When clots turn deadly
A family friend Elizabeth, 64, broke her left ankle when she fell down a flight of stairs at home in June. As it was a clean break, her orthopaedic doctor told her she did not require surgery. Instead, he put her leg in a cast boot, reassuring her that the broken fibula (calf bone) would eventually fuse on its own, and sent her home, telling her to get plenty of rest.
Elizabeth (name changed for patient confidentiality reasons) spent most of the next six weeks in bed, only getting out when she really needed to with the aid of crutches. Her cast boot was adjustable, so she loosened it whenever she needed some relief. At the end of July, just five days before she was scheduled to get her cast boot removed, she collapsed while taking a shower. Feeling light-headed and short of breath, she called out to her husband, but before he could phone for the ambulance, she passed out in his arms.
Elizabeth died a few hours later from a blood clot in the lung, a condition known as pulmonary embolism. Before her fall, she was a healthy and active woman who followed a sensible diet, exercised regularly and didn't smoke or drink. Her prolonged immobility was believed to have created the conditions for a blood clot to form in her injured leg. lizabeth had deep vein thrombosis (DVT).
Her doctors later told her family that the clot in her leg broke off, moved upwards and became lodged in an artery of her lungs. The day before she died, Elizabeth had complained that her left thigh and knee were sore, but her family had no idea that her life was in mortal danger.
DVT is commonly associated with long-distance flying and is sometimes referred to as 'economy-class syndrome'. But long-haul travellers are not the only people at risk. Dr Nicholas Cox, a Melbourne-based cardiologist, says it is not unusual for DVT to develop in people who have been immobilised for a lengthy period, as is usually the case after hip or knee surgery, or following a severe injury when a person is confined to bed for a lengthy period.
Orthopaedic specialist Dr Yeung Yeung from Asia Medical Specialists says the prevalence of DVT is well documented in hip and knee surgeries, but not in foot and ankle surgeries. She says that calf swelling and pain can be symptomatic of DVT, and if a clot is found, the patient is usually prescribed anticoagulants to help thin the blood. Yeung points out, however, that a clot is not easy to detect and by the time any complications arise, it is usually too late to save the patient.
Yeung says she advises her injured patients who are at risk of developing DVT to stay adequately hydrated during the immobilisation period, to prevent their blood from thickening. She also tells them to move their injured limb or the adjacent uninjured joints, to get their blood pumping more efficiently. 'Pain control can also give a sense of security to patients and therefore encourage early mobilisation,' she adds.
Other groups at risk of developing DVT include the elderly, women who are pregnant, on the pill or oestrogen replacement therapy, the obese, smokers, those who have had blood clots before, and those who have recently had congestive heart failure or a heart attack. These groups are more prone to DVT due to abnormalities with their blood clotting, Cox says. Some of these abnormalities are also inherited. So, if a close family member has or has had DVT, you are also considered to be high-risk. If you are not sure about your family's medical history, Cox says that specific blood tests can reveal if you have a propensity to clots.
If you belong to any of these high-risk groups, there are certain measures you can take to reduce the risk. Anticoagulants can help if you have had blood clots before or having just undergone certain types of surgery after which blood clots can form. You're also advised to avoid sitting for extended periods; however, if you've just had surgery or are recovering from an illness or injury and require bed-rest, try to get up and move every now and again, to improve blood circulation in your legs. Otherwise, ask your doctor to recommend appropriate leg exercises which you can do every hour to keep the blood moving. Avoiding dehydration may also help, Cox suggests.
When you are dehydrated, your blood thickens and has a greater tendency to clot. And of course, whether or not you are part of the high-risk group, it helps to exercise regularly, maintain an ideal weight, and stick to a heart-healthy diet that is low in both saturated fat and cholesterol and high in fibre. If you're wondering whether compression stockings can help reduce your risk, Cox says that the scientific evidence to suggest they work is not very convincing.
Plus, they can be uncomfortable and difficult to get on and off. However, that's not to say you can't wear them, because they are a sensible preventive treatment, Cox adds.