Travellers beware: Deep vein thrombosis

One of the saddest deaths I have witnessed was that of a young man who sustained a severe head injury. We admitted him to hospital and spent a long time and plenty of money looking after him. He survived and actually regained consciousness, He also became so much better that he was able to walk out of hospital. Well, nearly! You see, he died at the hospital gates. He simply collapsed and died from a blood clot that had dislodged from his veins into the heart.

A patient of mine travelled to Dubai for surgery and returned after a successful operation, only to die suddenly a few days later. This was from exactly the same condition, deep vein thrombosis and pulmonary embolism. Another patient suffered a neck injury and was in bed for only a few days before surgery to fix her broken neck. However, in this woman, a few days of being immobile were enough. She nearly died after complaining of severe leg pains, leg swelling and difficulty in breathing.

Deep vein thrombosis

This means blood clot in the veins of the legs. Often due to lack of movement and therefore stagnation of the blood in the veins leading them to clot up and clog the same veins. The legs swell and become very painful. Untreated, the clots extend up into the abdomen and could very easily float up to the heart where they block the major veins carrying blood from the lungs to the heart-the pulmonary veins. This blockage stops a huge amount of blood from returning to the heart and therefore the heart stops working, suddenly leading to immediate or imminent death.

Deep vein thrombosis is common in patients with severe head injuries, cancer, the obese and pregnant women. These people are often immobile and therefore doing little leg exercise. When we exercise the legs, the muscle action pumps the blood in the veins out towards the heart. This effectively prevents blood from stagnating and clotting up in the legs.

Travellers beware

Let’s review a few public cases that have occurred in Nigeria. Unconfirmed reports suggest that Susan Harvey ‘Goldie’ may have died from deep vein thrombosis after returning from a long trip to the USA. The late Professor Olikoye Ransome-Kuti may have also died from deep vein thrombosis. We lost a colossus in that man! Anyway, regardless, I wanted to ask those travelling long distance to places such as the USA, China, India and other faraway places to be aware and ensure they actively protect themselves against this killer.

How to prevent it?

We would probably never know how many people come back from a long trip, slump and die suddenly. Sadly, it seems to affect the affluent especially those who fly first class and business class with very comfortable and relaxed chairs. Many are so lazy they do not get up and walk about because they are in first class! Well, the risk is that you develop blood clots in the legs and increase your risk of sudden death. Some airlines encourage exercise and activity while seated. Take advantage and do not act like you are too big to take a walk. Do walk around on the plane: find someone to talk to and save your own life!

Depending upon the risk for deep vein thrombosis (DVT for short), different preventive measures are used. Walking and calf exercises reduce venous stasis because leg muscle contractions compress the veins and pump blood up towards the heart. In immobile individuals, physical compression methods can improve blood flow.

The use of graduated compression stockings that fit below the knee and give about 15–30 mm Hg of pressure to the ankle has been suggested. Compression stockings have sharply reduced the levels of DVT in airline passengers. I will also recommend the use of aspirin for some days before and certainly weeks after returning to reduce your risk.

Anticoagulation, which increases the risk of bleeding, might be used in high-risk situations. The risk of major bleeding with long-term anticoagulation is about 3% per year but anyone with a high risk of DVT should be considered for treatment. Speak to your doctor.

Proper treatment of DVT

You and your doctor should figure out what may have caused your DVT, so you can take steps to avoid getting more clots. Your doctor may give you a drug to dissolve the clot. These medicines can save your life, but they can also cause bleeding that is hard to stop. You'll have to be in the hospital, and the staff will watch you carefully. One of my patients on such medications developed severe bleeding during her menstrual periods.

If your symptoms aren't life-threatening, or if using a thrombolytic would be too dangerous, your doctor will give you medication that interrupts the clotting process or stops platelets in your blood from sticking together. They don't break down the clot, but they'll keep it from getting bigger while your body works on dissolving it. 

Afterward, you'll probably take a blood thinner pill for at least 3 months. If your doctor prescribes a drug called warfarin (Coumadin), you'll need to get your blood tested often to make sure you have the right amount of the drug in your system. You won't need blood tests if you take a newer blood thinner, such as apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), or rivaroxaban (Xarelto). For some very serious cases, a specialist may need to do surgery to break up and remove the clot. 

Okay, what is the bottom line here? Please be aware and do all you can to help yourself prevent sudden death. This one is not in your hands, but in your legs! Get moving!