YOU Should Be Concerned!

Are you or someone you love possibly at risk?

What was once believed to be mostly a post-op concern for surgical patients is now a serious issue for millions of Americans, many of which, have no idea they are at risk. Take this scenario for instance:

A seventy year old man returning from a vacation with his wife, experiences a longer than expected flight due to delays. It turns out to be about 7 hours on the plane. He sits in the window seat next to his wife but refuses to get up during the flight, the gentleman that he as, as to not disturb the woman holding a sleeping infant in the seat next to his wife. In the car ride home he mentions to his wife about soreness in his right leg, but gave no more attention to it thinking he probably bumped it on the crowded plane. Early the next morning he develops an uncomfortable shortness of breath followed closely by a persistent cough that begins to produce a small amount of blood. The blood finally causes a trip to the hospital where he was diagnosed with a venous thromboembolism(VTE) and treated for a pulmonary embolism(PE).

This man was treated and thankfully lived. However, thousands of people each year die from such an event, and it could be you or someone you know.

- Example of a VTE

- Example of a Pulmonary Embolus


What is a VTE?

Venous thromboembolism (VTE) is a possible life-threatening condition that arises from the development of a blood clot within a vein that is primarily associated with patient immobility, and vascular injury. Are you at high risk of experiencing a VTE? Your life style alone may have placed you within this category. Though there are numerous causes of VTEs, the most significant is the increased risks if you‘re physically inactive (immobile) for an extended length of time, if you’re over weight, if you smoke, and/or if you use birth control. VTEs are estimated to affect an average of two million people a year in the United States. Of these affected, Mary Ann E. Zagria, Pharm D, Senior Care Consultant Pharmacist and President of MZ Associates, attributes 200,000 deaths per year of pulmonary embolism as the result of such VTEs.

In general, blood clots are not uncommon and are repaired by the body naturally with a seal (platelet plug). Under normal circumstances, once the bleeding has stopped, the clot will slowly be eliminated (lysed) by plasmin. Under inadequate circumstances, the blood clot may develop into a life-threatening situation because the pressure created by the blood flow can cause the blood clot to dislodge from the venous wall (thromboembolism) and allow its migration through the bloodstream to eventually become embedded in an artery or a lung (pulmonary embolism). The lack of circulation beyond the clot eliminates oxygen and nutrients to the succeeding tissues leading to tissue death (necrosis). It's imperative to eliminate the clot rapidly to restore circulation. The sooner the clot is eliminated, the lesser the damage incurs and/or the less chance of death.

http://www.vteconsultant.com/vteconsultant/VTE-prevention-understanding-current-strategies-The-Anticoagulant-Timeline.html

How could this have been prevented?

There a are a few things that could have been done to prevent this man suffering from a VTE.
1) He could have been warned by his health care provider of his increased risk of a VTE due to his age and his survival from cancer for 20 years. Also, that these combined with sitting confined for such a long time made him a prime candidate for VTE. A complete list of risk factors can be found at the CDC website.
2) The health care provider, having assessed him correctly, could have had him on prophylaxis medication for a VTE such as daily aspirin therapy or possibly a warfarin regimen.
3) He could have been alerted by a friend or a family member who knew his condition and knew that he was at risk, and they possibly could have alerted him in time to take an active role in his own health care.

Where does he go from here?

Now that the VTE exists it has to be treated. There are several options and combinations of therapy used to treat this condition. The use of warfarin, unfractionated heparin, low molecular weight heparin, and fondaparinux are used to prevent further clotting. Then thrombolytic agents are used to break up the clot. All of which have there own complex methods of action. These as with all medications come with risks and complications. In fact, The Joint Commission's National Patient Safety Goal 3E states the need to "Reduce the likelihood of patient harm associated with the use of anticoagulation therapy". So it is important that prescribers and administrators as well as patients are aware of the risks of anticoagulation therapy.

American & American-Eagle Airlines.(2009, October 15). Onboard Our Flights [Special section]. American Way Magazine, 96-97.

Zagria, M.A.(2009, July). Raising awareness about Pulmonary Embolism. U.S.Pharmacist: The Journal for Pharmacists’ Education, 24-26.