What is pulmonary embolism?
Pulmonary embolism (PE) is one of the most vicious and devastating respiratory diseases. It can take an otherwise healthy appearing person and strike them dead in a matter of minutes. The more people know about prevention of this disease, the more lives will be saved. Pulmonary embolism usually refers to a respiratory disease in which a large blood clot is formed in the leg, and then suddenly breaks free, and travels through the circulation to the lung. The blood flow to the lung is occluded by this large clot, and the person can either feel a very sudden onset of shortness of breath and chest pain, or just collapse due to the lack of oxygen and effects on the circulation. Awareness about pulmonary embolism and how fatal it can be increased after David Bloom, an NBC journalist, suddenly died from this disorder.
Where do pulmonary emboli come from?
The usual first step for having this disease is forming a blood clot in the leg. Clotting, in and of itself, is a good thing. Otherwise, you might bleed to death from an otherwise minor injury. However, anything that stops the flow of blood can also be dangerous. Blood clots in the leg may be completely asymptomatic, or the person may have leg swelling and/or tenderness. There are many things which contribute to this, and each of them have a small aspect that may help prevent pulmonary embolism. First, there is a strong role for genetics in this disorder. Clotting disorders run in families, so if other family members have had deep venous thrombosis (leg clots), pulmonary embolism, lupus, or other clotting disorders (called thrombophilias or hypercoagulability) , blood tests can be done to determine your risk for making clots. Clotting may also be the first sign of a new cancer somewhere in the body. Some people may require blood thinners to prevent clot formation if they have these disorders. Next, injury to the blood vessels will also promote clotting, such as smoking, surgery, or trauma (i.e., a fractured leg). Immobility makes this much worse, especially bed rest or prolonged travel. The best prevention is walking, but if someone is unable to walk, they may also benefit from blood thinning medications or devices placed on the leg called intermittent compression boots. Estrogen supplements, either in contraceptives or hormone replacement therapy, also increase the risk of clotting. Finally, pregnancy and obesity can also increase the risk of clotting.
How are blood clots discovered?
Clots can be found with imaging, either using CAT scans, perfusion scans, angiograms, or ultrasound. Once detected, they can be managed with blood thinning medications or surgical procedures. Once someone has had a clotting event, they are at increased risk for recurrence and may need to stay on anticoagulation for an extended period of time, or when circumstances place them at increased risk (i.e., future surgeries).
Is there any special treatment for life-threatening blood clots?
If very large blood clots form, they can travel through the heart and into the pulmonary artery and block blood flow. This causes severe shortness of breath and critically low blood pressure. In this circumstance, clot busting / dissolving medications can be used, either via an intravenous or a catheter that is fed directly into the vessel. In some cases, an intravascular device or surgery may be used to physically remove the clot.
What are the major risks of blood thinners?
The main risk is bleeding. Often, if bleeding occurs the blood thinner is reversed with other medications or blood products and the bleeding can be controlled. However, bleeding that occurs in the brain can be devastating. Patients on blood thinners are often advised not to engage in any activity in which there is a strong risk of internal injury (i.e., skiing, football, contact sports) and to immediately seek medical attention if they hit their head, even if they feel perfectly fine (since slow bleeding may not be detected initially). Blood thinners must be changed or adjusted in pregnancy.
What medications or foods do I need to avoid while on blood thinners?
The main medication is aspirin, and this can be an ingredient in any over the counter product (such as cold formulations or pain relievers), so you must check the label. Many antibiotics, some vitamins/supplements/herbal medications and other medications may affect blood thinners, so frequent monitoring is necessary, and you should always remind your doctor and pharmacist that you are on blood thinners. There are some foods (with vitamin K) that do interact with blood thinners. For most patients, if they do not eat an excessive amount of any one food, this usually does not affect their use of blood thinners. However, there are some patients who may have to alter their diets to keep their blood appropriately thin.
Can I bleed to death from blood thinners?
With small cuts and injuries, the blood thinners will just make it take a little longer to stop bleeding (i.e., 5-10 min). Applying direct pressure to the wound without interruption (to peak and see if it is still bleeding), is usually the most effective way. However, if you experience a head injury, even if it seems minor, you should seek medical attention because bleeding here may not cause any symptoms initially. On the other hand, if there is any major injury (i.e., deep penetrating wound, fracture, coughing or vomiting of blood or bloody or black stools) then you should immediately go to the ER to prevent a life-threatening bleed.
What if I need to have a medical procedure?
Your doctor will discuss with you how to safely interrupt your therapy, and what other protection you may need while off therapy.
What if I cannot have blood thinning medications?
Some people cannot stay on blood thinning medications because of chronic bleeding, anemia, recent surgery, or a history of bleeding into the brain. For these patients, instead of being on blood thinning medications, they have a device placed into their blood vessel that acts as an umbrella or filter and catches any large clot and keeps it from passing from the legs into the heart and lungs, while still allowing some blood to circulate through it. While this will prevent most life-threatening pulmonary emboli, the chronic partial blockage of the circulation can lead to chronic leg swelling and discomfort.
Self-Check for Prevention of Pulmonary Embolism
- Stop smoking.
- Avoid estrogen products.
- Avoid extended periods of immobility when traveling.
- Stay well-hydrated.
- I know which medications to avoid and when to have my blood tested to measure the medication and adjust the dosage.
- I know to avoid contact sports and other activities that may make me more prone to injury (i.e., skiing, motorcycle riding, and weightlifting).
Managing Doctors
- Primary Care
- Pulmonology
- Hematology
- Vascular Surgery