Anyone facing more serious musculoskeletal issues, whether it be a leg or pelvic fracture or even spinal surgery that confines them to bed for extended periods permanently depriving them of the ability to move, is unfortunately at an increased risk of deep vein thrombosis. However, those at risk also include individuals who engaged in sedentary occupations or leading a physically inactive lifestyle for other reasons. Regardless of the risk factor, it is worth being aware of the danger of thrombosis and taking preventive measures.
Veins and thrombosis
The role of veins in our body is to transport “used” blood back to the heart. Thrombosis occurs when a blood clot (thrombus) forms in the blood vessels (usually in the veins) due to a blood clotting problem, partially or completely blocking the flow of blood depending on its size and location. Blood returns most difficulty from the lower limbs and pelvic region to the heart, thanks to the counteraction of gravity and the considerable distance from the heart – this is counteracted by the venous valves in the vessel wall, and in the case of deep veins, the pumping force of the surrounding muscles during movement. If we do not move our legs for a long time, we deprive the deep veins of this muscle pump that pushes blood upward, leading to a slowdown in circulation. Additionally, when this is combined with predisposing factors, the risk of deep vein thrombosis in the legs increases significantly.
However, blood clot formation itself does not necessarily pose a serious problem. The significant complication arises when a clot passes to the lungs or brain, leading to conditions such as pulmonary embolism or stroke.
Risk factors
As we discussed, those engaged in sedentary occupations and individuals confined to bed or a chair are at an increased risk due to the lack of movement in their legs. Unfortunately, deep vein thrombosis can occur in anyone, even as a consequence of an extended period of travel.
It further increases the risk:
- genetic predisposition: those with a family history of thrombosis are at an elevated risk,
- smoking, as it damages the blood vessel walls,
- taking medications that increase blood clotting or have such side effects (including certain contraceptives),
- pregnancy and the postpartum period,
- overweight or obesity,
- certain medical conditions, such as certain types of cancer.
Symptoms of deep vein thrombosis
Thrombosis in the leg has relatively recognizable symptoms:
- oedematous swelling of one leg, with a “doughy” texture,
- measurable thickening of the calf,
- warmth of the skin surface,
- bluish-red discoloration of the skin,
- pain around the veins, intensifying with walking,
- muscular fever-like sensation,
- severe pain in the knee crease when dorsiflexing the foot.
- as a late symptom: brownish discoloration around the ankle.
However, there is also a condition known as ‘silent thrombosis,’ which does not involve pain or other noticeable symptoms. It is only revealed through subsequent symptoms or the occurrence of complications.
The main signs of a severe, potentially life-threatening complication like pulmonary embolism include:
- chest pain,
- difficulty in breathing,
- coughing,
- coughing up blood,
- general weakness.
Actions to be taken in case of suspected thrombosis
The first and most crucial step is complete immobility to prevent the detachment of the blood clot and its passage into the lungs. Therefore:
- do not walk on your own,
- lie down immediately,
- elevate the leg,
- call the doctor on duty or emergency without delay.
Treatment of thrombosis
Treatment for suspected thrombosis requires a thorough examination by a specialist. The primary focus of therapy is to restore blood flow, prevent the growth of the clot, and inhibit the detachment of smaller clots. This is primarily achieved through the prescription of anticoagulant medications, which can be delivered through injections or oral tablets or surgical removal of the clot may also be considered. During treatment, strict bed rest, leg elevation, and compression bandaging are typically prescribed for a few weeks.
In the long term, the use of medical aids, such as compression stockings, the application of creams containing horse chestnut extract, lifestyle changes, and specific exercises may be necessary.
Prevention
Whether predisposing factors or immobility, or a history of deep vein thrombosis makes it necessary, prevention is crucial.
Key aspects of prevention include:
- Regular physical activity, or if it is not possible, movement of the lower limbs.
- Performing specialized vein exercises on a daily basis, which enhance circulation in the lower limbs and stimulate the muscle pump.
- Adequate fluid intake.
- Give up smoking.
- Weight loss.
- Maintaining a balanced diet.
Additionally, during long journeys, it is advisable to take breaks and get out of the vehicle every 1-1.5 hours, move and exercise your limbs, and perform exercises for your legs. If this is not possible (e.g., during a flight), move and exercise your legs while seated – movement of your feet, soles, toes, and ankles can be also beneficial.
