Clotting Legs - Blood Clots in veins

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Sunday December 23, 2007
Clotting legs
By Dr A. T. KUMARARAJAH

Blood clots in the vein can spell major trouble. Doctors need to do more in terms of preventing its occurrence in those who are at high risk for it.

EACH year, an increasing number of lives are lost to complications of one particular condition, usually referred to as the 揺conomy class syndrome

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Acquired disease factors

Acute medical illnesses like acute infection, heart attack, stroke, heart failure, respiratory failure, nephrotic syndrome and inflammatory bowel disease are some of the diseases where patients are known to have a higher risk for DVT, both in the pre-and post-operative periods.



Risk specific for women

Though there is no gender bias for DVT risk, women however have an extra set of factors like hormone replacement therapy (HRT), oral contraceptive pills (OCP) and pregnancy which should be taken into account.

As far as HRT is concerned, the patients on it have a risk of at least two times higher and the figure is about 1.5 to 2.5 times higher for those on OCPs.

Women with BMIs above 35, or those with hypertension and previous history of VTE, are at the highest risk and should not be on the pill.  

The Royal College of Obstetricians suggest that there is no need for discontinuation of HRT, while for those on OCPs, they will need to discontinue for at least four weeks before any major surgery.

Pregnancy is also another physiological condition where the risk of DVT is known to be higher. If the risk of venous thromboembolic (VTE) diseases (DVT is part of this spectrum of such diseases) are one in 10,000 in non-pregnant women, then it抯 in the order of 0.7 to 1.3 in every 1,000 pregnant women. This is a whopping 10 times increase for pregnant mothers.  

In fact VTE in pregnancy is the third leading maternal mortality factor in Malaysia.  



What happens after DVT?

DVT can have serious consequences. The blood clot in DVT usually remains stuck to the vessel wall and the symptoms tend to settle gradually.  

However, there are various main possible complications, which is the potentially fatal pulmonary embolism, post-thrombotic syndrome and pulmonary hypertension.

Pulmonary embolism is a very serious and potentially fatal condition that can also arise because of DVT. Although we can抰 quantify the prevalence in Malaysia easily, there is one case of pulmonary embolism reported every minute in the US alone and that account for some 650,000 cases every year.  

A large pulmonary embolus can cause collapse and sudden death. It抯 reported that four out of every 10 patient who develops acute PE will die when left untreated.





The role of prophylaxis

Physicians and patients have a crucial role to play to alleviate the risk of DVT. If the right patient can be profiled and managed appropriately, then the risk of DVT can be managed well.  

We should be able to marry risk predictors, signs and symptoms to develop a clinical prediction rule. This will then allow us to profile the patients to high, moderate or low risk

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just wanna add -

dvt - reminds me of my neighbour when i was in oversea -
she was pregnant at that time - and she showed me her blood
clotting - vericose veins which was unimaginable  pain -

and she hafta wear one tight - (doctor prescribed) i think quite
expensive around C$100 one leg - brown in colour but the legging / tight
contain some stuff that makes the veins less painful  etc
i am not exactly sure what that is - but she hafta wear it
all the time - till almost the time she going for delivery -

and my sister also suffers this too during her pregnancy -
only during pregnancy --
and when i read an article about it - it said that it is genetic -
meaning if your mother suffers it before - at least one of the
children will inherit it -

amazed

Vena Varikos pada kaki

Oleh Dr. JAMALUDIN YUSAK (Pakar Bedah Am, Pusat Perubatan Darul Ehsan, (DEMC), Shah Alam)

VENA timbul boleh berlaku pada bahagian muka (kiri) dan kaki sementara vena varikos yang teruk akan menyebabkan salur vena timbul dengan lebih jelas, seperti pada kaki (gambar tengah) di samping menyebabkan ulser kaki.

Pergerakan darah di dalam badan manusia adalah melalui dua saluran iaitu arteri atau saluran nadi yang mengalirkan darah dari jantung ke seluruh badan, dan vena (vein) atau pembuluh darah yang membawa darah dari seluruh badan balik ke jantung.

Aliran darah di dalam arteri mempunyai tekanan kuat dan deras berdasarkan kekuatan degupan jantung seseorang.

Manakala pengaliran darah di dalam vena adalah lebih lemah berdasarkan pergerakan otot-otot anggota badan dan juga otot kecil yang terdapat di dalam dinding vena sendiri.

Apabila seseorang itu berdiri, darah akan berkumpul dengan banyak di bahagian kaki akibat dari kesan tarikan bumi dan tekanan aliran darah yang rendah.

Perjalanan darah di dalam vena menjadi lancar dan tidak berkumpul di kaki melalui pergerakan otot-otot anggota badan.
Selain itu, otot kecil yang terdapat di dalam dinding vena turut mengepam darah kembali ke jantung dan terdapat juga injap-injap di dalam vena yang menghalang darah kembali ke bahagian kaki (mengalir songsang).

Sistem pengaliran darah vena di kaki di bahagi kepada dua iaitu, vena luaran (saphenous vein) yang mengalir di bawah permukaan kulit dan vena dalaman (deep vein) yang mengalir berhampiran tulang dan otot.

Vena varikos (vericose Vein)

Varikos adalah daripada perkataan Latin yang bermakna 揵erpintal