Venous thrombosis in Russia occurs annually in a million people. When and with whom are blood clots formed, is it possible to “predict” their appearance, to feel the birth and to “clear out” them before they become deadly?
Tells Candidate of Medical Sciences, physician-therapist, cardiologist at Atlas Biomedical Holding Maria Kirillova.
Thrombosis is a condition in which blood clots (blood clots) form in the blood vessels (veins and arteries). Most often, blood clots form in the veins or venous thrombosis occurs (in which a blood clot forms at the site of the venous vascular bed, mainly in the legs). Any blood clot interferes with normal blood flow, however, a catastrophe occurs at a time when a blood clot reaches a size comparable to the size of the vessel and completely blocks the blood flow, or when a blood clot (or small part of it) comes off and along with the blood flow enters the lungs (this state called pulmonary embolism.
Then find out.
2/3 of venous thrombosis are asymptomatic or with erased symptoms. A person is worried about moderate pain in the leg and a slight swelling, but not so pronounced as to make him consult a doctor. Of the three cases of thrombosis, one progresses, and two – spontaneously resolve.
However, this does not always mean that the resolved thrombosis passed without a trace. Even in this case, irreversible changes occur on the wall and valve of the affected vein, which lead to the development of chronic venous insufficiency. With a duplex vascular scan, doctors often see post-thrombotic changes in the deep veins of the lower leg in patients who have never been diagnosed with venous thrombosis.
Wait, who’s coming?
How to notice thrombosis at an early stage? More often, it “starts” in the veins of the leg and is accompanied by quite tolerable local pain and swelling. In an unfavorable scenario, the thrombus will increase in size, involving the veins of the thigh and small pelvis in the process. Gradually, there is massive swelling, redness of the skin, arching pain, swelling of the saphenous veins. From the moment the first symptoms appear, it usually takes 5-10 days to see a doctor. The exception is ileo-femoral thrombosis, which in u makes itself felt immediately – severe edema and palpable pain.
“Mute” thrombosis (with no symptoms) can occur in bedridden patients (after surgery or paralysis) or if a blood clot forms in the veins of the pelvis (usually occurs during pregnancy and childbirth, in the postpartum period, when taking oral contraceptives). In such situations, the first sign of the disease may be pulmonary thromboembolism “without a clear source.”
What is the most dangerous blood clot? The larger the vein and the larger the size of the thrombus, the higher the chance of a thromboembolism. The most dangerous are the proximal (located close to the center of the body) blood clots – in the veins of the thigh, pelvis and retroperitoneal space. The incidence of embolus with such localization is above 50%.
A small peripheral thrombus (for example, in the tibia) can also become hypothetically dangerous. It also migrates to the pulmonary arteries and disrupts the movement of blood. Small emboli in 75% of cases are asymptomatic, but they still pose a threat to life, the truth is delayed. Sooner or later in the absence of treatment, they can lead to impaired blood circulation and in some cases – to death. Therefore, any identified thrombus in the veins requires active treatment.
Who to look for?
Venous thrombosis is a multifactorial disease that occurs with an unfavorable set of circumstances. To say who is threatened with thrombosis, and who does not, it is impossible for today (only in some cases the predisposition to thrombosis can be identified using a coagulogram – a comprehensive analysis of blood clotting indicators).
This is only partly true. These circumstances can actually lead to the formation of blood clots, but only with complex effects. For example, if you sit motionless in an uncomfortable posture for 9 hours and the entire flight refuses to drink, and you suffer from obesity, varicose veins and are taking contraceptives – the chance to get out of the plane with a blood clot is really quite large. But if the case is limited to something one (for example, varicose veins or taking contraceptives) – you risk no more than other people.
Truly dangerous factors are considered operations and injuries (especially in the complex). Such blood clots are considered clinically provoked, so all patients with herbs and after operations are examined for blood clots.
In 10-20% of patients with thrombosis may be the first sign of a malignant neoplasm. Patients over 50 years old when detecting clinically unprovoked thrombosis are advised to carry out an in-depth search for cancer.
So, what is next?
At the first suspicion of thrombosis, you need to consult a doctor. In acute cases, the patient is immediately sent to the operating table – for ligation of the veins, installation of a cava filter or surgical removal of a blood clot. But more often thrombosis is treated on an outpatient basis. The doctor will conduct a primary diagnosis, confirm the conclusion on an ultrasound (duplex vein scan), and prescribe anticoagulants – blood thinners, the purpose of which is to release the lumen of the vessel. Be patient! The duration of taking anticoagulants can vary from 3 months to a conditionally lifelong use. And all this time it will be necessary to go to the clinic, so that the doctor assesses the effectiveness (absence of relapse), safety (absence of bleeding) of the therapy and determines the necessary duration of treatment.