Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) are often not optimally diagnosed by many physicians. These are serious but preventable medical conditions. Deep Vein Thrombosis (DVT) is a medical condition which occurs when a blood clot forms in deep vein. These clots usually could develop in the lower leg, thigh, or pelvis. These can also occur in arm. One should have knowledge about DVT, because it can happen to anybody and can cause serious illness, disability and morbidity. DVT is preventable and treatable if detected early.
Pulmonary Embolism (PE) is also referred to as complication of DVT.
It happens when part of the clot breaks off and travels through the blood
stream to the lungs, causing a blockage called Pulmonary Embolism (PE).
If the clot is small; with appropriate treatment, people can recover from PE. However,
there could be some damage to the lungs. If the clot is large, it could stop
the blood reaching lungs and can be fatal.
Risk Factors that could cause DVT
Anybody can have a DVT. However, the factors listed below could increase the
chance if having DVT. The chance increases for someone who has more than one of
these factors at the same time.
·
Hospitalization and some major surgery.
·
Being bedridden for long time due to illness.
·
Travelling for extended time beyond four hours
in continuity.
·
Older age.
·
Overweight or obese
·
Family history of Venous Thromboembolism (VTE.)
·
During and just after pregnancy.
·
Hormonal contraceptive medication (Estrogen
based medication).
·
Hormonal Replacement Therapy (HRT).
·
Trauma due to injury.
Preventing tips for DVT
Following tips could help prevent DVT:
·
Move around as soon as possible after having
confined to the bed, after illness, injury, or surgery.
·
If you are at risk of DVT talk to your Physician/Surgeon
for appropriate medication.
·
When sitting for long periods of time such as
travelling for more than 4 hours; get up and walk around after 1 to 2 hours.
·
Raising and lowering your heels while keeping
your toes on floor.
·
Raising and lowering your toes while keeping
your heels on the floor.
Symptoms of DVT
Most of the people with DVT have no symptoms at all. The following are the
most common symptoms of DVT that could occur in affected part of the body:
·
Swelling
·
Pain
·
Redness of the skin
·
Tenderness
If you have any doubt of having DVT consult your doctor as soon as possible.
Pulmonary Embolism (PE)
One can have Pulmonary Embolism (PE) without any symptoms of a DVT.
Signs and symptoms of PE could be:
·
Difficulty in breathing
·
Faster than normal or irregular heartbeat.
·
Uneasiness
Coagulation Mechanisms of our Body
Our blood is a very complex tissue of our body, in the form of a
fluid. It plays a variety of roles for homoeostasis. Our blood has cellular
and noncellular components uniformly suspended in liquid phase. Blood
plays multiple roles in our body for sustain life and longevity. There are three
types of cells in our blood:
·
Red Blood Cells (RBCs) or Erythrocytes
·
White Blood Cells (WBCs) or Leucocytes
·
Platelets
Red Blood Cells (RBCs) or Erythrocytes provide red color to our
blood. RBCs carry oxygen from lungs to various organs and parts of our
body. White Blood Cells (WBCs) provide us natural and acquired immunity.
Platelets along with other soluble coagulation factors (CFs) take
part in coagulation of blood to safeguard us from internal of external
bleeding. There are ‘XIII’ coagulation factors (CFs) in our blood. We know
the chemistry and role of all the coagulation factors. Coagulation of Blood
occurs through two mechanisms:
·
Intrinsic Pathway and
·
Extrinsic Pathway
Both the coagulation mechanisms involve various coagulation factors and
finally lead to activation of factor ‘X’. Factor ‘X’ along with
certain factors leads to formation of Thrombin from Prothrombin. Thrombin
is central in clotting process, and it converts Fibrinogen to Fibrin;
activates factor ‘V’, ‘VIII’ and ‘XI’, leading to generation
of more Thrombin and stimulation of Platelets. Further by
activating factor ‘XIII’, thrombin favors the formation of cross-linked
bonds among Fibrin molecules, thus stabilizing the clot.
This determines that direct inhibition of Thrombin is a highly
desirable target for prophylaxis and therapy of various Coagulation
Disorders (CDs). Thrombin has
3-sites for target activation:
Sites 1 and 2 are called Exosites and site-3 is called
an active site. Exosite-1 is the Fibrin binding site of Thrombin
and Exosite-2 serves as the Heparin-Binding Domain. The clotting
pathway has traditionally been inhibited by using Heparin and Warfarin
for treatment and prophylaxis of Coagulation Disorders (CDs).
Heparin inhibits free Thrombin by binding simultaneously to Exosites
on Thrombin and Antithrombin, forming a Heparin-Thrombin-Antithrombin
Complex. But Heparin cannot inhibit Fibrin bound Thrombin. Heparin
can bind independently to Fibrin and Thrombin to form Fibrin-Heparin-Thrombin
bridge.
It has been documented that both unfractionated heparin (UFH) and low
molecular weight heparin (LMWH) are associated with variable anticoagulant
effect and heparin induced thrombocytopenia (HIT) in around 3%
cases. Warfarin acts as a Vitamin-K antagonist to inhibit
formation of clotting factors (II, VII, IX, X). Vitamin-K antagonists have a number
of shortcomings, including a delayed onset of action and interindividual
variability in anticoagulant effect. Other drugs and foods have also
been reported to alter anticoagulant effect of Vitamin-K antagonists. Anticoagulant
treatment requires regular and frequent monitoring.
The effectiveness of heparin and warfarin in prophylaxis and treatment of various thromboembolitic disorders has been well established. Effective use of these drugs comes with a steep cost of various side effects and problems like bleeding tendencies and immune thrombocytopenia. Parenteral administration needs hospitalization and constant monitoring during therapy.
Posts
