What is Venous Thromboembolism
Definition: Venous thromboembolism (VTE) is the lodging of a blood clot in the vein. The formation of blood clot in a deep vein, which happens usually in the leg, is referred to as Deep Vein Thrombosis (DVT). The breaking loose of a clot that makes its way to the lungs is called Pulmonary Embolism (PE). Both are collectively known as venous thromboembolism which is a dangerous and life-threatening medical condition.
The lower extremities are the most common site for DVT, but it may affect other areas including the upper extremities, mesenteric and pelvic veins, as well as the cerebral veins. A venous thrombi is mainly composed of red blood cells and fibrin. It can form in sites of damage blood vessel and areas of stagnant blood flow such as valve pockets of the deep veins in the calf or thigh. Thrombi either: (1) remain in the peripheral veins, where they eventually undergo endogenous recanalization and fibrinolysis; or (2) cause pulmonary embolism when reached the pulmonary arteries.
Venous thromboembolism is a leading cause of death and disability worldwide. Due to the unawareness of many people about VTE, the death population percentage from this ailment has been increasing in number.
1. Venous Thromboembolism Epidemiology
Every year, there are an estimated 10 million cases of venous thromboembolism worldwide whether it be low, middle, or high income country. In the US and UK, venous thromboembolism-related medical conditions kills more people than AIDS, forms of cancer, and motor vehicular accidents combined. There are over 100,000 to 300,000 VTE-related deaths every year. Up to 60% of venous thromboembolism cases occur during or after hospitalization, making it one of the most preventable factors of hospital death.
2. Risks of Venous Thromboembolism
Always remember that venous thromboembolism does not discriminate. It does not choose certain people. It affects any age, gender, race or ethnicities. Smoking and alcohol consumption are very common risks for developing venous thromboembolism. Cardiovascular risk factors like hypertension, diabetes, and high cholesterol are also linked with the development of this condition. Other factors include obesity, family history of blood clots, previous surgeries, and usage of estrogen-based medications like oral contraceptives. Most patients with venous thromboembolism carry one or two of these factors.
3. Signs and Symptoms of VTE
Venous thromboembolism can occur without any warning signs or symptoms. It can go unrecognized and undiagnosed by a healthcare professional. But in some cases, symptoms can be observed to suggest deep vein thrombosis or pulmonary embolism. In deep vein thrombosis or DVT in the leg, common signs and symptoms are tenderness or pain which often starts in the calf or thigh, swelling of the ankle or foot, redness or noticeable discoloration and increased warmth on physical examinations. On the other hand, pulmonary embolism symptoms include unexplained shortness of breath, rapid breathing, chest pain, rapid heart rate, light headedness, or passing out.
4. Available Treatment for Venous Thromboembolism
Venous thromboembolism is a serious and life threatening condition which certainly requires immediate medical attention. There are different treatments that can be done for patients with VTE. Available options are anticoagulants such as heparin, dabigatran, warfarin, edaxaban, and apixaban; mechanical devices like compression stockings; and thrombolytic therapy. You can get compression socks here. Early diagnosis and treatment often lead to recovery, but long-term complications such as post-thrombotic syndrome may occur.
5. Diagnostic Therapies for Venous Thromboembolism
Different types of therapies can be used to diagnose patients with venous thromboembolism, acute case of pulmonary embolism, and deep vein thrombosis. The widely available method is called Duplex Ultrasonography. It’s an imaging procedure and the usual diagnostic method of choice for DVT being less invasive and less costly than other procedures. However, it cannot always distinguish between acute and chronic deep vein thrombosis and findings can be difficult to achieve in obese patients. The gold standard for diagnosing deep vein thrombosis is called “Contrast Venography”.
6. Pregnancy and Venous Thromboembolism
Venous thromboembolism is a leading cause of maternal death. The main reason for the increased risk of venous thromboembolism in pregnancy is hypercoagulability. The hypercoagulability among pregnant women appears as early as the first trimester making it a time of heightened time of risk for having venous thromboembolism to occur. Hypercoagulability is present in pregnant woman in order to protect them from bleeding challenges during childbirth. Increased risks for venous thromboembolism during pregnancy include being pregnant at the age of 35 years old and above, cesarean section, pre-eclampsia, a history of previous venous thromboembolism, and family history of thrombosis. LMWH (low molecular rate heparin) is the anticoagulant of choice when pregnant.
7. Venous Thromboembolism in Children
Approximately 95% of cases of venous thromboembolism in pediatric patients occur in people with cancer, surgery/trauma, congenital heart disease, and systemic lupus erythematous. Venous thromboembolism among children was originally thought to be rare, but an increase in the number of incidents related to venous thromboembolism in pediatric patients have been observed over the years. Venous thromboembolic events are most common in neonates and infants, followed by adolescents. Interestingly, children between ages 6 to 10 years have the lowest incidence compared to the 2 former age groups.
8. Venous Thromboembolism is an economic burden
In addition to being a disease burden, venous thromboembolism can cause significant global economic burden. Multiple diagnostic tests and treatments, prolonged hospitalization and follow-up care – with the inclusion of recurrent VTE – can be significantly costly. In the US, diagnosis and treatment of venous thromboembolism cost $15.5 billion every year. But by focusing on VTE prevention, healthcare systems can save money, improve outcomes, and ultimately save lives. Some countries have already began implementing venous thromboembolic disease protocols and policies that standardize – and even encourage – hospital use of venous thromboembolism prophylaxis practices.
9. Preventing Venous Thromboembolism
Research advocates that VTEs are often preventable. Evidence-based prevention strategies can stop the development of clots in ‘at-risk’ individuals. Hospital patients should also be advised to perform foot/leg exercises or move around as soon and as often as possible.
10. Awareness against Venous Thromboembolism
Venous thromboembolism doesn’t only bring disease burden on a family but costly treatments and diagnosis as well. Venous thromboembolism is worldwide and many are caused by hospitalization associated factors. Many are now bringing into awareness around the world information about these types of conditions and made the 13th of October “World Thrombosis Day”. Every year it is being celebrated to make people understand it further.
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