism with a fatal outcome, and sudden cardiac arrest and respiratory arrest is the first and only symptom of ongoing venous thromboembolism. A pulmonary embolism is mostly caused by a blood clot. In 90 percent in patients, its source is deep vein thrombosis. We have already talked about the mechanism of its formation. To show the scale of the problem, because I'm not going to scare anyone, only 30 percent. cases of pulmonary embolism are detected in the lifetime of the patient. This means that the vast majority (55-70%) of PE patients still die of this disease without proper diagnosis and treatment.

• There is also an idiopathic thrombosis, i.e. one where we do not know its cause

W.T .: This form of thrombosis occurs in many patients with UC. Often, it is based on a hidden neoplastic process - this applies to 10 percent. sick. It is worth remembering to do the appropriate research in time.

According to an expertprof. Witold Tomkowski, president of the Polish Foundation for Combating Thrombosis "Thrombosis"

I have establishedCoalition Against Thrombosis , it is an informal, interdisciplinary "round table" bringing together specialists from various fields of medicine in which there is the greatest risk of venous thromboembolism. Currently, the coalition consists of over a dozen scientists, but we invite everyone who helps to raise awareness of the risks associated with venous thromboembolism to participate in its work. Our goal is to reduce the mortality and complication rate associated with thrombus-induced stroke. We will strive to facilitate the diagnosis of deep vein thrombosis, increase public awareness of the risks associated with venous thromboembolism and atrial fibrillation.

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