Česky
Lack of exercise is cited as the most common cause of thrombosis. Why does its incidence increase in the summer?
Yes, we are active in summer, but we also travel more often. That is why we see more cases of so-called travel thrombosis in the ambulance in summer. This is a thrombosis in healthy, often young people, caused by immobility for several hours while travelling long distances. If dehydration, especially if associated with higher alcohol intake, is added, the risk of thrombosis increases. This risk applies to all means of transport, although air thrombosis, which has historically been the longest known, has a special status. It is reported that the risk of thrombosis is double for flights over four hours and triple for flights over eight hours. As early as 1988, the so-called 'economy (tourist) class syndrome' was described, when a link was discovered between the development of thrombosis and embolism in travellers in cramped spaces with legs bent. Leg position also contributes to thrombosis. When the legs are bent or crossed, blood flow slows down, which helps the formation of a thrombus. Paradoxically, another group of patients are athletes who have developed thrombosis as a result of injury to the limb and its immobility. This thrombosis is usually prevented by injections of heparin.
What are the dangers associated with thrombosis?
There are two serious complications. Pulmonary embolism and post-thrombotic syndrome.
Pulmonary embolism is an acute form of so-called thromboembolic disease, where a thrombus released from a thrombosed limb travels up to the pulmonary circulation. If the thrombosis is extensive, it can end in death. The second complication is rather chronic and is related to an insufficiently patent limb after thrombosis. It is characterized by pain, heaviness, cramps, swelling and eventually a tibial ulcer.
What are the warning signs for thrombosis?
The most common sign is pain, which is spontaneous, often more pronounced after compression of the limb. It may be permanent or just related to movement. Sometimes patients describe only pressure or a feeling of discomfort.
Another symptom is swelling. It can be extensive but also discrete with oozing in the ankle area. Less common symptoms are a feeling of higher temperature in the limb or colour changes. Symptoms are typically unilateral.
To make matters worse, a certain percentage of people completely lack these symptoms, which is typical of elderly and hospitalized patients.
Who is most at risk of developing thrombosis?
There are many risk factors, often in combination, and the accumulation of these risks is typical for the development of thrombosis. For example, a woman who is overweight, takes hormonal contraceptives, and flies a long-haul airplane has a 60-fold higher risk of thrombosis compared to a woman who does not have these factors.
Risk factors include: older age, obesity, immobilization, pregnancy and postpartum status, hormonal contraception and replacement, known thrombophilic mutations, cancer and serious internal diseases, trauma and postoperative conditions.
I would like to draw attention to an underestimated risk factor, which is also related to immobilization, and that is prolonged sitting. Many cases of thrombosis occurring while sitting at work or participating in a marathon of computer games have been described in the literature. The phenomenon of death of young healthy people who have spent many hours at a computer in a row has been named as e-thrombosis. Sitting at a computer is a common work and leisure activity in the 21st century and therefore the risk of this thrombosis applies to the majority of the population and may not be extreme. Studies that have quantified the risk of this thrombosis have identified sitting for ten or more hours in a day, two of which were continuous, as a risk; each additional hour spent sitting led to a further 10% increase in risk. The most affected occupations were IT specialists, managers, administrative workers, taxi drivers and cashiers.
How effective is stocking prevention?
It is used as prevention in high-risk groups, in high-risk situations - for example, in post-surgical conditions or in patients with a history of thrombosis, and in patients with a known thrombophilic mutation when they will need to travel long distances. The use of stockings is not recommended for prevention in the general population.
What would you recommend for patients with a history of thrombosis?
If they are cured and have no difficulties, they no longer need to wear elastic stockings, for example, and certainly do not have to live in fear that the thrombosis will undoubtedly return and have fatal consequences. On the other hand, they must be aware of the risks of thrombosis and try to prevent them. I advise my patients to be cautious in risky situations - the aforementioned travelling, but also sitting for long periods at work or any other activity. In these situations, I recommend elastic stockings, but of course they must follow the basic regimen - try to stop driving or sitting after 30-60 minutes and walk, exercise their legs, pay attention to the drinking regime. I would be happy if these simple rules could be adopted by the general public so that thrombosis could be prevented.
So, anyone who has read this interview to the end and found themselves sitting at a computer for more than 2 hours should get up now and take a walk so as not to add to the ranks of our thrombosis patients.
