World Thrombosis day (WTD) takes place every year on October 13, the birthday of Rudolf Virchow who was a pioneer in the pathophysiology of thrombosis.
A German physician, pathologist, biologist and anthropologist, Virchow developed the concept of “thrombosis” and advanced our understanding of this condition. International Society for Thromobosis and Haemostasis (ISTH) introduced World Thrombosis Day October13 in 2014.
One in four people worldwide are dying from conditions caused by thrombosis. It’s a startling fact that up to 900, 000 people in the United States alone are affected by blood clots each year, about 100,000 of those people will die, which is greater than the total number of people who lose their lives each year to AIDS, breast cancer, and motor vehicle crashes combined. Thrombosis does not discriminate. Clots can affect anyone regardless of location, age, ethnicity or race.
What Is Thrombosis?
Thrombosis is the formation of a blood clot in a blood vessel. The vessel may be any vein or artery as for example, in a deep vein thrombosis (venous) or a coronary artery (arterial). The clot itself is termed a thrombus.
Once formed, a clot can slow or block normal blood flow, and even break loose and travel to an organ. A clot that travels to the circulation is called an embolism. Thrombosis is the often preventable underlying pathology of heart attack. Thrombosis, thromboembolic stroke, and venous thromboembolism are the top three cardiovascular killers.
Types of thrombosis
The two broad classifications of thrombosis are venous and arterial, depending on whether the clot develops in the vein or an artery. Venous and arterial thrombosis are variations of similar pathologic mechanisms. Both are influenced by acquired or inherited risk factors.
Venous thromboembolism or VTE is a condition in which blood clots form most often in the deep veins of the arm or leg, known as deep vein thrombosis or DVT, and can travel in the circulation and lodge in the lungs, known as pulmonary embolism or PE.
Thrombosis in the arteries can lead to heart attack or brain stroke causing paralysis.
What is the mechanism of Thrombosis?
The mechanism of thrombosis is postulated by Virchow. Its triad of factors : Stasis, Hyper coagubility and Vessel wall injury or trauma.
Fig: Virchow’s Triad
DVT is deep vein thrombosis occurring mainly in vessels of calf , thigh or pelvis
Warning Signs and Symptoms:
VTE can occur without any warning signs or symptoms and can go unrecognised and undiagnosed by a healthcare professional. Symptoms that do appear may be associated with either DVT or PE. DVT: Leg
VTE does not discriminate. It affects people of all ages, races and ethnicities, and occurs in both men and women. Certain factors and situations can increase the risk of developing potentially deadly blood clots.
Research suggests that VTEs are often preventable and evidence-based prevention strategies can stop the development of clots in ‘at-risk’ individuals.
What are the most common tests done to see blood clot?
A blood test called a D-Dimer
An ultrasound of the arm or leg to look for the DVT
A CAT scan of the chest with intravenous dye to look for a PE
Individuals who are deemed ‘at-risk’ should be given appropriate prevention-”prophylaxis” which can include:
Anti-clotting medications (e.g., blood thinners, referred to as “anticoagulants”)
Mechanical devices (e.g., compression stockings, intermittent pneumatic compression devices or rapid inflation venous foot pumps)
Hospital patients may also be instructed to move around or do foot/leg exercises as soon and as often as possible.
DVT and PE are serious, life-threatening conditions that require immediate medical attention. Treatment can differ by patient but typically includes blood thinning medication to break up clots and prevent new ones from forming. Depending on specific conditions, a patient might need:
Anticoagulants (e.g., injectables such as heparin, enoxaparin, or low molecular weight heparin, or tablets such as apixaban, dabigatran and rivaroxaban, edaxaban and warfarin)
Mechanical devices (e.g., compression stockings which may decrease your risk of long term problems that can be caused from having clots or a special filter placed in a vein)
Thrombolytic therapy (e.g., tissue plasminogen activator)
Early diagnosis and treatment can often lead to recovery, but long-term complications, such as post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension may occur.
Recommendations for prevention of DVT:
Heart- healthy eating
Being physically active
Aiming for a healthy weight
Risk assessment and periodic check ups
Long hours of travel in flight or by road have more risk of getting VTE if you have risk factors. It is due to the immobility. If you’re travelling for four hours or more by plane, train or car, take these steps during the journey:
wear loose, comfortable clothes
do calf exercises at least every half hour
walk around whenever you can
drink plenty of water
do no drink alcohol or take sleeping pills
Medical advice before travel if you have risk factors for VTE
Reducing the burden of cardiovascular diseases in nation is responsibility of individual, community, Government and non government organisations. At the individual level healthy life style- Heart Healthy diet, physical activity, limiting alcohol and quitting smoking are key points.
Community, government and non government organisations should encourage healthy life style from school age. Avoiding ultra -processed food and physical activities can reduce childhood obesity. Health awareness activities, advocating for regular health checkups are instrumental in prevention. “Prevention is better than Cure”
Let us work together to keep Blood Flowing. Say no to Clot!
*Dr Datta Dharmadhikari is a consultant haematologist at Bokamoso Private Hospital