A thrombus (clot) formed in the blood vessel or heart breaks loose and is carried by the bloodstream to plug in another blood vessel and blocks it, called a thromboembolism. It is dangerous as it can affect multiple organs like lungs, brain, kidneys, gastrointestinal tract, or legs. It can cause disease (morbidity) or death (mortality).
Associated Anatomy
Blood Vessels
Causes of Thromboembolic disease
- Having inherited this disorder or having a family history of thromboembolism
- Overweight or obesity
- Advanced age
- Chronic diseases like cancer, heart or lung disease, and IBS (inflammatory bowel disease).
- An injury to a vein either due to disease, trauma, or major surgery
- Use of a central venous catheter
- Wearing a cast
- Being confined to the bed for a prolonged, i.e., immobility for any reason
- Maintaining a sitting posture for a long duration(crossed legs)
- Treatment for birth control that is estrogen-based
- Restriction of movements due to fracture
- Autoimmune disorders
- Hardening of arteries
- Hypercoagnable state
Symptoms of Thromboembolic disease
- Cramps or soreness, often starting in the calf area.
- Swelling and pain in the affected leg or arm. Sometimes it may be in both legs or arms.
- Feeling warmth in the affected leg can be severe.
- The skin of the affected leg may look red shiny or discolored.
- Discomfort or pain in the chest may worsen while coughing or taking a deep breath.
- Feeling dizzy or lightheaded.
- One side of the body feels weak or numb.
- Sudden change is felt in the mental state.
- The rapid increase in pulse and breathing.
- Blood in sputum.
Possible Treatment of Thromboembolic disease
Anticoagulants or blood thinners reduce the clotting ability of the blood. Anticoagulants can cause bleeding, so they must be monitored to prevent bleeding.
Some injectable anticoagulants are:
- Unfractionated heparin is injected into a vein
- Low molecular weight heparin (LMWH) and fondaparinux are injected under the skin subcutaneous
Some oral anticoagulants are:
Warfarin
No AC3: Dabigatran
Rivaroxaban
Apixaban
Edoxaban.
- Thrombolytics are also called clot busters. They work by dissolving the clot. They are for severe cases. The filter can be inserted inside the Inferior vena cava to trap or capture the moving clot.
- Surgical procedures like thrombectomy/embolectomy is done to remove the lodged clot.
Risk factors of Thromboembolic disease
- People aged 60 and above are at risk.
- An extended stay in the hospital and prolonged bed rest or paralysis restricts movements of the legs still and stops.
- Surgery or injury of the veins increases the risk.
- The veins in the pelvis and legs feel more pressure during pregnancy.
- Hormone replacement pills or oral contraceptives.
- Being obese or overweight increases the pressure in the veins of the pelvis and legs.
- Smoking affects blood circulation and can increase the risk of blood clots.
- Cancer, heart failure, and Inflammatory bowel disease increase the risk.
Typical test
- Duplex ultrasonography uses sound waves to check blood flow in the veins. It detects blockages or clots in the deep veins.
- D-dimer blood test measures the substance released when a blood clot breaks in the blood. A contrast dye is injected into a large vein, and an X-ray is taken. This is called Contrast Venography.
- Magnetic resonance imaging (MRI) and computed tomography (CT) scan are imaging tests. Ventilation-perfusion scan uses a radioactive substance to show the ventilation and perfusion scan.
- Pulmonary angiography is an invasive test and is used in certain patients to diagnose pulmonary embolism.
Prevention
- If you are in bed for a long duration, try to move as soon as possible. One should avoid sitting still so that blood starts to flow.
- Quit smoking
- Regular exercise will help in blood circulation and will help to control weight.
- While traveling for more than four hours, one needs to Change posture around every 1 to 2 hours.
- Exercising legs by raising and lowering heels and keeping toes on the floor will benefit.
- Avoid wearing tight clothes.
- Change the lifestyle and follow the doctor’s recommendation.
Secondary Prevention
- Using oral anticoagulants instead of vitamin K is growing, effective, and safe even if lower doses are given.
Additional Type
There are two types of thromboembolism.
- Venous thromboembolism occurs when a clot in the veins blocks it. It includes deep vein thrombosis (DVT) and pulmonary embolism (PE).
- Arterial thromboembolism occurs when a clot in the artery blocks it. It restricts the blood flow due to clots. ( ischemia)
Differential Diagnosis
The symptoms of DVT can be similar to that of hematoma, lymphedema, cellulitis, and arterial insufficiency,
Patients with PE can have a differential diagnosis- Congestive heart failure, acute respiratory distress syndrome, pneumonia, and myocardial infarction. So to evaluate PE, an assessment must be done to rule out the above conditions.
Epidemiology
- There is an exponential increase in the risk with age (after 60).
- There is not much difference between men and women suffering from thromboembolism.
- Asian-Pacific Islanders and Hispanics are at a lower risk of developing thromboembolism. In the US, 100000 to 300000 deaths for VTE are reported yearly. In Europe, the number rises to more than 500000 deaths annually.
- Thromboembolism is seen to develop more commonly in winter than in summer.
Expected Prognosis
The expected outcome of thromboembolic disease often depends on the present type. For many conditions, such as deep vein thrombosis and pulmonary embolism, it is essential to treat the condition immediately to avoid severe complications and even death.
Natural Progression
Depending on the comorbidities, the mortality rate varies. In the first 30 days, patients with acute VTE and have multiple comorbidities, including heart failure and atrial fibrillation, have a high mortality rate (4.5%) when hospitalized. Patients with unstable PE have reported a mortality rate of 14%.
Pathophysiology
When a platelet and fibrin clot is formed within the vascular lumen, Venous thrombosis, the clinical formation of thrombi, is seen in vessels with large lumens having deep veins like that of the arms, legs, and pelvis. There is propagation with the proximal extension of the clot. Clinical symptoms are visible when the clot propagates such that it obstructs vascular flow. When the clot dislodges, it can embolize to a distant site. The pulmonary vasculature is the most common site. Pulmonary vascular flow, if obstructed, can cause impaired gas exchange, alveolar edema, or even pulmonary alveolar necrosis. Increased pulmonary vascular resistance and pulmonary hypertension are seen in chronic repetitive pulmonary embolization. In the cardiac abnormalities, paradoxical embolism of the clot occurs in systemic arterial vascular tree may cause CVA.
Complications
The blood flow can be hindered in both veins and arteries by thrombosis. Stroke, heart attack, and breathing issues are the most severe problems.
- As PE is life-threatening, immediate help is needed as the lung is blocked by a blood clot that travels from another part of the body to pulmonary artery.
- Postphlebitic syndrome occurs when a clot damages a vein and reduces blood flow, causing swelling, skin sores, and discoloration.
- Blood thinners can cause bleeding, increasing the treatment complications.
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