What are the signs and symptoms of deep vein thrombosis. How is DVT diagnosed. What are the risk factors for developing a blood clot in the leg. How can deep vein thrombosis be prevented and treated. What complications can arise from untreated DVT.

Understanding Deep Vein Thrombosis: Causes and Risk Factors

Deep vein thrombosis (DVT) is a serious medical condition characterized by the formation of blood clots in the deep veins, typically in the legs. These clots can pose significant health risks, including the potential for pulmonary embolism if they break loose and travel to the lungs. To fully grasp the nature of DVT, it’s crucial to understand its underlying causes and risk factors.

What Causes Deep Vein Thrombosis?

DVT occurs when blood thickens and clumps together in a deep vein. This can happen due to several factors:

• Damage to the inner lining of a vein
• Sluggish or slow blood flow
• Increased blood thickness or clotting tendency

Vein damage can result from physical injuries, surgeries, or inflammatory processes. Slow blood flow often occurs during periods of immobility, such as after surgery or during long travels. Certain medical conditions and medications can increase the blood’s propensity to clot.

Who is at Risk for Developing DVT?

Several factors can increase an individual’s risk of developing deep vein thrombosis:

1. Previous history of DVT
2. Inherited blood clotting disorders
3. Hormone therapy or birth control pills
4. Recent surgery or trauma
5. Prolonged immobility
6. Pregnancy and postpartum period
7. Cancer and its treatments
8. Advanced age (over 60)
9. Obesity
10. Smoking

Is having multiple risk factors additive? Indeed, the presence of multiple risk factors significantly increases the likelihood of developing DVT. It’s essential for individuals with several risk factors to be particularly vigilant about prevention and early detection.

Recognizing the Symptoms of Deep Vein Thrombosis

Identifying the symptoms of DVT is crucial for early detection and treatment. However, it’s important to note that not all cases of DVT present with noticeable symptoms. When symptoms do occur, they typically manifest in the affected leg.

Common Signs and Symptoms of DVT

• Swelling in the affected leg or along a vein
• Pain or tenderness, often felt while standing or walking
• Increased warmth in the swollen or painful area
• Redness or discoloration of the skin

Can DVT symptoms be mistaken for other conditions? Yes, DVT symptoms can sometimes be confused with other leg problems, such as muscle strains or cellulitis. This underscores the importance of seeking medical evaluation for persistent leg symptoms, especially if you have known risk factors for DVT.

The Silent Threat: Pulmonary Embolism as a Complication of DVT

One of the most serious complications of deep vein thrombosis is pulmonary embolism (PE). This occurs when a blood clot breaks free from its original site and travels through the bloodstream to the lungs, where it can block blood flow.

Recognizing Pulmonary Embolism

The symptoms of pulmonary embolism can be sudden and severe:

• Unexplained shortness of breath
• Chest pain, particularly when breathing deeply
• Coughing up blood
• Rapid breathing and elevated heart rate

Why is pulmonary embolism so dangerous? PE can be life-threatening as it impairs oxygen exchange in the lungs and places strain on the heart. Prompt recognition and treatment of PE are critical for preventing severe complications and potential fatality.

Diagnosing Deep Vein Thrombosis: Medical Approaches

Accurate diagnosis of DVT is essential for appropriate treatment. Healthcare providers employ a combination of clinical assessment, patient history, and diagnostic tests to confirm the presence of a blood clot.

The Diagnostic Process

1. Medical history review
2. Physical examination
3. Diagnostic tests

During the medical history review, doctors inquire about risk factors, recent surgeries or injuries, and current medications. The physical exam focuses on identifying signs of DVT in the legs, such as swelling or tenderness.

Key Diagnostic Tests for DVT

While several tests can be used to diagnose DVT, ultrasound is the most common and non-invasive option. How does ultrasound detect DVT? Ultrasound uses sound waves to create images of blood flow in the veins, allowing doctors to visualize any blockages or abnormalities indicative of a clot.

Other diagnostic tests may include:

• D-dimer blood test
• Venography
• CT or MRI scans

These tests help confirm the diagnosis and determine the extent and location of the clot, guiding treatment decisions.

Treatment Strategies for Deep Vein Thrombosis

Once diagnosed, prompt treatment of DVT is crucial to prevent complications and promote recovery. The primary goals of treatment are to stop the clot from growing, prevent it from breaking loose, and reduce the risk of recurrence.

Anticoagulation Therapy

The mainstay of DVT treatment is anticoagulation, often referred to as blood thinners. These medications don’t actually thin the blood but rather interfere with the clotting process.

Common anticoagulants include:

• Heparin (unfractionated or low molecular weight)
• Warfarin
• Direct oral anticoagulants (DOACs) like rivaroxaban or apixaban

How long does anticoagulation therapy typically last? The duration of treatment can vary depending on the individual case, ranging from 3-6 months to indefinite therapy for those at high risk of recurrence.

Additional Treatment Approaches

In some cases, additional treatments may be necessary:

1. Thrombolysis: Using medications to dissolve the clot
2. Inferior vena cava filters: Implanted devices to prevent clots from reaching the lungs
3. Compression stockings: To reduce swelling and prevent post-thrombotic syndrome

Each treatment approach is tailored to the individual patient’s needs, considering factors such as the size and location of the clot, overall health status, and risk of bleeding.

Preventing Deep Vein Thrombosis: Proactive Measures

While not all cases of DVT can be prevented, there are several strategies individuals can employ to reduce their risk, especially those with known risk factors.

Lifestyle Modifications for DVT Prevention

• Maintain regular physical activity
• Stay hydrated
• Avoid prolonged periods of immobility
• Manage weight through healthy diet and exercise
• Quit smoking

How can one prevent DVT during long travels? When traveling for extended periods, it’s important to:

• Take frequent breaks to walk and stretch
• Perform simple leg exercises while seated
• Stay hydrated
• Wear loose, comfortable clothing

Medical Interventions for High-Risk Individuals

For those at higher risk of DVT, such as individuals undergoing surgery or hospitalization, additional preventive measures may be recommended:

1. Prophylactic anticoagulation
2. Use of compression stockings or pneumatic compression devices
3. Early mobilization after surgery

These interventions are typically prescribed by healthcare providers based on individual risk assessments.

Living with DVT: Long-Term Management and Considerations

After the initial treatment phase, individuals who have experienced DVT often require ongoing management to prevent recurrence and address potential long-term complications.

Post-Thrombotic Syndrome

Post-thrombotic syndrome (PTS) is a common long-term complication of DVT, characterized by chronic leg pain, swelling, and skin changes. How can PTS be managed? Management strategies for PTS include:

• Consistent use of compression stockings
• Leg elevation
• Regular exercise
• Weight management

Ongoing Monitoring and Follow-Up

Regular follow-up with healthcare providers is essential for individuals with a history of DVT. This may involve:

1. Periodic ultrasound examinations
2. Adjustments to anticoagulation therapy
3. Assessment of recurrence risk
4. Evaluation for chronic complications

Can individuals with a history of DVT lead normal lives? With proper management and adherence to treatment plans, most people with a history of DVT can maintain a good quality of life. However, it’s crucial to remain vigilant about symptoms and maintain open communication with healthcare providers.

Emerging Research and Future Directions in DVT Management

The field of DVT research is dynamic, with ongoing studies exploring new treatment options, improved diagnostic techniques, and more effective prevention strategies.

Advancements in Anticoagulation Therapy

Recent years have seen the development of novel oral anticoagulants (NOACs) that offer potential advantages over traditional therapies. These medications typically require less frequent monitoring and have fewer food and drug interactions compared to warfarin.

What are the potential benefits of NOACs in DVT treatment? NOACs may offer:

• More predictable anticoagulant effects
• Reduced need for regular blood tests
• Fewer dietary restrictions
• Potentially lower risk of intracranial bleeding

Personalized Medicine Approaches

Researchers are exploring ways to tailor DVT prevention and treatment strategies based on individual patient characteristics, including genetic factors. This personalized approach aims to optimize treatment efficacy while minimizing risks.

How might genetic testing influence DVT management? Genetic testing could potentially:

1. Identify individuals at higher risk for DVT
2. Guide the selection of the most appropriate anticoagulant
3. Inform decisions about the duration of anticoagulation therapy

Improved Diagnostic Techniques

Ongoing research is focused on developing more accurate and efficient diagnostic tools for DVT. These include:

• Advanced imaging techniques
• Biomarker-based tests
• Point-of-care diagnostic devices

These advancements aim to improve early detection and reduce the need for invasive diagnostic procedures.

Novel Therapeutic Approaches

Scientists are investigating new therapeutic strategies for DVT management, including:

1. Targeted thrombolytic agents
2. Nanotechnology-based drug delivery systems
3. Cell-based therapies for vein repair

These innovative approaches hold promise for more effective and potentially safer treatments for DVT in the future.

As research in the field of DVT continues to evolve, it’s essential for both healthcare providers and patients to stay informed about the latest developments. This ongoing progress offers hope for improved outcomes and quality of life for individuals affected by deep vein thrombosis.

Department of Surgery – Deep Vein Thrombosis

Deep vein thrombosis (throm-BO-sis), or DVT, is a blood clot that forms in a vein deep in the body. Blood clots occur when blood thickens and clumps together.

Most deep vein blood clots occur in the lower leg or thigh. They can also occur in other parts of the body.

A blood clot in a deep vein can break off and travel through the bloodstream. The loose clot is called an embolus (EM-bo-lus). It can travel to an artery in the lungs and block blood flow. This condition is called pulmonary embolism (PULL-mun-ary EM-bo-lizm), or PE.

PE is a very serious condition. It can damage the lungs and other organs in the body and cause death.

Blood clots in the thighs are more likely to break off and cause PE than blood clots in the lower legs or other parts of the body. Blood clots can also form in veins closer to the skin’s surface–however, these clots won’t break off and cause PE.

Other Names for Deep Vein Thrombosis

• Blood clot in the leg.
• Thrombophlebitis.
• Venous thrombosis.
• Venous thromboembolism (VTE). This term is used for both deep vein thrombosis and pulmonary embolism.

Causes

Blood clots can form in your body’s deep veins if:

• A vein’s inner lining is damaged. Injuries caused by physical, chemical, or biological factors can damage the veins. Such factors include surgery, serious injuries, inflammation, and immune responses.
• Blood flow is sluggish or slow. Lack of motion can cause sluggish or slow blood flow. This may occur after surgery, if you’re ill and in bed for a long time, or if you’re traveling for a long time.
• Your blood is thicker or more likely to clot than normal. Some inherited conditions (such as factor V Leiden) increase the risk of blood clotting. Hormone therapy or birth control pills also can increase the risk of clotting.

Risk Factors

The risk factors for deep vein thrombosis (DVT) include:

• A history of DVT.
• Conditions or factors that make your blood thicker or more likely to clot than normal. Some inherited blood disorders (such as factor V Leiden) will do this. Hormone therapy or birth control pills also increase the risk of clotting.
• Injury to a deep vein from surgery, a broken bone, or other trauma.
• Slow blood flow in a deep vein due to lack of movement. This may occur after surgery, if you’re ill and in bed for a long time, or if you’re traveling for a long time.
• Pregnancy and the first 6 weeks after giving birth.
• Recent or ongoing treatment for cancer.
• A central venous catheter. This is a tube placed in a vein to allow easy access to the bloodstream for medical treatment.
• Older age. Being older than 60 is a risk factor for DVT, although DVT can occur at any age.
• Overweight or obesity.
• Smoking.

Your risk for DVT increases if you have more than one of the risk factors listed above.

Signs and Symptoms

The signs and symptoms of deep vein thrombosis (DVT) might be related to DVT itself or pulmonary embolism (PE). See your doctor right away if you have signs or symptoms of either condition. Both DVT and PE can cause serious, possibly life-threatening problems if not treated.

Deep Vein Thrombosis

Only about half of the people who have DVT have signs and symptoms. These signs and symptoms occur in the leg affected by the deep vein clot. They include:

• Swelling of the leg, or along a vein in the leg
• Pain or tenderness in the leg, which you may feel only when standing or walking
• Increased warmth in the area of the leg that’s swollen or painful
• Red or discolored skin on the leg

Pulmonary Embolism

Some people aren’t aware of a deep vein clot until they have signs and symptoms of PE. Signs and symptoms of PE include:

• Unexplained shortness of breath
• Pain with deep breathing
• Coughing up blood

Rapid breathing and a fast heart rate also may be signs of PE.

Diagnosis

Your doctor will diagnose deep vein thrombosis (DVT) based on your medical history, a physical exam, and test results. He or she will identify your risk factors and rule out other causes of your symptoms.

For some people, DVT might not be diagnosed until after they receive emergency treatment for pulmonary embolism (PE).

Medical History

To learn about your medical history, your doctor may ask about:

• Your overall health
• Any prescription medicines you’re taking
• Any recent surgeries or injuries you’ve had
• Whether you’ve been treated for cancer

Physical Exam

Your doctor will check your legs for signs of DVT, such as swelling or redness. He or she also will check your blood pressure and your heart and lungs.

Diagnostic Tests

Your doctor may recommend tests to find out whether you have DVT.

Common Tests

The most common test for diagnosing deep vein blood clots is ultrasound. This test uses sound waves to create pictures of blood flowing through the arteries and veins in the affected leg.

Your doctor also may recommend a D-dimer test or venography (ve-NOG-rah-fee).

A D-dimer test measures a substance in the blood that’s released when a blood clot dissolves. If the test shows high levels of the substance, you may have a deep vein blood clot. If your test results are normal and you have few risk factors, DVT isn’t likely.

Your doctor may suggest venography if an ultrasound doesn’t provide a clear diagnosis. For venography, dye is injected into a vein in the affected leg, which makes the vein visible on an x-ray image. The x-ray will show whether blood flow is slow in the vein, which may suggest a blood clot.

Other Tests

Other tests used to diagnose DVT include magnetic resonance imaging (MRI) and computed tomography (to-MOG-rah-fee), or CT scanning. These tests create pictures of your organs and tissues.

You may need blood tests to check whether you have an inherited blood clotting disorder that can cause DVT. This may be the case if you have repeated blood clots that are not related to another cause. Blood clots in an unusual location (such as the liver, kidney, or brain) also may suggest an inherited clotting disorder.

If your doctor thinks that you have PE, he or she may recommend more tests, such as a lung ventilation perfusion scan (VQ scan). A lung VQ scan shows how well oxygen and blood are flowing to all areas of the lungs.

For more information about diagnosing PE, go to the Health Topics Pulmonary Embolism article.

Treatment

Doctors treat deep vein thrombosis (DVT) with medicines and other devices and therapies. The main goals of treating DVT are to:

• Stop the blood clot from getting bigger
• Prevent the blood clot from breaking off and moving to your lungs
• Reduce your chance of having another blood clot

Medicines

Your doctor may prescribe medicines to prevent or treat DVT.

Anticoagulants

Anticoagulants (AN-te-ko-AG-u-lants) are the most common medicines for treating DVT. They’re also known as blood thinners.

These medicines decrease your blood’s ability to clot. They also stop existing blood clots from getting bigger. However, blood thinners can’t break up blood clots that have already formed. (The body dissolves most blood clots with time.)

Blood thinners can be taken as a pill, an injection under the skin, or through a needle or tube inserted into a vein (called intravenous, or IV, injection).

Warfarin and heparin are two blood thinners used to treat DVT. Warfarin is given in pill form. (Coumadin® is a common brand name for warfarin.) Heparin is given as an injection or through an IV tube. There are different types of heparin; your doctor will discuss the options with you.

Your doctor may treat you with both heparin and warfarin at the same time. Heparin acts quickly, while warfarin takes 2 to 3 days before it starts to work. Once the warfarin starts to work, the heparin is stopped.

Pregnant women are usually treated with just heparin, because warfarin is dangerous during pregnancy.

Treatment for DVT using blood thinners usually lasts for 6 months. The following situations may change the length of treatment:

• If your blood clot occurred after a short-term risk (for example, surgery), your treatment time may be shorter.
• If you’ve had blood clots before, your treatment time may be longer.
• If you have certain other illnesses, such as cancer, you may need to take blood thinners for as long as you have the illness.

The most common side effect of blood thinners is bleeding. Bleeding can happen if the medicine thins your blood too much. This side effect can be life threatening.

Sometimes the bleeding is internal (inside your body). People treated with blood thinners usually have regular blood tests to measure their blood’s ability to clot. These tests are called PT and PTT tests.

These tests also help your doctor make sure you’re taking the right amount of medicine. Call your doctor right away if you have easy bruising or bleeding. These may be signs that your medicines have thinned your blood too much.

Thrombin Inhibitors

These medicines interfere with the blood clotting process. They’re used to treat blood clots in patients who can’t take heparin.

Thrombolytics

Doctors prescribe these medicines to quickly dissolve large blood clots that cause severe symptoms. Because thrombolytics can cause sudden bleeding, they’re used only in life-threatening situations.

Other Types of Treatment

Vena Cava Filter

If you can’t take blood thinners or they’re not working well, your doctor may recommend a vena cava filter.

The filter is inserted inside a large vein called the vena cava. The filter catches blood clots before they travel to the lungs, which prevents pulmonary embolism. However, the filter doesn’t stop new blood clots from forming.

Graduated Compression Stockings

Graduated compression stockings can reduce leg swelling caused by a blood clot. These stockings are worn on the legs from the arch of the foot to just above or below the knee.

Compression stockings are tight at the ankle and become looser as they go up the leg. This creates gentle pressure up the leg. The pressure keeps blood from pooling and clotting.

There are three types of compression stockings. One type is support pantyhose, which offer the least amount of pressure.

The second type is over-the-counter compression hose. These stockings give a little more pressure than support pantyhose. Over-the-counter compression hose are sold in medical supply stores and pharmacies.

Prescription-strength compression hose offer the greatest amount of pressure. They also are sold in medical supply stores and pharmacies–however, a specially trained person needs to fit you for these stockings.

Talk with your doctor about how long you should wear compression stockings.

Prevention

You can take steps to prevent deep vein thrombosis (DVT) and pulmonary embolism (PE). If you’re at risk for these conditions:

• See your doctor for regular checkups.
• Take all medicines as your doctor prescribes.
• Get out of bed and move around as soon as possible after surgery or illness (as your doctor recommends). Moving around lowers your chance of developing a blood clot.
• Exercise your lower leg muscles during long trips. This helps prevent blood clots from forming.

If you’ve had DVT or PE before, you can help prevent future blood clots. Follow the steps above and:

• Take all medicines that your doctor prescribes to prevent or treat blood clots.
• Follow up with your doctor for tests and treatment.
• Use compression stockings as your doctor directs to prevent leg swelling.

Contact your doctor at once if you have any signs or symptoms of DVT or PE. For more information, go to “What Are the Signs and Symptoms of Deep Vein Thrombosis?”

Travel Tips

The risk of developing DVT while traveling is low. The risk increases if the travel time is longer than 4 hours, or if you have other DVT risk factors.

During long trips, it may help to:

• Walk up and down the aisles of the bus, train, or airplane. If traveling by car, stop about every hour and walk around.
• Move your legs and flex and stretch your feet to improve blood flow in your calves.
• Wear loose and comfortable clothing.
• Drink plenty of fluids and avoid alcohol.

If you have risk factors for DVT, your doctor may advise you to wear compression stockings while traveling, or he or she may suggest that you take a blood-thinning medicine before traveling.

Living With Deep Vein Thrombosis

NHLBI Resources

Non-NHLBI Resources

Clinical Trials

Links to Other Information About Deep Vein Thrombosis

NHLBI Resources

Non-NHLBI Resources

Clinical Trials

Deep Vein Thrombosis (DVT) / Thrombophlebitis

The term venous thromboembolism (VTE) is used to describe two conditions, deep vein thrombosis (DVT) and pulmonary embolism (PE). This term is used because the two conditions are very closely related. And, because their prevention and treatment are also closely related.

Deep vein thrombosis is a blood clot or thrombus in a deep vein. They are most common in the leg. But they may develop in the arm or other part of the body. Part of the clot, called an embolus, can break off and travel to the lungs. This is a pulmonary embolus (PE). This can cut off the flow of blood to all or part of the lung. PE is an emergency and may cause death. If you have symptoms that may indicate a blood clot in the lungs, call 911 or get emergency help. Symptoms of a blood clot in the lungs include chest pain, trouble breathing, coughing (may cough up blood), a fast heartbeat, sweating, and fainting. 

Two other complications of a blood clot are chronic venous insufficiency and post-thrombotic syndrome.

• Chronic venous insufficiency may happen following a blood clot in a leg vein. It means that a vein no longer works well. It is a long-term condition where blood pools in the vein instead of flowing back to the heart. Pain and swelling in the leg are common symptoms. 

• Post-thrombotic syndrome may also happen following a blood clot in a leg vein. It is a long-term problem with pain, swelling, and redness. Ulcers and sores can also happen. All of these symptoms may make it difficult to walk and take part in daily activities.

What are the risk factors for deep vein thrombosis?

Risk factors include:

• Overweight or obesity

• Blood clotting disorder

• Age over 60 years

• Surgery

• A long period of not moving, for example, when in the hospital or on a long trip

• Birth control pills or hormone replacement therapy

• Certain diseases and conditions, such as:

  • Previous blood clot

  • Varicose veins

  • Heart problems, such as heart failure, or heart attack

  • Inflammatory bowel disease

  • Lupus, a disease of the immune system

  • Cancer and some cancer treatments

• Paralysis

• Pregnancy

• Having a central venous catheter, for example, in a large vein in the chest

What are the symptoms of deep vein thrombosis?

Deep vein thrombosis may happen without symptoms. Common symptoms include pain, swelling, and redness in the leg, arm, or other area. 

These symptoms may mean that you have a blood clot. The symptoms of a blood clot may also look like other medical conditions. Always see your healthcare provider for a diagnosis.

How is deep vein thrombosis diagnosed?

Along with a medical history and physical exam, your healthcare provider may do other tests including:

• Duplex ultrasound. This procedure involves placing ultrasound gel on the affected area and then moving a handheld device across it. A picture of the blood flow is displayed on a monitor. Duplex ultrasound is the most common test for DVT.

• Lab work. Blood work may be done to look for blood clotting and other problems.

What is the treatment for deep vein thrombosis?

Specific treatment will be determined by your healthcare provider based on: 

• How old you are

• Your overall health and medical history

• How sick you are

• The location of the clot

• How well you can handle specific medicines, procedures, or therapies

• How long the condition is expected to last

• Your opinion or preference

The goal of treatment is to prevent the clot from getting larger, to prevent a blood clot from traveling to the lungs, and to decrease the chance of another blood clot forming.

Treatment may include:

• Blood thinners (anticoagulant medicines). These medicines decrease the ability of the blood to clot. Examples of anticoagulants include warfarin and heparin. Other anticoagulants may also be used, including rivaroxaban, apixaban, dabigatran and enoxaparin. The most common side effect of blood-thinning medicine is bleeding. Report bruising or bleeding to your healthcare provider right away. You may have blood in the urine, bleeding with bowel movements, a bloody nose, bleeding gums, a cut that will not stop bleeding, or vaginal bleeding. 

• Clot busters (fibrinolytics or thrombolytics). These medicines are used to break up clots.

• Inferior vena cava filter. In some cases, a filter is placed in the vena cava (the large vein which returns blood from the body to the heart). This filter prevents clots from reaching the heart and lungs.

How can deep vein thrombosis be prevented?

Preventing deep vein thrombosis can include:

• Anticoagulant medicines are given to certain patients having surgery to prevent blood clots.

• Wiggling the toes and moving the ankles helps to prevent blood clots caused by long periods of sitting or lying down.

• When you travel and must sit for long periods of time, you can reduce your risk of a blood clot by doing the following: 

  • Walk up and down the aisles (if traveling by plane or bus)

  • Stop about every hour and walk a little (if traveling by car)

  • While sitting, move your legs, ankles, and toes

  • Wear loose clothing

  • Limit the amount of alcohol you drink

  • Drink a lot of water and other healthy drinks

Prevention may also include: 

• Walking.  Getting up and moving as soon as possible after surgery or illness

• Sequential compression device (SCD) or intermittent pneumatic compression (IPC). Special sleeves go around both legs. They are attached to a device that applies gentle pressure to the legs. Remove the sleeves so that you do not trip or fall when you are walking, such as when you use the bathroom or shower. Ask for help if you cannot remove and replace the sleeves. 

• Elastic or compression stockings, if prescribed by your healthcare provider.

Blood Clots – Common Causes, Symptoms and Treatment Options

Blood Clots can cause heart attacks and strokes. If you are experiencing suspicious heart problems or numbness in your arms or legs, you should go to the nearest emergency center (ER) for treatment immediately.

What is a Blood Clot?

A blood clot is a thickened mass in the bloodstream. It is made from platelets, which are crucial to healing wounds and cuts. However, when platelets accumulate and cause a blood clot, this mass can travel throughout the body and into a person’s lung, heart, brain, and other vital organs. Blood clots can cause a heart attack, stroke and death. If you are experiencing the symptoms of blood clots, you should go to the nearest ER immediately.

SignatureCare Emergency Center has multiple locations in Houston, Austin, College Station and other cities in Texas. Find an emergency center near you and seek immediate medical attention if you believe you have a blood clot.

Common Causes of Blood Clots

Many health conditions can lead to blood clots depending on which part of the body the clot forms. Below are some of the most common causes of blood clots.

Heart-related causes

• Abnormal heart rhythm – Also known as atrial fibrillation, this condition is the result of irregular electrical impulses in the upper chamber of the heart. It causes blood to clot in the lower chambers.
• Heart attack – A deadly condition caused when clots decrease or stop the flow of blood to the heart. The heart tissue dies, causing the organ to malfunction.

Vein-related causes

• Prolonged immobility – Sitting or lying down for long periods of time can decrease blood flow and cause clotting in the legs and lower abdomen.
• Pregnancy – Pregnancy strains the legs and lower abdomen and can restrict the flow of blood in these areas. This risk can be elevated if a woman is carrying multiple pregnancies or is overweight.
• Smoking – Smoking hardens the arteries throughout the body and restricts the normal flow of blood from the lower extremities to other parts of the body.
• Birth control pills – Birth control pills increase the production of estrogen and other chemicals that encourage blood clotting. Women who take oral contraceptives raise their risk of developing blood clots.

Arterial-related causes

• High blood pressure – High blood pressure causes arterial hardening and decreases blood flow and clotting.
• High cholesterol – Too much cholesterol in the blood encourages masses to form and can cause clots to travel from one area of the body to another.
• Diabetes – Diabetics produce too much protein known as fibrinogen. Too much fibrinogen in the blood causes the blood to clot excessively.
• Genetics – A family history of blood clots and heart disease raises a person’s risk of inheriting and developing the same complications.

Other causes of blood clots

• Surgery – Undergoing surgical procedures can raise a person’s risk of developing blood clots. Many hospitals require patients to wear surgical socks or leggings to encourage normal blood flow during their hospital stay.
• Genetic mutations – Some inherited genetic mutations and conditions, most notably Pseudoxanthoma Elasticum (PXE), raise the risk of clots and arterial hardening.

Think you have blood clot? Go to the nearest emergency room.

When to seek Emergency Treatment for Blood Clots

Determining whether or not you have blood clots can be difficult without proper medical care. However, you should call a doctor if you experience numbing of your arms, hands, feet or legs. You should also get medical help if you experience a rapid heartbeat that does not subside with rest or a medication like low-dose aspirin. You should go to your nearest ER if you experience any of these symptoms or have chest, leg or back pain that does not subside with over-the-counter remedies or home treatment. Or, if any of the following symptoms are present:

• Shortness of breath or difficulty breathing
• Loss of consciousness or feeling light-headed
• Confusion or difficulty answering questions
• Sudden and intense pain that is located on only one side of the body
• Facial numbness or slurred speech
• Inability to lower and raise arms or grasp things with hands
• Inability to walk or bear weight on legs or feet

If you are experiencing symptoms of blood clots, please the closest ER. Our ERs are open 24/7 and we have several emergency center locations.

Additional information about blood clots can be found here.

Visiting the Emergency Department for a Blood Clot: What to Expect

Taking a trip to the emergency department (ED) is stressful and potentially costly – but it can be lifesaving. For patients with deep vein thrombosis (DVT) or pulmonary embolism (PE), it’s especially important to receive treatment in a timely manner.

When should you go to the ED?

If you suspect that you have a blood clot or experience any of the signs and symptoms, you should consider going to the ED.

Signs of DVT include:

• Swelling of the legs, ankles, or feet
• Discomfort, heaviness, pain, aching, throbbing, itching, or warmth in the legs
• Skin changes in the leg such as discoloration, thickening, or ulceration

Signs of PE include:

• Sudden shortness of breath
• Chest pain
• Coughing up blood
• Rapid or irregular heart rate

What can you expect in the ED?

While every patient’s ED trip will be different, there are a several things that you can expect when you visit. First, a medical professional will take your health and medication history. The doctor treating you will need to know what medications you take and how often. This information is especially important if you end up at an ED away from your home, in another state, etc. After discussing your medical history, the doctor will examine you and may ask some more detailed questions about your symptoms. Imaging is typically the next step after the physical exam. An ultrasound is the most common diagnostic test for DVT and uses sound waves to create a picture of the arteries and veins in the leg. Doctors also can order a blood test known as the D-dimer test. Computed tomography (CT) scans are typically used to diagnose PE.

While you’re in the ED, you may be seen by multiple healthcare providers along the way, including doctors, nurses, and physician assistants. If you visit a large teaching hospital, you may also be seen by clinicians in training. All of these medical professionals are a resource for you. “Don’t be afraid to ask questions in the emergency room,” says Dr. Jeremiah Schuur, Chair of the Department of Emergency Medicine at the Warren Alpert Medical School of Brown University. “Since you may see multiple providers, it’s a good idea to ask questions or clarify things to make sure you understand what the doctor is considering and what the plan is.”

Will you be admitted to the hospital or sent home?

If a DVT is confirmed, you may be discharged and sent home with injectable or oral anticoagulant medication (sometimes called a blood thinner). That said, every patient is different, and you may be admitted to the hospital if the ER doctor believes it’s necessary.

Some patients with PE may also be sent home, according to Dr. Schuur, although the majority will be admitted. Studies have shown that it’s safe for certain patients to be discharged, such as those with a small PE and no other health risks. (This discharge practice is more common in Europe than in the U. S.) It’s safest to assume that you’ll be admitted to the hospital for treatment if you have a PE.

If I’m sent home, what do I do after my ED visit? 

After your visit to the ED, it’s important to follow up with your primary care provider (PCP) within the next several days. Your PCP can help guide the next phase of your treatment and may refer you to a doctor who specializes in cardiovascular disease.

The bottom line

Take your symptoms seriously. The ED is there to help you in times of need. It’s always better to make the trip and have a blood clot ruled out than to stay home and potentially have complications.

Vaccine side effects: With all this talk about blood clots, how do I know if I’m affected?

Rare cases of blood clotting linked to the administration of COVID-19 vaccine AstraZeneca has thrown the medical condition under the spotlight, but what is blood clotting, and what are the symptoms?

Key points:

• Very rare cases of vaccine-induced blood clotting symptoms can occur four to 20 days after AstraZeneca’s administration
• The blood vessels involved are smaller than those affected by deep vein thrombosis, which can occur on long plane flights 
• The symptoms have only been reported in about one in 250,000 people vaccinated with AstraZeneca in Europe

Blood clotting is the body’s natural response to injury or trauma.

Cell fragments called platelets activate to stick to a ruptured blood vessel wall, seal it up, and stop it from bleeding.

The platelets work with dissolved clotting factors in the blood that form a strong net called fibrin.

University of Adelaide haematologist and blood researcher Dan Thomas said blood clots could move around the body when the circumstances that produced the clotting overwhelmed the factors that dissolved clots.

For example, when blood is flowing too slowly during prolonged periods of inactivity, like on long plane trips, clotting could form deep within a vein.

Read our full coverage of the coronavirus pandemic

“Symptoms of a usual blood clot include leg swelling, calf muscle pain, shortness of breath, pain when breathing in deeply, or coughing up blood,” Dr Thomas said.

“But the rare symptoms of clotting after a COVID vaccine are completely different from a normal leg vein clot from plane travel, for instance, because the blood vessels involved are smaller. “

Authorities started rolling out AstraZeneca to Australians in March.(ABC News: Bension Siebert)

What are the symptoms?

Dr Thomas said the symptoms of vaccine-induced clotting, as they were known so far, included:

• Severe gut pain commencing 4–20 days after receiving the vaccine 
• A persistent headache unresponsive to paracetamol
• A general feeling of systemic unwellness beyond four days after the vaccination
• Stroke-like symptoms, seizures or vomiting

He said the stroke-like symptoms, also known as a transient ischaemic attack, could feel like:

• Dizziness
• Transient loss of speech or balance
• Weakness on one side of the body
• Confusion
• Blurred vision

Dr Thomas said platelets had been activated by antibodies in a rare phenomenon where the body thought they were bad because they were sitting next to some of the vaccine, which resembled a foreign pathogen.

“The vaccine-induced clotting syndrome appears to activate platelets, making them clot, leading to a decreased platelet count and evidence of fibrin degradation,” he said.

“Fortunately, it looks as though these antibodies can go away over time and we can accelerate their removal by treatment with immunoglobulin.”

The AstraZeneca vaccine is now only preferred for Australians over 50.(ABC News)

Dr Thomas said people taking the medication heparin to prevent blood clots could be at increased risk of clotting disorders from COVID-19, or the AstraZeneca vaccine.

“Most importantly, if anyone is worried they may be getting a clotting reaction after being vaccinated, this can be immediately diagnosed with a blood test,” he said.

Read our full coverage of the coronavirus pandemic

A distinct type of clotting

The Australian Technical Advisory Group on Immunisation (ATAGI) said symptoms were different to those commonly associated with vaccines.

The common side effects of headaches, muscle aches, fevers and chills can begin within 24 hours of being vaccinated and last up to two days, but the onset of clotting symptoms began four to 20 days after vaccination.

Read our full coverage of the coronavirus pandemicDownload the ABC News app for all the latest.

ATAGI said the symptoms resulted from a distinct type of “thrombosis associated with thrombocytopenia”.

“Most cases involved a type of clot in the brain called cerebral venous sinus thrombosis (CVST),” it said in a statement.

“Most reported cases involve cerebral veins (presenting as CVST), but thrombosis of other parts of the body have also been reported.”

The ATAGI said CVST had also been noted as a complication of COVID-19 itself.

Dr Thomas said on rare occasions the virus had “caused loss of blood flow to a limb”, which would present as whiteness in a person’s feet accompanied by pain.

Some 1,178,302 vaccine doses were facilitated by the government by April 11. (Photo: Insiders)

Pfizer preferred for under 50s

The Federal Department of Health said about one in every 250,000 people vaccinated with AstraZeneca in Europe had been diagnosed with the rare blood clotting.

So far, there had been just two reported cases likely linked to AstraZeneca in Australia.

Read more about COVID-19 vaccines:

The department said there was a potentially greater risk for people below the age of 50 to develop thrombosis with thrombocytopenia after being administered the vaccine.

It had led to a preference towards the Pfizer vaccine for that age group in Australia, while people above 50 would continue to be given the AstraZeneca vaccine.

“It is important to note the AstraZeneca vaccine remains highly effective at preventing death and severe illness among people who have contracted COVID-19,” said health department heads in a joint statement last week.

“And that the incidence of the blood-clotting syndrome is very rare.”

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How to Diagnose a Blood Clot (with Pictures)

About This Article

Medically reviewed by:

Master’s Degree, Nursing, University of Tennessee Knoxville

This article was medically reviewed by Luba Lee, FNP-BC, MS. Luba Lee, FNP-BC is a board certified Family Nurse Practitioner (FNP) and educator in Tennessee with over a decade of clinical experience. Luba has certifications in Pediatric Advanced Life Support (PALS), Emergency Medicine, Advanced Cardiac Life Support (ACLS), Team Building, and Critical Care Nursing. She received her Master of Science in Nursing (MSN) from the University of Tennessee in 2006. This article has been viewed 38,321 times.

Co-authors: 7

Updated: January 27, 2021

Views: 38,321

Medical Disclaimer

The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment.

Article SummaryX

To diagnose a blood clot, keep an eye out for swelling, especially in your arm or leg, which can be an early sign of a clot. You may also notice severe pain around the location of the clot or displaced pain, like in your back, shoulder, or jaw. Your skin might feel warm to the touch and develop a reddish or bluish discoloration that doesn’t go away. If you notice these symptoms, or if you experience sudden weakness or numbness in your arm, leg, or face, make an appointment with your doctor as soon as possible. To learn how to work with a doctor to treat a blood clot, scroll down!

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How to Spot a Clot and Get Treated

• Blood clots have been reported in a small minority of people after receiving COVID-19 vaccines by AstraZeneca and Johnson & Johnson.
• Clots can cause problems if they block an important vein or artery.
• Symptoms of clots include shortness of breath, swelling, and severe and persistent headaches.
• See more stories on Insider’s business page.

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Blood clots have been reported in a small number of people after receiving COVID-19 vaccines from AstraZeneca and Johnson & Johnson.

The benefits of AstraZeneca’s vaccine still outweigh the risks, the European Medicines Agency (EMA) said in a press release. Still, the agency’s safety committee said it’s important to know the signs of a possible clot.

A blood clot occurs when the blood thickens and forms a semi-solid mass. It can be a helpful response to stop bleeding in the case of injury, but these blockages can cause problems if they cut off blood flow to a vital area.

Blood clots can cause blockages in the legs, abdomen, and lungs. Most of the blood clots associated with the AstraZeneca vaccine have occurred in veins in people’s brains. These clots, known as cerebral venous sinus thrombosis (CVST), can lead to stroke, seizures, and death.

So far, most of the clots reported have occurred in women under 60 years of age within two weeks of vaccination. Since young people are more likely to experience this side effect, UK vaccine regulators recommend that people under 30 do not get the AstraZeneca shot unless they’ve already received their first dose.

Blood clot symptoms include shortness of breath and headaches

The EMA said patients who got the AstraZeneca vaccine should seek medical assistance immediately if they have the following symptoms:

• shortness of breath
• chest pain
• swelling in your leg
• persistent abdominal (belly) pain
• neurological symptoms, including severe and persistent headaches or blurred vision

Some mild side effects, like pain at the injection site or other body aches, are common in the days post-vaccine. But if you experience severe or persistent symptoms around four to 20 days after vaccination, you should seek medical attention, according to the World Health Organization.

Blood clots are typically treated with anti-clotting medication. Complications can be avoided if the clot is caught early.

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90,000 “A blood clot was removed from the vessel – and the person spoke.” How doctors save patients from strokes and heart attacks

A patient with a severe stroke who could not speak was brought to the X-ray operating room, but as soon as the doctor removed a blood clot from the cerebral vessel, the person started talking right on the operating table, moving his arm and leg. Miracle? For the doctors of the X-ray Department of Endovascular Surgery of the Emergency Hospital in Minsk, this is, albeit almost gem-quality, but daily work. They save patients with strokes and heart attacks 24 hours a day, seven days a week.

How vessels are checked using X-rays in a hospital

It is now approximately 11 o’clock in the afternoon, and we with a photographer go to one of the X-ray operating rooms of the city clinical emergency hospital. We were given shoe covers, dressing gowns and hats in advance, but this is not all that is needed so that we can be here. Each is wearing a special X-ray protective suit that weighs at least ten kilograms.It is in these that doctors operate and the medical staff works.

Operations on the vessels of the brain or heart are performed here under X-rays through a puncture in the radial or femoral artery. They are very gentle for the patient, but doctors will not enter the operating room without special equipment, moreover, everyone has a dosimeter with him, everyone works in turn, as prescribed by the rules. The patient is also protected from radiation with a special diaphragm so that the beam hits only where it is needed.

We are accompanied by the head of the X-ray department of endovascular surgery, the angiographic room of the emergency hospital Alexander Beimanov. He has been working in emergency medicine for 20 years. He was one of the first to start treating heart attacks with stenting in 2002, and 13 years later it became necessary to develop a new direction – endovascular treatment of ischemic strokes.

Alexander Eduardovich studied in Italy with the world’s leading experts, in Belarus his mentor was the famous cardiac surgeon and professor Yuri Ostrovsky.After graduating from the medical institute in Grodno, Alexander Beimanov worked as a surgeon at an emergency hospital in Gomel, and after an internship on assignment, he was offered to do cardiac surgery: at that time it was planned to create a cardiac surgery center in Gomel.

– While still in the medical institute, I walked past Vladimir Burakovsky’s book on cardiovascular surgery and said: “Someone is lucky, someone is doing this!” – he recalls.

For several years, Alexander Eduardovich went to clinical residency in Minsk and worked in today’s Republican Scientific and Practical Center “Cardiology”, and then became one of the students of the International Heart School in Italy, worked and trained in the Department of Interventional Cardiology at the Physiology Clinic in Pisa.As I dreamed, the Leaning Tower of Pisa was visible from the operating room window.

– It was a wonderful school, where I met all the leading experts in the world! – he recalls. – They were invited to give lectures and demonstration operations.

And even after this practice, despite knowing both English and Italian, he had no doubts whether to return home or not. It seems that this is the very same romantic doctor who lives according to the principle “who, if not us.” He wanted to return and develop interventional cardiology in the country, already then realizing that the future was in the treatment of strokes.A 46-year-old woman is now in the operating room; she is undergoing an important study – coronary angiography. Using this method, you can identify coronary heart disease, understand where and how the coronary arteries narrow, and save a person’s life.

The study is also carried out through a puncture, in this case, the radial artery on the arm. A contrast agent is injected through special catheters, which fills the lumen of the artery. X-ray beams are directed to the artery, and its relief is visible on the angiograph screen. So doctors can conclude about the patient’s condition.Fortunately, everything is in order with her – the large coronary arteries are clean, changes in very small vessels. She will be treated with medication, no surgery is needed.

Four doctors work in the operating room, two more are outside and monitor the woman’s condition on monitors. After the procedure, the person remains in the hospital for another day or two, then you can go home.

For coronary angiography in the hospital sent from clinics. For example, it is needed for coronary heart disease, when a person takes pills, but they do not help. Some are afraid of this procedure, but nothing better has been invented yet. If it is not done, then sooner or later a heart attack may occur. The procedure is performed under local anesthesia, coronary angiography is painless for the patient and takes only 20-40 minutes.

A woman in the queue for coronary angiography is a 72-year-old man. Almost until this age, he led an active life, while running, he suddenly felt pain in his heart, switched to walking, but the pain did not go away. Doctors state: a patient with coronary arteries is in trouble, a very serious lesion at the level of the left coronary artery trunk, and surgery cannot be avoided here.

In total, 1,700 patients pass through the angiography room in the hospital annually, approximately 700-800 of them undergo operations on the heart and blood vessels of the brain. In 90% of cases, these are patients with acute coronary syndrome.

The faster you remove a blood clot during a stroke, the better

The uniqueness of this department of the emergency hospital is that it treats strokes and heart attacks using interventional technologies. Two complications – one of which is the main cause of death, the second – ranks first in disability.Doctors here remove blood clots with a catheter through a puncture in the femoral or radial artery.

Alexander Eduardovich shows a photograph of a blood clot: visually it is a blood clot, but it is he who can be fatal for the patient – if it comes off and gets into the brain.

Signs of a stroke: impaired movement of the limbs on one side, speech impairment, change in facial expressions. As soon as you notice such manifestations, you urgently need to call an ambulance. It happens that suddenly a person’s arm or leg has stopped moving, but there are no other signs, the body can rebuild within a day, but if nothing is done and does not go to the doctor, then in 15% of cases in the next three months a stroke will occur.

In the emergency room, the work is organized in such a way that patients with cerebrovascular accidents are sent for computed tomography, and then delivered to the operating room, bypassing the emergency department. All this is needed to help a person faster, because every minute counts. More than two thousand patients with ischemic strokes pass through the clinic every year.

For strokes, computed tomography is more often done than magnetic resonance imaging, because, according to Alexander Beimanov, it is faster, and in an open CT machine, a person is not so nervous and moves less, and the quality of the picture will be better as a result.

– It happens that they brought a person, and we do not know when the stroke began. Then we do not just a computed tomography, but a computed tomography with perfusion, when you can study the blood flow and see which zone is already dead.

If the patient has no contraindications, then within the first 4.5 hours from the onset of the stroke, drugs that dissolve the blood clot can be administered, but, unfortunately, they are not always effective. Therefore, in the emergency hospital, the patient not only begins to administer these drugs, but also immediately undergo surgery inside the vessels to restore blood flow.Why exactly such interventional operations? They are much more effective, and they can be performed in patients after six to eight hours from the onset of a stroke, and more recently, up to 24 hours. But at the same time, there must be strict indications. Unfortunately, in some cases, when the brain is severely damaged, the technique can be dangerous. According to foreign experts, it can be used in 10-12% of all cases of ischemic strokes, and this is a difficult teamwork of X-ray surgeons, neurologists, anesthesiologists, radiologists, sometimes you need help from neurosurgeons.The faster the clot is removed and the blood flow restored, the more chances that a person will have no neurological consequences and the body will be able to rebuild. And this means that after a stroke, he will serve himself, he will be able to walk. If you miss the time, then part of the brain will die, and the stroke will be treated with pills, and then the chances of a normal life are much less.

Recently, among the patients of the department, there are many young women who are brought in with a tear of the vertebral artery.A girl is doing yoga, a bad turn of her head – and she is on the operating table. There were cases when patients were brought who sharply turned their heads while parking the car, after massage or manual therapy.

The oldest patient with a heart attack is 101 years old. And she was operated on

– On January 2, we had a patient born in 1938 with a heart attack. There was practically no blood flow in the left coronary artery, and besides that, she also had a lesion of the right coronary artery.What to do? We must take risks! We went to a desperate operation in order to restore at least some blood flow. And today I called about this patient, she is in the cardiology department and is preparing for rehabilitation. We have avoided a fatal outcome, – says Alexander Beimanov.

In emergency medical care, people are saved from acute myocardial infarction seven days a week, 24 hours a day. According to European statistics, if a patient is treated for a heart attack with tablets without thrombolytics, which dissolve blood clots, then the lethality is about 15%.With thrombolytics – about 7-8%. If we use intervention technologies, then the mortality rate is within 4-5%.

The operation can be performed on a person regardless of age. The oldest patient with a heart attack was 101 years old.

“We put two stents on her, restored blood flow,” says Alexander Eduardovich. – Now the average age of our patients is 69-72 years.

Everyone’s heart attack proceeds differently, but the main symptoms are pain behind the sternum, which radiates into the interscapular space, left arm, and lower jaw.

– Although we meet patients whose heart attack is manifested by nausea, vomiting and heartburn, people call an ambulance, doctors do a cardiogram, and then there is a heart attack. The classic picture is chest pain. You need to pay attention to all the pain behind the breastbone that occurs with minor physical exertion, emotional distress, anxiety.

Ideally, a person with a heart attack should be on the operating table 90-120 minutes after the first contact with doctors.This is the golden time when you can save the myocardium. According to many European and American protocols, the time when it is possible to operate on a heart attack has been extended to 12-24 hours from the onset of the disease, but here it still depends on whether it is a large-focal or small-focal heart attack. After 12 hours, part of the myocardium will be restored, but something will die, although the scar may be small, and the patient will not have heart failure in the future.

– Why are we afraid to take a patient to the operating table if more than 12 hours have passed since the heart attack? We are afraid of myocardial rupture.We will restore blood flow, but the myocardium has already been changed, and there may be a rupture on this changed one. But if the patient’s condition threatens his life, there are complex heart rhythm disturbances, pressure does not hold, there is pulmonary edema – we take him to the X-ray operating room.

Alexander Beimanov notes that doctors analyze their database of patients and see that patients with heart attacks and strokes, after the ambulance has made a decision to be hospitalized, reach the emergency room on average in 15 minutes. On the way, they already call the clinic and tell them that they are taking such a patient so that the operating room can be prepared there.It takes about 20 minutes more to prepare the team, make a cardiogram for the patient, and take tests. This is the ideal time when the patient has clear symptoms of myocardial infarction. But it happens that he has many concomitant diseases, then you need to understand more accurately.

– Right now, a patient was brought to the clinic, she is in intensive care, and we are deciding what to do next. She has atypical symptoms: there are changes in the brain, internal organs, there is congestive pneumonia, and in this case, changes in the cardiogram are not considered decisive.In the near future they will take a picture of her, take tests – and we will decide whether to take her to the X-ray operating room or not.

Now, on the basis of emergency medical care, doctors from other regions and foreigners are trained in sparing operations for strokes and heart attacks. Alexander Beimanov does not hide the fact that negotiations are already underway to create a training center for them, including for foreign doctors. This will attract additional money: after all, his clinic pays for the training of a physician. On the other hand, the rating of the hospital and its specialists will increase.

– If we become such a training center, then we ourselves will be able to study more, there will be even more motivation to direct us to internships. And this is not only very interesting, but also extremely necessary, since everything is constantly being improved, new evidence of treatment protocols, more effective devices, new drugs, and techniques appear.

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causes of occurrence, symptoms of the disease, diagnosis and treatment methods

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-medication.In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. For a diagnosis and correct prescription of treatment, you should contact your doctor.

Hemangioma: causes, symptoms, diagnosis and treatment.

Definition

Hemangioma is called vascular hyperplasia (proliferation of cells of the vascular wall) – a disease that is classified as a benign tumor (benign neoplasm) and can be either congenital or appear within a few months after the birth of a child.

Hemangioma of the skin in adults occurs, but not often, since most tumors resolve on their own in childhood. If a similar neoplasm has appeared on the skin of an adult, where there were no surface defects before, then such a tumor requires careful diagnosis.

If in childhood the hemangioma is poorly expressed (in the form of an abrasion or a small speck), then in adulthood, under the influence of certain factors, it can grow and increase.

Hemangiomas form, as a rule, on the scalp, face, neck and, less often, on the trunk and limbs. Favorite locations on the internal organs are the liver, bones, lungs.

Hemangiomas of the skin are more often single neoplasms, but there are exceptions. It is noticed: if there are more than five hemangiomas in visible areas of the body, it is highly likely that there is also a hemangioma of internal organs.

Causes of hemangiomas

The causes of hemangiomas are not fully understood.One theory is that overgrown endothelial cells may be residual embryonic cells. Another assumption is that the hemangioma begins to grow in utero in conditions of chronic lack of oxygen. It is possible that the formation of a tumor can provoke acute infections, including respiratory viral infections, if the mother had such in the first trimester of pregnancy. This is only a theory, because hemangiomas also occur in children born to mothers with a normal pregnancy.

It is noted that hemangiomas are more common in premature babies and in multiple pregnancies.

Threats of miscarriage, placenta previa (very low location of the placenta in the uterus, which complicates natural childbirth), placental abruption and inflammation, umbilical cord entanglement, preeclampsia (a complex of symptoms including edema, increased blood pressure and protein detection in urine analysis), mother’s age (over 38 years) are also risk factors.

Classification of the disease

Hemangiomas of childhood are divided into congenital and infantile (infant).

Congenital hemangiomas appear, grow and reach their maximum size in utero.

It is not uncommon for large hemangiomas to be seen during ultrasound screening. A newborn appears with a hemangioma, which can subsequently decrease in size and disappear on its own within a year and a half (rapidly involution), decrease, but not completely disappear (partially involution) or not change at all (not involution).If a congenital hemangioma grows, then only in proportion to the child’s growth. It occurs with equal frequency in both boys and girls.

Infantile (infant) hemangiomas appear during the first weeks of life.

Infantile hemangioma 90 120 90 150 90 120
Such a hemangioma is preceded by a patch of altered skin or a red spot. The growth of a hemangioma can last up to six months of a child’s life. Then comes the period of growth arrest, it lasts an average of two months, and then there is a phase of slow reduction of the neoplasm, which can last up to ten years.

Infant hemangioma occurs five times more often in girls than in boys.

Infantile hemangiomas can be located on the skin (simple capillary hemangiomas), under the skin (venous and cavernous hemangiomas) and be combined.

Depending on the histological structure and the caliber of the vessels, hemangiomas are divided:

• into capillary,
• venous,
• cavernous,
• combined.

Capillary or superficial hemangioma of the skin (port port wine stain) .

Located on the surface of the skin and is a dense network of closely intertwined capillaries lined with endothelial cells. This form occurs in 90-96% of cases, is characterized by intensive proliferation of new vessels and is considered the initial stage of development of education.

Venous hemangiomas .

Formations are represented by veins of small and medium caliber. Such hemangiomas tend to grow deep into the skin and above its surface.

Cavernous or cavernous hemangiomas .

Cavernous formation is considered the next stage in the development of the venous form of hemangioma. It consists of cavities bounded by the endothelial layer of blood vessels and separated by septa. Such a hemangioma is formed as a result of overfilling of defective capillaries with blood and rupture of their walls with the formation of cavities (cavities) and hemorrhages (hematomas). The blood in these cavities, due to the increase in coagulation properties, forms small clots.

Combined hemangiomas .

This type of hemangiomas includes formations that have signs of several forms of varying severity.

Symptoms of hemangioma

• Capillary or superficial hemangioma of the skin (port wine stain) is prone to proliferation into the surrounding tissues and is a volumetric elastic formation from pale pink to rich red or burgundy outlines, with irregularities somewhat rising above the surface of the skin.When pressed, the hemangioma turns pale, but then quickly takes on its original appearance. When localized on the back of the head it is called “stork bite”, when localized on the forehead – “angel’s kiss”.

  The edges of the hemangioma indicate the stage of its development: an even outlined edge is observed in the phase of growth arrest and the phase of tumor shrinkage. During active growth, the edges are blurred.

• Venous hemangiomas are dark red with a blue or purple tint.They are not common, but they are quite large in area.
• Cavernous or cavernous hemangiomas have the appearance of a soft bluish-purple or violet elastic elastic subcutaneous formation with outlines clearly delimited from the surrounding tissues and a rough surface through which small vessels are visible. A small part of the formation rises above the surface of the skin, the rest is located deep in the tissues and can penetrate not only into the subcutaneous tissue, but also into the muscles.When pressed for several seconds, the tumor shrinks, its volume and color intensity decrease, which quickly recover after the pressure is removed.
• Combined hemangiomas combine signs of superficial and subcutaneous forms, while the subcutaneous part takes up a larger volume.
• Hemangiomas of internal organs .

Small hemangiomas of internal organs often do not manifest themselves in any way and are accidentally detected during research related to other diseases.

In order for the liver hemangioma to give pain, it must reach an impressive size – 5-10 cm. The hemangioma of the spine does not cause any symptoms if it is inside the vertebra. As soon as it affects the periosteum (the membrane that covers the bone) or ligaments, constant pain occurs. A tumor compressing the roots of the spinal nerves can lead to various sensory disturbances in the extremities.

Some hemangiomas immediately cause symptoms, this is due to the peculiarity of the location.Growing up, they quickly disrupt the function of the organ. These include hemangiomas of the larynx, trachea, eye tumors.

Diagnosis of hemangioma

Diagnosis of hemangioma begins with a survey of the patient and / or his representatives about the course of the disease, the first manifestations, the dynamics of events. Then a detailed examination of the vascular formation is carried out. Depending on the symptoms and location of the hemangioma, an in-depth examination by a narrow specialist (ophthalmologist, otorhinolaryngologist, etc.) may be required.etc.).

To clarify the size, depth, structure of the neoplasm, an ultrasound study with the study of blood flow is shown. However, in some hemangiomas, it may be uninformative.

What is thrombosis and how to treat it

Thrombosis is a formation inside blood vessels. They can occur both in the arteries and in the veins, affecting both deep and superficial veins. Therefore, thrombosis is different: thrombotic blockage of deep veins is called “deep vein thrombosis”, and the terms “thrombophlebitis” or “varicothrombophlebitis” are applicable to superficial veins.

Phlebologist and surgeon of the Clinic of Modern Cosmetology Yulia Shcherbatova.

“A thrombus is not always a blood clot, as is often thought. It can be a drop of fat, a detached atherosclerotic plaque, an air lock, or a combination of several of these factors, ”says Grigory Anchikov, a phlebologist and surgeon at the Clinic of Modern Cosmetology of Yulia Shcherbatova.

The expert adds that deep vein thrombosis is more dangerous, since a larger volume of blood passes through them and thrombi with a fluctuating apex often occur in them.The risk that such a blood clot will come off and start moving towards the heart is high.

First of all, people with varicose veins are at risk. Especially those who do not treat her.

phlebologist and surgeon of the Semeynaya network of clinics

“Among others – pregnant women, patients with obesity, patients taking oral contraceptives. They increase the risk of blood clots and long flights, injuries, and intake of insufficient fluid, ”says Ilya Sorokvasha, a phlebologist and surgeon at the Semeynaya network of clinics.

Phlebologist and surgeon at the TsIDK clinic.

“Obstruction of venous outflow creates increased intra-abdominal pressure, that is, straining. Therefore, you need to be more careful with strength training when a lot of weight is lifted. Swimming, cycling and jogging are useful for prevention, because they are associated with the rhythmic contraction of the calf muscles, ”adds a phlebologist and surgeon at the TsIDK clinic.

The course of thrombosis may be asymptomatic, but this is rare.

“Thrombophlebitis is manifested by thickening of the vein, redness and soreness when pressed. As a rule, thrombophlebitis is preceded by varicose veins. Deep veins are located between the muscles, next to the bones, so of course they play a major role in venous outflow. Deep vein thrombosis manifests itself in bursting pain and swelling. Pay attention to the slightest pain in the legs and the difference in their size between each other, ”explains Dmitry Rasskazov, phlebologist and surgeon at the TsIDK clinic.

The best diagnostic methods are ultrasound angioscanning (USAS), angiography with the introduction of a contrast agent, CT.They help to see blood clots in the vessels and determine the functioning of the blood flow.

In the past, doctors recommended small doses of aspirin to thin the blood to prevent thrombosis.

“The latest large and complete study in tens of thousands of people has shown that aspirin increases the risk of bleeding. Therefore, such a recommendation has now been ruled out, ”says Dmitry Rasskazov.

Unfortunately, yes. But there must be good reasons for this – for example, concomitant diseases, the complication of which can be thrombosis.In addition, thrombophilia can be inherited, so it is important to get tested for thrombophilia.

The most dangerous thing is that parts of a detached blood clot can get through the heart into the pulmonary arteries. This can lead to a lung infarction called pulmonary embolism (PE). If a significant part of the pulmonary arteries is blocked, then a lethal outcome is possible.

Phlebologist Evgeny Ilyukhin says that “massive thromboembolism of the branches of the pulmonary artery ends fatally in 30% of cases, almost every tenth patient with PE develops this fatal event within an hour from the onset of the first symptoms – chest pain, shortness of breath, shortness of breath, fainting, dizziness, rapid breathing. “

The main prevention of thrombosis is regular medical examination in order to exclude concomitant pathology that can lead to thrombosis. If there is no pathology, then it is important to observe and treat hypodynamia, move, and eat in a balanced way. With a long sitting position, you need to get up and walk once an hour, pull your socks, make circular movements with your foot. If you have varicose veins, then you need to wear compression underwear, which is selected individually with a phlebologist.Doctors say that no ointment can prevent blood clots.

Thrombophlebitis up to the knee are treated on an outpatient basis, and higher, closer to the groin area – by surgery, such as “dissolving” blood clots – thrombolysis. The nature of the thrombus itself also matters: if it is floating, then bed rest is important, and if it is attached to the wall of the vessel, then you need to lead an active lifestyle and watch the thrombus.

In all cases, the main treatment is the administration of anticoagulant drugs, which reduce blood clotting and prevent the formation of new blood clots.

90,000 When the fibrin clot is stretched, the individual threads are ordered and unwound

Blood clots, often clogging arteries with a fatal outcome, are not inferior to rubber in their mechanical characteristics – they can be safely stretched three times without the slightest sign of damage. This phenomenal ability is provided by the elasticity of fibrin molecules.

Despite the seemingly uniform structure, proteins have a variety of properties – from super-strong structural molecules to fast and active enzymes.Some of these abilities still do not find a logical explanation.

For example, fibrin, which instantly forms a strong and elastic three-dimensional base for blood clots and blood clots. Thanks to this skill, the blood flow in damaged, but restored vessels does not stop. Unfortunately, this also allows blood clots to remain in the cavity of veins and arteries for many years, breaking off at the most unforeseen moment.

John Weisel of the University of Pennsylvania and his colleagues have figured out the secrets of fibrin biomechanics:

When the clot is stretched many times, the separately spaced fibers line up in parallel, maintaining strength and elasticity.

Protein structure levels

In addition to the amino acid sequence of the polypeptide (primary structure), the three-dimensional structure of the protein, which is formed during folding (folding), is extremely important. The three-dimensional structure is formed as a result of the interaction of structures …

Fibrin cannot be called a permanent protein – it is formed in the body only at the moment of urgent need, and then it is destroyed by enzyme systems.Any damage to the vessel wall, be it an incision, rupture or inflammation at the site of an atherosclerotic plaque, activates the blood coagulation system.

As a result of a multistep reaction, the detailing of which took more than a century, a three-dimensional network is formed: first, stabilizing “tails” are split off from fibrinogen, a soluble precursor molecule. Then the fibrin tangles turn into threads, forming a clot (fibrin aggregate, unstabilized fibrin). In the third stage, coagulation factor XIIIa stitches the individual threads together, finally stabilizing the thrombus.

The authors of publication in Science
had to perform the same transformations with human fibrin in a test tube before starting to stretch the resulting clot.

Fibrin retained its elastic capacity even with threefold lengthening.

Thrombus

a blood clot formed by blood corpuscles stuck in the fibrin networks. It can cause a malfunction of the circulatory system by blocking a vessel with thrombophlebitis.

In this case, the bonds that hold the individual fibrils together are preserved. That is, the threads do not slide relative to each other, which could explain this phenomenal elongation.

Weisel and colleagues proposed a different model – they fixed the samples under tension, after which they obtained electronic and atomic microscopic images of both the surface of the bunch and its section.It turned out that with an elongation of 2.5 times, the orientational order parameter, which characterizes the ordering of the filaments, increases from 0.1 to 0.7.

Moreover, the spaces between the fibrin filaments are preserved. This allows enzymes to penetrate into the clot, destroying it as soon as the defect in the vessel wall is restored.

When stretched twice, the individual threads become closer to each other and the relative volume occupied by them increases from 5 to 24%.

This is accompanied by a decrease in the size of the clot by almost 10 times (see.video), and the fibers are thinned almost three times (the diameter decreases from 185 nm to 74 nm). Scientists managed to find an explanation in this thinning. As it turned out, the fibrin molecule, which is a spiral, unwinds a little, lengthening, but at the same time retaining its elastic properties. Of all the structural proteins, only elastin is capable of this.

The fact is that any protein is initially a chain of amino acids, which immediately after synthesis is packed first into a secondary and then a tertiary structure.First it is a spiral or “folded sheet”, and then – tangles.

As it turned out, the parameters of the spiral can change,

which is not true at all for all proteins: for example, the same collagen, which is similar to fibrin in chemical composition, also forms a spiral, but it does not stretch. The result is only 50 percent, maximum 70 percent lengthening, which is nothing compared to 200-250 percent lengthening of the fibrin clot.

Now scientists expect to understand what is violated in pathological situations – with thrombosis of the veins of the lower extremities or the formation of clots at the site of atherosclerotic plaques.But the members of the research team, specializing in biomechanics, probably plan to reproduce the described processes in new polymer materials.

Savior by Blood: a method to prevent the growth of blood clots in COVID-19 has been found | Articles

Immediately in 11 Moscow clinics, including the 40th hospital in Kommunarka and the N.V. N.V. Sklifosovsky, a method for predicting the rate of blood clots in severe COVID-19 is currently being studied. Explosive thrombus formation, leading to heart attacks and strokes, turned out to be one of the most dangerous consequences of the new coronavirus on the body. Using the device “Thrombodynamics Recorder”, scientists plan to determine the required doses of anticoagulants (blood-thinning drugs) and promptly change them depending on the severity of the patient’s condition. The aim of the study is to develop a new COVID-19 treatment protocol that would reduce the number of deaths.

Reduce risks

The new coronavirus damages the endothelium, the layer of cells that lines the inner surface of blood vessels, causing increased blood clots.This is one of the most dangerous effects of SARS-Cov-2 on the body, along with the “cytokine storm”.

– Autopsies of patients who died from COVID-19 showed that in 90% of cases their lungs were clogged with blood clots, – Corresponding Member of the Russian Academy of Sciences, Professor of Moscow State University, told Izvestia. Lomonosov Fazli Ataullakhanov. – Our research is aimed at reducing the death rate from coronavirus.

As noted by the scientist, about a month ago, the Ministry of Health of the Russian Federation introduced a prophylactic dose of heparin, a drug that dramatically reduces the activity of blood coagulation, into the protocol for the treatment of all patients with COVID-19 admitted to hospitals.

– Our studies have shown that a prophylactic dose of heparin works well in 70% of cases. But for 20% of patients it is insufficient, and for 10% it is excessive – such patients are at risk of bleeding. The doctor sees that the patient’s condition continues to deteriorate, and increases the dose of heparin at his own peril and risk, the expert commented.

Photo: Moscow City News Agency / Alexander Avilov

The device “Thrombodynamics Recorder”, according to him, allows you to make this process controlled and safe.

– The device was created 10 years ago for the diagnosis of hemostasis (the body’s system, which maintains the liquid state of the blood, is responsible for stopping bleeding and dissolving blood clots that have fulfilled their function. – Izvestia), prevention and treatment of heart attacks, strokes, deep vein thrombosis and thromboembolism of the pulmonary artery, – Ilya Spiridonov, General Director of GemaCor, which manufactures the device, explained to Izvestia.

If patients with COVID-19 regularly monitor the state of blood coagulation using this device, then it is not possible to fight thrombosis blindly, but by precisely adjusting the dose of anticoagulant depending on the characteristics of the body.

Within normal limits

One of the properties of our blood is the ability to clot in a timely manner, that is, to form a clot – a thrombus to stop bleeding. If this mechanism is broken, the coagulation system does not work correctly. By examining hundreds of healthy people, the scientific group of Fazli Ataullakhanov determined the limits of the rate of thrombus formation. As the professor notes, it should be in the range from 20 to 30 microns per minute. If this speed is 31–32 microns per minute, you should already be on your guard.40 instead of 30 is a very serious violation. In the case when this figure exceeds 50 microns, you need to act immediately, otherwise the patient will definitely get thrombosis.

– At this rate, blood clots begin to grow not only in places of vascular damage, but everywhere. Spontaneous clots appear anywhere, and the risk of serious consequences is very high, – Fazli Ataullakhanov told Izvestia.

Photo: Izvestia / Pavel Bednyakov

When the capillaries of the lungs are clogged with blood clots, the tissues are not supplied with food, oxygen or drugs.But bacteria, which are always present in the body, multiply. With COVID-19, it turned out that even in patients who are brought to the hospital in a relatively mild condition, the blood coagulation system is often in an overactive state, that is, it tends to give thrombosis. This can only be traced by laboratory research; the process can remain invisible for a long time.

– It can be assumed that people with a physiologically higher level of blood clotting are more susceptible to a severe form of the disease.Therefore, in case of hemodynamic disorders in patients with coronavirus infection, there is an obvious need for urgent action on the part of doctors to prevent thrombosis, – said Alla Zagainova, Candidate of Biological Sciences, Associate Professor of the Department of Human and Animal Anatomy and Physiology of Tyumen State University.

New protocol

Patients from eleven Moscow clinics are participating in the study. Among them are the 40th hospital in Kommunarka, the N.V. N.V. Sklifosovsky, 23rd, 51st, 52nd, 64th hospitals, clinic of the Academy of Sciences in Troitsk near Moscow.

A blood test is taken from patients once a day and the process of thrombus formation is visualized. This monitoring covered about 800 patients. The first, observational phase of the study will end at the end of June. In the second, scientists will offer options for the dosage of anticoagulants, depending on the rate of blood clots in specific patients.

– We are participating in research to save as many of the lives of our patients as possible. In this case, the contribution to science is a pleasant bonus, ”Sergei Tsarenko, deputy chief physician for anesthesiology and resuscitation of Moscow hospital No. 52, told Izvestia.- So far we have just started, but have already clarified some of the subtleties of the correction of hemostasis in a severe group of patients who are on ECMO (devices for saturating the blood with oxygen during the development of acute respiratory failure. – Izvestia).

Photo: RIA Novosti / Denis Abramov

The result of the research will be to determine the significance of the thrombus rate factor in the severity of the disease and the survival rate of patients with COVID-19. The group studies the state of hemostasis in conjunction with all other significant parameters of the patient’s condition, including data on blood oxygen saturation, CT readings that record the percentage of lung damage, the state of the immune system, temperature, pressure, etc.etc.

Already now, the rate of thrombus formation is recognized as one of the most significant indicators for predicting the outcome of the disease. The study will make it possible to draw statistically reliable conclusions and propose a new treatment protocol for patients with COVID-19.

This technique for visualizing the growth of a clot (thrombus) is patented both in Russia and in Europe, the USA and China. For the study of hemostasis in COVID-19, GemaCor provided its devices free of charge. If the method is recommended for widespread use in clinics treating coronavirus patients, the company will be able to produce up to a thousand devices by the end of the year.

New modifications of the device and tests for it have now been developed, allowing to visualize not only clot growth, but also fibrinolysis – dissolution of a thrombus, as well as the generation of thrombin – a key element of the hemostasis system. So far, only scientists in university clinics around the world are working with these novelties; they have not yet been introduced into practice.

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Who is at risk of blood clots and how to prevent sudden death

Every year in Europe alone, more than half a million people die from complications, which are called thromboembolic complications, and in the common people – from blood clots.That’s double that of car accidents, breast cancer, prostate cancer and AIDS combined.

Blood clots threaten people of any age. And the worst thing is that the disease is asymptomatic, and then, as they say, hits on the spot. At risk are patients after surgery and trauma; those who have been on bed rest for a long time; those that often endure long flights. Those who are taking hormonal contraceptives or have had the flu. And even those who just move a little.

Can the development of killer blood clots be prevented? Academician of the Russian Academy of Sciences, President of the Association of Phlebologists of Russia, Vice-President of the Russian Society of Surgeons Alexander Kirienko spoke about this in an interview with “MK”.

– Alexander Ivanovich, what are thromboembolic complications?

– Doctors talk about them when a thrombus occurs in any part of the cardiovascular system, that is, a blood clot in the cavities of the heart or great vessels, part of which can break off and migrate through the blood stream.With thrombosis of the left atrium or ventricle, a detached thrombus (embolus) enters the aorta, and from there into the vessels of the heart, which can lead to the development of myocardial infarction. Blood clots trapped in the arteries of the head are the cause of ischemic stroke. Blood clots in the artery of the intestine are fraught with necrosis of the intestine, and in the arteries of the extremities – they threaten their gangrene. If a thrombus occurs primarily in the veins of the legs (venous thrombosis), then the detached thrombus enters the pulmonary arteries. The resulting thromboembolism of the pulmonary arteries is the cause of severe cardiopulmonary failure, which often leads to death.

– Why is this happening?

– Venous thrombosis occurs when a number of unfavorable circumstances occur, which lead to a slowdown in blood flow through the vein of the legs, an increase in blood coagulation and damage (often microscopic) of the venous wall. The speed of blood flow through the veins slows down sharply when people are limited in mobility due to adherence to bed rest, a long flight or driving in a car. The blood clotting potential increases in response to trauma, bleeding, surgery, dehydration, the development of malignant tumors, uncontrolled intake of female sex hormones for contraception or replacement, infection.The genetic predisposition also matters – the presence of so-called congenital thrombophilia in people. Venous thromboembolic complications often occur in patients with malignant neoplasms, in patients of trauma and orthopedic hospitals, burn departments; in patients who have undergone cerebrovascular accident, gynecological operations (including abortion), etc. In fact, this is one of the most common hospital complications. But often thromboembolic complications occur in people at home.

– Who is at risk?

– People leading a sedentary lifestyle and forced to comply with bed rest; obese; cancer patients; have undergone bone trauma and various surgical interventions. In addition, persons with dehydration who are uncontrollably taking female sex hormones with a genetic predisposition are at risk of venous thrombosis.

– Are patients able to carry out such self-diagnosis or is it just a doctor’s business?

– It is the doctor’s job to identify these complications and predict them, but the patient can help him by telling in detail the history of his life, past illnesses and symptoms that he has recently.

– What to look for, what symptoms should seem alarming?

– It is extremely difficult for the patient himself, and sometimes the doctor, to notice the first symptoms of thrombosis. Pain and swelling of the leg may indicate it. Unfortunately, they appear only in those cases when the thrombosis has already been of considerable extent. Therefore, these symptoms cannot be called early. In addition, symptoms appear quite late if the patient is forced to comply with bed rest.Sometimes the first manifestation of such asymptomatic thrombosis may be a life-threatening pulmonary embolism. That is why it is more important not to look for the symptoms of an already developed thrombosis, but to prevent its occurrence!

– How to prevent them?

– It is very important to lead an active, mobile lifestyle, not to overeat (obesity is one of the significant risk factors), to undergo regular medical examinations, which allows detecting malignant neoplasms and other serious diseases in the early stages.Women who are going to take hormones for contraceptive purposes or for the treatment of menopausal disorders should definitely discuss this with a gynecologist. Sometimes, to prevent thrombosis, it is enough to quickly activate the patient, make him walk immediately after the operation, use compression hosiery (special elastic knee-highs or stockings). In necessary cases, doctors prescribe special drugs – anticoagulants, the choice of which is quite wide in modern conditions.And, finally, if your leg is suddenly ill and swollen, or you have shortness of breath and chest pain for no apparent reason, you need to consult a doctor as soon as possible, who has every opportunity to make the correct diagnosis and prescribe the necessary treatment.

– According to the international study ENDOSE, in Russia only 26% of patients in surgical departments receive adequate prophylaxis, while in Germany, for example, this figure is 92%. What is the reason?

– For quite a considerable time in Russia, the leading causes of death of patients in surgical hospitals were hemorrhagic and infectious complications.With the introduction of new technologies and advances in the treatment of surgical infection, the frequency of these complications has significantly decreased, and venous thrombosis and pulmonary embolism began to take the first place in their structure. In Western countries, this happened earlier. In addition, there have long been clinical standards of treatment and prevention, which have been introduced in our country relatively recently. The unfavorable state of the prevention of hospital thromboembolic complications prompted the Russian Society of Surgeons and the Association of Phlebologists of Russia to initiate the project “Safety area from venous thromboembolic complications.”The goal of the project was to introduce the ideology of preventing these complications in various Russian regions into the minds of doctors and into the practice of surgical hospitals. This is justified both from a medical, ethical and financial standpoint (the cost of prevention is many times lower than the cost of treating complications that have already arisen). Over time, therapists, neurologists, cardiologists, obstetricians-gynecologists, orthopedic traumatologists and representatives of other medical specialties have joined the surgeons. The implementation of the project allowed doctors to train the principles of risk assessment and effective prevention of these common complications, many of our patients were saved, saved from the disabling consequences of thrombosis and embolism, and their usual quality of life was preserved.

Published in the newspaper “Moskovsky Komsomolets” No. 26873 dated July 31, 2015

Newspaper headline:
Killer blood clots

Arpimed

Method of application

• Swallow the tablet with a glass of water.
• Try to take your tablets at the same time every day. It doesn’t matter if you take Lisinopril before or after meals.
• Continue taking Lisinopril until your doctor allows you to stop taking it, the treatment is long.It is important to take Lisinopril every day.

First dose

• Take special care after taking the first dose of Lisinopril or when increasing the dose. This can lead to a sharp drop in blood pressure than subsequent doses.
• Taking the first dose may make you dizzy. If this is observed, you should lie down. If you are concerned about this, please see a doctor as soon as possible.

Adults

Your dose depends on your health condition and on whether you are taking any other medicines at the same time.Your doctor will recommend how many tablets to take each day. If you are unsure of something, ask your doctor or pharmacist for advice.

Treatment of high blood pressure

• The recommended starting dose is 10 mg once daily.
• The usual dose for long-term use is 20 mg once daily.

Treatment of heart failure

• The recommended starting dose is 2.5 mg once a day.
• The usual dose for long-term use is 5 to 35 mg once daily.

Post-heart attack treatment

• The recommended starting dose is 5 mg within 24 hours after a heart attack and 5 mg every other day.
• The usual dose for long-term use is 10 mg once daily.

For the treatment of kidney diseases caused by diabetes mellitus

• The recommended dose is 10 mg or 20 mg once daily.

If you are an elderly person, have kidney problems, or are taking diuretics, your doctor may prescribe a lower dose than your usual dose.

Use in children and adolescents (aged 6-16 years) with high blood pressure

• It is not recommended to use Lisinopril in children under 6 years of age or in children with severe renal impairment.
• The doctor will find the right dose for your child.The dose depends on the child’s body weight.
• The recommended starting dose for children weighing 20 to 50 kg is 2.5 mg once a day.
• The recommended starting dose for children weighing more than 50 kg is 5 mg once a day.

If you have taken more Lisinopril than recommended

If you have taken more Lisinopril than prescribed by your doctor, you must contact your doctor or the nearest hospital.

Symptoms of the following are most likely: dizziness, heart palpitations.

If you forget to take Lisinopril

• If you forget to take Lisinopril, take it as soon as you remember, but if it’s time for your next dose, do not take the missed dose.
• Do not take a double dose of the drug to compensate for the missed dose.

If you stop taking Lisinopril

Do not stop taking the tablets without consulting your doctor, even if you feel well.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Tell your doctor right away if you notice any of the effects listed below.

• Severe allergic reactions (rare, affects 1-10 out of 10,000 people).

Symptoms may include sudden onset:

• Swelling of the face, lips, tongue, or throat. This can make it difficult to swallow.
• Severe or sudden swelling of the hands, feet, and ankles.
• Difficulty breathing
• Severe itching of the skin (with blisters).

• Severe skin lesions, such as a sudden, unexpected rash or burning sensation, redness or flaking of the skin (very rare, affects less than 1 in 10 people.000).
• Infection with symptoms such as fever and severe worsening of general condition, or fever with local symptoms of infection such as sore throat / pharynx / mouth or urinary problems (very rare, affects less than 1 in 10,000 people).

Other side effects:

Often (observed in 1-10 out of 100 people)

• Headache
• Feeling dizzy, especially on rising suddenly.
• Diarrhea
• Dry cough that does not go away.
• Vomiting
• Kidney problems (confirmed by a blood test)

Uncommon (observed in 1-10 out of 1000 people)

• Mood changes
• Discoloration of fingers or toes (pale blue accompanied by redness) or numbness or tingling in fingers or toes.
• Change in taste
• Drowsiness
• Dizziness (vertigo)
• Sleep problems
• Stroke
• Rapid heartbeat
• Runny nose
• Nausea
• Abdominal pain or indigestion
• Skin rash or itching
• Lack of erection (impotence)
• Feeling tired or weak (loss of strength)
• An excessive decrease in blood pressure may occur in people with the following conditions: coronary artery disease, narrowing of the aorta (artery of the heart), renal artery, or heart valves; an increase in the thickness of the heart muscle.If this happens to you, you may feel dizzy, especially when standing up suddenly.
• Changes in blood test values ​​that show the functional state of the liver and kidneys.
• Heart Attack
• Visual and auditory hallucinations

Rarely (observed in 1-10 out of 10,000 people)

• Confusion of consciousness
• Skin rash (urticaria)
• Dry mouth
• Hair loss
• Psoriasis (skin problem)
• Impaired sense of smell
• Breast augmentation in men
• Changes in some cells or other elements of the blood.Your doctor will need to take blood samples periodically to check if Lisinopril has any effect on blood composition. Signs of an impact may include feeling tired, pale skin, sore throat, high fever (fever), joint and muscle pain, swelling of the joints or glands, or sensitivity to sunlight.
• Low blood sodium levels (symptoms may include fatigue, headache, nausea, vomiting).
• Sudden renal failure.

Very rare (occurs in less than 1 person in 10,000)

• Sinusitis (feeling of pain and stuffiness behind the cheek and eyes).
• Whistling breath
• Low blood sugar (hypoglycemia). Symptoms: Feeling hungry or weak, sweating and heart palpitations.
• Inflammation of the lungs. Symptoms: cough, feeling short of breath and high temperature (fever)
• Yellowing of the skin or whites of the eyes (jaundice)
• Inflammation of the liver.May cause loss of appetite, yellowing of the skin and eyes, and darkening of urine
• Inflammation of the pancreas. It causes moderate to severe stomach pain
• Severe skin lesions. Symptoms include: redness, blistering and scaling
• Sweating
• Oliguria or anuria
• Liver failure
• Puffiness
• Intestinal inflammation

Unknown (frequency cannot be estimated from available data)

• Depression symptoms
• Fainting

Side effects in children were found to be comparable to those in adults.

If you have any side effects, talk to your doctor or pharmacist. This includes any side effects not listed in this leaflet.

Reporting side effects

If you notice any side effects, tell your doctor, pharmacist or pharmacist about it, including any side effects not listed in this leaflet. You can also report side effects of Arpimed LLC by going to the website www.arpimed.com and fill out the appropriate form “Report side effects or ineffectiveness of the drug” and to the Scientific Center for the Expertise of Drugs and Medical Technologies. Academician E. Gabrielyan by going to the website www.pharm.am in the section “Report side effects of the drug” and fill out the form “Card of messages about side effects of the drug”. Scientific center hotline: +37410200505; +37496220505 By reporting side effects you are helping to gather more information on the safety of this medicine.

How to store Lisinopril

• Lisinopril , 5 mg tablets.

The drug should be stored out of the reach of children, protected from moisture and light at a temperature of 15 ⁰ C -25 ⁰ C.

• Shelf life – 3 years. Do not take lisinopril after the expiration date printed on the drug packaging. The expiry date refers to the last day of the specified month.
• Do not dispose of medicines into waste water or sewage system. Ask the pharmacist how to dispose of the drug that you no longer need. These measures are aimed at protecting the environment.

Contents of the box and additional information

One Lisinopril 5 mg tablet contains:

active substance: lisinopril (in dihydrate format) – 5 mg

excipients: sodium starch glycolate, microcrystalline cellulose, magnesium stearate.

What Lisinopril looks like and contents of the pack:

Lisinopril 5 mg tablets: Round flat tablets of white or almost white color with a score on one side and bevel on both sides, odorless.