Deep vein thrombosis and pulmonary embolism are two related conditions that affect the circulatory system.

DVT occurs when a blood clot forms in a deep vein, usually in the leg, while PE happens when a part of that clot breaks free and travels to the lungs.

These conditions are serious and can be life-threatening if left untreated, making early detection and management critical.

The formation of a blood clot in the deep veins is often due to a combination of factors, including:

1, Injury to the blood vessel wall as in a trauma or limb surgery.

2, Slowing of the blood circulation as in obesity or prolonged immobility like when travelling or being bedridden.

3, Changes in blood composition that lead to increased clotting, as in cancer, heart failure, smoking, general inflammatory diseases, and some genetic conditions.

Once a clot forms, it can grow and extend inside the vessel, increasing the risk of fragmentation and dislodgment to the lung arteries, where it can cause a pulmonary embolism. PE severity depends on the size and final lung “landing” location of the clot, ie, the degree of lung obstruction it causes.

How common is a DVT or a PE?

It is estimated that DVT affects up to 900,000 people in the USA each year, with PE occurring in up to 600,000 individuals annually (Source: CDC).

According to a study published in the Journal of Thrombosis and Haemostasis, the incidence of DVT in the general population is estimated to be around 1 to 2 cases per 1,000 individuals per year, with the incidence increasing with age.

Another study published in the American Journal of Medicine estimated the incidence of PE to be around 0.69 cases per 1,000 individuals per year in the general population.

How can DVT or PE be diagnosed?

The diagnosis of DVT and PE can be challenging, as the symptoms are often non-specific and can mimic other disorders. At times, symptoms can also be minimal or even absent. With that, DVT and PE tend to be easily overlooked, unless a high degree of suspicion is raised when the clinical scenario is conducive to vascular clotting.

DVT can cause swelling, pain, redness and warmth in the affected limb. Very often, none of these symptoms take place and the DVT is clinically silent.

PE may cause chest pain, shortness of breath, rapid breathing, and coughing up blood. In some cases, PE can lead to sudden death.

The diagnosis of DVT and PE usually involves a combination of medical history, physical examination, blood work, and imaging tests such as ultrasounds, CT scans, or MRIs of the legs and/or pelvis and/or lungs.

How can DVT or PE be treated?

The treatment of DVT and PE typically involves the use of anticoagulant medications or “blood thinners” to prevent further clot formation and migration. The most common used ones are:

1, Heparin and its derivatives, which are injectable in the veins or under the skin.

2, Warfarin that is oral and typically follows heparin usage.

3, Direct blood thinners, such as Pradaxa, Xarelto or Eliquis, which are more reliable than warfarin as they do not need require blood work monitoring or diet restriction.

In severe cases, a clot-buster drug, much more potent than the above blood thinners, may be used to emergently dissolve the clot.

In some instances, an intervention or a surgery may be necessary to remove the clot and/or prevent further migration.

How can DVT or PE be prevented?

Several measures can be taken to prevent DVT and PE, especially in high risk individuals. Some of these methods include:

Staying active

Regular physical activity can help improve circulation and reduce the risk of blood clots. It is recommended to engage in moderate-intensity exercise for at least 30 minutes a day, most days of the week.

Maintaining a healthy weight

Obesity is a risk factor for DVT and PE, and maintaining a healthy weight can help reduce this risk. It is recommended to aim for a body mass index between 18.5 and 24.9.

Quit smoking

Tobacco can damage the blood vessels and increase the risk of clot formation.

Avoid prolonged sitting or standing

Individuals who sit or stand for long periods of time are at higher risk of developing blood clots. It is recommended to take frequent breaks to stretch and move around, especially during long flights or car rides.

Wear compression stockings

These are designed to improve circulation in the legs and can help reduce the risk of DVT.

Take blood thinners

In individuals who are at very high risk of DVT or PE, such as those who have undergone major surgery or who have cancer or previous blood clots, prophylactic anticoagulant medication may be recommended to prevent blood clots from forming. In some cases, aspirin can be an option too.

Joseph Yammine is a consultant cardiologist at the Bermuda Hospitals Board. The information herein is not intended as medical advice nor as a substitute for professional medical opinion. Always seek the advice of your physician