By Dr. Umarashid Guloba

Venous thrombosis is a condition in which a blood clot (thrombus) forms in a vein. This clot can limit blood flow through the vein, causing swelling and pain. Most commonly, venous thrombosis occurs in the “deep veins” in the legs or thighs, this is called a deep vein thrombosis, or DVT. Normally, the body stops clots from forming by breaking them down continuously. 

DVT is the most common type of venous thrombosis. However, a thrombus can form anywhere in the venous system. If a part or all of the blood clot in the vein breaks off from the site where it is formed, it can travel through the venous system; this is called an embolus. If the embolus lodges in the lung, it is called pulmonary embolism (PE), a serious condition that leads to over 50,000 deaths a year in the United States. A massive PE can cause death in a very short time. We have no statistics for Uganda but the incidence increases with age. A clot to the brain will cause a stroke and one to the heart will cause a heart attack or myocardial infarction. 

 RISK FACTORS 

If a person is found to have a DVT and there is no known medical conditions or recent surgery, it is possible that an inherited condition is the cause. Some medical conditions and medications increase a person’s risk of developing a blood clot: eg,

●Pregnancy

●Obesity

●Smoking

●Heart failure

●Previous DVT or pulmonary embolism (PE)

●Increased age

●Cancer – Some cancers increase substances in the blood that cause blood to clot.( blood cancers)

●Kidney problems, such as nephrotic syndrome 

●Certain medications (eg, some birth control pills, hormone replacement therapy, erythropoietin, tamoxifen, thalidomide). 

Lastly, trauma or surgery is a major risk factor for clot formation and this explains why the deputy IGP got a clot.

Clotting is necessary to prevent excessive bleeding. Naturally, the body will form clots to plug any holes in the blood vessels which usually happen after accidents or trauma. Some people have a genetic condition where they can’t clot and can often bleed to death from a simple cut. This is called Hemophilia and is very rare.

All the blood from the body  and especially the lower limbs returns to the heart before it’s sent to the lungs to pick oxygen. Clots which commonly form in the calf muscles of the legs( Entumbwe) will move to the heart( sometimes getting bigger along the way ) and block the vessels in the lungs causing Pulmonary Embolism. This is because blood vessels get bigger as you move from the legs upwards and the heart is like a big muscular blood vessel. Only the vessels of the lungs become small on this journey of the clot.

PREVENTION:

1. Improve blood flow in your legs to avoid stasis. If you sit for long periods of time or are traveling for more than 4 hours, get up often, every 45-60 minutes and move around if possible. If not, do leg exercises or stretches by raising your legs on your toes and tightening the calf muscles.
2. If you get any swelling, tightening, redness, pain especially out of proportion in the calf muscles after no trauma or even mild trauma and in ONE leg, see your doctor immediately.
3. Ambulate as soon as possible after surgery and for some surgical conditions, blood thinners or drugs to prevent clots will be prescribed for you.
4. Wear loose comfortable clothing.
5. Avoid smoking.
6. Avoid alcohol and medicines that will make you sleepy while on long trips as they can prevent you from moving around.
7. Wear compression stockings if you have a high risk.
8. Get an annual general check up and more often if you have diabetes, hypertension, cancer, heart disease and a family history of clots or sudden death.

Dr. Umarashid Guloba is attached to the #MUBS Health Services Center, you can contact him on his email at uguloba@mubs.ac.ug.