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Senior Citizen Health & Medicine
Killers of 300,000 a Year: DVTs, PEs Most Likely to
Strike as We Age
Most deaths can be prevented by education, preventive
actions
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March 17, 2008 - They kill 300,000 people a year -
but most of them could be prevented. They strike more than a million
people every year, most of them out of the blue - and half without
causing symptoms. They target the bedridden, the hospitalized, the
elderly - and even some generally healthy people too. They are among
those villains that are more likely to strike as we get older. But many
senior citizens have no idea what they are, who gets them, or how to
avoid them.
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Read the latest news on Senior
Health & Medicine |
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“They” are blood clots that form in the veins of
the lower body, and sometimes break off and travel to the lungs, where
they can be deadly. In the legs and pelvis, they’re called
DVTs, short for deep-vein thrombosis. If they break off and travel
to the lungs they’re called PEs, for
pulmonary embolisms.
And they’re just starting to get the kind of
respect they’ve deserved all along.
Finally, after killing millions of people and
causing symptoms in millions of others, DVTs and PEs have made it onto
the radar screen of hospitals, government agencies and insurance
companies that want to prevent as many of them as possible.
But ultimately, everyone needs to learn more about
these clots, so more of them can be caught early before they become
dangerous, say
University of Michigan Cardiovascular Center experts who study and
treat DVTs and PEs. This is especially true for people who are planning
to have surgery or other treatments that will keep them off their feet
for days or weeks – making their legs more prone to vein clots.
“DVTs have been overlooked as a public health
threat for many decades, but they’re taking center stage now in the
health care community, and we hope individuals will also become more
aware,” says
Thomas Wakefield, M.D., chief of the
Section of Vascular Surgery at the
U-M Medical School and a member of the U-M Cardiovascular Center.
“At the same time, laboratory research is revealing more and more about
these clots, and how they could be targeted by new treatments.”
At the same time, the U-M Health System is leading
the way in preventing DVTs and PEs in all hospitalized patients. At the
end of April, a new computerized tool will make it even easier for
doctors, nurses and physician assistants throughout U-M’s three
hospitals to evaluate patients for their risk of clots, and provide
preventive care.
This tool, which grew out of a successful effort in
the U-M Department of Surgery that was spearheaded by the Office of
Clinical Affairs, will likely raise UMHS even further above the national
average for clot prevention.
Already, more than 91 percent of Medicare patients
hospitalized for surgery at UMHS receive appropriate DVT prevention
within 24 hours of their operation – much higher than the national
average of 75 percent, among hospitals listed in the federal Hospital
Compare database that tracks hospital quality. In all, 97 percent of U-M
surgical patients receive doctor’s orders for appropriate anti-clot
care. (Learn more, and find data on other hospitals, at
www.hospitalcompare.hhs.gov.)
Who’s at risk? (Also read more about risk
below this story)
First, it is important for all senior citizens to
know that the risk increases as your age increases.
Hospitalized patients are one of the highest-risk
groups for DVTs and PEs, as are those who have a spinal cord injury or
other paralysis, says Wakefield. A hospital patient’s risk varies
depending on the reason for the hospitalization, the seriousness of the
illness and any surgery he or she might have had.
As many as half of all hip-replacement patients,
for example, may develop a DVT or PE if they do not receive appropriate
preventive therapy.
Cancer patients may also have a high risk due to
their underlying malignancy, along with the medications they take.
At least 100,000 cases of PE occur each year in the
U.S. and it is the third most common cause of death in hospitalized
patients.
But clots affect many other people, and can happen
outside the hospital too.
One of the most publicized risk factors for DVTs in
relatively healthy people is long airplane flights, especially
trans-Atlantic or trans-Pacific flights where a passenger might be
sitting for many hours. Travelers on long car, bus or train rides also
face risk if they don’t get up and move around regularly, Wakefield
notes.
Young, otherwise healthy people are also more
likely to develop a DVT if they’re dehydrated, pregnant (especially
women on bed rest), new mothers, or are significantly overweight. Other
at-risk people include members of families that have a genetic
predisposition to abnormal clotting – a condition called thrombophilia.
And women who take birth control pills or hormone replacement therapy
also have a somewhat higher risk.
What are the signs? What can be done?
About half the time, DVTs announce their presence
by causing swelling, pain, redness and tenderness in a leg or other area
of the lower body near a “deep vein.” DVTs are not the same thing as
varicose veins or spider veins, though those two conditions can mean
that a person is at risk of a DVT or PE because of chronically poor
circulation in the legs.
But many DVTs go unnoticed until they break off and
cause a PE. When that happens, a person might experience sudden
shortness of breath or chest pain that gets worse with a deep breath or
coughing. They may even cough up blood. No matter what the symptoms, PE
patients must get treatment immediately, or risk dying from the effects
of the clot.
To keep a PE from happening once a DVT is found,
doctors will often prescribe one of several blood-thinning drugs that
encourage the body to break down the DVT clot and keep more clots from
forming. Compression stockings can also be worn, to help blood move out
of the legs.
In some patients, a DVT is large and dangerous
enough that doctors may try to remove it by threading a tiny catheter
into the vein, use a device to mechanically disrupt the clot, and infuse
specialized medications to help dissolve the clot. A new clinical trial
comparing this approach to blood-thinning drugs will soon begin
nationally and U-M will be a site for this trial.
And in patients who have a high risk of PE and
can’t take blood-thinning medicines, a wire filter device to catch clots
might be implanted in the vena cava, the large vein that leads from the
lower body. In 1973, the first such filter was co-developed by Lazar
Greenfield, M.D., who is now an emeritus professor of surgery at U-M.
The “Greenfield filter” has been improved many times since then, and is
still used.
To help people with DVTs, PEs and other
vein-related conditions, the U-M Cardiovascular Center will soon launch
a multidisciplinary clinic for venous disease. There, patients will be
able to get coordinated, specialized care from vascular surgeons,
interventional radiologists, vascular medicine specialists,
hematologists and the U-M Anticoagulation Service, which specializes in
optimizing the care of patients who need long-term blood thinning
treatment with the drug warfarin or other drugs.
New clues through research
Although prevention and treatment for DVTs and PEs
has come a long way in recent years, scientists and doctors still have a
lot to learn about why they happen, and what the long-term risks are for
someone who has already had a DVT or PE.
The U-M has a large team of researchers who study
clot formation, vein wall damage caused by DVTs, and possible new
treatments for DVTs and PEs. They pursue their basic-research studies in
the
Conrad Jobst Vascular Surgery Research Laboratory, named for a
pioneer in the field of compression garments, and endowed by a gift from
his wife Caroline before her death.
This month, U-M researchers led by
Peter Henke, M.D., published a paper in the Journal of Vascular
Surgery on the effect of low-molecular weight heparin on DVT clots and
vein wall recovery, based on research in mice. That study may have
direct implications for clinical use of the drug.
Also this month, Wakefield, Henke and their
colleague Daniel Myers, DVM, published a major review article on the
mechanisms of vein clot formation and resolution in the journal
Arteriosclerosis, Thrombosis and Vascular Biology. That paper provides
evidence that inflammation plays a role in the formation of DVTs – a
finding that challenges previous thinking about their origin.
For more on U-M basic vascular research, visit the
Jobst Laboratory site at
sitemaker.umich.edu/jobst. For more on vascular care at U-M, and the
free vein screening on March 28, visit
www.umcvc.org or call toll-free 1-888-287-1082.
Editor’s Notes
Original report written by: Kara Gavin
Doctors at the U-M Cardiovascular Center are
preparing to launch a new specialized Venous Disease Clinic for people
with DVTs, or vein problems that might make them prone to DVTs. They’re
also holding a
free screening on March 28 for anyone who suspects they might have
vein-related problems.
Are You At Risk for Deep Vein Thrombosis?
Deep Vein Thrombosis (DVT) Awareness Month in
March
Deep vein thrombosis (also called DVT or blood
clots) is an under-diagnosed and preventable medical condition that
occurs when a blood clot forms in a large vein. Every year 30,000 to
60,000 people in the U.S. die when part of the clot breaks off and
travels through the bloodstream to the lungs, causing a pulmonary
embolism. Learn if you’re at risk and how to protect yourself.
In recognition of Deep Vein Thrombosis (DVT)
Awareness Month in March, CDC encourages you to find out if you are at
risk for DVT and learn how to protect yourself.
Almost anyone can have DVT. However, certain
factors can increase the risk of developing this condition. The risk
increases even more for someone who has more than one risk factor at the
same time.
Factors that increase the risk of developing DVT
include:
•
Major surgery
•
Immobility, such as being in the hospital and long travel
•
Recent injury
•
Increased estrogen, from birth control pills, pregnancy, and certain
medications
•
Certain chronic medical illnesses, such as heart disease and cancer
•
Previous DVT
• Age
(risk increases as age increases)
•
Obesity
•
Smoking
Five steps you can take to protect yourself:
1. Move around as soon as possible after having
been confined to bed, such as after surgery,
illness, or injury.
2. Talk to your doctor about wearing graduated
compression stockings (sometimes called "support
hose" or "medical compression stockings").
3. When sitting for long periods of time, such as
when traveling for more than four hours:
• Get
up and walk around every 2 to 3 hours.
•
Exercise your legs while you’re sitting by:
•
Raising and lowering your heels while keeping your toes on the floor.
•
Raising and lowering your toes while keeping your heels on the floor.
•
Tightening and releasing your leg muscles.
• Drink plenty of water,
and avoid drinking anything with alcohol or caffeine in it.
4. Talk to your doctor about medication
(anticoagulants) to prevent or treat DVT.
5.
Exercise regularly, maintain a
healthy weight, and
don’t smoke.
For More Information from Centers for Disease
Control & Prevention (CDC)
>>
DVT Information
>>
Information for Health Care Professionals
>>
CDC Division of Blood Disorders
Centers for Disease Control & Prevention
What Is Deep Vein
Thrombosis?
Deep vein thrombosis (throm-BO-sis), or DVT, is a
blood clot that forms in a vein deep in the body. Blood clots occur when
blood thickens and clumps together.
Most deep vein blood clots occur in the lower leg
or thigh. They also can occur in other parts of the body.
A blood clot in a deep vein can break off and
travel through the bloodstream. The loose clot is called an embolus.
When the clot travels to the lungs and blocks blood flow, the condition
is called
pulmonary embolism (PULL-mun-ary EM-bo-lizm), or PE.
PE is a very serious condition. It can damage the
lungs and other organs in the body and cause death.
Blood clots in the thigh are more likely to break
off and cause PE than blood clots in the lower leg or other parts of the
body.
Blood clots also can form in the veins closer to
the skin's surface. However, these clots won't break off and cause PE.
The animation linked below shows a deep vein blood
clot. Click the "start" button to play the animation. Written and spoken
explanations are provided with each frame. Use the buttons in the lower
right corner to pause, restart, or replay the animation, or use the
scroll bar below the buttons to move through the frames.
The animation shows how a blood clot in a deep vein
of the leg can break off, travel to the lungs, and block blood flow.
>>
Click to Animation from National Heart, Lung and Blood Institute and
links to more detailed information
>>
More information on Thrombophlebitis (Also called: Deep vein
thrombosis, DVT, Phlebitis) at MedlinePlus
What Is Pulmonary
Embolism?
A pulmonary embolism (PULL-mun-ary EM-bo-lizm), or
PE, is a sudden blockage in a lung artery, usually due to a blood clot
that traveled to the lung from a vein in the leg. A clot that forms in
one part of the body and travels in the bloodstream to another part of
the body is called an embolus.
PE is a serious condition that can cause:
●
Permanent damage to part of your lung from lack of blood flow to lung
tissue
●
Low oxygen levels in your blood
●
Damage to other organs in your body from not getting enough oxygen
If the blood clot is large, or if there are many
clots, PE can cause death.
Overview
In most cases, PE is a complication of a condition
called
deep vein thrombosis (DVT). In DVT, blood clots form in the deep
veins of the body—most often in the legs. These clots can break free,
travel through the bloodstream to the lungs, and block an artery.
This is unlike clots in the veins close the skin's
surface, which remain in place and do not cause PE.
Outlook
If left untreated, about 30 percent of patients
with PE will die. Most of those who die do so within the first few hours
of the event.
>>
More information on Pulmonary Embolism from National Heart, Lung and
Blood Institute
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is also a card to send to friends in the hospital.