A layperson's guide to a debilitating condition.
Thrombosis is the formation of a solid blood clot in an arterial or venous vessel where it can interfere with normal blood flow.
About 1 in 20 suffers from vein clots or lung clots at some point, and about half of those suffering from thrombosis have other illnesses such as cancer or develop the clot while recovering from surgery or a serious accident. While most episodes of blood clotting are not dangerous, some can be serious and even fatal.
Thrombosis is a straightforward, helpful guide for non-medical readers that explains important issues regarding this condition:
- Causes of thrombosis
- Prevention of blood clotting
- Diagnosis and treatment
- New and current drug therapies
- The latest surgical procedures
- Day-to-day management.
Thrombosis is an invaluable resource for those suffering from the condition and for their families.
About the Author
Dr. Jack Hirsh, CM, HD, FRCP (C), FRACP, FRSC, Dcs is Director of the Henderson Research Centre. For over 20 years, he worked as a professor at McMaster University in the Departments of Pathology and Medicine and the Department of Clinical Epidemiology and Biostatistics, and has published hundreds of scholarly articles.
Table of Contents
Chapter One: Blood in Circulation
Chapter Two: Blood Clots: A Modern Risk for Modern Times
Chapter Three: The Symptoms of Venous Clots
Chapter Four: Diagnosis of Venous Clots
Chapter Five: Prevention of Clots in Veins and Lung Arteries
Chapter Six: Treatment
Chapter Seven: Inherited Thrombophilia
Chapter Eight: Thrombosis in Children
Table of Drug Names Glossary Further Resources Index
Normally, blood flows through our arteries and veins smoothly and efficiently, and we never think much about it. However, if a clot blocks the smooth flow of blood, the result can be serious and can even cause death. Diseases arising from clots in blood vessels include heart attacks, stroke and deep venous thrombosis, and pulmonary embolism. These disorders collectively are the commonest cause of death and disability in the developed world. This book is about clots in veins, which cause deep vein thrombosis and pulmonary embolism, as opposed to clots in arteries, which cause heart attacks and stroke. Except in rare circumstances, clots in veins and clots in arteries are caused by different types of disorders, are treated differently, and produce quite different complications.
Many people who develop deep vein thrombosis or pulmonary embolism are anxious because they don't know what to expect in the early stages of their illness (will they get better or not?), what they can and should not do when discharged from hospital while taking oral blood-thinning medication, and what will happen when they stop treatment.
Discontinuing treatment can be especially stressful because at that time people with a history of such clots will be told that they have a risk of developing another episode of clotting or, if their legs are swollen, that the swelling might never go away. Consequently, while they want to be able to recognize the symptoms of a new episode of clotting so that they can go to a hospital emergency room for diagnosis and treatment, they do not want to become neurotic and alarmed by every twinge or ache. For some patients, the fear of another event or the presence of life-long symptoms, such as swelling in the affected leg, looms as a constant reminder of their clotting disorder rather like a toothache or headache that won't go away and prevents them from enjoying life.
There is no need for pessimism, however, because in most cases the news is good. Many people recover completely and have no further problems from clotting and, in almost all cases, serious complications can be prevented by modern treatments. People with vein clots can play golf, swim, jog, and participate in most activities, even while on blood thinners, and can usually participate in all activities after they have discontinued treatment.
The aim of this book is to allay anxiety and encourage people with clots to live full, normal lives by providing them with information about the symptoms of vein clots, the methods used to diagnose them, the various treatment options, and the risk of complications both from the treatment they receive and from the vein clots themselves.
As a physician who has been looking after patients with deep vein thrombosis and pulmonary embolism for more than thirty-five years, I
never cease to be amazed at how simple answers to my patients' questions provide them with so much relief. When I see a patient for the first time, she or he is often armed with a list of questions and is anxious. Thanks to excellent clinical research in the field of venous thrombosis, most questions can be answered, and patients leave the clinic relieved and with a new resolve. It is my hope that this book will be a convenient and useful source of reference and, by presenting key information, provide relief for the anxious patient, relative, or partner.
During the course of a lifetime about one in twenty people will develop a blood clot in their veins, usually in their legs, that will cause discomfort. The discomfort usually takes the form of pain and swelling in the affected leg. The clot can also break off and travel through the bloodstream into the arteries of the lungs and cause chest pain and difficulties with breathing. The medical term for a clot in the vein is "venous thrombosis"; and for clots that develop in deep veins, "deep vein thrombosis." The medical term for a clot that begins in veins and breaks off and travels to the lung is "pulmonary embolism."
About 50 percent of those who develop these kinds of clots will have some other condition that increases their risk, such as a bout with cancer, recent surgery, a serious medical illness, or a serious accident, but for the other 50 percent, the clot can occur "out of the blue." We now know that some people who develop vein clots without obvious cause have an abnormality in their blood that is often inherited.
Most episodes of leg clots are not dangerous, and might not even cause symptoms, but some can be serious; if the clots are large and break off and travel to the lungs they can even cause death. Fortunately, these serious events can usually be prevented by using relatively simple and well proven measures in people who are at risk for venous clotting (for example, those requiring surgery) or by recognizing less serious early signs of leg or lung clots, and treating them promptly.
This book is written for people who, for a number of reasons, have a special interest in blood clots in the veins or lung arteries, perhaps because they:
- suffer from this disorder
- have a relative or friend who has venous thrombosis or pulmonary embolism
- have a family history of blood clots
- are concerned about developing blood clots after exposure to risky situations, such as surgery, major trauma, or long-distance travel
- are concerned about the risk of clots associated with taking estrogen-containing birth control pills or hormone replacement therapy
This book will answer some of the questions that have been asked of me by patients and their physicians during thirty years of supervising a referral clinic for people with suspected venous thrombosis or pulmonary embolism. My goal is to provide the reader with an understanding of the nature of these clots in the legs and lungs; their causes and complications, including post-thrombotic syndrome and pulmonary hypertension; and the methods used to diagnose, prevent, and treat them.
Some of the more difficult concepts are discussed more than once, the repetition reflecting my experience with people who, as they acquire information, often return to questions on some of the more complex topics.