THROMBOSIS EXPERTS SPEAK OUT

Blood clots: Unmasking a silent killer among Kenyans

There is widespread ignorance of the disease, despite it being as common as cancer.

In Summary

• Blood clots they say are lifesavers when they seal a cut. But they can be dangerous, even deadly when they form inside an artery or vein.

• Lifestyle measures such as weight reduction, regular exercise, avoiding dehydration, are all helpful in preventing DVT as well.

Thrombosis is a condition in which blood clots form (most often) in the deep vein of the leg , groin or arm ( deep vein thrombosis or DVT)
Thrombosis is a condition in which blood clots form (most often) in the deep vein of the leg , groin or arm ( deep vein thrombosis or DVT)
Image: COURTESY

Simple tasks like walking, bending the foot become a challenge to people afflicted by Deep Vein Thrombosis.

One of your foot swells, you experience excruciating leg pain, leg cramps, often starting in the calf, forcing you to break off from wearing that nice pair of heels actually its all types of shoes.

Other symptoms of DVT may include redness, bluish or whitish skin discolouration.

 
 
 
 

These symptoms do not manifest in some patients and those that experience some or all the aforementioned symptoms largely ignore the condition.

"Probably the swelling, redness and pain in the foot are caused by walking in high 'stilettos'. Let me take a break from wearing heels," some women would say.

When the pain persists they turn to massage or relaxants assuming its a muscle pull.

Doctors are raising the alarm that such half-hearted approaches may turn preventable conditions into silent killers.

There is widespread ignorance of the disease, despite it being as common as cancer. It affects one in four people globally, hurting their lives and careers.

Currently, no data exist on its prevalence in Kenya. However, the disease is largely unknown, even among doctors, with some misdiagnosing it as cellulitis of the arm or leg- a bacterial skin infection characterized by swollen, red, painful skin.

This month is Thrombosis Awareness Month, experts, women suffering from deep vein thrombosis shared their experiences with the Star in the hope of raising awareness.

South African Trained Vascular and Endo-Vascular Surgeon, Dialysis access Surgeon and Venous Specialist,Dr Hardeep Gill
South African Trained Vascular and Endo-Vascular Surgeon, Dialysis access Surgeon and Venous Specialist,Dr Hardeep Gill
Image: LYNDSAY NYAWIRA
 
 
 

What is Deep Vein Thrombosis?

South African Trained Vascular and Endo-Vascular Surgeon Dr Hardeep Gill says DVT forms when a blood clot is present in one of the body's deep veins, usually within a muscle of your leg.

Blood clots, medics say, are lifesavers when they seal a cut. But they can be dangerous, even deadly when they form inside an artery or vein.

"The biggest danger of having a clot formed in the veins is that the clot could break off and travel to your lungs causing a blockage known as a pulmonary embolism or PE which is fatal," Gill said.

Blood clots are the leading cause of sudden death amongst seemingly healthy people, cancer patients and hospitalised patients.

With Acute Arterial Thrombosis, the blood clot in the artery affected block the circulation going to a particular organ or limb.

"That leads to strokes, heart attacks, gangrene of the limbs. Failure to correct this urgently would lead to loss of limb or life," Gill said.

CAUSES 

Gill says pregnant women are at risk of developing blood clots.

Other causes are using birth control pills or hormone therapy, obesity, family history or genetic predisposition to forming blood clots.

"Immobility, including prolonged bed rest due to illness or injury and long travel in a car or airplan and smoking are also risk factors to blood clot formation,"Gill said.

Vice Chair, Kenya Society of Thrombosis and Hemostasis Dr. Harun Otieno,
Vice Chair, Kenya Society of Thrombosis and Hemostasis Dr. Harun Otieno,
Image: LYNDSAY NYAWIRA

Vice-Chair, Kenya Society of Thrombosis and Hemostasis Dr Harun Otieno, said patients with decreased mobility due to bed rest or recovery - or who experience blood vessel trauma - are more likely to develop blood clots.

"60 per cent of all VTE cases occurs during or within 90 days of hospitalisation, making this a leading cause of hospital-associated death," Otieno said.

Certain surgeries and medical procedures are considered to have a higher risk of DVT or PE.

"They include orthopaedic surgery, major general surgery of the abdomen, pelvis, major gynaecological surgery and cancer chemotherapy," Otieno said. 

Cancer itself can also lead to deep vein Thrombosis.

Former TV presenter Janet Kanini died in April 2017 after battling stage four lung cancer.

The late Kanini in 2015 was first diagnosed with Deep Vein Thrombosis months later the multiple blood clots had diffused to her heart and in the pulmonary artery leading to her lungs.

The clot was removed, two weeks into a routine check-up, another clot had recurred in her right leg.

Curious to find out the source of clotting she travelled to India for further tests. That's when it was discovered she had stage 4 lung cancer, plus another clot in the heart, plus DVT.

DEADLY

Dr Otieno said DVT in itself is not deadly if well treated, but if untreated there is a very high chance of the blood clot dislodging from the leg and travelling to the lungs. 

"Unfortunately, it is not easy to predict which patient with DVT will develop PE," he said.

"That being said, the main risk factor for PE is untreated DVT so prevention, diagnosis and treatment for DVT are very important to prevent the fatal complication of PE."

PREVENTION

Otieno said for hospitalised patients,hospitals should identify patients who are at risk and advise giving prevention/prophylaxis blood thinners to reduce the risk of developing DVT.

"Patients undergoing hip or knee surgery, other major surgeries should receive blood thinners to prevent DVT in hospital and even sometimes after discharge," he said.

Early ambulation, compression stockings he said can also help prevent DVT or PE. 

"Lifestyle measures such as weight reduction, regular exercise, avoiding dehydration, are all helpful in preventing DVT as well," Otieno adds.

During long flights or even travel in public transport, it is recommended that you should walk around frequently, stand up and stretch your legs.

TREATMENT

Blood thinners or anticoagulants are used to treat blood clots.

"DVT and PE treatment is initially started in hospital and continues for at least three months, to prevent dangerous recurrence of another DVT/PE," Otieno said.

The blood thinners may be either injectable or oral, depending on the clinical situation. 

For patients with clearly identifiable risk factors, like major surgery or trauma, treatment should be given for at least three months.