To clot or not to clot? Part two - Ahwatukee Foothills News: Valley And State

To clot or not to clot? Part two

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Posted: Wednesday, May 11, 2011 2:00 pm | Updated: 4:15 pm, Mon Oct 29, 2012.

Editor's note: This is the second part of a two-part column on blood clots. The first was published in the May 4 AFN.

One of the most dreaded medical situations is a blood clot that forms when and where it shouldn't (please refer to part one of this series of articles to learn about the clotting cascade mechanism). This type of clot can occur in a leg or any major body organ such as the lung, brain or heart. When it occurs in the leg, the medical term is Deep Vein Thrombosis, or DVT. Besides being quite painful, there is always the fear that the clot could "break off" and become what is then called an embolus. This embolus can travel as swiftly as the heart's pulse beat can carry it to the lungs, brain or heart (a pulmonary or cerebral embolus or heart attack). An embolus to any of these major organs could cause severe damage and even death.

There are "risk factors" to help identify those who might be prone to developing a DVT. They include:

1. A history of having had a DVT in the past.

2. Anything that intrinsically makes the blood more likely to clot such as an inherited blood disorder, smoking, or the use of hormones either for menopause or for birth control.

3. Anything extrinsically that makes the blood more likely to clot such as inactivity from being bed-ridden for any length of time to sitting at a desk day after day for long hours.

4. Pregnancy.

5. Cancer treatments.

6. Being older than 60 (although DVT can occur at any age).

7. Being overweight/obese.

Unfortunately, only about half of the people who have a DVT actually have signs or symptoms. The obvious symptoms are swelling of the leg along a vein with pain or tenderness in that area. The swelling is generally warm to the touch and reddened.

Symptoms such as these should be immediately evaluated by a medical professional. Besides doing a proper history and physical exam on you, you may have to undergo an ultrasound of the leg, which creates a picture of the clot, it's degree of blockage and how well the blood might or might not be flowing. A blood test called D-dimer might be done, which measures a substance in blood that gets released during blood clot dissolution.

If the ultrasound is inconclusive, a venogram might be ordered. This is an X-ray test where a dye is injected that makes it easier to see if blood flows smoothly or is blocked.

Treatment for a DVT has three main goals: To stop the clot from getting bigger, to prevent the clot from breaking off becoming a dreaded embolus, and to reduce the chances of recurrence. This is accomplished mainly by prescribing medicines called anticoagulants.

These medicines are commonly called "blood thinners" but this is a misnomer as they don't really make the blood any thinner than previously, rather they simply interrupt that clotting cascade.

In short, the blood simply doesn't clot as easily as it once did. Obviously, these medicines are great for this purpose but not without risks and consequently very close monitoring is required.

• Agnes Oblas is an adult nurse practitioner with a private practice and residence in Ahwatukee Foothills. For questions, or if there is a topic you would like her to address, call (602) 405-6320 or email aoblas@newpathshealth.com. Her website is www.newpathshealth.com. com

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