You might be shocked to learn that one of the leading causes of preventable death is something many people have never heard of — and often don’t know they have. One in four people worldwide is dying from conditions caused by thrombosis, i.e., the formation of blood clots in a blood vessel, making it a leading global cause of death and disability. When a blood clot forms in an artery or vein, it can lead to heart attack, stroke, or a life-threatening clot in the lungs (i.e., venous thromboembolism or VTE). Quoted as a major health problem and one of the most common preventable causes of hospital deaths in the western world, VTE has rarely evoked such consideration in India.
It is a popular misconception that VTE incidence in Asian populations, including India, is lower than in western populations, but recent studies have proven otherwise. The incidence of VTE in India is highly underestimated. Anyone can be susceptible to deep-vein thrombosis (DVT), which is the formation of a blood clot in a deep vein, most often in the leg. Even otherwise healthy people can suffer from DVT after being immobile over a period of time, merely spanning a few weeks. Certain categories of patients are at higher risk, namely those recovering from a surgery or being hospitalized for a major medical illness for a long period.
According to Dr Abhay Bhave, Haematologist, Lilavati Hospital and Research Centre, “Thrombosis is one of the leading causes of death worldwide and Indians have the same risk of incurring thrombosis as any other patient group. In fact, while our risk is high, our interventions to prevent this highly preventable condition are inadequate. As a ballpark estimate, clinical experience shows that at least 9 per cent of hospitalised patients die from conditions caused by lung thrombosis in India, especially in the younger population. Though many times asymptomatic and hence a challenge to diagnose, the seriousness of thrombosis is underappreciated. Hence, it is necessary to educate people about the risk factors, signs, and symptoms of thrombosis to encourage patient ownership. In my experience, 10-15 per cent of VTE cases occur during or within 90 days of hospitalisation, especially in the ICU as well as in tertiary care centres. But this figure could be higher in hospitals where there are no standard DVT prevention protocols in place. Unfortunately, we do not have a registry to report the same.”
He also added, “There is a small risk of recurrent pregnancy losses in some women, who may have a tendency to clot such that pregnancy does not progress, resulting in miscarriage. Such women need to be identified through blood tests and given blood thinner medication to better the outcome and take the pregnancy to term. Some women have their first thrombosis after they take estrogen-containing medications such as birth control pills or hormone replacement therapy, due to an underlying clotting tendency known as thrombophilia.”
Plus, a family history of thrombosis or certain genetic factors can also increase a person’s risk of developing blood clots. Sedentary lifestyle, stress, long-duration travel, obesity, immobility and older age also add to the formation of blood clots.
The International Society on Thrombosis and Haemostasis (ISTH) is celebrating the sixth anniversary of a global movement called World Thrombosis Day on October 13that increases awareness of this often-overlooked condition and now is reaching billions of people around the world each year. Here are some key facts that you need to know about thrombosis:
- Thrombosis is the formation of potentially deadly blood clots in an artery (arterial thrombosis) or vein (venous thrombosis).
- Many times, the condition can be ‘silent’ and is hence a challenge to diagnose
- When a blood clot forms in the deep veins of the leg, it is known as deep vein thrombosis (DVT).
- If a blood clot travels in the circulation and lodges in the lungs, it is known as a pulmonary embolism (PE).
- Together, DVT and PE are known as venous thromboembolism (VTE), a sudden, dangerous and potentially life-threatening medical condition. DVT + PE = VTE.
- A blood clot that forms as a result of atrial fibrillation (AFib) is an example of arterial thromboembolism. If that clot breaks free, it can travel in the circulation and lodge in an artery in the brain and cause a stroke.
- Any patient admitted to the hospital with a family history of clotting tendency must inform the doctor, so that prevention measures can be taken.DVT/PE (VTE) is the best example of the adage that prevention is better than cure!
- Despite prevention, thrombosis may still occur in 10-15 per cent of cases, in patients who have a strong tendency to a clot that defies standard prevention methods.
- Sometimes DVT is the front runner to a cancerous change, especially in older patients and your doctor may perform tests to check for this.
- Patients undergoing certain surgeries such as a caesarian section, complicated surgeries of the abdomen and hip surgeries can develop clots post-procedure. Such patients should be particularly watchful for symptoms.
During a hospital stay, which can elevate risk simply by reducing physical activity and blood flow, all patients and/or their caregivers should remember to advocate for thrombosis prevention measures. People who are undergoing surgery or cancer treatment should know they are at even higher risk. Commenting on this, Dr Bhave said, “Hospital related thrombosis can be reduced by careful risk stratification at the time of admission and thereafter every day till the patient is in the hospital. It is important that every hospital has a specialized team and policies in place on how to prevent, detect and treat VTE if it occurs. Appropriate DVT prophylaxis (a prevention protocol) and close observation of patients while admitted in the hospital also helps prevent DVT/VTE.”
If you are at elevated thrombosis risk, it is especially important to know the signs and symptoms of the condition so you can seek medical attention as soon as possible. Symptoms of a DVT include one-sided limb pain or tenderness, swelling, redness, discolouration or warmth either in your calf, thigh or arm. People with PE often experience shortness of breath, rapid breathing, chest pain (which may be worse with deep breaths), rapid heart rate and light-headedness and/or passing out. A severe headache and persistent vomiting despite therapy could indicate DVT in the blood vessels of the brain. If you experience any of these symptoms, seek medical attention immediately.
Through such awareness campaigns, come let’s save our near and dear ones and make a difference to the community!