Venous thromboembolism

"Early detection and prevention in this disease is of utmost importance".

DR. RAMÓN LECUMBERRI VILLAMEDIANA
CODIRECTOR. HAEMATOLOGY AND HAEMOTHERAPY DEPARTMENT

Venous thromboembolic disease (VTE) in any of its forms (deep vein thrombosis or pulmonary embolism) is a process characterized by the coagulation of blood inside the veins (thrombosis), with the resulting consequences of the displacement and fixation in the lung of the whole or a fragment of the clot (embolism).

It should not be confused with the presence of varicose veins, since, although these may be the cause of VTE, they consist of venous dilations in which there is not always a thrombus obstructing the light of the vein. The typical location of venous thrombosis is in the veins of the calf and thigh.

Venous thrombosis is the third cause of cardiovascular death after acute myocardial infarction and stroke. However, it can be prevented and treated.

The long-term prognosis of the patient who has suffered an episode of VTE can be complicated by the appearance of recurrent thrombosis, despite anticoagulant treatment, and the presence of post-thrombotic syndrome, characterized by chronic venous insufficiency, which conditions circulatory problems and alterations in the skin of the limb that can become ulcerated and present gangrene.

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What are the symptoms of venous thromboembolism?

There are local symptoms, mainly the pain located in the venous path of the leg, which increases with the dorsal flexion of the foot; the edema of the limb which is soft and progresses from the root of the affected member, in which there is a feeling of heaviness and a certain degree of functional impotence, and increased local heat in the limb.

Sometimes there are general symptoms such as fever, increased heart rate and respiratory symptoms such as cough, dyspnea and occasionally hemoptysis as manifestations of pulmonary embolism.

The most common symptoms of deep vein thrombosis are:

  • Pain in the affected limb.
  • Edema.
  • Feeling of heaviness.
  • Increased local heat in the limb.

Do you have any of these symptoms?

You may have a venous thromboembolism

Who can suffer from it?

There are acquired risk factors, that is, situations that predispose to the appearance of VTE.

The most important of these are advanced age, major surgical operations, patients with prolonged immobilization, such as in the case of cerebral infarction or heart failure, inflammatory diseases of the intestine, pregnancy and puerperium, neoplasms and oral contraceptives.

In addition, there are congenital risk factors, which carry a genetically determined tendency to present VTE, the most frequent being resistance to protein C (factor V Leiden) and prothrombin mutation, which can affect several members of the same family.

How is leg thrombosis prevented?

There are clinical situations, after a surgical intervention or people who have been bedridden for a long time, that favor and increase the risk of presenting a venous thrombosis.

That is why in these cases, it is necessary to carry out pharmacological prevention measures, administering heparin subcutaneously or anticoagulant medication orally.

As general measures that can diminish this risk are the precocious deambulation, avoiding the immobilization during a too prolonged time, to drink great amount of water and the accomplishment of exercises in which the musculature of the legs contracts and this way the venous return is stimulated.

How is venous thromboembolism diagnosed?

<p>&nbsp;Imagen Laboratorio de Bioquimica</p>

The methods currently available for the diagnosis of venous thromboembolism include clinical diagnosis, analytical tests and radiological studies.

The presence of isolated symptoms and/or signs does not allow the diagnosis to be made with certainty because they are non-specific. Therefore, complementary tests are always necessary, being fundamental the venous ultrasound (of fast realization, painless and possessing high sensibility) and the helical TAC, to rule out pulmonary embolism.

At present, if the results of the ultrasound and/or TAC and of a special laboratory test (D-dimer) are negative, the diagnosis of venous thromboembolism can be safely ruled out, without the need to resort to invasive tests.

How is venous thromboembolism treated?

Early detection and prevention are essential to diminish the sequelae that venous thromboembolic disease can produce in the medium and long term.

To prevent VTE is to fight against the risk factors. If the process has a special impact on cardiac, post-operative, neoplastic, infected patients, etc., it will be precisely on them that we must establish prophylaxis.

The main preventive measures are, firstly, physical measures and, secondly, pharmacological ones. Among the former, all measures that favor venous return will be beneficial, such as elevating the feet from the bed, early mobilization, as well as the different models of bandages, pneumatic compression and elastic stockings; all of this to increase the flow of the deep veins of the legs.

Pharmacological measures are mainly indicated in patients at high risk for VTE. Many substances have been used, such as aspirin, heparin and other anticoagulants, but at present the method of choice is the subcutaneous administration of a low molecular weight heparin preparation, since these substances have been shown to be very effective in reducing complications derived from VTE in patients with risk factors.

Until now, the current treatment of thrombosis, consisted of the administration of heparin intravenously or subcutaneously followed by Sintrom.

The new oral anticoagulants, Dabigatran, Rivaroxaban and Apixaban, have made a strong breakthrough in the treatment and prevention of thrombosis and are replacing traditional drugs.

The new oral anticoagulants have several advantages for the patient

  • They do not require laboratory monitoring.
  • They are convenient, since they are administered orally.
  • They have few interactions with other drugs and foods.
  • They lead to fewer hemorrhagic complications, especially cerebral hemorrhage.

Where do we treat it?

IN NAVARRA AND MADRID

The Hematology and Hemotherapy Service of the
at the Clínica Universidad de Navarra

The Hematology Service of the Clinic, formed by specialists of recognized national and international prestige, has integrated molecular diagnostic techniques and the use of new personalized treatments in its assistance work, allowing a more precise and fast diagnosis of the hematological diseases.

The joint work of the medical staff and the researcher facilitates the development and application of the new treatments and at the same time the precise evaluation of the result of the treatments.

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