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Blood Clots: What You Don't Know Can Kill You

Hospital patients vulnerable to deep vein thrombosis, pulmonary embolisms

FRIDAY, Nov. 1, 2002 (HealthDayNews) -- Along with the public service signs denouncing smoking and promoting blood donations, the corridors of the Ochsner Clinic Foundation in New Orleans are now plastered with posters warning of two little-known dangers: Deep vein thrombosis and pulmonary embolisms.

It's part of a new initiative by health-care experts across the country to increase awareness about two conditions that are responsible for 10 percent of all hospital deaths each year.

Deep vein thrombosis (DVT) occurs when a blood clot forms in the leg and blocks the flow of blood. This can lead to potentially life-threatening pulmonary embolisms (PE), which is when a clot breaks free, travels north and lodges in a lung. If the clot is large enough, it can cause sudden death.

About 600,000 Americans develop pulmonary embolisms every year, and 200,000 people die from them. The American College of Chest Physicians says this may be the most preventable cause of hospital death.

Until now, DVT and PE have fallen through the cracks.

"Everybody assumes that someone else is going to be taking the lead on it and because no group 'owns' the condition, it wasn't happening," says Dr. Steven Deitelzweig, Ochsner's section head of hospital-based internal medicine.

Deitelzweig is spearheading the initiative at his clinic to raise the public profile of the problem, until now overshadowed by "celebrity" conditions such as stroke and heart attack.

However, he's not the only one. In February, a group of medical experts formed the Council for Leadership on Thrombosis (CLOT) Awareness and Management, which is sponsoring free screening programs at 185 hospitals nationwide. It has also established the ClotAlert Resource Center, which includes a Web site that provides information and services.

"There's a lot more now in the medical literature than ever before alerting physicians and other health-care providers about the risk of pulmonary embolism and deep vein thrombosis and, importantly, the effective ways that are available to prevent these conditions from occurring in the first place," says Dr. Samuel Goldhaber.

Goldhaber is co-chairman of CLOT, as well as director of the Venous Thromboembolism Research Group at Brigham and Women's Hospital in Boston and an associate professor of medicine at Harvard University Medical School.

People hospitalized for long periods of time are particularly at risk because blood can collect in the legs and increase the probability of a clot forming. Air travelers can also be prone to the condition -- in this case, dubbed "economy-class syndrome" -- thanks to long hours spent cramped in a seat, experts say.

Those with cancer, chronic heart or respiratory failure, inherited or acquired predisposition to clotting, and varicose veins also have an increased risk. So do people who are obese, as well as women who are pregnant or are taking birth control pills or hormone replacement therapy.

Symptoms of DVT can include leg pain, swelling, tenderness, discoloration or redness. Often, though, there are no symptoms.

"It's a very difficult diagnosis to make. Half of DVTs have no symptoms or signs and PE can mimic many other conditions such as heart attack or anxiety or pneumonia or heart failure," Goldhaber says.

"Unless you think about it as a diagnosis, it can be very difficult to make," he adds. "The lay public is not really aware of PE. You rarely have someone calling an ambulance and saying, 'I think he's having a PE.'"

Deitelzweig and his colleagues have developed a "clinical assessment tool" to help identify people at risk of DVT. The various risk factors -- obesity, heart failure, infections, lung problems, prolonged immobility -- are put on a grid and everyone admitted to the hospital is assessed and put in a category of low, medium or high risk.

"It's part of the intake," Deitelzweig says.

People with two risk factors get treated with non-pharmacological devices, such as compression stockings. If a person has three or more risk factors, or if he or she has two risk factors and has also had a stroke or cancer, they get at least one blood-thinning drug.

Ochsner also has a multidisciplinary "thrombosis consult services" unit, which can be sent anywhere in the hospital to provide a more specific assessment of a patient's risk.

There's no data yet on the effectiveness of the program, but "a member of the [services] team gets called every day now to help manage patients," Deitelzweig says. "Now, we have the structure and it appears to be working for us."

In addition to encouraging hospitals to develop programs for preventing blood clots, the CLOT group is also focusing on outpatient practices.

"These days, many of the patients who would traditionally be in the hospital are managed at home," Goldhaber says. "These patients may, ironically, be at an even greater risk because they're not getting the intensive physical therapy they might get in the hospital."

What To Do

For more information on the Council for Leadership on Thrombosis, visit Thrombosis Online or call 1-800-CLOT-FREE. For more on deep vein thrombosis, visit the University of Massachusetts Medical School.

SOURCES: Samuel Goldhaber, M.D., co-chairman, Council for Leadership On Thrombosis (CLOT) Awareness and Management, director, Venous Thromboembolism Research Group, Brigham and Women's Hospital, Boston, and associate professor, medicine, Harvard University Medical School, Boston; Steven Deitelzweig, M.D., section head, hospital-based internal medicine, Ochsner Clinic Foundation, New Orleans
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