by Donna Castellone, MS, MT (ASCP) SH •
March 07, 2019
We have months for everything! This month DVT awareness is a public health initiative to raise awareness of the commonly occurring medical condition and its complication of a pulmonary embolism (PE). Beginning in 2003, over 50 organizations assembled in Washington, DC to make DVT a national health priority resulting in March being DVT Awareness month.
Let's discuss DVT, or am I preaching to the choir? How educated are you? Are you aware of the signs, symptoms and risk factors? Let's see, what do you know and more importantly what can you do to increase awareness?
Deep vein thrombosis (DVT) and pulmonary embolism (PE) affect upwards of 600,000 Americans each year and cause more deaths each year than the more well-publicized conditions of breast cancer, AIDS, and motor vehicle accidents.1
DVT/PE is a leading cause of preventable hospital deaths in the United States.2
DVT/PE is the leading cause of maternal death in the United States.3
One-half of DVT/PE patients will have long-term complications and one-third will have a recurrence within 10 years.4
An estimated $10 billion in medical costs in the US each year can be attributed to DVT and PE.5
While so many Americans are affected annually by DVT, 74% have no awareness of DVT.
There are two types of veins: deep and superficial. Deep veins are large and surrounded by muscle in the center of a limb. DVT occurs when a clot forms in the leg and results in partially or completely blocked circulation. Symptoms include: swelling, pain, discoloration and hot skin at the affected area. Did you know that HALF of DVT episodes have minimal, if any, symptoms! Additionally, there is no routine evidence- based screening test for venous thromboembolism (VTE). The main ways that doctors assess your risk for VTE are by taking a good medical history and by evaluating your signs and symptoms.
DVT is diagnosed through venous ultrasound, venography and impedance plethysmography. Ultrasound is the gold standard for diagnosis of DVT. Using real time imaging, the deep veins are evaluated, flow is assessed using Doppler, and a diagnosis is made. Ultrasound is inexpensive, relatively painless, portable, and does not use ionizing radiation. Ultrasound has dramatically improved the diagnosis, treatment, and outcome of DVT.
Clots that occur above the knee can break off and travel through the blood stream and block a vessel in the lung leading to a PE. Symptoms for pulmonary embolism include: shortness of breath, pain with deep breathing, rapid breathing, increased heart rate and cough. In patients who develop PE, up to 300,000 will die each year. More Americans die annually from DVT/PE than from breast cancer and AIDS combined.
When looking at the risk of DVT there are 3 factors to consider: venous stasis, hypercoagulability and damage to the blood vessel wall. This is the basis of Virchow's triad which was developed by Rudolf Virchow that contributes to thrombosis.
Alterations in normal blood flow include venous stasis, turbulence and varicose veins. It can also occur with endothelial damage which is often due to surgery, trauma or a hypercoagulable state resulting from cancer, pregnancy or congenital disorders.
In addition, certain individuals are at a higher risk for DVT including:
Having a prior DVT
Long period of immobility via travel or bed rest
Age greater than 65
genetic or acquired- Factor V Leiden
Combining an existing clotting disorder with immobility can raise the risk of DVT.
As a result of this about 40% of VTE occur in hospitals or post discharge and 30% occur in cancer patients.
So how do we improve these statistics? One of the biggest ways is prevention. In the US fatal PE may be the most common preventable cause of hospital death. For example, without prevention during hip replacement surgery, 60% of patients will get a DVT.
Having a healthy lifestyle, maintain circulation, getting 30 minutes of exercise a day, maintaining your weight and avoiding long periods of sitting can all help in the prevention of a DVT. If you smoke, you should quit. While traveling, one should avoid alcohol, sleeping pills, stay hydrated, move their legs and wear compression stockings if they are at a risk for DVT. Risk factors should also be evaluated prior to surgery to discuss preventive measures.
Some risk factors, which include age or family history, cannot be changed but behaviors can be modified.
Prophylaxis is very effective at reducing the occurrence of thrombosis. The most common treatment is anticoagulation and the use of compression socks. Thrombolysis is where a radiologist accesses the vein and removes the clot. Patients who are at a high risk and have had multiple clots have the option of an IVC filter. This filter is inserted in the inferior vena cava and will catch any clots that are traveling and prevents a PE.
Warfarin has been the standard treatment for VTE but it requires monitoring. In the last 5-10 years, direct oral anticoagulants (DOACs) are being used in the treatment VTE.
The anticoagulants used for DVT can include heparin, low molecular weight or the DOACS (warfarin included) and the newer drugs of apixaban, dabigatran, rivaroxaban and edoxaban. Thrombolytic therapy includes the clot dissolving enzyme of tissue plasminogen activator (tPA).
DVT is not only treatable but also can be prevented. Living a healthy lifestyle and taking precautions based on risks can prevent the more serious PE. Awareness is important, so pass your knowledge around! Discuss this with people who are not aware. As health care professionals, it is a service to be able to educate people or at least point them in the right direction. I have included several websites for additional information.
For more information about DVT Awareness Month, visit http://www.preventdvt.org.
Nabel, Elizabeth MD (Director, NIH’s National Heart, Lung, and Blood Institute) in the Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism US Department of Health and Human Services 2008 p. 5.
Baglin TP, White K, Charles A. Fatal pulmonary embolism in hospitalized medical patients. J Clin Pathol 1997;50(7):609-10.
Berg CJ, Atrash HK, Koonin LM, Tucker M. “Pregnancy-related mortality in the United States 1987-1990”. Obstet Gynecol 1996;88(2):161-7 Also see Marik. P.E. and Plante, L.A. “Venous Thromboembolic Disease and Pregnancy”. New England Journal of Medicine, volume 359, number 19, November 6, 2008, pages 2025-2033.
Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous thromboembolism: a public health concern.Am J Prev Med. 2010 Apr;38(4 Suppl):S495-501.