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Guest column | Dr. Rao Musunuru

Deep vein thrombosis is killer we can avoid

David Bloom happily accepted an assignment from NBC News to cover the Iraq War in 2003.

A healthy 39-year-old and an avid tennis player, he was embedded with the U.S. Army. His family understandably feared for his life. But he wanted to serve his country and his fellow citizens by providing firsthand, impartial, eyewitness news from the front lines. He knew something terrible could happen while covering the war. He was committed to doing his job, delivering accurate news to the people, at any cost.

Something terrible did happen. He was killed at a tender age. He did not die from a gunshot wound, a roadside bomb or friendly fire. The killer was a massive blood clot that traveled from his leg (deep vein thrombosis, or DVT) to his lungs, resulting in pulmonary embolism, PE, that killed him almost instantly.

He did not know he had an inherited blood-clotting disorder, which never caused him any problems in the past. He thought that his legs hurt badly for two days before his death because he had been cramped inside the tank for too long. He did not realize that the leg pain was because of a blood clot in the vein. He did not seek medical attention. He could not imagine that the killer within him was waiting to strike at any minute.

Deep vein thrombosis resulting in pulmonary embolism represents a major public health problem. It is estimated that as many as 600,000 cases may occur each year in the United States resulting in more than 100,000 deaths. That is more deaths each year than from some other well-known conditions like breast cancer, AIDS or motor vehicle accidents.

DVT/PE is considered to be the No. 1 cause of preventable hospital deaths. In 2004, March was designated DVT awareness month to raise awareness among the public and medical community of this life-threatening condition.

A careful family history remains the most rapid and cost-effective method of identifying a predisposition to blood clots in the veins as a result of inherited blood clotting disorder. Acquired risk factors for a venous thrombosis include advancing age, malignancy (cancer), hormonal changes (contraceptives, pregnancy or postmenopausal hormone replacement), obesity, smoking, hypertension and diabetes.

The triggering factor for precipitation of blood clots in the leg veins in people with inherited or above-mentioned acquired risk factors is immobilization; for example, prolonged continuous travel, hospitalization, prolonged medical illness, surgery, trauma, nursing home confinement and stroke. Injury (surgery, trauma) also stimulates the body's clotting process and DVT/PE can occur within a few hours and up to several months after the event.

Under right (or wrong) circumstances, a blood clot in the leg (causing calf pain, redness, and swelling) can break loose from the wall of the vein and travel in the bloodstream, first to the heart and then to the lungs, where it blocks circulation, causing shortness of breath, chest pain, fast heart, low blood pressure, fainting and even sudden death.

Controlling the risk factors, avoiding the triggering factor (immobilization), recognizing the symptoms and seeking immediate medical attention are the key factors in preventing sudden death and also chronic disability, either from the lungs (shortness of breath) or the legs (venous insufficiency).

Doctors can prescribe blood thinners in addition to compression devices to prevent blood clots when immobilization or a risky event cannot be avoided. Doctors can also treat with blood thinners, clot busters, filters or even surgery (depending on the seriousness) if a blood clot already reached the lung.

The best way to defend yourself from a killer is to arm yourself with knowledge — how the killer operates, how to avoid being attacked and how to protect yourself, when attacked.

Dr. Rao Musunuru, a cardiologist practicing in Bayonet Point, serves on the National Heart, Lung and Blood Advisory Council for the National Institutes of Health.

Deep vein thrombosis is killer we can avoid 03/01/09 [Last modified: Sunday, March 1, 2009 6:25pm]
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