Deep Vein Thrombosis
By Allan R. Handysides and Peter N. Landless
I fly a lot in the course of my work, and a few months ago I noticed a painful leg. My doctor diagnosed deep vein thrombosis. I have been on blood thinner pills, and get blood tests twice a week. Is this going to be an ongoing problem? I’m 42 years old.
Our blood has many functions. One of them is to ensure the integrity of its circulation so it can carry out some of its other functions: transporting oxygen and carbon dioxide, moving nutrients and their metabolic products around the body, and ensuring hormones can be carried to their sites of action.
Blood also repairs damaged blood vessels and prevents bleeding, while at the same time not being too “clottable” and closing off major vessels. This would result in coronary thrombosis, or a clot in the heart vessels. Strokes, too, can result from clots.
A clot commonly forms in the large veins of the lower leg. When this happens the patient usually notices pain, sometimes in the calf, as well as swelling of the leg and dilation of the veins. The limb may also feel warmer than the other one.
Such an event is problematic, but it carries an even greater risk. Should the clot or pieces of it break off, they would be carried in the blood to the heart, then pumped into the arteries of the lungs. This blocks blood supply to segments of the lung and reduces the efficiency of respiration. A large clot could plug the whole lung and kill the patient within a minute or two.
Clotting is much more likely to occur when the blood flow is sluggish or stagnant. This means constriction to flow and pressure to the veins. Bedridden, inactive patients are more at risk for clots.
There are other causes for sluggish blood flow in veins. You don’t say whether you are male or female, but pregnancy, with the large uterus, may dam back the blood flow, and so might pelvic tumors. Birth control pills and cancers also can increase the ability of blood to clot. Women on hormones are at increased risk, as well.
Old sports injuries that left damaged veins, long airplane rides during which one does not move the legs much—all these must be considered. So, too, must recent childbirth or surgery.
Because you are only 42 years old, you may have more going on. People with recurrent thrombosis, a family history of thrombosis, or clots in unusual places such as hepatic, or portal, veins, may have genetic factors at work. You can be screened for these inherited conditions that could be making your blood clot more easily.
Ultrasound has proved very useful in diagnosing large vein problems; the smaller veins are not as easily checked with ultrasound. The ultimate test for a blood clot is a venogram, during which dye is injected and pictures are taken to show the venous architecture.
Taking an anticoagulant, commonly called a “blood thinner,” is the usual treatment. This partially blocks the clotting mechanism, which has to be carefully checked to be sure one’s blood can continue with some of its clotting capability. That is why you are having those blood tests: to ensure you get enough, but not too much, of an effect. After some six months your doctor may taper you off the anticoagulant.
At that point, some doctors will prescribe a daily aspirin to lower the platelet stickiness. You should drink lots of water to prevent your blood from becoming too concentrated. Activity is essential, because the muscles squeeze the vein and help push the blood along. If you must travel a lot, request an aisle seat and get up frequently to walk and stretch.
We suggest you discuss some of the issues we have just touched on with your doctor, as we have space to cover only the salient features here.
Allan R. Handysides, a board-certified gynecologist,
is director of the General Conference Health Ministries Department.
Peter N. Landless, a board-certified nuclear cardiologist,
is an associate director of the General Conference Health Ministries Department.