Monday, June 22, 2020

Understanding thrombosis-acting together

October 13 is the fourth "World Thrombosis Day", a day closely related to our health, but many people do not know. The Department of Vascular Surgery of the First Affiliated Hospital of Xi'an Jiaotong University held a World Thrombus Day publicity clinic in the outpatient hall. The purpose is to let more people understand the seriousness of thrombosis and the importance of prevention and treatment, thereby reducing thrombosis.

Blood is a "flowing river" in the body. If the river of life is blocked, can you imagine how serious the consequences will be? Take this opportunity, let us take a look at thrombosis knowledge.

Origin of thrombosis

Professor Rudolf Virchow of Germany named "thrombosis, embolism, fibrinogen" in 1856 proposed three major factors of thrombosis: vascular wall damage, abnormal blood flow, abnormal blood composition. The theory is still recognized today. In March 2014, the International Society of Thrombosis and Hemostasis (ISTH) announced Rudolf Virchow’s birthday (October 13) as "World Thrombosis Day" to commemorate his first proposal of the "thrombosis" theory; The recognition of thrombotic diseases promotes the standardized diagnosis and treatment of thrombotic diseases.

Thrombosis hazard

The World Health Assembly has set a global goal to reduce premature deaths from noncommunicable diseases, including reducing cardiovascular mortality by 25% by 2025. To achieve this goal, it is important to reduce thrombosis. Chronic non-communicable diseases have become the number one health threat to our nationals! The deaths caused by chronic diseases in my country have accounted for 85% of the total deaths of the people. Only by doing preventive work can we seize the leading role in the prevention and control of chronic diseases. Venous thrombosis is also an important factor that seriously affects national health and even life-threatening.

Thrombosis refers to the formation of blood clots in arteries or veins, and is the root cause of three fatal cardiovascular diseases (heart disease, stroke, and venous thromboembolism). Among them, venous thromboembolism refers to thrombosis in the legs and lungs, which is not as important as heart disease and stroke.

According to data provided by the International Society of Thrombosis and Hemostasis: in the United States, 100,000 to 300,000 people die each year from venous thrombosis, and the number of related hospitalizations exceeds 500,000. In Europe, 500,000 people die each year from venous thrombosis, more than the combined death toll from AIDS, breast and prostate cancer, and highway traffic accidents. In China, the situation of venous thrombosis may be equally severe, but the lack of epidemiological data masks the widespread impact of thrombotic diseases.

Thrombosis can occur in blood vessels in any part of the body. The incidence of venous thrombosis is higher than that of arterial thrombosis, and the ratio of the two can reach 4:1. In a group of medical autopsy data, venous thrombosis accounts for 40% to 60%, but only 11% to 15% is clinically diagnosed. Microthrombi are quite common in autopsy, up to 37.6%, and are more common in lung, liver, kidney and brain. Venous thrombosis can occur in veins in the lower limbs, liver, pelvis, and vagina, but the lower limbs are more common.

In short, too few people understand these blood clots and their life-threatening consequences, and many doctors fail to diagnose as early as possible in order to prevent or treat them correctly. Therefore, too many people die from this preventable disease.

How does venous thrombosis work?

Blood flows in veins and blood vessels, just like water flows in river channels. There is sediment in the river and blood cells in the blood; there is a dam to intercept the river and there is a valve control switch for the blood. If the river is full of sand and silt, the water in the river will look for breakthroughs and flood into disasters. If the blood has coagulation conditions such as high blood lipids and many blood coagulation factors, then blood cells will accumulate and form a thrombus when they accumulate to a certain extent.

In medical terms, the causes of thrombosis include the lack of antithrombin, oral contraceptives for malignant tumors, and long-term bed rest, postoperative surgery, and obesity. Therefore, to stay away from blood clots, "moving" is the most effective prevention and control measures.

Venous thrombosis is a clinically common thrombus, usually caused by slow blood flow or stasis. Venous thrombosis is characterized by a large amount of red blood cells and fibrin, and platelets show aggregation and degranulation changes, and their number is small; the appearance of thrombus is like a whole blood clot in a test tube, and the color is dark red, called red thrombus. Venous thrombosis often causes vascular occlusion, so the proximal end of the thrombus is mainly red blood cells, and new platelets often adhere to the surface. This kind of thrombosis mostly occurs in large veins, such as popliteal veins, femoral veins, and hip veins, which can be manifested as lower limb edema, pain, and skin color changes. Thrombosis can flow into the pulmonary artery with blood, causing pulmonary embolism.

The pathogenesis of venous thrombosis includes venous endothelial injury, blood hypercoagulability and venous blood stasis. Hospitalization, surgery, and prolonged sitting will increase the incidence of venous thrombosis. Too few people know the fatal consequences of thrombosis in the legs and lungs, and too many people die from such a preventable disease.

Deep vein thrombosis (DVT)-thrombosis in the leg-pulmonary embolism (PE)-when the thrombus transfers to the lungs-these two dangerous thrombi add up to venous thromboembolism (VTE).

In other words, blood clots in the legs and lungs can occur in people of any age. Some people will not have any warning signs or symptoms. Therefore, it is very important for everyone to understand the risk factors, signs, and specific events or conditions that can cause or cause thrombosis.

What is thromboembolism?

Thromboembolism is a potentially fatal disease caused by the formation of blood clots in arteries or veins. Once a thrombus is formed, it will slow or block normal blood flow, and even fall off and migrate to other organs. Thromboembolism can have serious consequences, and the three major killers of cardiovascular disease-myocardial infarction, stroke and venous thromboembolism (VTE) are all closely related to it.

Thromboembolism has caused great concern worldwide

In 2012, the World Health Assembly (WHA) decided to adopt a global goal to reduce premature mortality from non-communicable diseases by 25% by 2025. To achieve this goal, the World Thrombus Day (WTD) Expert Committee and its partners believe that WHA must directly intervene in thromboembolism and venous thromboembolism (VTE).

In May 2015, the International Society of Thrombosis and Hemostasis (ISTH) and the "World Thrombosis Day (WTD) Expert Committee at the 68th World Health Assembly called on the World Health Organization (WHO) to increase its focus on thromboembolism and regard VTE as a special The cause of lethality is included in the next WHO global study on disease burden.

What is venous thromboembolism?

Venous thromboembolism, that is, a blood clot is formed in a vein, referred to as VTE. The formation of blood clots in deep veins (usually occurring in the lower extremities) is called deep vein thrombosis, or DVT for short. When a blood clot in a vein sheds and travels to the lungs with the blood flow, a pulmonary embolism, or PE, is formed. DVT and PE are collectively called VTE, which is a very high-risk and potentially fatal cause.

VTE is the leading cause of death and disability worldwide. According to the data released by the Expert Committee of "World Thrombosis Day", there are nearly 10 million cases of VTE worldwide each year, covering developed and developing countries. Nevertheless, it is still believed that even in the United States and Europe, where information systems are relatively developed, there are still many cases that have not been effectively registered.

A joint study of the "World Thrombosis Day" expert committee and Ipsos-Reid found that public awareness of thromboembolism, deep vein thrombosis and pulmonary embolism is much lower than other diseases such as heart failure, stroke, hypertension, breast Cancer, prostate cancer and AIDS. And the data shows that the public's awareness of VTE is very low, and less than 50% of adults know that thromboembolism can prevent it.

The global disease burden caused by 4VTE

On October 9, 2014, the "World Thrombosis Day" expert committee published the first "World Thrombosis Day" in the world and published it in the Journal of Thrombosis and Coagulation. The article entitled "Thromboembolism-the main force of the global disease burden" Global Burden of Disease Research Report. The article systematically reviews the VTE-related disease burden in developing countries, moderately developed countries, and developed countries. Studies from Western Europe, North America, Australia and southern Latin America (Argentina) have shown a certain degree of consistency, that is, the annual incidence rate of the population is between 0.75-2.69 per thousand, and the incidence rate of people over 70 years old is increased by 2 per thousand Between -7. Although the overall incidence rates in China and South Korea are not high, due to the aging society, the overall disease burden cannot be ignored.

In developing countries and moderately developed countries, VTE-related treatments during hospitalization are most closely related to disability-adjusted life years (DALYs), while in developed countries it ranks second, surpassing iatrogenic pneumonia and catheters. Related bloodstream infections and serious adverse drug reactions.

About VTE, numbers are talking

Nearly 10 million cases of VTE occur worldwide each year

100,000-300,000 VTE-related deaths occur annually in the United States

544,000 VTE-related deaths occur annually in Europe

The number of deaths due to VTE in the United States and Europe each year exceeds the total number of deaths due to AIDS, breast cancer, prostate cancer and traffic accidents

60% of VTE occurs during hospitalization or after discharge, ranking first among preventable and causeable causes of death in the hospital

Risk factors for VTE

VTE can occur at any age, race, and gender, and certain factors increase the risk of thrombosis.

High risk factor

Be hospitalized

Undergo surgical treatment, especially hip, knee and tumor related surgery

Long-term braking, including bed rest, long-distance travel, etc.

Moderate risk factors

Over 60 years old

Family history of thrombosis

Cancer, receiving chemotherapy

Estrogen drugs: oral contraceptives, hormone replacement therapy HRT, etc.

Other factors

obesity

Pregnancy or childbirth

Smoking

Excessive drinking

Early warning symptoms and signs of VTE

The VTE, known as the "silent killer", often does not have any signs when it occurs. Once the patient has symptoms, it indicates that deep vein thrombosis (DVT) or pulmonary embolism (PE) has occurred.

Deep vein thrombosis (DVT)

Pain, usually starting from the popliteal fossa

Swelling of the limbs, especially the ankles

Limb swelling

Elevated body temperature

Pulmonary embolism (PE)

Unexplained shortness of breath

Chest pain, which may increase when breathing deeply

Fast heart rate

Mild loss of consciousness or syncope

VTE risk assessment and prevention

Related research shows that VTE is usually preventable. Evidence-based medicine-based prevention strategies can prevent patients at risk from developing thrombosis.

Medical staff perform a VTE risk assessment on the patient to determine what risk state they are in. The assessment tool is usually a questionnaire or scale to understand the patient information, including the patient's age, medical history, medication, special lifestyle, etc., so as to analyze and judge the potential risk level of the patient's lower extremity or pulmonary embolism (high risk, medium Degree risk, low risk).

If you have not conducted a risk assessment of VTE during hospitalization, please take the initiative to communicate with your doctor.

When a patient is judged to be at risk, they need to take appropriate preventive measures, including:

Anticoagulant

Physical prevention. Use anti-thrombus elastic stockings, plantar venous pumps, interstitial inflation and compression devices, etc.

At the same time, patients should be instructed to move as soon as possible, or do lower limb and foot exercises.

VTE during hospitalization

During hospitalization, due to trauma, surgery, treatment, rehabilitation and other reasons, the amount of activity has been reduced or even limited, thus greatly increasing the risk of VTE.

In fact, 60% of VTE occurs during hospitalization or after discharge, and ranks first among preventable and controlable causes of death in the hospital. Medical personnel need to assess the risk of VTE in patients and take corresponding preventive measures.

About VTE in the hospital, numbers are talking

60% of VTE occurs during hospitalization or after discharge, ranking first among preventable and causeable causes of death in the hospital

About 32,000 inpatients in the UK develop VTE every year

More than 540,000 inpatients in the United States develop VTE every year

Approximately 30,000 hospitalized patients develop VTE in Australia every year

Surgical patients will face an increased risk of VTE

Surgery and some hospital treatments have been confirmed to increase the risk of VTE, including:

Orthopedic surgery, especially hip and knee surgery

Surgery, especially abdominal surgery, pelvic surgery, hip or lower limb surgery

Obstetrics and Gynecology Surgery

Urology surgery

Neurosurgery

Cardiac surgery

Peripheral Vascular Surgery

Cancer chemotherapy

If you or your family need to receive the above treatment, please communicate with your doctor about the risk assessment and preventive measures of VTE.

4 "mortal" moments

Blood flows in blood vessels, just like water flows in river channels. If the "sand" blood cells in the blood deposit in one place and gather together, then the blood channel of the blood will be blocked, and the "water" in the river will also have no way to go and become a disaster.

Thrombosis includes venous thrombosis and arterial thrombosis, in which the incidence of venous thrombosis is higher than that of arterial thrombosis, and the ratio is about 4:1. It is not difficult to imagine that factors such as slow blood flow, viscous blood, and high blood lipids are likely to cause the blood to be in a "hypercoagulable state", and blood cells accumulate and induce thrombosis. The following situations are the most dangerous moments when a blood clot is "sneak attacked".

People who stay in bed for a long time after surgery should pay special attention. Because the body cannot move in time, blood flow becomes slow, and blood clots are quietly "breeding". Data show that long-term hospitalization can cause leg vein thrombosis in more than two-thirds of patients; hip and knee surgery, or cancer surgery patients are at higher risk.

Long-distance travel is also a high-risk factor for venous thrombosis. When traveling by air, train, or long-distance bus, your legs are restricted to a small, narrow space, and you are in a posture for a long time. People generally drink less water, don't like to move, and have poor blood circulation to the lower limbs, which is easy to form clots. If the thrombus falls off, blocking important blood vessels, it is easy to induce "Economy Class Syndrome".

Playing mahjong and poker to the forefront, many people are reluctant to "fight" all night long. At this time, the body is already in a state of fatigue, unable to get normal operation and rest, plus sedentary, sleepless and forgetful food, the viscous blood cannot be diluted in time, and the "garbage" in the blood cannot be removed in time, which is very easy to be The thrombus is "staring".

Computers and TVs have brought us convenience and happiness, and have also reduced many people to "sofa potatoes" and "screen faces." Studies have shown that men and women between the ages of 40 and 79 who watch TV for more than 5 hours a day are twice as likely to have fatal pulmonary vascular obstruction caused by blood clots as those who watch only 2.5 hours of TV a day.

"Motion" is the natural enemy of thrombosis

Thrombosis is not a patent of the elderly and the "old disease". It can occur at any age and anyone. Among them, the most serious consequence of deep vein thrombosis is pulmonary embolism. Once it happens, it is often very dangerous. In severe cases, it can die within 1 to 2 hours, and the doctor has little time to rescue. Even after the dangerous period, the patient still has a risk of recurring fatal pulmonary embolism.

The data shows that every hour of sit-in, the risk of deep vein thrombosis will increase by 10%; sitting for more than 90 minutes will reduce the blood circulation of the knee joint by 50%. With the improvement of people's living standards, changes in eating habits and lifestyles, the incidence of global venous thromboembolism is also increasing year by year.

However, thrombosis also has a natural weakness, that is-hi "quiet" afraid of "moving". Therefore, for most people, venous thrombosis can be prevented. To avoid venous thrombosis, "moving" is the most effective prevention and control measures. Pay attention to proper physical exercise in life, enhance physical fitness, and promote blood circulation; entertain yourself to avoid staying up late to play cards and addicted to online games; office workers and long-distance travelers should pay attention to "stretching their arms and kicking their legs" every 2~ Stand up and walk around for 3 hours; for high-risk patients with deep vein thrombosis, it is necessary for the hospital to establish and implement preventive monitoring and treatment.

When unexplained limb swelling and pain, increased skin temperature, or breathing difficulties, chest tightness and other suspected embolism symptoms should be paid great attention to and seek medical attention in a timely manner.

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