|
E-mail this page to a friend!
Older People More Susceptible to Blood Clots When
Traveling
Nov. 30, 2004 People over 60 and those obese
too often one in the same are the most likely to suffer, and sometimes
die, from deep vein thrombosis (DVT), a blood clot in a vein deep within
the muscles, usually in the calf or thigh. When the clot breaks up an
enters the lungs in can cause a deadly pulmonary embolism, and this risk
doubles for each 10 years after age 60. Sitting motionless for long
periods of time like traveling by car or plane
increases the risk of DVT.
The following article from the FDA Consumer
magazine (November-December
2004 Issue) offers advice on avoiding and treating DVT.
Avoid Deep Vein Thrombosis: Keep the Blood
Flowing
By Linda Bren
Holiday travelers will soon clog the nation's
highways and inundate its airports in numbers not seen in recent years.
The number of travelers over the four-day Thanksgiving holiday is
expected to surpass the 31 million Americans who traveled more than 50
miles by car and the 5 million who went by plane in 2003, according to
AAA spokesman Lon Anderson. "This is the first year we've seen travel
returned to what it was pre-9/11," he says.
No matter what the mode of transportation, sitting
motionless for long periods may put some travelers at an increased risk
for deep vein thrombosis (DVT), a blood clot in a vein deep within the
muscles, usually in the calf or thigh. But people can reduce their risk
of getting DVT, says the American Heart Association (AHA), by taking
some simple precautions on long trips.
The AHA estimates that 1 out of every 1,000
Americans develops DVT each year. "It oftentimes gives you a swollen,
painful leg, usually in the calf," says Richard Stein, M.D., a
cardiologist and associate chair of medicine at Beth Israel Medical
Center in New York City and a spokesman for the AHA. "But it can be
silent," producing no noticeable signs. "Tragic cases are when ... a
piece of thrombus [blood clot] breaks off and goes into the lungs," says
Stein. This complication of DVT, known as pulmonary embolism, was
brought to public attention in 2003 when it caused the death of
39-year-old NBC reporter David Bloom. Bloom had spent long hours
reporting the war in Iraq from the cramped quarters of a military
vehicle.
Any long period of immobility--such as being
bedridden from illness, recovering from surgery, or sitting for extended
periods while traveling--is a risk factor for DVT and pulmonary
embolism, says the National Heart, Lung, and Blood Institute (NHLBI).
DVT can also develop in other instances when the blood flow in the legs
is restricted and slows down. Restricted flow may occur with certain
types of cancer and cancer treatment, obesity, inherited clotting
disorders, pregnancy, and damage to the veins following injury or
orthopedic surgery.
Clotting the blood is "nature's way of trying to
prevent bleeding," says Wolf Sapirstein, M.D., a cardiologist at the
Food and Drug Administration. But when nature's protective mechanism
overcompensates and precautions aren't taken, there is a danger of blood
clots.
Reducing the Risk While Traveling
DVT has been dubbed "economy-class syndrome,"
reflecting the cramped legroom in economy class airline seating. But it
can happen to passengers in any seating class of an aircraft, according
to the Federal Aviation Administration. It can also happen to people on
long rides in cars, trains, or buses.
"People should not be afraid to travel," says
Stanley Mohler, M.D., professor emeritus of aerospace medicine at the
Wright State University School of Medicine in Dayton, Ohio. "They should
just anticipate that they may be inclined to be immobile," he says, and
take precautions. A two-hour flight wouldn't be a problem, he says, but
a 12-hour flight would be "a big problem" if a person sits inactive the
entire time. Children who travel don't appear to be at risk for DVT,
says Mohler, because they are generally more active in their seats than
adults.
In adults, "hub-and-spoke flying is also a
problem," he says, referring to a series of connecting flights
interspersed with long hours of waiting between flights. "It's important
for passengers to keep moving their legs to help the blood flow," even
when waiting in the airport terminal, says Mohler, who advises walking
when possible. "When you walk, the muscles of the legs squeeze the veins
and move blood to the heart."
Another way to help move blood to the heart is to
wear compression stockings, which put gentle pressure on the leg
muscles. Studies in healthy people have shown that wearing compression
stockings minimizes the risk of developing DVT after long flights,
according to the AHA. These stockings are available at medical supply
stores.
Stein advises avoiding regular socks with very
tight elastic bands at the top and sitting with your legs crossed for
long periods of time, which constricts the veins. He also urges
travelers who can't walk around frequently to exercise their legs by
curling or pressing the toes down, which causes the muscles to contract
and squeeze on the leg veins, helping to pump the blood along.
Airlines, also, are encouraging passengers to
periodically move and stretch their legs. The Australian carrier Qantas,
for example, offers leaflets with leg exercises that passengers can do
in their seats. Qantas began printing warnings for DVT on its tickets
following the highly publicized death of a 28-year-old woman in October
2000. The woman died from a pulmonary embolism shortly after she stepped
off a 20-hour Qantas flight from Australia to England after attending
the Olympic Games in Sydney.
Stein also advises drinking plenty of fluids to
prevent dehydration. Dehydration causes blood vessels to narrow and
blood to thicken, increasing the risk for DVT. Reducing alcohol and
coffee consumption, which both contribute to dehydration, is also
recommended. These steps aren't scientifically proven to prevent DVT,
but they're common sense, says the AHA. As for taking aspirin to prevent
DVT, "there is no real evidence that an aspirin reduces the likelihood,
but it very possibly could be of value," says Stein.
When traveling by car, "Don't take a 10-hour trip
without stopping every couple of hours," says Stein. "Get out and walk a
bit." Even if you're the driver, you still need to take walking breaks,
he says. "Pushing on the gas pedal isn't enough activity even for the
one leg."
"Deep vein thrombosis went unrecognized for decades
because the clots that formed in the large veins in the legs often
started coming off in little pieces after a person had been home for a
day or two," says Mohler, "so they would go to the emergency room with a
suspected possible heart attack."
Chest pain can be a symptom of both heart attack
and pulmonary embolism. Other common symptoms of pulmonary embolism are
unexplained shortness of breath and coughing up blood. It's important to
tell your doctor if you have taken a long trip recently, says Mohler, so
you can be diagnosed correctly.
If you have any symptoms of pulmonary embolism, sit
down and tell someone you have an emergency and need immediate help,
says Stein. At that point, "there is no value in putting your feet up or
drinking gallons of water. Getting to an emergency room quickly is your
best shot."
Another potential complication of DVT is post-phlebitic
syndrome, a permanent condition caused by valves in the leg veins that
don't work properly. "The body has mechanisms within itself to dissolve
clots, but it's a very slow process," says George Shashaty, M.D., an FDA
hematologist. "In the interim, an inflammatory reaction occurs that can
scar the veins, especially the valves." The valves then fail to prevent
blood from flowing backwards, allowing the blood to pool in the leg
veins and cause pain, swelling, and sometimes varicose veins and skin
ulceration.
Diagnosis and Treatment
A commonly used FDA-approved medical test to
diagnose DVT is the duplex ultrasound, says Sapirstein. A handheld
device is passed back and forth on the surface of the affected area,
sending sound waves from the body to a machine that generates and
displays a picture of the blood flow on a video screen for a doctor to
evaluate.
Another less commonly used test, venography, may be
done to diagnose DVT if ultrasound does not give a clear diagnosis, says
Sapirstein. A dye is injected into a vein, which makes the blood flow
visible when an X-ray is taken.
Duplex ultrasound, chest X-rays, and other tests
may be used to diagnose a pulmonary embolism.
"The primary treatment for deep vein thrombosis and pulmonary embolism
is blood thinners," says Sapirstein. Blood thinners, or anticoagulants,
such as heparin, will not dissolve clots already formed, but will keep
them from growing and prevent new ones from forming. Heparin may be
given as an injection below the skin surface or into a vein
(intravenously).
People at risk for DVT may be prescribed the blood
thinner Coumadin (warfarin) to keep clots from growing. Warfarin is
currently the only FDA-approved blood thinner taken orally. "Other
agents are being developed as oral anticoagulants but aren't on the
market yet," says Kathy Robie-Suh, M.D., Ph.D., an FDA internist.
Warfarin interacts with many other medications. "If you are on warfarin,
the doctor needs to know all the other medications you are on, including
over-the-counter," says Robie-Suh, and patients should make sure they
take their warfarin before going on a trip. People who have had one deep
vein clot are prone to getting more.
"When a patient cannot tolerate blood thinners or
continues to develop clots, then you have to go to an alternative, such
as a filter," says Sapirstein. The FDA has cleared medical filters, such
as "umbrella filters," that a surgeon can insert into the vena cava, a
large vein in the abdomen that returns oxygen-depleted blood to the
heart. The filter is inserted in a folded position and then springs open
against the vein walls to keep the vein open for blood flow. The filter
does not keep blood clots from forming, but it prevents their passage
from the veins in the lower extremities to the heart and lungs. These
filters may either remain in place permanently or be removed later.
Another treatment alternative for pulmonary
embolisms is administering one of the FDA-approved thrombolytics. These
potent drugs, known as "clot-busters," are given intravenously to
quickly dissolve large clots that are unlikely to break up on their own.
They are used only in life-threatening situations because they may cause
sudden and severe bleeding.
What Makes Deep Vein Thrombosis More Likely?
-
an inherited
condition that causes increased risk for clotting
-
low blood flow
in a deep vein due to injury, surgery, or being immobile
-
cancer and its
treatment
-
other medical
conditions, such as varicose veins
-
sitting for a
long period of time, as on long trips
-
pregnancy and
the first six weeks after giving birth
-
being older than age 60
-
being overweight
-
taking birth
control pills or hormone therapy
-
having a
medical condition that requires a tube placed in a vein to allow
easy access to the bloodstream for medical treatment (central venous
catheter).
Facts About Deep Vein Thrombosis and Pulmonary
Embolism
-
Nine out of 10
cases of pulmonary embolism are caused by blood clots that form in
the legs and then travel to the lungs.
-
More than
600,000 people in the United States have a pulmonary embolism each
year, and more than 10 percent of them die from it.
-
Most who die do
so within 30 to 60 minutes after symptoms start.
-
Pulmonary
embolism occurs equally in men and women.
-
The risk of having a pulmonary embolism doubles for each 10 years
after age 60.
Click to More Senior News on the
Front Page
Copyright: SeniorJournal.com |
