Spring and summer are fast approaching, a time when many families take to the sky or the open road to the perfect vacation destination.
If you are planning a trip that involves more than four hours of travel in the air, car, bus, boat, or a train, it’s important to know if you have any risk factors for developing blood clots, and plan ahead to include movement in your travels.
Most blood clots, called deep vein thrombosis (DVT), are easily treated. Symptoms may include pain in the leg, redness, and swelling. However, if the clot breaks free and travels to the lung it becomes a life-threatening condition called a pulmonary embolism (PE).
Although the exact number of people impacted is unknown, the Centers for Disease Control and Prevention estimates as many as 900,000 people in the United States are affected by DVT and PE each year, and up to 100,000 people die each year from these conditions.
“PEs happen because people are in medical situations that can make them more prone to blood clots,” says Dr. Omar Ali, Interventional Cardiologist at Lowell General Hospital. He notes DVTs and PEs can happen at any age, from a pregnant woman in her 20s to an 80-year-old man who had hip surgery.
“I often talk about tennis player Serena Williams when I discuss risk with patients,” says Ali. “Here is someone who couldn’t be healthier, but had two pulmonary embolisms after a foot injury and after pregnancy – being laid up after being extremely active is one factor that made her prone to clots.”
There are several treatment options for DVT to prevent the clot from becoming bigger. Typically, blood thinning medications are prescribed, or a clot busting medication called tPA is delivered intravenously. Compression stockings may also need to be worn to improve blood flow in the legs.
If someone with DVT starts experiencing symptoms such as chest pain, shortness of breath, a bloody cough, sweating, or blue lips or nails, it may be a PE and lifesaving treatments are needed.
At Lowell General Hospital, interventional cardiologists use an advanced technology to treat PEs, called catheter-driven thrombolytic therapy. Approved by the FDA in 2014, this treatment has been extremely successful for patients with a PE where the right ventricle of the heart becomes enlarged and strained.
Using special x-rays and ultrasound scans, medication is guided directly through the pulmonary artery to the clot via a small tube, or catheter. When the tip of the catheter reaches the clot, a clot-dissolving drug is given. The radiofrequency ultrasound makes small holes in the clot allowing the medication to penetrate. In most cases, the blood clot will completely dissolve within 1-2 days while the patient is closely monitored in the intensive care unit (ICU).
“Because every PE case is different, it’s a real team approach with our cardiologists, cardiac cath lab staff, emergency department, ICU intensivists, ICU nurses, and radiology,” says Dr. Ali. “We diagnose a PE with a CT scan, and the PERT team (Pulmonary Embolism Response Team) is activated. An echocardiogram confirms if this is the right type of patient with the right risk, and we aim to have the procedure completed within 60 minutes.”
Typically the patient’s heart rate, oxygen, and chest pain improve after the procedure. And although the course of therapy for PEs is not as well-defined as the treatment for a heart attack, Dr. Ali has seen the benefits firsthand.
“Catheter-driven therapy safely dissolves these dangerous clots in a shorter timeframe than we’ve been able to do before. Not only can it save a patient’s life, but it also enables the heart to completely recover.”
Risk Factors for DVT
- Family history of blood clots
- Previous DVT or PE
- Age – risk increases over 40
- Recent surgical procedure
- Use of estrogen (i.e. birth control) or hormone replacement therapy
- Cancer treatment
- Limited mobility (i.e. leg or foot injury)
- Varicose veins
If you have any of these risk factors, be sure to discuss them with your primary care provider.