“DVT Device Breaks Up Dangerous Clots”
Heather Hall, MD
Heather Hall, MD, Vascular Surgeon, Weiss Memorial Hospital, talks about a new way to
treat deep vein thrombosis.
What causes DVT?
Dr. Hall: There are a lot of risk factors for DVT. Anything that’s going to restrict
someone’s movement and make them less mobile can put them at risk for DVT. So, if
you think about it things like increasing age, being overweight, or surgery, anything that’s
going to make you less mobile is going to put you at risk. The reason is that the blood is
flowing from the leg towards the heart and if you’re less active the blood flow through
those veins is slower, putting you at risk for developing a clot. Other things that can
make you at a higher risk for developing a DVT are things like medical conditions or
habits that make the blood more likely to clot; so things like cancer, pregnancy, smoking,
and some inherited blood disorders.
Does it affect women more often than men?
Dr. Hall: It does affect women more often than men and part of that is due to estrogen.
So, other risk factors are birth-control pills that contain estrogen or hormone replacement
therapy that includes estrogen. Those components put women at a higher risk.
Can you talk about how many people are impacted by this every year?
Dr. Hall: So, DVT in the United States is actually a huge health problem. Some
estimates say that about 300,000 to 600,000 people per year in the United States will
develop a DVT or blood clot. More recent estimates put that at about 2 million cases per
year. The average person has about a one in 1,000 risk per year of getting a blood clot,
and as you add different risk factors that risk increases.
Can this become fatal?
Dr. Hall: DVT can cause symptoms in the leg like pain and swelling, but it’s when that
clot breaks off and travels to the lung and becomes a pulmonary embolism that it can be
fatal. Even though there may be about 2 million cases of DVT per year in the United
States, there’s probably about 100,000 cases of fatal pulmonary embolism per year in
the United States. That is more than the deaths from breast cancer and AIDS combined.
How many of those would you say realistically could be prevented?
Dr. Hall: I think a great number of those could be prevented. So you know the way to
reduce your risk from developing a pulmonary embolism or having a death from a
pulmonary embolism is recognition of a DVT. If a person experiences very sudden pain
or swelling in their leg, they need to seek care from their doctor right away. Their doctor
will ask them a series of questions about their symptoms. If they think that the likelihood
of them having a DVT is high, they’ll refer them for a diagnostic ultrasound.
So let’s say that someone does have a clot what are the treatments that they can
look at?
Dr. Hall: We can treat DVT with blood thinners for anticoagulation and that’s been the
standard of care for decades. The sooner that the blood thinner is started the better for
the patient. That treatment however is somewhat flawed if you think about it. The way
that a blood thinner works is that it prevents the clot from getting bigger. It also reduces
the chance of that person getting more clots in the future, but blood thinners don’t
completely dissolve the clot. That is where the treatment falls a little bit short.
More recently there have been other ways to treat these blood clots. In Mallory’s case,
she is a healthy young woman who was a college student and developed pain and
swelling in her leg. She might have initially thought this is probably something benign
and hopefully this will go away, but that pain and swelling persisted and so luckily for her
she recognized this as being an abnormal thing and came to the emergency room to be
evaluated. Mallory was in a long car ride from St. Louis to Chicago and was sitting in the
car the entire time trying to make good time on the highway and didn’t take any breaks.
We also know from Malory’s case that once we were able to do some blood work on her,
we saw that she did have a factor in her blood that made her more prone to clot than the
average person. When Mallory came in, she was evaluated by the emergency rooms
team and was found to have pain and swelling and redness in her leg and was quickly
evaluated with an ultrasound. An ultrasound is really the most sensitive way to diagnose
DVT and ultrasound also allows us to pick up when these blood clots are in these larger
veins, again the thigh and pelvis. So, it allows us to select patients that are good
candidates for the more advanced treatment. She was started on blood thinners right
away, but we saw that she had large clots within her thigh veins and her pelvic veins.
Because of her young age and her desire to be active, we discussed the risks and
benefits of this advance therapy of giving the clot busting medications and decided to go
ahead and treat her.
So she’s been a success?
Dr. Hall: Yes. In Mallory’s case we did get her started on the blood thinners right away
and we were able to also treat her with the lytic medication and the Trellis device to
physically break up the clot. We were able to get good clearance of her veins within 24
hours and she was able to be discharged home simply on a blood thinner. She’s done
very well since her procedure, she’s active, and has minimal symptoms left in that leg.
What’s the recovery time like with a device may be versus just taking blood
thinners?
Dr. Hall: With the traditional therapy with blood thinners, some patients will get the blood
thinner in the emergency room and if they’re young and they’re reliable they’ll get
discharged from the emergency room just with the blood thinner. Patients that have
more extensive clots or patients that have pulmonary embolism typically will be admitted
to the hospital and those patients will be seen by a vascular surgeon. However, the
therapy itself can be done within a 24 hour period; so even though it may involve an
overnight stay in the hospital, it still gets patient’s home with a significantly decreased
clot burden and significantly reduced symptoms.
Is there a difference between recovery times or is it about the same?
Dr. Hall: Recovery times can be shorter using lytic medication on larger clots
So I understand there’s some that can be resolved with blood thinners and some
are going to require clot busting medications. How does the device with the clot
busting medication compare to just using the clot busting medication? Is there a
difference in resolution of the symptoms or is it the same?
Dr. Hall: That’s the problem. We know that patients that have extensive DVT in their leg
are more likely to have this post thrombotic syndrome. So about a third to a half of
patients that develop extensive DVT are going to develop post thrombotic syndrome,
where even though the clot is resolved they continue to have pain and swelling and
discomfort in that leg for the rest of their life. If we use these clot busting medications
and resolve the clot sooner, fewer patients are going to have this post thrombotic
syndrome. So their leg is not only going to feel better sooner, but they’re less likely to
have complications down the road.
Once you get it are you predisposed to getting it again in the same leg?
Dr. Hall: Yes. So, any individual that has a DVT they have a risk of having recurrent
DVT at some time in their life. For example, if someone has a major operation and has a
DVT after that, that’s a transient risk factor; so they are less likely to get a DVT later in
life. If you have someone that has a genetic disorder, like being overweight or obese,
then if that person develops a DVT, they’re more likely to have a recurrence because
their risk factors are ongoing.
This information is intended for additional research purposes only. It is not to be
used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any
medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no
responsibility for the depth or accuracy of physician statements. Procedures or
medicines apply to different people and medical factors; always consult your
physician on medical matters.
If you would like more information, please contact:
Caren Perlmuter
Marketing & Community Outreach
Weiss Memorial Hospital
Cperlmut@weisshospital.com
773-564-5670
Sign up for a free weekly e-mail on Medical Breakthroughs called
First to Know by clicking here.