THROMBOSIS

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INTRODUCTION-

A thrombus is a blood clot in the circulatory system. It attaches to the site at which it formed and remains there, hindering blood flow.

Doctors describe the development of a thrombus as thrombosis.

A thrombus is most likely to occur in people who are immobile and in those with a genetic predisposition to blood clotting.

A thrombus can also form after damage occurs in an artery, vein, or surrounding tissue.In this article, we look at blood clotting and the different types of thrombi. We also look at the symptoms, diagnosis, and treatment of a thrombus.

TYPES-

Thrombosis occurs when blood clots block your blood vessels. There are 2 main types of thrombosis:

• Venous thrombosis is when the blood clot blocks a vein. Veins carry blood from the body back into the heart.
• Arterial thrombosis is when the blood clot blocks an artery. Arteries carry oxygen-rich blood away from the heart to the body.

A blood clot is usually a normal physical response to injury.

It quickly forms a plug that can reduce or prevent bleeding. However, a thrombus can cause severe health problems, as it interrupts the function of a blood vessel.

A section of a blood clot that breaks free from the thrombus and circulates in the bloodstream is called an embolus.

An embolus moves through the vascular system until it lodges in a different part of the body.

An embolus is a dangerous and potentially fatal complication of thrombosis. It is especially dangerous if it reaches the heart, lungs, or brain (embolism).

Doctors categorize thrombi based on the type of blood vessel in which they develop:

When a thrombus forms in an artery, such as in the heart or brain, it is called an arterial thrombosis.

When a thrombus occurs in a vein, it is called a venous thrombosis. When this happens in the deep veins of the leg, it is called deep vein thrombosis (DVT).

CAUSES-

Clotting occurs due to a series of chemical reactions between blood cells known as platelets and proteins called clotting factors.

When a person is in good health, the body regulates the clotting process according to its needs.

However, a clot can form more easily when a person:

• uses tobacco
• has high cholesterol
• has obesity or is overweight
• has cancer
• has diabetes
• is stressed
• has an inactive lifestyle

Venous thrombosismay be caused by:

• Disease or injury to the leg veins
• Not being able to move around (immobility) for any reason
• A broken bone (fracture)
• Certain medicines
• Obesity
• Inherited disorders, or a greater likelihood of having a certain disorder based on your genes
• Autoimmune disorders that make it more likely your blood will clot
• Medicines that increase your risk of clotting (such as certain birth control medicines)

Arterial thrombosismay be caused by a hardening of the arteries, called arteriosclerosis. This happens when fatty or calcium deposits cause artery walls to thicken. This can lead to a buildup of fatty material (called plaque) in the artery walls. This plaque can suddenly burst (rupture), followed by a blood clot.

Arterial thrombosis can occur in the arteries that supply blood to the heart muscle (coronary arteries). This can lead to a heart attack. When arterial thrombosis occurs in a blood vessel in the brain, it can lead to a stroke.

Some of these factors also increase the risk of atherosclerosis, a condition wherein fatty plaque deposits line the blood vessels and clog them.

Atherosclerosis makes blood clots more likely to block the arteries and the veins.

SYMPTOM-

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Each person’s symptoms may vary. Symptoms may include:

• Pain in one leg (usually the calf or inner thigh)
• Swelling in the leg or arm
• Chest pain
• Numbness or weakness on one side of the body
• Sudden change in your mental state

The symptoms of thrombosis may look like other blood disorders or health problems. Always see your healthcare provider for a diagnosis.

Deep vein thrombosis signs and symptoms can include:

Swelling in the affected leg. Rarely, there’s swelling in both legs.

• Pain in your leg. The pain often starts in your calf and can feel like cramping or soreness.
• Red or discolored skin on the leg.
• A feeling of warmth in the affected leg.

Deep vein thrombosis can occur without noticeable symptoms.

When to see a doctor

If you develop signs or symptoms of deep vein thrombosis, contact your doctor.

If you develop signs or symptoms of a pulmonary embolism — a life-threatening complication of deep vein thrombosis — seek immediate medical attention.

The warning signs and symptoms of a pulmonary embolism include:

• Sudden shortness of breath
• Chest pain or discomfort that worsens when you take a deep breath or when you cough
• Feeling lightheaded or dizzy, or fainting
• Rapid pulse
• Coughing up blood

Symptoms of arterial thrombosis

A thrombus in an artery can result in:

• unstable angina, which is a type of chest pain
• heart attack
• ischemic stroke
• peripheral arterial limb ischemia, a condition that significantly reduces blood flow to the limbs

These conditions all require prompt medical attention.

People should seek emergency treatment if they experience any of the following symptoms:

• chest pain
• shortness of breath
• drooping on the lower half of the face
• a sudden loss of strength in one arm or leg
• a limb that has become cold, pale, and painful

Diagnosis

Doctors use several different methods to diagnose the presence of a thrombus. For example, they may use:

• Duplex ultrasound: This is the most common test for diagnosing DVT. A duplex ultrasound uses sound waves to create images of the blood flowing through the arteries and veins.
• A D-dimer test: This test measures the levels of a substance in the blood that results from the breakdown of blood clots. High levels of this substance may indicate the presence of DVT or another type of blood clot. However, the test is not definitive. If the result is normal and few risk factors are present, a person does not have a high risk of DVT.
• Venography: For venography, a doctor will inject a dye into a vein in the affected leg. This dye makes the vein visible on some types of X-ray, such as a fluoroscopy. If the scan shows a slower-than-usual blood flow through the vein, a thrombus may be present.
• MRI and CT scans: These scans create detailed images of organs, tissues, and blood vessels.
• A VQ scan: This is a nuclear imaging study. It uses a radioactive substance called a radiotracer to reveal, on a scan, the flow of air and blood within the lungs.

A doctor may request blood tests to check for a genetic blood clotting disorder. This may be necessary in cases of repeated unexplained blood clots.Thrombi in the liver, kidney, or brain may develop due to an inherited clotting disorder.

RISK FACTOR-

Many of the risk factors for venous and arterial thrombosis are the same.

Risk factors for venous thrombosis may include:

• A family history of a blood clot in a vein deep in the body, called a deep vein thrombosis (DVT)
• A history of DVT
• Hormone therapy or birth control pills
• Pregnancy
• Injury to a vein, such as from surgery, a broken bone, or other trauma
• Lack of movement, such as after surgery or on a long trip
• Inherited blood clotting disorders
• A central venous catheter
• Older age
• Smoking
• Being overweight or obese
• Some health conditions, such as cancer, heart disease, lung disease, or Crohn’s disease

Risk factors for arterial thrombosis may include:

• Smoking
• Diabetes
• High blood pressure
• High cholesterol
• Lack of activity and obesity
• Poor diet
• Family history of arterial thrombosis 
• Lack of movement, such as after surgery or on a long trip
• Older age

Many factors can increase your risk of developing deep vein thrombosis (DVT). The more you have, the greater your risk of DVT. Risk factors include:

• Inheriting a blood-clotting disorder. Some people inherit a disorder that makes their blood clot more easily. This condition on its own might not cause blood clots unless combined with one or more other risk factors.
• Prolonged bed rest, such as during a long hospital stay, or paralysis. When your legs remain still for long periods, your calf muscles don’t contract to help blood circulate, which can increase the risk of blood clots.
• Injury or surgery. Injury to your veins or surgery can increase the risk of blood clots.
• Pregnancy. Pregnancy increases the pressure in the veins in your pelvis and legs. Women with an inherited clotting disorder are especially at risk. The risk of blood clots from pregnancy can continue for up to six weeks after you have your baby.
• Birth control pills (oral contraceptives) or hormone replacement therapy. Both can increase your blood’s ability to clot.
• Being overweight or obese. Being overweight increases the pressure in the veins in your pelvis and legs.
• Smoking. Smoking affects blood clotting and circulation, which can increase your risk of DVT.
• Cancer. Some forms of cancer increase substances in your blood that cause your blood to clot. Some forms of cancer treatment also increase the risk of blood clots.
• Heart failure. This increases your risk of DVT and pulmonary embolism. Because people with heart failure have limited heart and lung function, the symptoms caused by even a small pulmonary embolism are more noticeable.
• Inflammatory bowel disease. Bowel diseases, such as Crohn’s disease or ulcerative colitis, increase the risk of DVT.
• A personal or family history of deep vein thrombosis or pulmonary embolism. If you or someone in your family has had one or both of these, you might be at greater risk of developing a DVT.
• Age. Being older than 60 increases your risk of DVT, though it can occur at any age.
• Sitting for long periods of time, such as when driving or flying. When your legs remain still for hours, your calf muscles don’t contract, which normally helps blood circulate. Blood clots can form in the calves of your legs if your calf muscles don’t move for long periods.

COMPLICATION-

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Thrombosis can block the blood flow in both veins and arteries. Complications depend on where the thrombosis is located. The most serious problems include stroke, heart attack, and serious breathing problems.

A serious complication associated with deep vein thrombosis is pulmonary embolism.

Pulmonary embolism

A pulmonary embolism occurs when a blood vessel in your lung becomes blocked by a blood clot (thrombus) that travels to your lung from another part of your body, usually your leg.

A pulmonary embolism can be life-threatening. It’s important to watch for signs and symptoms of a pulmonary embolism and seek medical attention if they occur. Signs and symptoms of a pulmonary embolism include:

• Sudden shortness of breath
• Chest pain or discomfort that worsens when you take a deep breath or when you cough
• Feeling lightheaded or dizzy, or fainting
• Rapid pulse
• Coughing up blood

Postphlebitic syndrome

A common complication that can occur after deep vein thrombosis is known as postphlebitic syndrome, also called postthrombotic syndrome. Damage to your veins from the blood clot reduces blood flow in the affected areas, which can cause:

• Persistent swelling of your legs (edema)
• Leg pain
• Skin discoloration
• Skin sores

PREVENTION-

You can reduce your risk of thrombosis by:

• Being active
• Getting back to activity as soon as possible after surgery
• Exercising your legs during long trips
• Quitting smoking
• Losing weight
• Managing other health problems such as diabetes, high blood pressure, and high cholesterol

Measures to prevent deep vein thrombosis include:

• Avoid sitting still. If you have had surgery or have been on bed rest for other reasons, try to get moving as soon as possible. If you’re sitting for a while, don’t cross your legs, which can hamper blood flow. If you’re traveling a long distance by car, stop every hour or so and walk around. If you’re on a plane, stand or walk occasionally. If you can’t do that, exercise your lower legs. Try raising and lowering your heels while keeping your toes on the floor, then raising your toes with your heels are on the floor.
• Make lifestyle changes. Lose weight and quit smoking.
• Exercise. Regular exercise lowers your risk of blood clots, which is especially important for people who sit a lot or travel frequently.

It is not always possible to prevent a thrombus. However, people can take steps to reduce their risk.

For example, a person can:

• avoid or quit tobacco smoking
• prevent excessive weight gain or lose weight to avoid obesity
• adopt a healthful diet
• exercise regularly

It is particularly important for a person to move around as much as possible after a surgical procedure or during long distance travel.

Those with a higher risk of developing a blood clot may also require anticoagulant therapy alongside medications to reduce blood pressure and blood cholesterol levels.

TREATMENT-

The aim of treating a thrombus is to achieve the following quickly and effectively:

• gain control over the symptoms
• restore the blood flow
• reduce and remove the thrombus

Doctors typically recommend the following treatments to deal with the effects of thrombi:

Surgery

Surgery for the effects of thrombosis will always be a medical emergency.

The procedure can involve directly accessing and unblocking an affected artery. In other cases, the surgeon will divert blood flow or completely bypass the blocked artery.

Inferior vena cava filters

Inferior vena cava (IVC) filters are small mesh devices that a surgeon can put in the inferior vena cava (a large vein), usually under local anesthetic.

The IVC filter traps fragments of the blood clot and prevents them from reaching the heart and lungs.

An IVC filter can be permanent, and doctors typically combine this treatment with anticoagulation medication therapy where possible. However, a surgeon may remove the IVC filter if the person’s risk of a blood clot declines.

Anticoagulants

Anticoagulants, or blood thinners, have a misleading name; they do not give the blood a thinner consistency.

Instead, they reduce the risk of a clot forming, which can reduce the size of a thrombus.

When taking anticoagulant medications, a person should visit a specialized anticoagulant management service instead of a primary care physician.

If anticoagulants are not effective, or if a person does not tolerate them well, a doctor will consider other treatment options.

Compression stockings

Doctors may recommend that people wear compression stockings while taking anticoagulant therapy for DVT.

The stockings help prevent calf pain and swelling, as well as reduce the risk of complications.

A person should wear compression stockings for as long as their doctor recommends.

Raising the affected leg

As well as wearing compression stockings, people should try to keep the affected leg elevated above hip level during the night.

This can relieve pressure in the veins, improve blood circulation, and help prevent complications.

Exercise

Once a doctor has prescribed compression stockings, they will usually recommend more frequent walking to stimulate blood circulation.

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