Dr Arvind Kohli
Recognized on 13 October every year, the birthday of Rudolf Virchow, pioneer in the pathophysiology of thrombosis, World Thrombosis Day (WTD) focuses attention on the often overlooked and misunderstood disease of thrombosis.This years theme has been adjudged as Move against Thrombosis which encourages people to get up and move to increase blood circulation, which can help lower the risk of blood clots. Reduced mobility can lead to a higher risk of blood clotting and is a significant driver in morbidity and mortality.
WHAT IS THROMBOSIS? .Thrombosis, both arterial and venous, is a major cause of mortality and morbidity across the world. Thrombosis occurs when a clot develops inappropriately inside a blood vessel such as a vein or artery. Although blood clotting at site of injury is a normal function of blood, thrombosis is a condition of concern – clots occurring in a blood vessel can grow to form a blockage known as a thrombus Once formed, a thrombus can restrict blood flow, and present further danger by breaking free – allowing its passage into an organ. In the circulatory system, this is called an embolism. Thrombosis can be life-threatening, frequently manifesting as cardiac arrest, thromboembolic stroke, and venous thromboembolism
Venous thromboembolism (VTE), with a reported annual incidence of 0.7-2.69 per thousand, has a high recurrence rate, negative impact on survival, and incurs high healthcare costs. Arterial thrombosis constituting ischemic heart disease and stroke is responsible for one in four deaths worldwide .
Stroke, a major complication becoz of thrombosis is rapidly developed clinical signs of focal(or global) disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than of vascular origin
It is responsible for 3.5% of disability adjusted life year (DALY) in India.Apart from risk factors like hypertension, diabetes, heart diseases and positive family history, other lifestyle related factors such as unhealthy diet, obesity, lack of physical activity, stress and tobacco use account for its occurrence. Changes in lifestyles, behavioural patterns, demographic profile (aging population), socio-cultural and technological advancements are leading to sharp increases in the prevalence of stroke. The disease by and large can be prevented by making simple changes in the way people live their lives or simply by changing our lifestyle.
Presenting features of stroke are Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body . Sudden confusion, trouble speaking, or difficulty understanding speech” Sudden trouble seeing in one or both eyes” Sudden trouble walking, dizziness, loss of balance, or lack of coordination” Impairment or loss of consciousness”
Acute Coronary EVENT(Heart Attack) acute coronary syndromes (ACS), an umbrella term for situations in which blood supplied to the heart muscle is suddenly blocked.
The blockage is usually due to a blood clot and can be sudden and complete. If a clot forms due to a plaque rupture, a part of the clot may break away and clog one of the coronary arteries causing ACS. Though less common, spasms in the coronary artery may also limit blood flow. Regardless of the cause of the blockage, it’s damaging to the heart and a medical emergency. Take note of these common signs of an acute coronary syndrome:Chest pain or discomfort, which may involve pressure, tightness or fullness Pain or discomfort in one or both arms, the jaw, neck, back or stomach Shortness of breath Feeling dizzy or lightheaded Nausea Sweating
Deep Vein Thrombosis When a blood clot develops within a deep vein in the body, it is known as deep vein thrombosis or DVT. It can affect people of any age, but the risk of DVT increases with age. Forty percent of DVTs develop into a potentially deadly pulmonary embolism (PE). These two conditions collectively are known as venous thromboembolism, or VTE.
Fatal PE is the most dramatic effect of VTE and remains the most common preventable cause of death in hospitalized patients. The best strategy is prevention by adequate prophylaxis for VTE. Early detection is essential for improved out come and requires a high degree of suspicion, when patients have: Unexplained tachycardia Unexplained fever Chest pain Dyspnea Hemoptysis Treatment of PE is decided by the cardiovascular status of the patient.
Intestinal ischemia occurs when at least a 75% reduction in intestinal blood flow for more than 12 hours. Bowel ischemia can be classified as small intestine ischemia, which is commonly known as mesenteric ischemia and large intestine ischemia, which generally referred to as colonic ischemia Etiologies of acute intestinal ischemia can categorize as mesenteric arterial embolism (50%), intestinal hypoperfusion or nonocclusive mesenteric ischemia (NOMI) (20% to 30%), mesenteric arterial thrombosis (15% to 25%) and mesenteric venous thrombosis (MVT)(5%).
LEG ATTACK While most understand the severity of heart attacks, few are aware of the condition of leg attacks. even though the disease affects about 10million Indians every year. Leg attacks are also known as Peripheral Arterial Disease (PAD) and is a condition in which plaque builds up in the arteries that carry blood to the limbs. Hence to prevent PAD or improve symptoms of PAD.its important to get plenty of physical activity Move against peripheral thrombus
Do not use tobacco. As Smoking increases the risk of PAD and makes PAD symptoms worse. Its important to control high blood pressure and manage high blood cholesterol and diabetes.as well to participate in supervised exercise training programs which can improve and prolong ability to walk longer distances.
Why is there limited awareness about blood clots?
Many people do not know much about blood clots and are not familiar with the signs and symptoms until it happens to them or someone they know. In addition, the signs and symptoms of a DVT and PE are similar to other health problems and can be misdiagnosed as other health conditions. A misdiagnosis can lead to delayed treatment of a DVT, resulting in a PE or even death. Understanding risk for a blood clot and the signs and symptoms can help patient seek treatment at the earliest sign of a blood clot to prevent any complication
Who is at risk for a blood clot Blood clots can affect anyone at any age, but certain risk factors, such as surgery, hospitalization,prolonged immobilisation pregnancy, cancer and some types of cancer treatments can increase risks. In addition, a family history of blood clots can increase a person’s risk. Medical diseases which affect blood rheology are important causes
DIAGNOSIS
The diagnosis of clot in vascular system is generally based upon clinical history ,timing of the event along with the available biochemical and radiology imaging
D-dimer assessment Plasma D-dimers are derivatives of fibrin degradation products and are found to be raised in patients with thromboembolism. Plasma D-dimer assay has very high sensitivity but poor specificity for venous thrombosis and hence a patient with low probability of DVT with a negative D-dimer test has almost no chance of having venous thrombosis.
Duplex ultrasonography also called Doppler test It is cheap, easily available, and non-invasive. However, it does have some disadvantages that need to be kept in mind – diagnosis of isolated calf vein DVT and evaluation of iliac veins is often dependent on operator experience, patient habitus, and the clinical situation. Despite these limitations, a negative report from a single, technically adequate ultrasound examination is sufficient grounds to withhold anticoagulation therapy.
Computerized tomography (CT) pulmonary angiography is the most useful test for detecting a pulmonary embolus. It can be combined with CT venography as a single scan to diagnose both PE and DVT.Carotid and brain CT angio scans and Coronary imaging are most important for assessment and diagnosis of stroke and myocardial events
World Thrombosis Day Campaign These campaigns play a crucial public health role in raising awareness, preventing disease, and demonstrate that resources directed to communicating prevention messages are cost?effective. There are simple public health messages with effective communication channels to the public that can have a direct impact on thrombotic disease awareness and prevention.
These messages include:
1)”Know the risks, signs, and symptoms of blood clots;”
2) Potentially fatal blood clots in the veins can be prevented;
3)Atrial fibrillation can be easily diagnosed by a doctor feeling one’s pulse, and
4) Effective strategies for prevention of stroke in patients with atrial fibrillation are available.
Take Action These thrombotic events either cause sudden death or a deterioration in the quality of life. Despite the seriousness of their outcome, not many people pay attention to their prevention. Although the outcomes of these thrombotic disorders are serious; their onset could be prevented using proper prophylaxis.
Hence The aims of the World Thrombosis Day campaign are to
(i) highlight the burden of disease and the need for action,
(ii) increase public awareness of the significant risks, signs, and symptoms of thrombosis,
(iii) empower individuals to talk with their healthcare providers about their risk for thrombosis and appropriate prevention,
(iv) galvanize organizations in countries across the globe, and
(v) advocate for “systems of care” to properly prevent, diagnose, and treat venous thrombosis (VTE) and atrial fibrillation (Afib)
(The author is Cardio Thoracic & Vascular Surgeon GMC Jammu)
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