DEEP-VEIN THROMBOSIS ADVICE

Thankfully, my father is now back at home and although he’s lost nearly two stone in weight he has got over the several very serious infections and has got his appetite back. Now he has to build up his strength before his body has to deal with another onslaught of chemotherapy and radiotherapy.

Thank goodness for my consultant haematologist brother – my “blood brother”, who has been on the case and recognised what treatment has been needed and when. Most crucially getting him straight back in to hospital when he started complaining of chest pains. It turned out that he had a deep-vein thrombosis that had caused a pulmonary embolus.

It seems that although 5 times more patients have died from blood clots after a hospital stay than as a result of a superbug, this condition rarely receives the attention that it deserves. Thromboembolic disease kills more people than road traffic accidents, breast cancer and MRSA combined per year – 25,000 NHS inpatients (25,000!!!) have died unnecessarily over the past year and although hospitals appear to be more on the case now, there doesn’t seem to be enough information and/or preventative measures being encouraged. The condition is relatively easy to avoid if you take the necessary precautions. This situation should not be happening. It seems that surgeons are good at giving prophylaxis as an inpatient but it mostly gets forgotten when their patients go home.

Typically DVT’s form in the deep veins of the calves and can be caused by a number of factors: increased “stickiness: of the blood; damage to the blood vessel wall; and sluggish blood flow. Underlying conditions such as pregnancy or an inherited tendency to clotting, an illness such as cancer or the effect of hormones in some types of contraceptive pill and hormone replacement therapy (HRT), all make blood stickier. Trauma and surgery can damage vein walls, but the main cause of sluggish blood flow is immobility and my father had all three of these. Consequently he was one of the 10% of people who had part of the clot break off and travel around the circulatory system, eventually becoming lodged in the lungs. 10% of people who get a pulmonary embolus will die.

As many as a third of patients will develop a DVT after surgery unless specific preventative measures are taken. Some practical advise that I read about recently in an article in The Times written by Dr Mark Porter includes the following:-

All patients should be individually assessed so that preventative measures can be tailored accordingly.
Seek advise if you are on the combined contraceptive pill (the mini-pill is fine) or HRT both should generally be stopped about a month before surgery
Proven anti-DVT measures include thigh-length compression stockings and blood-thinning drugs (typically heparin injections).
Stockings must be fitted according to calf size, not foot size.
Try and keep active and mobile as soon after an operation as possible
Look out for any typical signs – including a tender swollen calf or if it has gone to the lungs, shortness of breath, chest pain on breathing deeply and sometimes coughing up blood.

My father is now being treated with the blood-thinning drug warfarin (heparin also used). My brother is closely monitoring the dose of warfarin because it depends on the increase in the time the patient’s blood takes to clot versus nonanti-coagulated blood. The baseline level is 1.0 and the ratio is called the INR which stands for international normalised ratio.
If it is too low then the blood may clot again, too high and may it may cause a bleed. My brother had to override the hospital’s request not to repeat a blood test until next week and he was right to do that. His dosage had to be increased owing to the ratio being made artificially high by the antibiotics he is no longer on. The dosage is often more art than science. The level can be affected by alcohol too and foods that contain vitamin K which is the antidote.

Warfarin is what they use for rat poison in case you didn’t know that – the rats die because no-one checks their international normalised ratio….

The risk of a fatal pulmonary embolus reduces rapidly once treatment has started and most people will make a complete recovery.