Thrombosis: risk factors, prevention, treatment
"I am only 26 years old, and I have diagnosed with thrombosis". Such messages on the Internet – dozens and even hundreds. Why the disease arises, who is in the risk group, and what prevention measures will help to avoid the formulation of a terrible diagnosis tells Maria Alekseevna Vinogradova, To.M.N., Hematologist, head of the branch of reproductive hematology and clinical hemostasiology of FSBI NTSAGIP.IN.AND.Kulakov MZ of the Russian Federation, Member of the European Hematology Association (EHA), Member of the International Society of Trombosis and Hemostasis (ISTH), Member of the American Society of Hematologists (ASH).
What is thrombosis? As he occurs?
Thrombosis is a serious life-threshing condition, in the process of which the formation of dense clots on the inner wall of vessels, thrombosis may affect any part of the body. Depending on the type of affected vessel, thrombosis is venous and arterial. Arterial thrombosis occurs in the case of atherosclerosis when fat deposits are formed as a result of a violation of fat exchange in the arteries, cholesterol plaques that narrow their clearance and leading to problems with blood circulation, or causing such heart rate disorders such as atrial fibrillation.
Among the main reasons for the development of venous thrombosis is a systematic increase in blood coagulation activity in combination with a slowdest speed. Any thrombosis is dangerous: it violates the blood supply of organs and is able to even lead to death.
Who enters the risk group?
Risk factors that contribute to the development of thrombosis. First of all, these are previous thrombotic episodes in a person’s life: they significantly increase the likelihood of repetition of the disease. An important role is played by excessive body weight, various systemic inflammatory diseases, oncological processes.
However, thrombosis may occur in a healthy person, and with age probability increases. In particular, among risk factors – a long limitation of mobility, especially after injury or surgical operations, receiving combined oral contraceptives or other hormonal drugs, prolonged flights. The risk of thrombosis is capable of raising a number of specially dedicated hereditary predisposing factors. Young women are important to remember that pregnancy and postpartum period can also contribute to the development of thrombotic complications.
What are the first symptoms? What can be a reason for an additional examination by a doctor? How diagnoses is made?
Symptoms of surface vein thrombosis – redness, itching, swelling – more obvious and visually noticeable than the symptoms of deep veins thrombosis, at least at the beginning of the development of the disease.
There is a delusion that deep vein thrombosis will definitely debut brightly: accompanied by acute pain, meaningful redness and restriction of the limb function. In fact, the symptoms are not always so obvious, and the pain appeared most often does not associate with problems with the vessels, it may seem to have a foot hurt. In the event that all symptoms are manifested: pain, redness and edema – must be consulted in a doctor and go through an ultrasound study.
To suspect thrombosis can a doctor of any specialty after inspecting the patient. But the diagnosis must be confirmed on the basis of Uz-Dopplerography – Studies of veins and features of blood flow.
It is important to diagnose thrombosis at an early stage due to the risk of developing serious complications associated with the so-called "tomb separation". An extremely dangerous state called the thromboembolism of the pulmonary artery may occur if the thrombus was formed, for example, in the deep vein of the leg, and then the blood current was delivered to a large pulmonary artery and clocked one of its branches. With such a blockage, the work of the entire cardiovascular system suffers, the significant heart failure develops, the hardest shortness of breath, hemochkali may appear. Such a condition is a reason for emergency therapy and, unfortunately, often leads to the death of the patient.
Therefore, any diagnosis of thrombosis should be as early as possible to prevent the development of such complications.
How thrombosis can affect pregnancy and child?
From the first days of pregnancy in the body of a woman there are significant changes that relate to the circulatory system. Also changing blood coagulation, which can increase the risk of thrombosis. As you know, during pregnancy, another body appears, which ensures the power of the fetus is a placenta. If the changes occur in its vessels, it can lead to a violation of the blood supply to the fetus, delayed its development, and often death. When it comes to the loss of pregnancy in late terms, it is definitely very hard for the patient: and emotionally, and physically. Our task is to identify risks of thrombosis as soon as possible and prevent the development of the disease.
Is thrombosis indication for pregnancy interrupt?
Any thrombotic event is an emergency situation and requires operational action. If we are talking about such life-degraded states such as pulmonary artery thromboembolism, it may be necessary to introduce special preparations that directly destroy Trombus (thrombolysis). Its use during pregnancy is still not investigated enough, but maybe. First of all, we save the life of the patient, and only then think about preservation of pregnancy, otherwise you can lose both. But thrombosis is not an indication for abortion of pregnancy: in the overwhelming majority of cases, it is enough to carry out the so-called anticoagulant therapy, which is aimed at the gradual dissolution of the thrombus and restoration of blood supply to organs. The drug and dosage appoints a doctor, self-medication in this case is unacceptable – this can lead to dangerous consequences. When choosing treatment, the doctor must assess the risk of bleeding. Do it yourself patient can’t. With the timely detection of thrombosis and correct therapy, neither the life of the mother nor the life of the child does not suffer.
That is, if you contact a specialist with a problem in time, you can cope with medication treatment, and in extreme cases already operational intervention?
Absolutely right. Medical treatment is always priority, the operational treatment of thrombosis is now almost completely absent. The operation can help if there are local problems (for example, significant manifestations of varicose veins)). It is important to influence the overall blood rolling system, since any system change must also be affected by systemically.
If it is impossible to eliminate those factors that led to thrombosis, then the drug prevention of thrombosis should be carried out throughout life. If they can be eliminated, the duration of therapy is set from 3-6 months to several years.
Are there measures for the prevention of thrombosis – what can be taken at the stage of pregnancy preparation?
Before the start of pregnancy you need to weigh all risk factors. This is especially important if the auxiliary reproductive technologies are applied, which is associated with the use of significant volumes of hormonal drugs that can adversely affect hemostasis. The deficiency of antithrombin and other natural anticoagulants that are present in our blood to balance the action of coagulation factors can also be an indication for treatment.
In the event that the risk of the development of thrombosis is large enough – we prescribe a patient prophylactic therapy. Treatment is required if the thrombosis has already been to pregnancy or in the patient confirmed antiphospholipid syndrome – an autoimmune process, which produces antibodies to part of own cells.
The previous thrombosis or a combination of four and more risk factors require the immediate start of thrombosis therapy; three factors – from the third trimester; Two or more factors – treatment in the postpartum period.
Is the disease inheritance transmitted?
The real proportion of hereditary risk factors for thrombosis is low. Significant factor – the presence of thrombosis in relatives of the first line of kinship, especially up to 50 years, spontaneous and even more re-development of thrombosis. Such women need to actively examine before pregnancy, as they have a very high probability of hereditary thrombophilia. More often, the cause of thrombosis becomes a combination of risk factors, which led to the emergence of thrombotic events.
Thus, appreciating all factors contributing to the development of thrombosis, we can effectively prevent the development of life-degrading consequences, to preserve women’s health and make it possible to make happy maternity even in the most difficult situations.