Deep vein thrombosis (DVT) is when a blood clot forms within a deep vein in the body, commonly in the deep vein of the calf area of the leg though it can also form in the pelvis and abdomen. Thrombosis is when a blood clot is formed within blood vessels (venous or arterial).
This impedes the natural free flow of blood whose consequences includes pulmonary embolism, myocardial infarction, stroke, and limb ischaemia Blood clots that form in a vein is referred to as venous thrombosis. DVT and pulmonary embolism are both known as venous thromboembolism (VTE). DVT and PE are not also a health condition a lot of Nigerians know even when it remains a silent killer.
Deep vein thrombosis in Nigeria
Prof. Sulaimon Akanmu who is a Professor of Haematology and Blood Transfusion at the College of Medicine, University of Lagos while speaking at the marking of the 2019 World Thrombosis Day conference organised by the multinational Pharmaceutical company Sanofi in collaboration with the Nigerian Society of Haematology and Blood Transfusion (NSHBT) disclosed that at least 50% of patients admitted in Nigerian hospitals could develop thrombosis.
He, therefore, advised that patients who are admitted in the hospital to always request for a thrombosis risk assessment and if found to be at risk, that they ask for preventive treatment. This is in line with what is obtainable in advanced countries like the UK where most patients admitted in the hospital get a VTE assessment and preventive treatment if appropriate.
While most advanced countries have put procedures in place to reduce the incidence and death due to VTE with adequate diagnosis facilities and awareness, Prof. Sulaimon Akanmu said the condition is not often detected in Nigerian hospitals while the patient is still alive. He further stated that most of the cases identified were detected during post-mortem.
A prominent entrainment writer called Azuka Oguijiuba narrating her experience on Instagram of how she developed DVT after she travelled to Los Angeles 3 days, got back, then to Dubai for some days and then to the United Kingdom (UK) where she collapsed and was rushed to UK hospital where she survived.
She is one of the few Nigerians who survived after developing VTE and was informed that the outcome may have been different if she had developed the condition in Nigeria as most people who develop the condition in Nigeria do not survive it. Sadly the cases of big brother and music star Goldie Harvey who died shortly after she returned from the 55th Grammy Awards in 2013 and former captain and coach of the senior national football team Stephen Keshi, who died in 2016 after complaining of pain in the leg pain. He was reported to have had the leg massaged at home.
According to the Professor, everything about VTE is wrapped in ignorance on the part of the healthcare professional and the general public. Fortunately, Sanofi launched its ‘VTE Safe Zone programme’ in some health institutions around Nigeria help improve the care of hospitalized patients to reduce the risk of VTE. The programme aims to educate healthcare professional like doctor’s pharmacists and nurses on the development of VTE risk assessment tools.
Symptoms of Deep vein thrombosis
- Swollen leg (usually around the calf) or arm.
- Red or discoloured skin around the affected area.
- Pain in the Leg
- The area may feel warm to touch.
Risk Factors for Deep vein thrombosis
- Recently been in hospital
- Antiphospholipid antibody syndrome
- Major surgery in the last 3 months
- Factor V Leiden
- Fracture in the femur or hip
- Prothrombin gene mutation G20210A
- Protein C or S deficiency (Protein C or S are naturally occurring anticoagulants)
- Long-distance travel
- Antithrombin deficiency
- Drugs that contain oestrogen e.g some contraceptives and hormone replacement therapy,
- Family history of deep vein thrombosis
Diagnosis of Deep vein thrombosis
- Physical examination – Your doctor will examine the affected area and will be looking out for Symptoms as listed above.
- Ultrasound – An ultrasound shows whether the blood in your vein is flowing normally and to search for a blood clot.
- Blood tests – A blood test to check for the presence of D-Dimer which is a small protein fragment that is usually present in the blood of people who have deep vein thrombosis.
- Computerized tomography (CT) or magnetic resonance imaging (MRI) scans –This is used to check for the presence of a clot.
- Venography – An X-ray of the vein (venogram) involves the injection of a dye into a vein to show how blood flows through your veins and where the clot is if there is a blood clot.
Treatment of Deep vein thrombosis
The main aim of the initial treatment phase (first 5–10 days) is to rapidly prevent more fibrin and thrombin clot from forming. This then prevents further thrombus formation and allows the body’s fibrinolytic system to start dissolving the thrombus already formed. As a result, the symptoms of acute deep vein thrombosis is reduced.
Anticoagulants are the main medications used to treat deep vein thromboembolism. Anticoagulants include Fondaparinux, warfarin, low molecular weight heparin (LMWH) unfractionated heparin (UFH) and direct oral anticoagulants (DOACs).
Examples of direct oral anticoagulants DOACs
Examples of low molecular weight heparin (LMWH)
Complications of Deep vein thrombosis
The most concerning complication of DVT pulmonary embolism. This occurs when the blood clot breaks off from the veins in the leg and travels to the lung where it blocks an artery going to the lungs. Pulmonary Embolism can be fatal.