Deep Vein Thrombosis (DVT) is a medical condition that occurs when a thrombus (blood clot) forms in one of the large veins, usually in the lower limbs, leading to either partially or completely blocked circulation. It may be caused by a variety of risk factors and triggering events, including cancer, obesity or restricted mobility due to acute medical illness, stroke, major surgery, previous DVT or respiratory failure. DVT symptoms may include tenderness, pain in the leg, swelling and discoloration or redness. The condition may result in health complications, such as pulmonary embolism (PE) and even death if not diagnosed and treated effectively.
Pulmonary embolism (PE) occurs when a blood clot or a part of it breaks loose from the wall of the vein and moves to the lungs, where it blocks a pulmonary artery or one of its branches. In the United States, of those who develop PE, up to 300,000 will die, which is more than from breast cancer and AIDS combined2. PE signs and symptoms include shortness of breath, chest pain, coughing/coughing up blood, and fainting.
Prophylactic (preventative) treatments for DVT include early mobilization (working to get bedridden patients up and moving around), sequential compression devices to promote blood flow, and/or anticoagulant medications.
What is the importance of DVT in Orthopedic Surgery?
Most of the orthopedic patients are bedridden following fractures and related surgeries. While analyzing the risk of DVT in a given patient orthopedic surgeries almost top the list. It is also important to note that as the age advances the risk increases. The fracture of the hip bone one of the commonest fractures in the elderly which requires surgery. The risk of DVT is highest in such patients. It is therefore important that the orthopedic surgeon takes due precautions to avoid this complication. Elective surgeries like knee and hip replacements also need to be added to high risk surgeries.
How to reduce the risk of DVT in orthopedic surgeries?
1. It is important to give correct and complete medical history of previous illnesses to the treating doctor. E.g. cancer is a high risk area and therefore if you have been treated for cancer please let the doctor know. See the list of risk factors below.
2. The sooner the patient gets up and gets going the risk starts to decrease and therefore co=operate with the physiotherapy to get going as early as possible.
3. Always discuss alternative treatment options with your doctor which would get you out of the bed earlier.
4. Doctors will teach you simple exercises while you are in bed to reduce this risk. Mechanical devices such as elasticated stockinet?s and/or compression pumps may be used to reduce the risk after the surgery.
5. Unless there is some contraindication for its use normally doctors use what is known as low molecular weight heparin in injection form once a day to reduce the risk. It is started around 6 to 8 hours after the surgery. Make sure it is given to you and if not find out why not?
6. The risk further decreases by undergoing spinal/Epidural anesthesia versus general anesthesia. So given a choice it is wise to get operated under spinal or epidural anesthesia. Mind you certain surgeries like spinal surgeries are not possible under spinal or epidural anesthesia.
What are the risk factors?
Immobility for an extended period of time
Over 40 years of age
Who have had blood clots already
Suffering from or who have had treatment for cancer
Who have had recent surgery especially on the hips or knees
Existing clotting abnormality or inherited clotting tendency
Overweight and obesity
Hormones or the oral contraceptive pill
Pregnancy or 2 months post-partum
Being treated for heart failure and circulation problems
Dehydration. Please note that one gets dehydrated at higher altitudes i.e. in an airplane. Drinking alcohol further increases the dehydration levels. So drink plenty of liquids during your air travel but not too much of alcohol.
Are you at risk from DVT even if you are not undergoing surgery?
YES! Prolonged journeys in cramped up space can lead to DVT. Remember Steve Vaugh the famous Australian Cricket Captain? He suffered from DVT on a flight from Australia to England. This is also known as ?economy class syndrome?. The recent reports of death in Airline passengers indicate the risk involved. I have 2 patients who developed DVT spontaneously after a 12 hour bus ride. So it is important to break your journey or walk around the bus/aircraft while traveling. Use of stockinet?s while traveling is a good idea. Remember obese people are at higher risk of developing DVT. If you are bedridden say for example with a plaster around your leg then you are also at risk of DVT.
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