Wednesday, April 18, 2007

Danger! Blood clots might kill

Vice President Dick Cheney was diagnosed just in time. The late NBC News correspondent David Bloom died from it.

DVT, deep vein thrombosis, and its impact on public figures has seemingly created an awareness revival, particularly by Bloom's widow Melanie, now the spokeswoman for the Coalition to Prevent Deep-Vein Thrombosis.

"The statistics show that 2 million Americans will develop a DVT each year," she says. "Out of that, 600,000 will go on to develop the pulmonary embolism. Out of that number, 300,000 will be fatal.

"That's a lot more than AIDS and breast cancer combined every year in the U.S. The numbers are staggering."

What exactly is deep vein thrombosis and who is at risk?

There are two types of deep vein thrombosis, said Dr. Michael Ombrellino, a vascular surgeon with the Vein Institute of New Jersey in Morristown.

"There is major deep vein thrombosis which effects the veins in the lower extremities," he said. "And there is minor which affects the calf veins."

If left untreated, the clot can travel to the lungs and cause a pulmonary embolism, Ombrellino said.

Such was the case with Bloom, who had pre-existing risk factors such as long-haul flights, particularly the ones between New York and Kuwait. Restricted mobility, such as Bloom sleeping in a tank with his knees up to his chin, is another factor.

Bloom also suffered from dehydration, due to dwindling supply lines. Staying hydrated is necessary to keep the blood thin and circulation flowing, said Ombrellino.

Other risk factors include obesity, indirect effects of trauma and genetic predisposition.

"Some birth control can play a role and cancer -- any malignancy," he said.

In September the Food and Drug Administration updated the label on the Ortho Evra birth-control patch to reflect the results of a study that found women using the patch faced twice the risk of clots than did women on the pill.

Age-wise, DVT primarily effects the elderly, though in Bloom's case it was genetic predisposition combined with his lifestyle risk factors.

"That's what we learned when they did the autopsy ... we had no idea that David had a genetic predisposition, and that's the Factor V Leiden," Melanie Bloom said. "That's basically an inherited blood coagulant disorder. They say if you have three or more risk factors at any given time, you could be at risk for what happened to David, which was a fatal, pulmonary embolism, or PE. I also learned that those with this Factor V Leiden or other genetic predisposition only make up a very small percentage of the number of deaths in America each year."

DVT treatments can range from compression stockings to blood de-clotting drugs such as Cuminin or the implantation of an inferior vena cava filter.

"This is a special metallic cage that is inserted through the inferior vena cava (the large vein that carries de-oxygenated blood from the lower half of the body into the heart) and it filters clots from the lower extremities," Ombrellino said.

With the exception of unexplained swelling of the lower legs, DVT onset is relatively asymptomatic, said Ombrellino. The gold standard in DVT detection is a venus ultrasound.

"If you are having shortness of breath, tightening of the chest, basically what that means is that a blood clot has broken away, traveled to the lungs and is now a pulmonary embolism, which is exactly what happened with my husband," Melanie Bloom said. "He had pain in his leg, and then the pain went away, he was feeling great. He called me the morning of the day he died. He ... sounded upbeat, he wasn't limping and everything was good. They were going to make the push across the Baghdad border, and that night ... he abruptly collapsed to the ground and died. The clot had broken free, so his leg didn't hurt anymore. But it had made its way to his lungs.