Blood clots restrict the normal flow of blood circulation in the body. Blood clots can occur in the legs, abdomen, arms, lungs, heart or the brain.
This week Interventional cardiologist Dr Harun A. Otieno discusses how blood clots are diagnosed, treated and managed.
The Ministry of Health 2018 national guidelines for cardiovascular diseases management notes that when a blood clot (thrombus) forms in one or more of the deep veins in your body, commonly in your legs in the case of Deep Vein Thrombosis, the common symptoms include;
- Sudden onset of pain in one leg or tenderness of the thigh or calf
- Leg swelling
- Skin that feels warm to the touch
The gold standard for diagnosis clots either in the legs or hands is an imaging test called a venous Doppler or ultrasound. If more accuracy is required a venogram test can be done with CT scanning.
Dr Otieno says that a blood tests can also be used to diagnose blood clots which mostly occur in the legs. “A blood test known as a D-Dimer checks for the presence of blood clots whereas an ultrasound visualizes the blood clot in the vein, if any” Dr Otieno said. However, the blood test can be positive but the ultrasound shows no evidence of a blood clot. ” A repeat ultra-sound is done in 7 days to rule out Deep Vein Thrombosis in such cases,” Dr Otieno added.
The main goal of treatment of blood clots is to prevent them from getting larger, breaking loose and travelling to vital organs like the lungs where they restrict blood supply and can cause complication, even death. Dr Otieno notes that the specific treatment given once a blood clot is confirmed is on a case-to-case basis.
A blood clot
According to Dr Otieno, a blood clot could have reached your lungs if you experience symptoms like difficulty in breathing, chest pain, fainting spells and a fast heartbeat.
The treatment options include;
- Medication- blood thinners
- Compression stockings
These medicines are given as an injection or by mouth to prevent the existing clots from getting bigger. Clot busting drugs cannot be used in some cases especially if the patient has low blood pressure, then surgery is performed to remove the clot. This surgery is known as thrombo-endarterectomy. These are medicines also known as anti-coagulants and their role is to reduce the body’s ability to form new clots.
These are elasticated stockings that fit over the foot and extend up to the calf. They are designed to assist venous blood flow out of the lower legs and back up toward the heart.
“The graduated compression stockings are used to prevent and treat blood clots. Class 1 are used to prevent blood clots from forming especially if you are hospitalized or travelling for long distances. Class 2 are used to treat severe varicose veins or swelling after a blood clot due to complications while Class 3 stockings are used when lymphatic fluid drainage is impaired like in lymphoedema,” said Dr Otieno.
What are the standards for the use of the graduated compression stockings?
- Ensure you wear the correct size
- Use stockings that provide the desired compression
- Remove the stockings daily for hygiene purposes and to inspect the skin condition
- Inspect the skin twice or thrice a day especially over the heels and bones prominence
- Wear class 1 stockings day and night in hospital until the patients no longer have significantly reduced mobility
- Discontinue the socks if there are blisters, discolouratio of the skin, pain or discomfort
In some cases, a surgery known as thrombectomy is recommended to remove a blood clot (s) that are very large or are causing severe damage to nearby tissues. After removing the clot, a small tube known as a stent may be inserted into the blood vessel to ensure it stays open.
Managing further risk
When all is said and done, here are a few lifestyle factors that can be adopted to prevent and manage blood clots.
- Wear loose fitting clothes
- Quit smoking
- Stay hydrated
- Wear prescribed compression stockings
- Exercise regularly
- Raise your legs whenever you are seated
- Manage your salt intake
- Maintain a healthy weight
- See the doctor if any new or sudden pain or swelling of the leg