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A long plane trip, broken leg can cause thrombosis. It is one of the most serious diseases of the venous system. The risk of its occurrence increases with age, but also young people, including women using hormonal contraception. If the disease is detected too late, it may result in pulmonary embolism and death. Why are we late with the treatment of thrombosis and can we protect ourselves against it? – we ask prof. Witold Tomkowski, an outstanding cardiologist and specialist in vascular diseases, President of the Polish Foundation for Combating Thrombosis “Thrombosis”.
Ela Dziob-Radziszewska / Onet .: Many of us are going on vacation. Traveling by plane, coach, long immobilization or staying in one position is conducive to thrombosis. How can we protect ourselves from it?
Prof. Witold Tomkowski: The most important thing is to take breaks for physical activity during the journey during which we are immobilized – e.g. in an airplane or a car. When driving a car, stop every 1-1,5 hours. For example, bend your foot a few times, do a few squats, jog for a while. This will stimulate the muscles and blood circulation. And if we travel by ship, we must dose the time spent in the sun.
This is a basic recommendation – for everyone. People who have experienced deep vein thrombosis or pulmonary embolism are particularly vulnerable. Before traveling, they should definitely consult their family doctor or specialist under whose care they are.
What else can we tell travelers?
So that the choice of clothes for the trip was not accidental. Avoid those that tighten tightly, belts pressing the abdomen, and socks with cuffs. The ideal solution are, for example, knee-high socks, tights or stockings with increased compression, which are also intended for athletes, e.g. runners.
The third important recommendation is your diet. Avoid alcohol when traveling. Choose mineral water or drinks that contain a lot of electrolytes, e.g. tomato juice.
How can thrombosis be detected at an early stage? What symptoms should worry us?
There are many of them. First of all, pain, redness, excessive heat in one of the legs, differences in their circumference and swelling. They are of different intensity. In many patients, the disease manifests itself asymptomatically, and only a few have these symptoms all at once. That is why it is so important to know about this disease. Unfortunately, the Polish health care system is not very sensitive to the problem of thrombosis. And making a correct diagnosis at an early stage, applying appropriate prophylaxis or implementing treatment means a cure for most patients. And avoiding possible fainting or serious consequences in the form of pulmonary embolism, shock, death.
Well, thrombosis is even called “the silent killer”.
This is what it is called because it may not produce significant symptoms for a long time. There will be, for example, slight aches and pains, such as shin or thighs, which are usually underestimated by patients. In my experience, when examining and looking for causes, we find deep vein thrombosis in patients with confirmed pulmonary embolism. It turns out then that it is with them
there are large clots in the deep vein system, but there are no changes in the physical examination! Making patients aware is the most important thing, because if a patient notices ailments, they disturb him, he seeks help from a doctor, it will be of great benefit to his health. I must emphasize that venous thromboembolism is one of the three most common and dangerous cardiovascular diseases next to heart attack and stroke.
Who is most at risk of it? Older, Younger, Women, Men?
The incidence of ailments (I am talking about deep vein thrombosis and pulmonary embolism, which we define in Poland as venous thromboembolism) is about 200-300 cases / 100 general population, i.e. about 000-100 thousand annually. Poles suffer from deep vein thrombosis or pulmonary embolism. Older people (over 120 years of age) belong to a group with an increased likelihood of developing the disease.
Only 40 percent. patients who died of pulmonary embolism, the correct diagnosis was made in the lifetime of the patient. In the European Union, the number of deaths caused by pulmonary embolism is approximately 500. annually. These are, of course, estimates. Converting this to the population of our country, we have tens of thousands of people dying every year from pulmonary embolism. These numbers tell us how serious the problem is venous thromboembolism. The time from the appearance of the first symptoms to the correct diagnosis is much longer in Poland than in Western European countries.
Apparently, the problem may appear when we suffer an injury, such as a broken leg?
In the case of deep vein thrombosis, the greatest risk that awaits a person is when he is in the hospital and is to have surgery on the bones, abdominal cavity or chest. The physician must assess the risk of thromboembolic complications and decide whether to apply pharmacological or other prophylaxis – e.g. use anticoagulant stockings. Or both. And if a patient goes to a ward due to a heart attack, respiratory failure, inflammatory disease, infectious disease or rheumatological disease, antithrombotic prophylaxis should also be used in such wards. Most major orthopedic procedures are associated with a high risk of such complications. And while this prophylaxis is commonly used in surgery (in 60-70% of patients), medical awareness in conservative wards is much lower and prevention concerns about 30% of patients. patients.
Why are doctors so low in awareness?
This is mainly due to the insufficient amount of knowledge acquired during the studies, insufficient information and insufficient reading. And every patient admitted to the hospital should have an appropriate scale analysis that allows to estimate the risk and classify the patient into the group: “low”, “moderate” or “high” risk of thromboembolic complications.
Apparently, cancer and thrombosis are related?
This disease has its dimension in cancer patients. If a patient with a malignant tumor develops thrombosis or pulmonary embolism, this fact significantly worsens the prognosis and the choice of appropriate therapy. Both oncologists and patients’ awareness of the risks can be decisive for life. Therefore, proper treatment and diagnosis of pulmonary thrombosis in the environment of cancer patients is so important.
What is the influence of alcohol and contraception on the development of thrombosis?
Contraception is always associated with an increased risk of thromboembolism. For the most part, it is used by young women, where the risk of thrombosis increases by about 5-6 times. But the incidence of thromboembolic complications is lower than in the general population. Consequently, there is no fear of universal danger here. Young women, on the other hand, should always be asked by the doctor who orders this contraception if they have experienced deep vein thrombosis before or if such cases have occurred in their immediate family. If such complications have occurred, then a series of additional tests can be performed so as not to expose the patient to additional risk.
So it is also genetically determined?
Thrombophilia is a disease that can be divided into congenital and acquired. Congenital, and therefore related to genetics. If the family history is positive, then in such a case you should think about performing tests that confirm or exclude the presence of congenital thrombophilia. Unfortunately, knowledge on this subject is small and social awareness is even smaller.
What is the biggest problem in the treatment of thrombosis today?
We have a large supply of drugs that are quite simple to use, which we can administer subcutaneously, intravenously, and also in the form of tablets. The only problem is that the newest oral medications that are direct inhibitors of clotting factors are quite expensive. However, when it comes to the quality of therapy and its safety, we obtained very good results. Through the use of appropriate drugs, we have reduced recurrences of venous thromboembolism to approximately 2%, and bleeding complications are twice as rare.
What is thrombosis most often confused with?
We should consider a number of disease entities. It can be venous insufficiency, inflammatory changes, lymphoedema, Becker’s cyst – many of these “doubts” cannot be resolved without ultrasound examinations of the deep vein system, which are the cheapest test to diagnose this disease.
Why do so few people get tested and downplay symptoms?
In my opinion, this is simply due to low awareness. We once conducted research and proved that if patients are addressed with certain content on symptomatology, the number of confirmed positive deep vein thromboses in the population increases significantly.
How much does thrombosis treatment cost on average in Poland and does everyone have access to this treatment?
It’s hard to say, it all depends on what medications we use. If the beginning of therapy is associated with the use of heparins and then vitamin K antagonists, these drugs are extremely cheap. However, if we use newer generation drugs, the monthly treatment is over one hundred zlotys.
Professor, you are associated with the Polish Foundation for Combating Thrombosis THROMBOSIS. What do you do in practice?
The educational activity of this foundation is directed primarily to the society, as well as to the medical community. We want to raise awareness of deep vein thrombosis and pulmonary embolism. We try to share the latest achievements in the field of diagnostics and antithrombotic treatment or thrombolytic treatment, we popularize certain methods of preventing venous thromboembolism. Unfortunately, the foundation has recently experienced some difficulties, related to the low interest of sponsors in this activity, which is dedicated primarily to ordinary people and not, for example, to a group of particularly wealthy patients.
From time to time, we get people’s medical histories. We try to help these patients. There is a similar foundation in the United States, supported not only by the pharmaceutical industry, but basically by a ton of different organizations. Unfortunately, such a support proposal has never been made in Poland so far.