Blood Clots: What You Don't Know Can Kill You

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Blood Clots: What You Don't Know Can Kill You

2 hours, 36 minutes ago

By Gardner

HealthScoutNews Reporter

FRIDAY, Nov. 1 (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.

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. 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.