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.