Health Checkup
1:00 am
Mon March 26, 2012

Deep Vein Thrombosis

Be aware that prolonged times of sitting still while traveling or while at the office can be dangerous. Blood clots can form in deep veins of the arms and legs, torso or pelvis, or the neck. In this KERA Health Checkup, Dr. Ana Lorenzo of Vein Care Solutions tells Sam Baker deep vein thrombosis or DVT can be a serious condition.

Dr. Lorenzo: There is an associated six percent mortality with someone who forms their first deep vein thrombosis.

Baker: How and why?

Dr. Lorenzo: There is an association with the conditions that predispose them to forming that clot to begin with. But additionally some clots break off and embolize and go to your heart and lungs. Common symptoms would include swelling and pain in an arm and leg. Occasionally the skin develops a blue or congested type of appearance to it. Those would be the classic symptoms, but there are many patients who do not develop these symptoms.

Baker:  Hearing about this now in connection with people who travel: is it specifically tied to that? Are we talking about that or are we just talking about cases of people sitting still for long periods of time?

Dr. Lorenzo: Correct. It’s the immobility. This can also occur when someone is critically ill and bed bound.  Or for when there is immobility because of a fracture.

Baker: But in terms of travel, it can’t help that when you have people crowded in coach on planes like sardines -- that can’t help matters.

Dr. Lorenzo: A lot of that is related to the fact that we’re not flexing our calf muscles. Our calf muscles are very important pumps for getting blood to return to our heart. So when you are immobilized by sitting too long or you wear tight, constrictive clothing - that also impairs flow.

Baker: Are some people more prone to this than others?

Dr. Lorenzo: Yes. There are people who have what we call a hypercoagulable disorder, in which they have a tendency to accumulate clot, either because they form it at an unusual rate or they don’t have the ability to reabsorb clot once its formed.

DVT occurs under a condition of a low flow state - for example, when someone is very dehydrated or has a very low blood pressure. It can occur when the vein is traumatized, either bluntly, like a sprain or a blow, or having an I-V in place. Additionally, if that patient or the person has that condition that predisposes them because of an abnormality of the blood itself.

Baker: Does pregnancy factor in here somewhere?

Dr. Lorenzo: In as much as the increased pressure in the pelvis can slow down the flow in your leg, yes it can.

Baker: Are there other conditions you could have that could lead to DVT?

Dr. Lorenzo: Things like malignancy, or in times of stress, like sepsis or severe infection.

Baker: How do you treat this?

Dr. Lorenzo: We mostly try to prevent it, trying to avoid times of prolonged immobility, avoiding dehydration, trauma to the veins. In the hospital we encourage patients to get up and walk as soon as they are able. The more critically ill a patient, the more likely it is that we will actually add a blood thinner to their medication regimen.

Baker: So back to people who are traveling. What can you do on your own to prevent this?

Dr. Lorenzo: We encourage people to do heel and toe raises to simulate the action of flexing the calf. Additionally I recommend that people have a well-fitted compression hosiery to prevent the pooling of blood into the legs.

Baker: Compression hosiery?

Dr. Lorenzo: They are socks that apply pressure so the natural tendency of gravity to pull blood into your legs is overcome.

Baker: Is it best to get up and walk around as opposed to sitting long periods before you board the plane?

Dr. Lorenzo: Walking before you board the plane and making sure you avoid dehydration is critical.

Dr. Ana Lorenzo is with Vein Care Solutions.

For more information:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001209/

http://www.ahrq.gov/consumer/bloodclots.htm