By Laura Freeman

Summer is the season when vacationers tend to travel more, squeezing into airline seats for hours or spending days in a car riding cross country. Before they go, many travelers, especially patients at higher risk for deep vein thrombosis, may benefit from a review of their risks and steps they can take to prevent problems.

“Situations and health issues that limit mobility for extended periods make it harder for veins to return blood to the heart. As blood pools, legs swell, veins and tissues can be damaged and clots may begin to form. In addition to being painful, if the clot breaks free and travels to the lungs or heart, it can quickly become a life threatening situation,” Director of the UAB Vein Center Marc Passman, MD said.

Although the problem can arise with little or no warning, vascular surgeon Passman,  who is also Director of Endovascular Surgery at UAB, says that some patients tend to be at greater risk due to pre-existing conditions, medications, hormonal shifts, lifestyle factors, heredity and even their work environment. For both patients and the health professional caring for them, it’s well worth learn how to reduce risks and to recognize a developing problem.

“Aging is a factor, as well as anything that reduces mobility,” Passman said. “Both pregnancy and some forms of birth control that alter hormones can put women at greater risk. Recent surgeries, trauma, cancer, obesity and inherited differences in clotting can increase risks. Jobs behind a desk, workbench or requiring frequent travel can make problems more likely. The single most addressable risk factor for clots is smoking. Chemicals in smoke seem to cause clumping, damage blood vessels and constrict circulation, which can increase the damage if a clot forms.”

In addition to being proactive about nutrition, activity and stopping smoking, patients should have a plan to counter the effects of immobility when they find themselves in a confined space for an extended period. Exercise-in-place techniques are available online to enlist calf, foot and thigh muscles in assisting veins to return blood to the heart. One called a calf push-up presses down with the ball of the feet while lifting the knees and relaxing them in a mini marching motion. When safe and possible, standing and walking on a plane, walks at regular rest stops on car trip, and standing, stretching and walking in place in a workspace can help.

Patients should also learn to recognize when problems are developing. “A clot in the leg may cause pain and swelling,” Passman said. “If a patient experiences shortness of breath or tightness in the chest, the clot may have broken loose and become an embolism. In this case, it’s time for the hospital. Don’t risk your life on wait and see.”

Ultrasound is used to identify clots in the legs, and CT imaging will likely be ordered if an embolism is suspected. If confirmed, IV medication to dissolve the clot begins and close monitoring continues until the situation stabilizes.

“What happens next depends to a great extent on whether an embolism is considered provoked or unprovoked,” Passman said. “If it is associated with a likely cause, such as an injury, it is usually thought to be provoked. The patient will probably need to be on oral blood thinners several months until the clot is dissolved.

“However, a surprising number of emboli are idiopathic or unprovoked and the cause may never be known. In these cases, referral to a hematologist to test for several types of heritable factors affecting clotting may be helpful. But sometimes the cause remains unknown.

“When patients have one clot they are at higher risk to have another later, and they may need to take a prescription blood thinner the rest of their life. We want to teach them the importance of vigilance in taking each dose on time every day. They should also be educated on looking out for other prescription and over the counter medications and supplements that can interact with their medication and increase the risk of excessive bleeding.”

In some situations, blood thinners may be contraindicated or some clots because of their position or size, may be more dangerous.

“We may consider placing a mesh device to catch a clot to prevent more damage, or perhaps use an endovascular procedure to actually remove the clot,” Passman said. “That’s when our vascular and endovascular teams come in. There’s a great deal we can do to help if we can get to the problem in time. However, the safest strategy is always prevention. It helps to know what puts you at greater risk, and what you can do to improve the odds for keeping your veins clear and healthy.”