Compliance is Mandatory to Improve Quality of Life after DVT

A thrombus (blood clot) forms when blood thickens and clumps together.

Deep vein thrombosis (DVT) is a serious condition that occurs when a blood clot forms in a vein located deep inside your body. A blood clot (or thrombus)   forms when blood thickens and clumps together becoming a gelatinous, solid state. Deep vein blood clots typically form in your thigh or lower leg, but they can also develop in other areas of your body.

Acute DVT affects nearly a million patients in the US ever year. Up to 60% of these patients develop some form of post-thrombic syndrome (PTS). PTS refers to the chronic leg pain, swelling redness and yes, possibly ulcers (sores on the leg). PTS can make it difficult to get around and the pain and discomfort greatly affect the quality of life. If you can, it is best to prevent PTS (Post Thrombic Syndrome) whenever possible. The standard of care for DVT and prevention of PTS is therapeutic anticoagulation, wearing compression stockings and early ambulation.

One possible complication of DVT and PTS is a venous ulceration. Because of poor blood circulation in the legs, the blood in the legs backs up and pools in the vein. Fluid may leak out of the vein into the tissue and lead to breakdown of the tissue and result in a venous ulcer which is slow to heal and often returns if you do not follow your physician’s orders to prevent them.

After a DVT, if conservative therapy (therapeutic anticoagulation, wearing compression stockings and early ambulation) does not give adequate improvement, endovascular treatment will need to be considered. Removal of the obstruction in this manner is invasive and puts you more at risk. So you can see why it is so important for you to follow your physician’s directions of anticoagulation, proper usage of compression stockings and early ambulation to improve the quality of life.

Please call our Certified Fitters at 1-844-472-8807. They will be pleased to assist you with the selection of a garment appropriate for your needs.

Vanda Lancour

http://www.supporthoseplus.com

Sitting Can Be Dangerous For Your Health

car3It is the time of the year that I start thinking about vacations. One of the first things I plan for is not my wardrobe, but my compression stockings. They can save my life. Vacations can be a particularly dangerous time for DVT because the extended time spent in an airplane, car, or train can increase your risk for Deep Vein Thrombosis (DVT). Air travel is the notorious culprit for causing DVT.  In an airplane you are sitting crammed between two other travelers. The air on the plane is dry, and the pressure is decreased with lower oxygen levels. The passenger’s legs are bent in the same position for hours and the seat you are sitting in for your safety is constructed with a fairly ridged metal frame which is cutting into the back of your legs compressing the popliteal vein and slowing down the blood returning to your heart. At this point you are a prime candidate for developing a DVT. Any situation in which the leg is bent at the knee for prolonged periods with little or no activity may lead to the reduction of blood flow and increase the risk of blood clots.

Risk factors which can increase your risk of DVT include:

  • Injury to a vein, often caused by:
    • Fractures
    • Severe muscle injury
    • Major surgery (especially of the abdomen, pelvis, hip, or legs)
  • Slow blood flow, often caused by:
    • Confinement to bed (possibly due to a medical condition or after surgery)
    • Limited movement (a cast on an extremity to help heal an injured bone)
    • Sitting for a long time, especially with crossed legs
    • Paralysis
    • Sedate lifestyle
  • Increased estrogen:
    • Birth control pills
    • Hormone replacement therapy, sometimes used after menopause
    • Pregnancy, for up to 6 weeks after giving birth
  • Certain Chronic medical illnesses:
    • Heart disease
    • Lung disease
    • Cancer and its treatment
    • Inflammatory bowl disease (Crohn’s disease or ulcerative colitis)
  • Other facts that increase the risk of DVT include:
    • Previous DVT or PE
    • Family history of DVT or PE
    • Age (risk increases as age increases)
    • Obesity
    • A catheter located in a central vein
    • Inherited clotting disorders
    • Varicose veins

A DVT may not have any symptoms but can cause pain, swelling and your leg (or arm) could feel warm to touch. If left untreated, a piece of the DVT (blood clot) can break loose and travel through the right side of the heart, and lodge in small or large branches of the pulmonary artery (blood vessels going to the lungs). This is called a pulmonary embolism or PE.  The symptoms can be chest pain, difficulty breathing, or coughing up blood or as extreme as collapse and sudden death.

Here are some simple steps to keep your travel from ending with a prolonged trip to the emergency room:

  • Wear properly fit compression socks or compression hose to prevent stagnation of the blood and increase the blood flow back to the heart.
  • Keep moving.  When you travel, get up and move around when it is safe to do so.
  • Drink plenty of water. Water helps keep you hydrated and less likely to develop clots
  • Avoid alcohol! Alcohol contributes to dehydration, which thickens the blood
  • Exercise your legs. Bend and straighten them several times ever half hour to hour.

The following was provided courtesy JAMA (Journal of the American Medical Association)

LegExercisesForAirTravel

Leg exercised for air travel. Lift toes and lift heels.

AtRest

At rest blood flow with the vein slows or stops.

FootPumpExercises

Foot pump exercises…Muscle contractions push blood through vein valves.

For your convenience you might want to check out our SIGVARIS Products at 20% off MSRP. We also have THERAFIRM Products 20% off MSRP. These are great products to make sure you are prepared for your vacation.

Sitting can be dangerous to your health,

Vanda Lancour
www.supporthoseplus.com

PS What is your favorite sock for travel?

Deep Vein Thrombosis (DVT) Through the Ages Continued

Last week we began studying the history of DVT. The most important advances in the field of DVT therapy occurred during the first half of the 20th century. However, numerous other therapeutic options, sometimes surprising, were tried during this period and later abandoned because of insufficient efficacy.

Even though the mechanisms of venous thrombosis (blood clots) had been discovered by the middle of the 19th century, it was closer to the 1920’s that a consensus appeared regarding the three factors contributing to thrombosis: stasis, vessel wall alteration, and hypercoagulability (abnormality of blood coagulation that increases the risk of blood clots in the blood vessels).

During the late 19th century and early 20th century, there were a number of breakthroughs that have changed DVT treatment. Many of these were discovered by accident.

1884 – Hirudin first isolated anticoagulant. It was extracted from the saliva of leaches. Hirudin could not be used as a powerful anticoagulant until production by genetic engineering in 1986.

1916 – Heparin first anticoagulant that could be effectively used for the treatment of DVT. A medical student, who was doing research to find products which would promote coagulation of blood, noticed some extracts became anticoagulant after prolonged exposure to air. Four years late he discovered true heparin.

1933 – Pure crystalline heparin was produced allowing its use in humans in 1935. The use of heparin became widespread (when available) because of its efficacy. It was administered for 7-10 days and cut the mortality from Pulmonary Embolism among inpatients with symptomatic DVT from 18% to 0.4%.

1941 – Vitamin K antagonists (VKAs) allowed anticoagulant therapy to be extended. Vitamin K is required for the correct production of certain proteins necessary in the blood clotting process. They are structurally similar to vitamin K and act as competitive inhibitors. The action of this class of anticoagulants may be reversed by administering vitamin K until there is no more VKA in the body. Vitamin K antagonists include coumarins which include, but are not limited to warfarin, coumatetralyl, phenprocoumon, acenocoumarol, dicoumarol, and non-coumarin VKAs such as fluindione and phenindione. All can be reversed by administering vitamin K.

1950 – Heparin was still the choice treatment for DVT, but surgical procedures were used for severe cases of DVT. The surgical procedures did not provide substantial clinical improvement.

1958 – First intraluminal “harpgrip” filter showed promise in preventing Pulmonary Embolisms. The filter could block movement of blood clot without significantly affecting the venous system; however it required major surgery and anesthesia for placement.

HarpgripMobbinUddinGreenfieldFilters

1967-1970 – The problem of a filter requiring major surgery and anesthesia for insertion was solved with the Mobin–Uddin umbrella. It could be inserted with a simple catheter under local anesthesia. Besides the potential for migration, this filter could cause gradual obstruction of the inferior vena cava. This was partially prevented by coating the filter with heparin.

1981 – Greenfield developed the first true percutaneous filter, which did not necessitate any surgical opening of a vein. However, truly retrievable filters (without a catheter and without persisting venous access) became available for clinical use only two decades ago. Therapeutic trials are currently underway.

Blood Clot

1970 – Venography (developed in 1923) became standardized and widely used for confirmation of DVT; physicians no longer treat clinically suspected DVT. This enabled physicians to diagnose and treat DVT while clinically asymptomatic and simplified DVT treatment with anticoagulants, ended bed-rest as a treatment, and allowed home treatment.

1980 – Development of low-molecular-weight heparin (LMWH) was the most significant step in the simplification of anticoagulant therapy. In most cases, it does not require monitoring. Was introduced in Europe and in 10 years was widely used.

1996 – Was demonstrated that LMWH given at home was safe and effective as unfractionated heparin administered in the hospital.

1996 – Evidence that early ambulation with compression stockings lessened pain and counteracted swelling without an increased risk of Pulmonary Embolism. This became widespread treatment and is now recommended treatment.

1997 – The usefulness of compression bandages in preventing post-Thrombotic Syndrome (long-term complications of DVT) shown. Even though Hippocrates prescribed compression bandages to treat leg ulcers, it was not until the late 19th century, after observing that superficial vein clots disappeared rapidly after application of compression bandages, physicians started prescribing compression bandages to their patients with DVT. Compression bandages started to be more widely used when anticoagulants became available. They were usually prescribed at the end of heparin treatment, once ambulation was authorized.

1938 – First Thrombectomy (blood clot removal). Twenty years later this procedure was improved and anticoagulant was added to prevent more blood clots from forming. Surgical thrombectomy is not recommended for routine treatment today. Early blood clot removal has been achieved using pharmacological thrombic agents. (Anticoagulation therapy for some patients is not a choice because of bleeding problems.)

1953 – Plasmin (also produced in the body) used to treat acute blood clots (including isolated DVTs) by dissolving them through intravascular infusion. In the same year streptokinase was also used for the same purpose. Streptokinase causes extra production of plasmin in the body.

It will be many years before the appropriate indications and contraindications are carefully defined about the use of thrombolytic agents, and the optimal approach (catheter directed vs. systemic administration) of the use of these agents to blood clots is identified, allowing the selection of the population at highest risk of Post Thrombotic Syndrome and lowest risk of bleeding. Nevertheless, it is likely that the long-term results, despite being promising, will not dramatically modify the routine management of DVT.

I hope you keep wearing your support socks and support stockings so you are less likely to have to deal with a DVT and DVT treatment!

Vanda
www.supporthoseplus.com