Terry’s right leg had ached for the last two months. She dismissed the discomfort attributing it to work fatigue.
When the pain shifted to the upper leg and her knee hurt too, she popped a few painkillers several times a day. The pain would go away anyway, she presumed, but each day, walking became a struggle. She walked in pain like her right limb didn’t belong to her and each step became a negotiation with her legs to carry her one more step. When the pain persisted, she took stronger painkillers as advised by a colleague. The ache went away for only for a day before it returned with even more excruciating pain.
A visit to the doctor was life-saving! An ultra-sound scan showed that she had two blood clots in her right leg. It appeared that they were travelling upwards towards her lungs., where they could become lethal. She was promptly placed on blood thinners that she took by mouth. Fortunately she was not hospitalized but was closely observed by her doctor.
The formation of a blood clot.
What is a blood clot or thrombosis ?
It is the solidification of blood at the site of an injured blood vessel. Blood clots are healthy and lifesaving when they stop bleeding. However, they can also be life-threatening when they form in abnormal sites or where they are not needed. When they form in deep vein of the legs, it is called DVT. When they dislodge and break off, they can travel to the lungs. Blood clots can lead to serious complications when they block blood flow to the lungs. They result in impeding the flow of blood through the circulation and can cause the heart to stop beating.
A 2011 paper by Michele Beckman and colleagues in the American Journal of Preventive Medicine recommended that when a patient presented with the symptoms of Deep Vein Thrombosis, it should be verified by an ultrasound given the high rate of sudden deaths.
Dr Harun Otieno, an Interventional Cardiologist at Africa Heart Associates, warns that blood clots mostly begin at the site of the clot especially in the leg. They manifest as a swelling, pain, redness, discoloration of the skin and tenderness on squeezing the leg. Cramps may occur when bending the foot. Dr Otieno further noted that in a small number of persons, there are minimal signs, hence regular medical checks are advisable for any discomfort in the legs.
Dr Harun A. Otieno FACC, FRCP Edin, an Interventional Cardiologist at Africa Heart Associates, Aga Khan University Hospital. Photo Courtesy of Africa Heart Associates.
“The formation of a clot may be due to damage of a blood vessel, a change in the normal blood flow or an abnormality in the blood where it has an increased tendency to clot,” said Dr Otieno. He further explains that Deep Vein Thrombosis and Pulmonary Embolism are cousins.
“When a blood clot forms in a major vein of the leg or, less commonly, in the arms, pelvis, or other large veins in the body, this is known as Deep Vein Thrombosis. When the blood clot travels to your lungs and blocks a blood vessel, this is known as Pulmonary Embolism,” Dr Otieno added.
According to Dr Otieno, most of the pulmonary embolism cases are treatable, if diagnosed early enough within the critical time.
“A large clot that has travelled through the bloodstream is life-threatening can completely block blood flow to the lung,” Dr Otieno noted. At this stage, the symptoms can be and is life threatening. Symptoms of a PE can include sudden shortness of breath, pain with deep breathing, fast heartbeat, coughing up blood, light-headedness, and fainting.
Who is at risk of developing blood clots?
The following factors can increase your risk of developing deep vein thrombosis (DVT).
- Inheriting a blood-clotting disorder
- Prolonged bed rest, such as during a long hospital stay, or paralysis
- Injury or surgery
- Birth control pills (oral contraceptives) or hormone replacement therapy
- Being overweight or obese.
- Heart failure.
- A personal or family history of deep vein thrombosis or pulmonary embolism.
- Being older than 60
- Sitting for long periods of time, such as when driving or flying
In addition, a 2019 research paper by Madhu Badireddyn and Vasudeva Ranjit Mudipalli showed that hospitalized patients are at increased risk of developing DVT (approximately 50%), and this increases the risk of pulmonary Embolism. PE is one of the most common, but preventable, causes of death in hospitalized patients, the pair noted. “This includes patients who are immobile, older than 70 years, active cancer, recent surgery, obese, history of blood clots, ongoing hormonal therapy and critically ill patients admitted to intensive care unit (ICU).
Dr Otieno further identifies the following factors and classifies them as either moderate, strong or ‘other’ contributors to developing blood clots.
The risk factors. Image courtesy of World Thrombosis Day.com
Can blood clots be prevented?
Certainly! Observe the following lifestyle choices to reduce the risk of having blood clots;
- Maintain a healthy weight
- Avoid prolonged periods of immobility even when travelling
- Exercise regularly, walk often
- Avoid high-dose estrogen pills, unless instructed by a doctor and closely monitored
The treatment of blood clots depends upon their location in the body. In the next episode, we explore the treatment and management of blood clots.