This Medical Monday series is about risk factors for venous thromboembolism, VTE (pulmonary embolism and DVT). The post ‘Are you on the red or blue team?‘ outlines the difference between arterial and venous clots.
We are going to cover
Strong risk factors; being in hospital, having surgery and immobility
Moderate risk factors; age (60+), a previous blood clot, family history of blood clots, thrombophilia, cancer, contraceptive pill and hormone replacement therapy
Other risk factors; obesity, pregnancy, smoking and alcohol
Being in hospital
How high is the risk?
Venous thrombosis is the leading cause of death in hospital ahead of infections and pneumonia. 60% of all DVTs occur in hospital. If you are admitted with an acute medical problem and remain in hospital for more than 2 or 3 days your risk of a DVT is more than 10 times higher than somebody out of hospital. In fact 1 in 10 of all hospital deaths are thought to be due to a pulmonary embolus.
Can the risk be reduced?
Yes the risk can be reduced in a number of ways.
Early mobilisation. The whole medical team including the doctors nurses and physiotherapist may discuss with you the importance of getting moving after surgery or an acute illness. Patients no longer have prolonged periods of bedrest. You may be encouraged to get out of bed as soon as you are able.
Drink plenty of water. It is important to maintain good hydration. If you become dehydrated your risk of a clot is increased.
Anticoagulants. If you are going to be immobilised in hospital for some time your doctors should discuss the use of anticoagulants such as low molecular weight heparin to reduce your risk of a blood clot. This treatment is given as injection under the skin once a day. This may continue until you are out of bed or for some high risk patients can continue after leaving hospital. Remember that this treatment is not suitable for you if you have previously had problems with bleeding.
What does this mean for me?
If you ever have to go into hospital there are several ways you can help yourself.
Be aware there is a risk.
Knowing there is a risk is very important as you can more easily talk to your doctor about the best option for you to prevent a blood clot. Surprisingly few people are aware that being in hospital is a risk. In a survey of people in hospital run by the Blood Clot alliance, over 70% of people had not heard of the term DVT and 85% had not heard of a PE. Approximately half of the patients said they had not been informed that they had a risk of thrombosis.
Many hospital now have leaflets for patients when they are admitted to hospital, explaining that there is a risk of thrombosis. These often encourage you to talk to your doctor about your risks of thrombosis and what measures can be taken to keep your risk as low as possible.
Be aware that simple measures can help.
After surgery or during recovery from an illness early mobilisation by getting out of bed and moving around can help. Obviously this should only be done with the guidance of your doctor. It is also important to move your feet when in bed and to maintain good hydration by drinking enough water.
Discuss treatment options with your doctor.
Ask about compression stockings and leg exercises. Ask about anticoagulant treatment and find out if it is appropriate for you. Your doctor should be able to explain the pros and cons of treatment. If you have previously had bleeding your doctor may believe it is safer for you not to have anticoagulants.
VERY IMPORTANT – If you have previously had a blood clot make sure your doctors are aware of this. Your risk of another clot is much higher that other patients and you may need more intensive treatment to prevent further clots.
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