Diagnosis of Deep Vein Thrombosis - Essay Example

?Venous Thromboembolism From Public Health Prospective By Insert Semester Definition Commonly referred to Deep vein thrombosis (DVT) or pulmonary embolism, this condition occurs in the body’s deep veins in cases of blood clot formation. The disorder can develop in all ethnicities and races, all genders and age groups with equal measure. Many of its risk factors are pregnancy, old age, oral contraceptives, obesity, cases of immobility and some types of surgeries. Venous thromboembolism (VTE) is the third most common acute cardiovascular disease after myocardial infarction and stroke. Death can be as high as 73% including mortality due to recurrent pulmonary embolism. The majority of people diagnosed with the disease tend to have it develop again after a long duration of inactivity such as bed ridden patients or people who sit down for long duration in flights or offices. Some clinical conditions such as pregnancy, clotting factors deficiency and paralysis from a spinal cord injury can be predisposing factors for the disease. Introduction Venous thromboembolism comprise of both PE and DVT. One of the most important devastating clinical problems is pulmonary embolism (PE) with its high mortality rate. Survivors of this condition develop long term complications including pulmonary hypertension and the post- thrombotic syndrome (PTS). An estimate of 1 in every 1000 individuals develops DVT annually in the UK and 1 in 10 with untreated DVT resulted in PE. In England the mortality rate from PE was reported as 25,000/year among hospitalized patients. VTE incidences in the US remain unknown, however there are close to 1 million cases reported every year that occur in hospitalized patients and it is responsible for 300,000 deaths. Most of these cases happen even after treatment. However early diagnosis and therapy institution is crucial to the mortality rate reduction. On the contrary, due to its non- specific symptoms and signs diagnosis of VTE and especially PE might be missed. According to research majority of deaths caused by PE have happened to patients who were never diagnosed on time. Studies show that acute DVT or PE events in its initial stage come with higher total health care costs and they can further be increased by cases of recurrent DVT or PE and PTS. Therefore, diagnosis and treatment of VTE is an expensive affair that many middle level people cannot keep up with which makes them more likely to die from this dangerous disease due to the financial burden. Most governments also find themselves in this nightmare as well. Providing health care to a big population is a big financial public health burden that is likely to dent an economy of a nation. Faced with such challenges it therefore becomes hard to counter and eradicate this kind of disease and many people end up succumbing to it. In US alone there is no systematic way of collecting VTE related mortality and morbidity data records. The information used mostly is based on occurring events and estimates of population based epidemiologic studies and analyzing of hospital patient discharges or databases of health insurance claims (MacDougall et al., 2006). Table One. Some cases of death in USA Pulmonary embolism Up to 200,000 Aids 14,499 Breast Cancer 40,200 Highway fatalities 42,116 Diagnosis of DVT At its early stage, the symptoms of DVT include pain, leg swelling and tenderness. In the case of PE the symptoms are a bit different and noticeable; the symptoms are shortness of breath tachycardia, tachypnea and chest pain. These symptoms presentations tend to be non-specific for both PE and DVT. This therefore requires imaging techniques for confirmation of the diagnosis of VTE in patients with these signs and symptoms (Welch & Bonner, 2010). There are imaging machines that are used in diagnosis with varying sensitivity. Duplex ultrasonography imaging is less expensive and its procedures are less invasive. Its sensitivity and specificity is quite recommendable with about 95% and 98% respectively for detecting DVT in patients showing symptoms with the exception of obese patients. Quantitative D-dimer test is the method used for diagnosis of symptoms related to PE. It helps diagnose thrombosis and in case of a negative D-dimer test, it suggests a low probability of PE. This therefore excludes the need for an expensive pulmonary CT angiography. CT is usually used to visualize thrombus directly and the imaging technique has become the standard technique for diagnosis of PE. Newer CTA scans with a number of slices have increased the diagnosing of smaller peripheral or sub segmental PEs. However the accuracy of these machines has been questioned since there is no uniform diagnosis of either PE or PVT which can be used for surveying the VTE condition among patients. Clinical practice as also been improved by administering prophylaxis heparin to bed ridden patients to reduce incidences of DVT among patients that have been admitted in hospitals. The advancement in technology has made diagnosis of this disease easier than before which gives a patient a higher chance of getting treated early. However this kind of medical procedure has not been pocket friendly to most of the victims of this deep vein disease. This leaves a big population of people with no option or alternative method of treatment. The mortality rate is therefore going to remain high in many parts of the world among the poor population. VTE has remained to be the most challenging disease in its treatment and therefore health facilities have resulted in advising people to adopt a healthy lifestyle to avoid the risk factors. Outlining the scope of the disease. Despite the fact that DVT is a killer disease majority of adults have no clue about the existence of the disease. As per a survey conducted on behalf of the American Public Health Association (APHA) it was proven that in as much as nearly 74% or three quarters of adults were not aware of this DVT condition. Those that were aware of the disease couldn’t even mention some of its risk factors. Moreover, the survey indicated that most of the health care providers had never had a discussion about the disease in a very big number of adults across the world. This shows the level of ignorance people are having about this disease. However, a number of organizations, foundations, networks, coalitions, societies among other like-minded groups have shifted most of their focus into creating awareness about thrombosis to the public. Their sole aim is to educate the patients, publics and health care providers on the issue of thrombosis, public policy, advocacy, improvement of health care delivery and research. If action is taken, most of DVT/ PE caused deaths could be avoided easily if diagnoses were done and managed early. But all in all, the fact remains that the only way of preventing PE/DVT would be to effectively predict the individuals who are at a greater risk of attack while at the same time making sure that people can access the necessary health care. The history of VTE Venous thromboembolism is a disease that is both hereditary and can be acquired through various risk factors as well. It is also referred to as hypercoagulable or thrombophilia states. Major theories explaining the pathogenesis of venous thromboembolism (VTE) show that the condition occurs as a result of; Hemodynamic change which is the alteration of blood flow, vascular endothelial injury and hypercoagulability (the altering of blood constituents). Some of the greatest researchers of this deep vein disease were able to define venous stasis, enlarged activation and vessel wall damage which serve as important contributions to the understanding of thrombosis to date (Wolberg et al., 2012). Prior to its discovery, DVT had a very high rate of mortality in many parts of the world. People did not have a clue on any of its risk factors and causes of the disease. Therefore those who had symptoms of VTE disease ended up being treated for other types of disease. Some died from negligence due to lack of knowledge of this condition. With time this rate of deaths across the world became a point of concern and research about the disease was conducted to establish its cause and how it can be prevented. Some of its risk factors were discovered and measures of controlling the disease were put into place. The treatment of the disease has been a big challenge since the chances of recurring again were very high among patients. Cases of recurrence were very fatal and always ended in death. The disease became the third most dangerous after cancer and stroke. Its rate of mortality was worrying and despite the many efforts to counter this condition, it became a very difficult case to handle. Risk factors of developing VTE A big population of people suffers from VTE. According to a research on a population based study, the statistics showed that 104 people per 100,000 were victims of the disease. Half of this percentage had the three risk factor characteristics present while suffering from VTE. There are a number of risk factors that have been reported and been witnessed in many patients that suffer from VTE, which have shown more than one risk factor. These risk factors include; pregnancy, aging in elderly people, unhealthy weight (obesity), immobility due illness or working conditions of a person, a recent major surgery, multiple trauma, cases of malignancy, congestive heart failure or respiratory failure, hormone replacement therapy, oral contraceptive and inherited hypercoagule condition (Anderson and Spencer, 2003, Spencer et al., 2006, Kearon, 2003). Table Two. Patients with clinically suspected DVT to increase in the number of risk factors, adapted from (Anderson and Spencer, 2003) Number of risk factors Age and VTE As it’s usually the norm, DVT/ PE affects the elderly due to its opportunistic nature to people who don’t involve in a lot of physical activities like walking due to age. This makes them immobile and at a higher risk of developing the deep vein condition. Victims of PE/ DVT have a slow increase with age until they reach the age of 50 which they increase rapidly. This is attributed to some sicknesses that render most aged people immobile which put them at a higher risk of contracting the condition (White et al., 2004). In cases when venous thromboembolism occurs in adults who have been hospitalized, it’s proven that the main risk factor for its cause was being old. As a result most surgery guidelines require that thromboprophylaxis should be administered after an operation as a predictor of postoperative venous thromboembolism (VTE). Table Three. Effect of age on the incidence of DVT, PE and VTE, Adapted from (CDC 2012) Age Race and VTE Racially, venous thrombosis (VTE) rate of occurrences varies by a great margin. Most African- Americans are five times more likely to suffer from this disease as compared to the Asian population. The Europeans have an immediate risk of this disease compared to other racial groups. When looking at the hospitalized patients suffering from VTE the number of deaths among Asians was significantly lower than Caucasians and African Americans. This shows the varying ways that this disease manifests itself in people from different races (Stein et al., 2004). History of a family and VTE A family that has a history of VTE has the possibility factor of heredity as a cause for VTE. Studies have shown that people born in families that have had cases of VTE among some of its family members stand at a higher risk of contracting the disease. Therefore members of such families are advised to be checked up for diagnosis of the disease as a measure of precaution (Mili et al., 2011). Gender and VTE (i) Female vs. Male Due to the different reproductive system in both genders, women tend to have a jump in the number of female individuals having the disease between the ages of 10 to 40. Males on the other hand start showing a similar increase after they reach the age of 50. Individuals between 20 to 39 years are more likely to suffer from VTE among women than in men. This can be attributed to hormone imbalances in both genders putting women at higher risk of contracting the disease than male. Therefore, more attention needs to be focused among women that have reached the age stated herein. The nature of the disease is more prevalent in women than male (Silverstein et al., 1998). (ii) Oral contraceptives and Females Women who use oral contraceptives tend to increase the risk of developing VTE condition than those that don’t use contraceptives. Studies have shown that women using contraceptives between the ages of 15 to 44 years are more prone to this disease. However the risk level varies with the duration an individual has been using the contraceptives with the ratio of contracting the disease usually decreasing with time. The use of contraceptives has become more common among young women who take them oblivious of the danger they are posing to themselves. This therefore makes treatment and control of VTE among women a challenge. It is advisable for clinical officers educate people of the dangers of using contraceptive as a birth control. Women should seek alternative methods of birth control to avoid falling victims of VTE (Huerta et al., 2007). (iii) Hormone replacement therapy and VTE Women are at greater risk of developing VTE at the age of 50 as a result of hormonal therapy. This is due to the effect of estrogen on factors of coagulation that cause hypercoagulation (Tchaikovski and Rosing, 2010). (iv) VTE and Pregnant women Pregnancy puts women at a higher risk of suffering from VTE and arterial thromboembolism. Studies show that in every 2 per 1000 deliveries there are always thromboembolic related events (Heit et al., 2005) . VTE development gives rise to many other medical conditions which leaves pregnant women more vulnerable to the disease. Many medical complications resulting in development VTE make it more risky for women who are pregnant, the possible mechanism is the that Pregnant women having increased risk for VTE as a result of hormonally induced decreased venous capacitance and decreased venous outflow(James, 2009). . Obesity and VTE Studies have linked VTE to being extremely overweight. People with unhealthy weight (obese) are more vulnerable to the disease than healthy people (Ageno et al., 2008). . Prolonged immobility and VTE Some types of lifestyles put people at greater risk factors of VTE. People who work for long hours while seated are likely to suffer from the disease due to lack of exercise and poor flow of blood. Such lifestyle should be discouraged (Aldington et al., 2008). Smoking and VTE There is a direct correlation between smokers and non-smokers discovered by studies conducted among smokers and non-smokers. Smokers were more likely to contract the disease than people who don’t smoke (Severinsen et al., 2009) . Hospitalized patients and VTE Most of hospitalized patients have one VTE risk factor. Patients tend to develop DVT in hospitals due to some major surgeries and been bed ridden for a long time and lack of therapies (Geerts et al., 2008, Caprini, 2010). Social economic and VTE Some factors like income levels among people and their usual lifestyles pose them at a risk of developing VTE. People at the age of 40 with low income and staying on their own are at a risk of contracting the disease compared to their age mate who have better income (Isma et al., 2012). Conclusion From the studies and evidence provided herein, the development of VTE related cases have been associated with many risk factors that are likely to affect anyone in the society. The disease brings a great challenge in its treatment, monitoring and eradication. Civil education is thus a good way that medical practitioners should employ to control the menace of the disease which has a very high rate of mortality in the entire world. Much need to be done to counter this deadly disease that majority of people are not aware of. References ABDOLLAHI, M., CUSHMAN, M. & ROSENDAAL, F. R. 2003. Obesity: risk of venous Thrombosis and the interaction with coagulation factor levels and oral contraceptive use. Thromb Haemost, 89, 493-8. AGENO, W., BECATTINI, C., BRIGHTON, T., SELBY, R. & KAMPHUISEN, P. W. 2008. Cardiovascular risk factors and venous thromboembolism: a meta-analysis. Circulation, 117, 93 102. ALDINGTON, S., PRITCHARD, A., PERRIN, K., JAMES, K., WIJESINGHE, M. & BEASLEY, R. 2008. Prolonged seated immobility at work is a common risk factor for venous thromboembolism leading to hospital admission. Intern Med J, 38, 133-5. ANDERSON, F. A., JR. & SPENCER, F. A. 2003. Risk factors for venous thromboembolism. Circulation, 107, I9-16. ANDERSON, F. A., JR., WHEELER, H. B., GOLDBERG, R. J., HOSMER, D. W., PATWARDHAN, N. A., JOVANOVIC, B., FORCIER, A. & DALEN, J. E. 1991. A population based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med, 151, 933-8. BAGOT, C. N. & ARYA, R. 2008. Virchow and his triad: a question of attribution. Br J Haematol, 143, 180-90. CAPRINI, J. A. 2010. Risk assessment as a guide for the prevention of the many faces of venous thromboembolism. Am J Surg, 199, S3-10. CDC June 8, 2012. Venous Thromboembolism in Adult Hospitalizations — United States, 2007–2009. Morbidity and Mortality Weekly Report, Weekly / Vol. 61 / No. 22. GAUTHIER, K., KOVACS, M. J., WELLS, P. S., G, L. E. G., RODGER, M. & FOR THE, R. I. 2013. Family history of venous thromboembolism (VTE) as a predictor for recurrent VTE in unprovoked VTE patients. J Thromb Haemost, 11, 200-203. GEERTS, W. H., BERGQVIST, D., PINEO, G. F., HEIT, J. A., SAMAMA, C. M., LASSEN, M. R., COLWELL, C. W. & AMERICAN COLLEGE OF CHEST, P. 2008. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 133, 381S-453S. GEERTS, W. H., PINEO, G. F., HEIT, J. A., BERGQVIST, D., LASSEN, M. R., COLWELL, C. W. & RAY, J. G. 2004. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest, 126, 338S-400S. GOLDHABER, S. Z., GRODSTEIN, F., STAMPFER, M. J., MANSON, J. E., COLDITZ, G. A., SPEIZER, F. E., WILLETT, W. C. & HENNEKENS, C. H. 1997. A prospective study of risk factors for pulmonary embolism in women. JAMA, 277, 642-5. GOLDHABER, S. Z., SAVAGE, D. D., GARRISON, R. J., CASTELLI, W. P., KANNEL, W. B., MCNAMARA, P. M., GHERARDI, G. & FEINLEIB, M. 1983. Risk factors for pulmonary embolism. The Framingham Study. 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