One of the important tasks solved by modern medicine is the prevention of pulmonary embolism. This problem is relevant due to the danger of disruption of the circulatory system, and in the period after surgery or during pregnancy, the risk of such a pathology increases dramatically. In addition, the prevention of pulmonary thromboembolism is relevant for a fairly wide range of people included in the risk group. From year to year, several more or less interesting works on this pathology are published, and yet the question still does not have a universal answer. So, what are the most effective measures to prevent thromboembolism, drugs to prevent this condition are known? Let's try to figure it out.
What is it about?
Thromboembolism is a pathology in which the pulmonary artery is blocked by a blood clot. A blood clot can form in any blood vessel in the human body, but when detached from where it formed, the bloodstream transports the clot within the body. At an unpredictable moment, such a blood clot can block a vessel. One of the most dangerous moments is the blockage of the pulmonary artery. As a rule, this situation is provoked by a clot that has formed in the righthalf of the departments of the heart or in the veins.
When an artery is blocked, the lung tissue does not receive blood, and along with it, the flow of oxygen is blocked. This leads to either a heart attack or pneumonia, when tissue necrosis provokes inflammation.
How to suspect?
The need for thromboembolism prevention has been documented at the state level. An order on this issue, as well as on several other aspects of he alth care in our country, was recently issued by the Ministry of He alth. However, it is no secret that prevention should begin with an educational program: the general population should be aware of the danger of such a pathology, the causes that provoke it, as well as the symptoms that suggest that the danger is near.
You can suspect a high probability of pulmonary thromboembolism if a person notices shortness of breath, weakness, fainting. In this state, one often feels dizzy, it hurts in the chest, and the syndrome becomes stronger when coughing, trying to inhale deeply. The check shows low blood pressure, accompanied by an increase in heart rate (the rate exceeds 90 beats / min). The veins in the neck swell and begin to pulsate. With thromboembolism, the patient coughs first dryly, then with a slight expectoration of sputum, spitting blood, at the same time the skin turns pale. The face, body in the upper half may acquire a bluish tint. Possible general hyperthermia. The severity of symptoms is determined by which artery was affected.thrombus - if it is a relatively small vessel, some symptoms may be very mild, while others may be completely absent.
Where did the blood clot come from?
Many ordinary people ask local doctors about whether it is possible to drink aspirin to prevent thromboembolism, but often do not even try to understand why blood clots form. Of course, aspirin in some cases can show a good result, as it thins the blood, but it does not eliminate all causes of thromboembolism. If you imagine where blood clots come from, compare it with your lifestyle and diagnoses, you can understand which reason is most likely to provoke a pathology. Based on this, preventive measures can already be taken. Thromboembolism after surgery is considered to have a fairly high risk of development, so such a situation should be treated with the utmost care, even if there is no other reason for the development of the disease.
As statistics show, blood clots are predominantly formed in the pelvic region, legs. Somewhat less often, the primary cause of blockage of the vessel is the formation of a clot in the cardiac system, veins of the liver, kidneys, or in the superior vena cava. Breaking away from the vessel wall, such a clot gradually migrates and can reach the pulmonary artery. In some cases, there is a blockage of two arteries at the same time - on the left and on the right.
Risk group
It is believed that the most relevant prevention of venous thromboembolism, if the blood is more characteristichigher than the norm, the level of coagulability. This is often observed about oncology, and it does not matter in which organ the malignant neoplasm is localized. In addition, the likelihood of blood clots increases with a sedentary lifestyle. This can happen if a person is in bed for a long time after a stroke, surgery, injury. Prevention and treatment of thromboembolism is important for the elderly, since age itself is a factor in classifying a person as a risk group. Also, those who are overweight are more likely to have a problem.
Prevention and treatment of thromboembolism is relevant information for those who have already started thrombosis, and there is also reason to believe that there is a genetic predisposition to this pathology. If it is known that increased blood clotting could be inherited to a person, if close relatives are diagnosed with varicose veins, then proper nutrition, prevention of thromboembolism are important aspects, knowledge and adherence to which allows you to maintain he alth and quality of life longer.
What else to look out for?
Prophylaxis of thrombosis and thromboembolism is relevant for those who have sepsis. This is a very serious disease, which is characterized by an infectious lesion of the blood, leading to malfunctions of many internal organs and systems. No less dangerous is the condition of those who inherited blood diseases, including those associated with increased clotting.
Be sure to know about the rules for the prevention of thrombosis andthromboembolism, those who have antiphospholipid syndrome. This is a pathological condition in which antibodies are produced against the cells of the body, including platelets, due to which the blood has the ability to clot. All this leads to an increased likelihood of blood clots, and the consequences of this process are unpredictable.
Hazards
A general idea of the prevention of thromboembolism is necessary for those who have spent a long time without movement, suffered varicose veins or celebrated their sixtieth anniversary - age also leaves its mark on blood quality. The likelihood of developing the disease is in overweight people and those who lead an unhe althy lifestyle - smoke, abuse alcohol, eat fatty foods and fast food.
Prophylaxis of thromboembolism is necessary for long-term use of diuretics, undergoing chemotherapy for cancer, recovery from surgery, trauma, and if you need to constantly be under a venous catheter.
Where to start?
Prophylaxis of thromboembolism is primary and secondary. Primary - these are activities that must be carried out among the risk group in the case when the diagnosis of "thromboembolism" has not been made. Secondary - these are measures aimed at preventing a recurrence of the crisis situation.
As part of the primary prevention of thromboembolism, comprehensive measures are being taken toprevent blood clots in the veins. First of all, the attention of doctors is riveted to the inferior vena cava. Most relevant for people leading a sedentary lifestyle. It is necessary to regularly use compress underwear or bandage the patient's legs with elastic bandages. Even if a very long recovery period is expected, the prevention of postoperative thromboembolism involves the maximum activity, as far as possible in the patient's condition. Reduce bed rest, if possible, and regularly give the body physical activity, gradually increasing it. Similar measures are needed if the patient has experienced a heart attack, stroke.
What else do you need?
A modern approach to the prevention of thromboembolism in the postoperative period, as well as when a person enters a risk group, involves the regular practice of therapeutic exercises. Additionally, the doctor may prescribe anticoagulants, under the influence of which blood clotting decreases somewhat. As a rule, they are prescribed if there is a high probability of complications.
Prophylaxis of thromboembolism in the postoperative period may include additional surgery. This is necessary if a section of the vein is abundantly filled with blood clots. With the consent of the patient, this element is removed from the body.
Alternative options
Cava filter gives good results. This measure for the prevention of thromboembolism before or after surgery is relevant for those patients who have blood clots in their legs. Filteris a specialized trap capable of passing blood, but retaining clots. There are several varieties of such filters, they differ somewhat from each other in design features. The trap is usually set below the orifice of the kidney veins in the vena cava. The patient with the filter is regularly examined to determine when the trap needs to be changed to a new one.
Pneumocompression of the legs can help. These are special balloons that are put on the legs, then inflated and deflated sequentially. The application of the method allows to reduce swelling, which often accompanies varicose veins. Leg tissues receive more oxygen, nutrition improves, the body more effectively dissolves blood clots that have accumulated in the circulatory system.
This is important
Preventive measures to reduce the risk of thromboembolism always involve changing the patient's lifestyle. If a person smokes, you need to completely abandon this bad habit. Minimize the consumption of alcoholic beverages. You will also have to start eating he althy, balanced food.
If thromboembolism has already occurred, then it is important to prevent relapse. These events will accompany a person all his life, since each new blood clot is a very serious risk. In medicine, there are a lot of cases of death from secondary thromboembolism. If the history contains a mention of such a situation, the patient is prescribed anticoagulants andtrap filter. You will have to regularly come for examinations to the doctor to check if it is time to change the trap to a new one. The pills that the doctor will prescribe will also have to be taken constantly, completely following the doctor's instructions. It is strictly unacceptable to cancel them or change them at will. Of course, you can’t smoke, drink alcohol, fried, fatty, smoked foods with a history of thromboembolism.
Low molecular weight heparins against thromboembolism
A good result in the prevention of thromboembolism can show nadroparin calcium. Preparations with this active ingredient can not be used during the period of gestation, feeding. As far as it was possible to find out during clinical trials, nadroparin calcium can cross the placenta, it was also found in breast milk, which caused a rather severe restriction. The use of this medication activates the processes of calcium leaching from the body. In addition, there is a bleeding risk that is about twice as high as with other heparins.
An alternative is fragmin. Medicines made on this active ingredient do not affect the concentration of calcium in the patient's body. The drug is most widely used in Belarus and CIS countries. Clinical trials have shown that fragmin can be used even during gestation, when the choice of drugs is very limited. The use of the drug is associated with a minimal likelihood of hemorrhage. If the patient is given artificial heart valves, if a shock condition is detected, it is recommended to resort tofragmin-based drugs.
Prophylaxis after surgery
Features of preventive measures directly depends on the reason for the operation and which organs it affected. There are three risk groups - low, medium, high. The probability of thromboembolism is least likely if a short-term operation was performed, lasting no more than half an hour, accompanied by one risk factor. If the operation was completely without risk factors, then the low probability of thromboembolism is also characteristic of those patients who underwent a longer surgical intervention. The probability of a lethal outcome provoked by blood clots under such conditions is less than a hundredth of a percent. To prevent even this small risk, it is necessary to start active movements as early as possible, apply elastic compresses to the legs, wear special compression underwear, apply pneumatic compression and electrical stimulation of the muscle tissue of the legs.
The average level of risk is characteristic of those patients who have been diagnosed with heart disease, disorders of the gastrointestinal tract, as well as those who have undergone emergency gynecological operations. Patients taking oral contraceptives are at moderate risk. In this group, the probability of death from thromboembolism reaches one percent. Preventive measures involve the use of fragmin, clexane. These drugs begin to be taken even before surgery (a couple of hours), thenthe course is continued during the rehabilitation period from seven to ten days.
Danger level: maximum
Those who are classified as a high-risk group should be most attentive to prevention. These are people who have undergone emergency, planned major surgical interventions. There is a high probability of developing thromboembolism during caesarean section. This group includes cancer patients suffering from extragenital pathologies, thrombosis, thrombophilia. If there is a history of pulmonary thromboembolism, the patient is already automatically classified as a high-risk group.
For persons from these categories, the probability of death, provoked by thromboembolism of the arteries of the lungs, reaches ten percent. To prevent a negative outcome, it is necessary to take measures to accelerate the flow of blood in the body. For this, anticoagulants are usually prescribed in a dose doubled compared to the average risk group. It is important that the doctor chooses the drugs based on the data obtained from the patient's analyzes. It is unacceptable to neglect the doctor's recommendations related to preventive measures, and first of all, it is important to regularly use prescribed medications.
Prevention: surgical method
Pulmonary thromboembolism can be prevented in quite a radical way – surgery. There are several methods that can effectively prevent the development of the disease. In some cases, the main veins are ligated below the femoral level. Many patients, especially in recent years, are fitted with trap filters that allow sufficienteffectively block possible complications if there is already a history of thromboembolism. Endovascular and some other high-tech surgical techniques allow thromboembolectomy, which also shows a high level of efficiency with an increased likelihood of pathology. Finally, they resort to the plication technique, treating the vena cava in the lower extremities.
Cava filter: when to use it?
A filter trap seems to many to be the best option to prevent pulmonary embolism. And yet, it is impossible to resort to it in all cases without exception. There are a number of indications for which such a filter can be implanted. Indications are:
- inability to use anticoagulants;
- thromboembolectomy of pulmonary artery;
- rather large, long-lasting, floating ileocaval type blood clot;
- increased chance of relapse due to deep vein thrombosis;
- bearing period;
- recurrence of pulmonary thromboembolism;
- proximal spread of phlebothrombosis, which is not prevented by the anticoagulants taken.
Prevention: research and results
From year to year, leading minds in medicine conduct research to identify more or less effective methods to prevent thromboembolism of pulmonary arteries. The main goal of scientific research is to reduce the death rate per year. Of the most recent studies on this issue, attention is drawn to work withcancer patients. Large-scale studies show that good statistics allow the collection of regular ultrasound examinations of the risk group. However, it is important that people who are at increased risk of developing pulmonary embolism have regular check-ups. This makes it possible to keep the situation under control. Studies show that the presence of blood clots is not always accompanied by clinical manifestations of thrombosis, quite a lot of cases are secretive.
As can be seen from medical statistics, regular examinations using the most modern ultrasound devices, as well as the installation of filter traps when factors of increased risk of thromboembolism are detected, give a much better result than regular ultrasound, accompanied by conservative therapy. In addition to implantation, studies have also shown improved outcomes and a lower annual mortality rate for vein ligation above the level of a dangerous thrombus, with crossectomy.
Specialists pay special attention: the most important element is modern diagnostics, including regular ultrasound checks if there is a possibility of developing pulmonary embolism.
