Deep vein thrombosis in the lower extremities combined with pulmonary embolism, a condition known as venous thromboembolism; the other upper extremity thrombosis, without pulmonary embolism. Pulmonary embolism is the result of a blood clot (thrombus) formed inside the deep veins (both lower and upper extremities) drifting down the blood stream to the pulmonary artery, stopping somewhere in the pulmonary artery and blocking it. Severe pulmonary embolism has a mortality rate of up to 30% if it is not diagnosed and treated promptly. In western countries, pulmonary embolism is the third cause of death after cardiovascular diseases and malignant tumors.
1.Venous thromboembolism occurs more often, but few of them are actually found
Deep vein thrombosis of the lower extremities has no obvious clinical symptoms in 70-80% of cases, and even if there are symptoms, they are often ignored. Pulmonary embolism is also far more likely to be asymptomatic than symptomatic, like the first patient who could not have been diagnosed without checking CT.
2.Common clinical manifestations of pulmonary embolism
Dyspnea, chest pain, rapid heart rate, rapid breathing, decreased activity endurance, deficiency or fainting, hemoptysis in a few patients, severe hypotension or shock, and even sudden death. Clinical routine examinations, such as electrocardiogram, echocardiogram and X-ray chest film often lack specific manifestations. Although CT pulmonary arteriogram can confirm the diagnosis of pulmonary embolism, you will not do this examination if pulmonary embolism is not considered clinically, and the diagnosis will be impossible. Another important index is D-dimer, which can effectively exclude venous thromboembolism if it is not elevated.
3. Once a pulmonary embolism occurs, the consequences can be very serious.
More than ten percent of deaths occur within one hour after the occurrence of pulmonary embolism. The incident of Xiong Zhuowei in Peking University Hospital was due to the death of a sudden pulmonary embolism after surgery, and similar cases have occurred in the past, especially the death related to surgery, which is often not due to the failure of surgery or heart problems, but often due to the irreparable pulmonary embolism. The good thing is that with the development of modern medicine, the entire medical community has improved its understanding of venous thromboembolism, and the development of antithrombotic drugs has also made great progress.
Since there may be no chance to save pulmonary embolism once it occurs, prevention is especially important. Prevention of pulmonary embolism should start with the prevention of deep vein thrombosis in the lower extremities. So, how to prevent venous thromboembolism?
4.First, let’s talk about the risk factors of venous thromboembolism.
There are three conditions that can lead to venous thromboembolism, which are damage to blood vessels or tissues, slowing down of blood flow and easy coagulation of blood, and various risk factors lead to venous thromboembolism through the above three mechanisms.
Risk factors can be divided into three main categories.
1, serious reversible or curable risk factors, such as severe trauma, major surgical procedures (e.g. hip or knee replacements, etc.).
2. less serious, but also less easily eliminated risk factors, such as serious medical illnesses (including heart failure, serious infections, etc.), prolonged bed rest due to paralysis, patients with malignant tumors, chronic inflammatory bowel disease, etc.
3, idiopathic, that is, the cause or predisposing factors are often not found in routine clinical examination, these patients are often younger and venous thromboembolism occurs without any predisposing factors, this condition is called easy embolism, often as a result of blood composition changes leading to blood hypercoagulation.
The chance of venous thromboembolism is related to the presence or absence, amount, duration and intensity of exposure to risk factors, and physicians often develop appropriate prevention strategies to prevent venous thromboembolism based on the patient’s risk level, which is called risk stratification in the medical profession. The preventive measures include both pharmacological and non-pharmacological categories. The drugs commonly used for prevention are low-dose normal heparin, low-molecular heparin, pentose, and oral factor IIa or Xa inhibitors. Non-pharmacologic preventive measures are also very important. General measures include drinking plenty of water, wearing loose clothing and pants, and moving the limbs more often, especially after various traumatic injuries and surgeries.
Early postoperative active and passive activities in bed, early departure from bed and early discharge from hospital. Patients who are at risk of venous thromboembolism when traveling long distances for more than 6 hours should move their limbs regularly, stand and walk regularly, and patients at high risk or who have already had venous thromboembolism should wear medical compression stockings or go to the hospital for subcutaneous injection of a prophylactic dose of low molecular heparin as prescribed by the doctor. In addition to compression stockings, there is also an intermittent inflatable compression device, which is mainly used in hospitals. Device prophylaxis alone is often used in patients at intermediate or low risk or in patients for whom anticoagulation is contraindicated, while high-risk and especially very high-risk patients can be prevented with a drug plus device approach.
The detection and effective treatment of deep vein thrombosis is important, as in the case of the two patients mentioned at the beginning, due to timely detection and diagnosis, both patients are now in stable condition and are being treated with low molecular heparin plus anticoagulation with warfarin, with the aim of preventing fatal pulmonary embolism. After the patients are discharged from the hospital, they should continue to take oral warfarin according to their condition, and monitor the blood coagulation index, that is, the International Normalized Ratio (INR), regularly, and adjust the dosage of warfarin according to the test results, in order to prevent the recurrence of venous thromboembolism or its recurrence.
Is it true that pulmonary embolism cannot or will not be easily diagnosed? Actually, it is not. As long as one is vigilant, as long as one is aware of this, it is still relatively easy to diagnose, the key is to think about it, but not to think about it.
Risk factors that are not too serious and not easy to eliminate: for example, chronic disease long-term bedridden patients, suddenly appear badly explained dyspnea or hypotension, clinical examination and not like heart failure and other problems, you should think of the possible occurrence of pulmonary embolism; although the incidence of thromboembolism in such patients is not so high, but the risk factors are difficult to be completely eliminated, often persist, and the time of oral warfarin needs 6-12 months.
The incidence of venous thromboembolism is high, the detection rate is low, and once it happens it is often irreversible, so it is important to increase the awareness of prevention and take effective preventive measures to prevent unpredictable occurrences. It is actually also simple: the older you are, the more and more sick you are, the more bedridden you are, or the bigger and longer the surgery, the greater the risk of venous thromboembolism.