Ana I. Casanegra, M.D., M.S., a vascular medicine specialist from the Mayo Clinic, dives into the world of venous thrombosis. She discusses the historical understanding of the condition and its serious complications, particularly pulmonary embolism. Key topics include risk factors like age and lifestyle, symptoms to watch for, and essential diagnostic tools. Dr. Casanegra also explores treatment options, including anticoagulants, while emphasizing the importance of personalized patient care and adherence to treatment strategies.
Venous thrombosis, especially in seniors, underscores the significance of age and other risk factors like immobility and hormonal therapies.
Effective DVT management requires thorough evaluation, shared decision-making regarding anticoagulants, and tailored treatment plans for confirmed cases.
Deep dives
Understanding Venous Thrombosis Risk Factors
Venous thrombosis, particularly deep vein thrombosis (DVT), poses a significant risk to individuals, with age being a noteworthy factor in its prevalence. Adults over the age of 60 have a much higher likelihood of experiencing DVT compared to younger individuals, with the ratio being one in 180 for seniors versus one in 10,000 for those around 20 years old. Other key risk factors include cancer, prolonged immobility, surgeries, and the use of hormonal therapies, including contraceptives and during pregnancy. Highlighting specific situations, healthcare providers often observe increased instances of thrombosis in patients recovering from hip fractures in nursing homes due to extended periods of bed rest.
Prevention Strategies for Travelers and Hospitalized Patients
During long-distance travel, wearing compression socks is recommended as a preventive measure against DVT, especially for flights lasting more than six to eight hours, as these can impede blood flow. Staying well-hydrated and performing leg exercises to stimulate circulation are also effective strategies during flights. In a hospital setting, patients at higher risk of thrombosis due to prolonged bed rest may benefit from prophylactic anticoagulation, particularly following surgeries. Utilizing assessment tools like the Caprini score allows healthcare providers to determine the appropriate prophylactic measures tailored to individual patient risk factors.
Diagnosis and Treatment of DVT
Diagnosing DVT requires a combination of clinical assessment and diagnostic testing, using tools such as the Wells score for deciding whether to proceed with further evaluation like a D-dimer test or an ultrasound. For confirmed cases of DVT, anticoagulant therapy is critical, typically treated for a minimum of three months. Providers must engage patients in shared decision-making regarding the choice of anticoagulants, considering lifestyle factors, insurance coverage, and potential drug interactions. Importantly, the management of DVT may differ based on whether it is isolated, proximal, or accompanied by other venous conditions, highlighting the importance of thorough evaluation and tailored treatment plans.
Venous thrombosis is an under diagnosed and potentially serious health condition, yet in many cases its preventable and certainly treatable when found. Its most serious potential complication is embolization, most commonly to the lung. As a medical condition, venous thrombosis has been known for many years. In fact, the triad of contributing factors to venous thrombosis including venous stasis, vascular injury and hypercoagulability were discovered in the mid-1800’s. Despite the long duration we’ve been diagnosing and treating the health problem, there’s still much we need to learn about it. The topic for today’s podcast is venous thrombosis and we’ll discuss its risk factors, how to diagnose a DVT and the best management recommendations. My guest will be Ana I. Casanegra, M.D., M.S., a vascular medicine specialist at the Mayo Clinic.
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
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