What you should know about thrombosis

March is ‘blood clot awareness’ month, dedicated to activities concerning blood clots. It’s in this regard that Rwanda Clot Awareness Network (R-CAN), a local network aimed at fighting the condition, organised community work to create awareness on the condition.

Community work that was carried out during Umuganda on Saturday in Nyamata, Bugesera District, aimed at increasing public awareness on thrombosis and ultimately, reduce deaths and disabilities from thromboembolic disease.

R-CAN, which started in 2015, also created a WhatsApp group comprising of about 50 people who survived the condition and are willing to help raise awareness.

During Umuganda, those who participated were taken through the risk factors, how to detect the condition, and how to get treatment as early as possible.

Also, about 100 participants were given health insurance.

Three years ago, Christine Ashimwe, the brains behind R-CAN, got a cough and chest pain. Clueless on what to do, she called her family doctor and obstetrician, but neither of them was able to recognise the issue immediately.

Five days later, the mother of three started wheezing and felt pain in the right side of her chest.

After being admitted in hospital, doctors discovered that she had a pulmonary embolism (PE) in the right lung, which was a result of deep vein thrombosis (DVT) in her right leg, a condition known as venous thromboembolism (VTE).

“I was experiencing something that I had only seen on TV, it was happening to me,” she says.

She was hospitalised for 10 days and discharged. She was put on anticoagulants, but has since experienced three recurrent PEs and one cerebral venous sinus thrombosis. Ashimwe has also been hospitalised more than 20 times since her initial diagnosis, due to recurrences and complications of VTE. 

And through her own predicament, the idea to create awareness about thrombosis was born.

Thrombosis; knowing the types

According to Kenneth B Ruzindana, a consultant obstetrician/gynaecologist at University Teaching Hospital of Kigali (CHUK), venous thromboembolism (VTE) is a condition in which blood clots form (most often) in the deep veins of the leg (known as deep vein thrombosis, DVT) and can travel in the circulation of blood and lodge in the lungs (known as pulmonary embolism, PE). 

Together, he says, DVT and PE are known as VTE - a dangerous and potentially deadly medical condition.

Whereas clotting is a normal process that helps stop bleeding, such as from a cut in the skin.

He notes that a clot can also form if the blood flow is too slow, the lining of a vein is damaged or, if a problem in the blood makes it easy.

“When a clot forms in a deep vein, blood flow in the vein slows down and causes the vein to swell. If a piece of a clot breaks free and moves through the blood vessels to the lungs, it is very serious,” he notes.

He adds that the condition, called pulmonary embolism (PE), can be fatal. Nearly one third of people who have DVT develop PE. It is important for patients to find and treat DVT early in order to prevent PE.

How dangerous is the condition?

Pulmonary and vein thrombosis is a condition that can kill within the shortest time, without one knowing it, according to medics.

They say, most of the time, physicians also fail to detect the condition because it camouflages and one can confuse it with some other condition, such as infections, among others.

Being pregnant is a risk factor, contraceptive pills, obese, sitting in the office for long hours; dehydration, among others, can put one at risk to develop thrombosis.

According to Yvan Ntwari, a general practitioner at La Nouvelle Clinic in Remera, there are strong and moderate factors that can expose one to the condition. For instance, he points out that being in the hospital for an extended period of time, having surgery (especially hip, knee and cancer-related surgery), not moving for long periods of time, like due to bed rest or long-duration travel, are among the main factors.

For the moderate ones, he says people who are at the age of 60 and above have greater risks of developing thrombosis.

Family history of blood clots, strokes, cancer, using estrogen-based medication such as oral contraceptives or hormone replacement therapy, pregnancy or a recent birth, smoking and alcohol consumption, pose a risk of getting the condition, according to Ntwari.

Pregnancy and thrombosis

Dr Ruzindana points out that pregnancy increases the risk of venous thromboembolism (VTE). 

He explains that pregnancy is a state of hypercoagulability due to alterations of coagulation proteins/factors. Pregnancy increases resistance to the anti-thrombotic factors such as protein C and protein S.

In addition to this, Ruzindana says venous stasis also increases as dilation of lower extremity veins occurs, followed by venous compression by the heavy and pregnant uterus and enlarging arteries in the pelvis. 

“Situations of decreased mobility, for instance surgery, caesarean delivery, bed rest, prolonged travel or air travel may exacerbate these factors. These factors work together to increase the risk of VTE in the pregnant and postnatal patient,” he says.

How and when to tell

Iba Mayale, an obstetrician/gynaecologist at Clinic Galien in Remera, Gasabo District, says there are various factors that one should be aware of, and seek medical attention as soon as they experience them or interact with someone complain about them.

The most common symptoms of deep venous thrombosis DVT, Mayale says, include pain and swelling of the lower extremity (the calf region and the thigh).

“80 per cent of pregnant women with DVT experience these symptoms, although few of them are diagnosed with DVT. Up to 70 per cent of women experience dyspnoea (difficulty in breathing) in pregnancy, although only a few have pulmonary embolism,” he says. 

On the other hand, Mayale clarifies that clinical signs and symptoms of pulmonary embolism are nonspecific. He says they could appear like signs of any other disease.

He, however, adds that the classic symptoms of pulmonary embolism are dyspnoea (difficulty to breathe (82 per cent), abrupt onset chest pain (49 per cent), and cough usually dry (20 per cent).

Prevention and treatment

Once the diagnosis of VTE is made, Dr Ruzindana says therapeutic anti-coagulation should be initiated in the absence of contraindications. 

In pregnancy, he points out, heparins (unfractionated and low molecular weight) are the preferred drugs for management of VTE.

There are is also medication that can be prescribed to prevent blood clots from forming before or after surgery. 

“It’s also important for such patients to stop taking certain medications before surgery. While at the hospital, the patient should be advised to wear special elastic stockings or inflatable boots,” Ruzindana says.

The reason behind this is that these devices squeeze the muscles to help keep blood flowing. And that they should be worn until the patient is well enough to leave the hospital.

Still in the hospital, Ruzindana says, patients should be allowed to walk around soon after the procedure. Their feet, or the foot of the bed, should be put in a raised position.
“When planning a long trip, especially if one is pregnant or has other risk factors for DVT, they should ensure that they take a lot of fluids, wear loose-fitting clothing, walk and stretch at regular intervals (for example, when traveling by car, they should make frequent stops to allow them to get out and stretch their legs,” he advises.

Special stockings that compress the legs below the knee may help prevent blood clots from forming. However, he advises that confirming with your physician first before trying these stockings on is ideal.

“This is so because some people are not advised to wear them. For instance, those with diabetes or problems with blood circulation,” Ruzindana adds.



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