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FeaturesDeep vein thrombosis: A silent killer

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Deep vein thrombosis: A silent killer

“Oh Mr X is dead. Oh, we saw him yesterday. Oh, he called me this morning.

What killed him suddenly? They say his death is attributable to a spiritual cause. African electronics. Oh, who killed him?” Most often when a loved one dies a sudden death in a Ghanaian community, we hear the above expressions that demonstrate shock and attribution of the cause of the death to a spiritual mischief.

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Consequently, someone in the family or community is directly accused of having killed the deceased spiritually. Medically, some sudden deaths are caused by undiagnosed disease conditions such as deep vein thrombosis (DVT) and embolism, which are one of the silent killer conditions that send people into their early graves.

The impetus of this article is to add to public education regarding DVT and embolism and the need for people to do regular health screenings or medical check-ups even when they feel healthy.   

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Deep vein thrombosis and embolism

DVT or thrombosis occurs when a blood clot (thrombus) forms in one or more of the deep veins or blood vessels in the body, usually in the legs.  An embolism occurs when a thrombus (clot, fat, air bubble or other feature) travels through blood vessels, with a risk of lodging elsewhere. If an embolus becomes stuck and severely blocks the flow of blood, it is called an embolism.

As such, both DVT and embolism can block blood flow and increase the risk of a heart attack or stroke and sudden death. Consequently, DVT is known as a “silent killer”. According to clinicians, it is the single largest cause of mortality in hospitals in patients admitted with another diagnosis; and it is the greatest cause of maternal mortality in pregnancy.

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“Silent killer” refers to the fact that the affected person does not feel any pain or discomfort and there may be minimal to no swelling. A clot in the leg or pelvis often occurs after an abdominal, pelvic or orthopaedic operation, trauma or stroke.

For emphasis, the clot can break off and pass through the heart to block the flow of blood to the lungs- pulmonary embolism (PE), resulting in shortness of breath, and/or chest pain with breathing. 

Pulmonary embolism can cause sudden death if the clot is large enough. This is one of the reasons why you can see someone healthy in the morning then you hear of his or her sudden demise later in the same day.

As such, it is not every sudden death that might be attributable to a spiritual cause. Any blockage in a vein or artery can cause life-threatening complications and sudden death.

A clot or thrombus can form because the blood is more prone to clotting or because the patient is sedentary or on bed rest. Also, those with cancer or long trips are vulnerable. 

What Causes DVT?

DVT occurs for a variety of reasons. Some people inherit a tendency to clot, referred to as thrombophilia. Several other factors can lead to blood clots in the legs (DVT). For example, cancer, obesity, pregnancy, prolonged travels, sedentary lifestyle (lack of exercise) and trauma to the leg, among others.  

Susceptibility

People who have recently had a surgical operation have a higher risk of developing blood clots in the legs, especially if it was an orthopaedic operation, such as a back, knee, or hip procedure.

Abdominal and pelvic procedures also raise the risk of blood clots, as well as people who have experienced physical trauma, especially to the legs. Those who have recently taken a long trip are also at an elevated risk for DVT. Long trips with little movement, especially with constricting garments or dehydration, increase the risk of developing clots.

Symptoms

A blood clot in the legs may be completely asymptomatic or “silent” within the affected vein, with no symptoms and minimal signs. Sometimes, there are visible signs or feelings in the leg, including Sudden or unexpected leg swelling, Pain, aching, fullness or pressure in the leg, Warmth or coolness in the lower leg and Skin discolouration of the lower leg.
Prevention

DVT prevention involves early mobilisation after an operation, pneumatic compression of the legs during and after the operation, and the use of anticoagulants, especially in those with a previous history of clots or a family history of clots, and in patients with cancer.

Compression stockings, hydration, and frequent movement or flexing of the foot can help when on long trips. This is especially important in overweight or obese people and pregnant women, due to their elevated risk for clots.

Advisedly, therefore, DVT risk can be reduced by: Maintaining a healthy body weight, staying active and exercising regularly, avoiding smoking, knowing your potential risk factors and discussing them with your healthcare provider and avoiding dehydration with long-distance travel.

Treatment

Clots in the deep veins require medical therapy. Doctors may prescribe an anticoagulant or “blood thinner” for the patient. The affected person must try to stay active, wear compression stockings, and elevate the legs when sitting.

Conclusion

Blood clots formed in arteries and deep veins of the legs are called venous clots. This is called deep vein thrombosis (DVT). Venous clots often break off and travel through the blood to another area of the body, often the lungs.

Apart from blood clot embolus, there are other emboli made up of fat, amniotic fluid and air bubbles. DVT is the most common cause of a pulmonary embolism (PE) and it is mostly asymptomatic. A PE damages the lungs and other organs, leading to sudden death, which most Ghanaians attribute to a spiritual cause.  

The writers are a Hospital Administrator and Assistant Registrar, UHAS-Ho, respectively.
Emails: afetikorto@yahoo.com and ragbefu@uhas.edu.gh

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