Pulmonary Embolism - part 2

Risk factors for pulmonary embolism

While it is possible for any individual to have blood clot in the vessels that may cause pulmonary embolism, there is no doubt that specific factors may augment the chances of having this condition.

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Prolonged immobility
It is very likely that long periods of immobility may result in the formation of blood clots in the legs - for instance, when you are in bed rest or undertaking a long journey. When a person is in bed rest, he/ she is basically restricted to the bed for a prolonged period, usually following a heart attack, surgery, during a serious ailment or when one has fractured his/ her leg. In such situations, the person is more susceptible to formation of blood clot in the legs.
Similarly, when one is undertaking a long journey, he/ she is forced to sit in a restricted position throughout the prolonged trip by plane or car. This inhibits blood circulation in the veins, which, in turn, results in blood clot formation in the legs.
Age
As people grow old they become more vulnerable to blood clot formation and the reasons for this may include dehydration, valve malfunction and other health problems.
Dehydration: Aged people are more susceptible to become dehydrated and, in turn, this may congeal the blood and possibly also result in the formation of blood clots.
Valve dysfunction: Several minute valves exist at intervals of a few inches within the comparatively large veins and these valves help in maintaining the flow of blood in the correct direction. Unfortunately, like any other part of our body, these valves also have a propensity to break down as we grow older. When these valves do not function as they should, blood stagnates at one place or it leads to formation of blood clots.
Health disorders: At the same time, elderly people are also more liable to have various health disorders that make them susceptible to independent dangers of forming blood clots, for instance, heart ailments, surgery for joint replacement and even cancer.
However, children seldom develop deep-vein thrombosis (DVT) or a venous thromboembolic event (VTE).
Family history
People with a family history of blood clots are more prone to have blood clots in future compared to those who do not have any member of their family who has suffered from this condition. It is assumed that this is owing to the presence of hereditary blood clot disorders, which can be calculated in any specialty blood clotting laboratory. Therefore, ensure that your physician is aware about your family's medical history, as this will enable him to ask for proper examinations related to inherited blood clotting problems.
Surgery
It is worth mentioning here that a main risk factor for formation of blood clots in the blood vessels is surgery - particularly surgery undertaken for knee or hip replacement. When the bones are readied for the purpose of artificial joints, it is possible that some tissue remains will get into the bloodstream and this may result in formation of blood clots. In addition, prolonged period of inactivity following any form of operation may also result in blood clot formation. The danger enhances depending on the period of time you are kept under ordinary anesthesia.
Medical conditions
Certain health problems and conditions may also add to the formation of blood clots inside the vessels, for instance, heart diseases, pregnancy and specific forms of cancer.
Heart disorders: Cardiovascular ailments and hypertension (high blood pressure) may increase the chance of the formation of blood clots inside the vessels.
Pregnancy: When the baby creates pressure on the veins in the region of the pelvis owing to its weight, it may inhibit the flow of blood from the legs. Hence, such slowing of blood flow as well as stagnation of blood in any particular place within the veins may result in the formation of blood clots.
Earlier blood clots: People, who have earlier endured either VTE or DVT, for whatsoever reason, are more prone to develop these conditions in future.
Cancer: Specific types of cancer, particularly those of the lungs, ovary and pancreas, may possibly enhance the concentration of substances in the blood that aid in forming clots. In addition, undergoing chemotherapy for cancer augments the dangers of developing blood clots further. Women having a medical history related to breast cancer and taking raloxifene or tamoxifen also have a greater chances of having blood clots in their vessels.
Lifestyle
Although it may seem surprising, specific ways of living are also considered to be risk factors for developing blood clots, especially obesity, smoking and using estrogen supplements.
Obesity: Overweight augments the chances of developing blood clots in the vessels, especially in women who have high blood pressure or those who smoke.
Smoking: Although the causes are yet to be comprehended completely, smoking tobacco makes some people liable to developing blood clots, particularly when it occurs in conjunction with additional risk factors.
Estrogen supplementation: You ought to know that estrogen contained in hormone replacement therapy as well as oral contraceptives has the aptitude to enhance the chances of forming blood clotting in your vessels. This is all the more true provided you are obese or smoke tobacco.
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Treatments and drugs

Pulmonary embolism requires immediate and proper treatment to avoid development of complications and sometimes even death. This condition may be treated by using anticoagulants, using clot dissolvers, vein filters, removing clots and by undergoing surgery.

Anticoagulants: Administration of heparin in the form of an injection provides quick results. In addition, you may use warfarin (Coumadin) and/ or rivaroxaban (Xarelto) which are available in pill form. While these medications also put off the development of blood clots, it usually takes some days before rivaroxaban or warfarin actually start working. Use of anticoagulants also has its downsides and the patients may experience side effects like bruising easily and bleeding gums.

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Thrombolytics (clot dissolvers): Usually, most of the blood clots dissolve by themselves, but there are specific medications that may help in dissolving the clots more quickly. However, these drugs are not used often and set aside only for severe conditions, because using them may result in abrupt and serious incidences of bleeding.

In a number of particular incidences of blood clotting, it is likely that your physician will ask you to heal pulmonary embolism using specific measures, including vein filter, clot removal and even surgery.

Vein filter: This treatment process involves using a catheter to position a filter in the inferior vena cava (the most important vein, which starts from the legs to the heart's right side). This filter works to catch as well as prevent the blood clots from traveling through the vessels that go to your lungs. This mode of treatment or inserting a filter is only meant for patients who are unable to take anticoagulant medicaments or in patients who do not get the desired benefits by using anticoagulants.

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Clot removal: This mode of treatment for pulmonary embolism is especially meant for people having significantly big clot in their lung and is extremely distressed. In this case, the physician is likely to pass a thin, supple tube (also called catheter) through the blood vessels and force the clot out. While this process of removing blood clots from the vessels is very complicated, it is also not successful all the times.

Surgery: When people with pulmonary embolism are in a distress and the thrombolytic drugs they are taking are not yielding the desired results or working as quickly as expected, it is possible that your physician will suggest you to undergo an emergency operation. Although this occurs very rarely, the objective of the surgery is to get rid of the maximum number of blood clots possible, particularly if the patient has a large blood clot in his/ her central (main) pulmonary artery.

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Significance of prevention

Preventive steps in the hospital

When patients with pulmonary embolism or those with a propensity to suffer from blot clot problems are admitted to hospitals, special measures are initiated to cure the condition. These measures include anticoagulant therapy, using pneumatic compression, making the patient wear graduated compression stockings and also undertake physical activities.

Anticoagulant therapy: In hospitals, medical practitioners administer anticoagulants like a heparin injection to people having blood clot problems prior to as well as following an operation. Anticoagulants are also given to patients who are admitted to the hospital with a stroke, heart attack and also with complications related to burn injuries and cancer. In addition, the patients may also be given oral anticoagulants like warfarin for some days prior to any important surgery with a view to lessen the chances of developing blood clots.

Pneumatic compression: This therapy entails using calf-high or thigh-high cuffs that fill with air by itself at intervals of few minutes to massage as well as squeeze the veins in the legs, thereby improving blood circulation to the legs.

Graduated compression stockings: This specialty compression stockings squeeze the legs gradually, facilitating the efficient flow of blood through the veins as well as the muscles in the legs. This is a very simple and economic means to ensure that blood does not pool in the veins following any common surgery.

Physical activity: It is important to note that resuming mobility at the earliest following a surgery is an effective way to put off pulmonary embolism and also hasten the general recuperation. In fact, this is why nurses often persuade you to rise from the bed and take a walk, just a day after an operation.

Preventive steps while traveling

As sitting in cramped position while undertaking long trips, whether by an aircraft or a vehicle, contributes to formation of blood clots in the veins located in the legs, you may initiate a number of measures to prevent this from happening.

First and foremost, it is essential that you should take a walk even while making a trip. In case you are traveling by an aircraft, get out of your seat and just walk around the airplane's cabin whenever possible. On the other hand, provided you are driving, stop your vehicle at intervals of an hour and walk around the car for a few times. It will also be helpful if you bend your knees for a couple of times.

Even while you are sitting, do some exercise to loosen, extend and turn your ankles around or even press the feet against the seat facing you. Alternately, you may rise from your seat and get down on your toes. Most importantly, never sit keeping your legs crossed for a prolonged period.

In addition, you need to ensure that you wear some kind of support stockings, which exert a firm and constant pressure helping the prevention of blood from amassing inside the deep veins. For instance, you may make use of a particular device known as a stocking butler, as it will facilitate in wearing the support stockings.

At the same time, drink lots of fluids, especially water and fruit juices to avoid dehydration. In fact, water is considered to be the best liquid to tackle with dehydration, which may add to the formation of blood clots in the veins. In addition, you also need to keep away from consuming alcoholic beverages or drinking caffeine, as these substances promote loss of body fluids.

Provided your physician has suggested so, you may also take heparin. In case you have suffered from or are still enduring VTE or DVT, it is advisable that you consult your physician prior to embarking on a long journey. It is possible that your physician will ask you to administer a dosage of long-acting heparin by yourself immediately prior to undertaking the trip. In addition, your physician may also tell you if you require repeating the heparin dose before the return journey.

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