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THROMBOEMBOLISM

 

Thromboembolism is a condition that includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). Deep vein thrombosis occurs when the blood clots are formed in a deep vein, generally in the legs.  A condition where the formed blood clots break and travel through the bloodstream to reach the lungs is known as pulmonary embolism.  Sometimes, these blood clots may cause damage to the venous valves and reduce the blood flow.

The presence of clots in the blood vessels of lungs obstructs sufficient air flow from traveling through the lungs. DVT and PE are life-threatening conditions and need immediate medical attention.

Signs and symptoms

The signs and symptoms of thromboembolism include:

  • Acute shortness of breath
  • Cough
  • Chest pain under the rib cage
  • Tenderness of thigh or leg pain
  • Swelling of the legs (edema)
  • Fever
  • Lightheadedness
  • Redness of the skin
  • Rapid breathing
  • Sense of anxiety
  • Tachycardia

Causes

Thromboembolism can be caused due to anything that affects the circulation or clotting of the blood, such as injury to veins, medications, surgeries or decreased movement.

Risk factors

The following are the potential risk factors related to thromboembolism:

  • Age: The risk of thromboembolism increases with increasing age.
  • Weight: Overweight and obese people are at higher risk of thromboembolism.
  • Pregnancy: Pregnant women have increased pressure in the veins of pelvis and legs.
  • Family history: People with a family history of thromboembolism are at increased risk of developing the condition.
  • Oral contraceptives: Oral contraceptives increase the clot formation in the individuals. Thus, it increases the risk of thromboembolism.
  • Smoking: Smoking interferes with the blood circulation and clotting process and increases the risk of developing thromboembolism.
  • Prolonged sitting and bed rest: The risk of thromboembolism increases with prolonged sitting or bed rest due to decreased blood circulation to the leg muscles.
  • Cancer: Some forms of cancer increases the clotting capacity. Thus, increasing the risk of thromboembolism.
  • Other diseases: Other diseases, such as Crohn’s disease, ulcerative colitis or heart failure increases the risk of thromboembolism.

 

Complications

The following are the complications of thromboembolism and requires immediate medical attention:

  • Pulmonary hypertension
  • Cardiac arrest
  • Pleural effusion
  • Breathing difficulties
  • Post-thrombotic syndrome

Diagnosis

The following are the tests recommended for diagnosing thromboembolism:

  • Blood test: A sample of your blood is collected and is measured for a substance known as D-dimer. It is a fibrin-specific degradation substance, which is released into the blood when the blood clots breakdown. D-dimer assay helps to trace out the presence of blood clots in the veins.
  • Chest X-ray: Chest X-ray generates the images of lungs and the internal organs. The most common findings in chest X-ray include pleural effusion and atelectasis.
  • Computed tomography (CT) scan: It is a three-dimensional imaging procedure, which enables to view the blood clots in the lungs.
  • Ventilation-perfusion scanning: It helps to diagnose PE. A small amount of radioactive substance is injected into the bloodstream to examine the blood flow.
  • Doppler ultrasonography: It is a noninvasive test used to diagnose DVT. Unlike an ultrasound, Doppler ultrasonography not only produces the images of the internal structures but also helps to visualize the blood flow through your blood vessels. This test is used to diagnose blood clots, a blocked artery, and blood circulation in your legs.
  • Pulmonary angiography: It helps to detect the obstructions in a pulmonary artery. This test is performed by inserting a catheter through the veins. A special dye is used to visualize the blood vessels of the lungs.
  • Magnetic resonance imaging (MRI) scan: MRI scans are used to generate detailed images of the internal organs and veins to analyze the clots.

Treatment

The treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) aims to control the clots from getting bigger and to prevent the formation of new blood clots. The treatment procedures may include:

Medications: Anti-coagulants (blood thinners) are the drugs used to treat DVT and PE. Warfarin and heparin are used to prevent the formation of new blood clots. These medications do not dissolve the blood clots, which are already present in the bloodstream. They act on certain blood proteins and prevent the formation of unwanted clots.

Thrombolytic therapy: Thrombolytics are used to dissolve large blood clots during life-threatening situations. This procedure involves in inserting a clot-dissolving enzyme known as tissue plasminogen activator (tPA) through an arm vein. This is done by inserting a catheter into the blood clot in the vein.

Pulmonary embolectomy: Embolectomy is a surgical procedure to remove the clots. A thin flexible tube known as a catheter is inserted through the blood vessels to remove the large clots.

Inferior vena cava filter: Vena cava is a large vein that carries blood from the lower body to the heart. A vena cava filter is inserted into the inferior vena cava (large vein), which prevents the blood clots from traveling to the lungs.

Prevention

The following are the preventive measures of thromboembolism:

  • Avoid staying inactive for a longer duration of time. Try to move around to ensure a proper blood flow to your legs.
  • Choose a healthy diet plan and drink adequate amounts of water.
  • Quit smoking as it can increase the risk of deep vein thrombosis (DVT).
  • Exercise regularly and stay active to prevent the formation of blood clots.
  • Maintain a healthy weight as obese people are at an increased risk of having blood clots.   
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