Thromboembolism is caused by a blood clot carried in the bloodstream. It leads to occlusion of the affected blood vessel, which then can no longer supply corresponding organs. If left untreated, thromboembolism can be fatal.
What is thromboembolism?
A thromboembolism is characterized by a blood clot that moves freely in the bloodstream and can completely occlude the corresponding blood vessel. It always arises from an existing thrombosis by mechanical detachment of a thrombus. There are both venous and arterial thromboembolism. In most cases, it is a venous embolism originating from thrombosis of the deep veins of the leg. In this case, the thrombus always moves toward the lungs and can cause pulmonary embolism. Arterial thromboembolism originates from arterial thrombosis in the arteries. If a thrombus detaches here, further peripherally located organs such as the brain, heart, eye, kidney or intestine are affected by an embolism. The oxygen supply to these organs is interrupted or severely reduced, which can lead to the partial death of certain parts of the organs. Heart attacks, strokes, retinal infarctions (eye) or mesenteric infarctions (intestine) develop. Often, thromboembolism develops suddenly, as if out of the blue and without prior symptoms. Only in cases of extensive thrombosis are symptoms present for a long time beforehand, which can be attributed to circulatory disturbances in important veins or arteries.
Causes
A prerequisite for thromboembolism is always the presence of thrombosis. This is a vascular disease that leads to the formation of a blood clot. The deep veins of the legs are most commonly affected by thrombosis. However, the same causes can also cause thrombosis in the veins of the arms or various arteries (arteries). However, when thrombosis is mentioned, it usually refers to thrombus formation in the leg veins. Overall, three main factors are responsible for the development of thrombosis. These include damage to the vessel wall, reduced flow velocity of the blood, and its altered viscosity. The vessel walls can be damaged by chronic inflammation. Major risks for inflammatory processes in the vessels are diabetes, arteriosclerosis, autoimmune reactions and smoking. This causes rough spots to form on the walls of the blood vessels, where smaller blood clots, which normally form constantly in the blood, become lodged. Further clots attach to these lodged thrombi until the blood vessel closes completely or a thrombus is washed through the bloodstream in the form of a thromboembolism. A change in flow velocity takes place, among other things, at points where turbulence can occur. In arteries, for example, this takes place when larger arteries divide into several smaller ones. But the flow of blood is also impeded in varicose veins or at aneurysms. Thrombi often form there as well, especially after long periods of lying down or unusual leg positions when traveling by bus or airplane. Crossing the legs can also disrupt blood flow. If the flow rate of blood slows down due to thickening of the blood, for example due to dehydration, thrombosis can also develop. Independent of these causes, there are still genetic blood clotting disorders that can lead to increased blood clotting and thus increase the risk of thrombosis.
Symptoms, complaints, and signs
Venous thromboembolism usually causes pulmonary embolism, which can also be fatal. In this case, blood clots from the deep veins of the leg enter the pulmonary arteries and block them. When the blood flow is almost completely interrupted, hardly any blood reaches the left ventricle. This endangers the oxygen supply to many organs of the body. Symptoms include sudden shortness of breath, cardiac arrhythmias, coughing up blood, leg swelling, chest pain and, in very severe cases, circulatory arrest. Smaller pulmonary embolisms may be asymptomatic, but over time lead to chronic pulmonary hypertension and heart failure. Arterial thromboembolism affects individual organs. Circulatory disorders caused by blood clots can cause infarctions of the heart, brain (stroke), eyes, kidneys, or intestines. The symptoms depend on the organ affected.
Diagnosis and course of the disease
Thrombosis can be diagnosed by blood tests for D-dimers, among other tests. These are breakdown products of thrombi. However, this test is not specific enough to be used as unequivocal evidence of thrombosis. However, venous thrombosis is now detected by ultrasound examination and confirmed by X-ray examination with contrast media.
Complications
Thromboembolism is a dangerous disorder and can result in very serious complications. Once a patient has survived a thrombosis, he or she is often left with a partially or even completely occluded vein, which can lead to blood back up in the affected limb. In the long term, the increased venous pressure often causes the development of varicose veins as well as swelling and skin changes on the lower leg, which can turn brownish. The formation of ulcers in the ankle area is also possible. These accompanying symptoms are referred to as postthrombotic syndrome and can impair the patient’s quality of life. The risk for such a development also exists when a blood clot is slowly broken down by the body, but this process results in the destruction of the sensitive venous valves. In these cases, the blood flow back to the heart is unimpeded only when the patient is lying down. In contrast, when sitting and especially when standing, the blood sinks back into the legs. Depending on how severe the venous valve damage already is, the affected limbs regularly swell significantly during the day. Edema forms. Such complications are to be expected in particular if the patient does not take the thromboembolism seriously or if it is not treated professionally by a doctor for other reasons. The worst complication that can accompany deep vein thrombosis is pulmonary embolism. In this case, there is a risk of sudden cardiac arrest resulting in death.
When should you see a doctor?
A thromboembolism is an emergency medical situation. Emergency medical services are needed to ensure the survival of the affected person. If there are irregularities in the heart rhythm, sudden shortness of breath, and chest pain, a doctor must be called. If there is swelling of the limbs, bloody sputum or internal weakness, acute action is required. In the event of a thromboembolism, persons present must respond quickly and professionally. First aid measures are necessary to ensure the survival of the affected person. Disturbances in blood flow, convulsions or impaired physical functions indicate a health irregularity. Discoloration of the skin, the formation of varicose veins, and limitations in range of motion should be examined and treated. If athletic or everyday obligations can no longer be fulfilled as usual, there is already a need for action. These are warning signals of the organism that should be followed up. Sensory disturbances, headaches or irregularities of the circulation should be examined and treated. Irregularities in memory, heart palpitations or gait unsteadiness also indicate health inconsistencies in the early stages of the disease. A feeling of internal heaviness, disturbances in muscle activity, or general malaise should be presented to a physician. Further testing is needed to allow a diagnosis to be made.
Treatment and therapy
In many cases, pulmonary embolism requires emergency treatment to save life. For this purpose, adequate ventilation must be provided. At the same time, administration of anticoagulants such as heparin, warfarin, or phenprocoumon is necessary. If shock symptoms occur, the circulation must be stabilized. Furthermore, in acute cases, the thrombi are dissolved in the course of lysis therapy (dissolution by enzymes) or destroyed by mechanical disintegration using catheter technology. Even after acute treatment, anticoagulants should be administered for several months or, in special cases, even for life. Lysis therapy, reopening of blood vessels by catheter technique, or thrombectomy (surgical removal of the thrombus) is also used for arterial thromboembolism.
Prevention
Thromboembolism can be prevented by a healthy lifestyle. This reduces the risk factors of diabetes, dyslipidemia, or atherosclerosis.A healthy lifestyle includes a balanced diet, plenty of exercise, avoidance of smoking and alcohol, and avoidance of stress and excess weight. After operations or accidents, the aim should be to mobilize the patient quickly in order to minimize the risk of thrombus formation. In the presence of coagulation disorders, the administration of clopidogrel or acetylsalicylic acid has been shown to prevent arterial thromboembolism.
What you can do yourself
The most important point is to avoid blood stasis. A coordinated diet and exercise are particularly helpful in this regard. Every day, affected persons should go for a walk for at least 30 minutes and this at least five times a week. In addition, especially in sedentary jobs, people should get up for ten minutes every two to three hours and walk a little. Activities such as swimming, cycling or light jogging several times a week are also recommended. Simple foot and leg exercises every morning for 15 minutes also help. Affected people can also be helped by the right diet. Especially foods, with plenty of vitamin E are recommended. Vitamin E contains anticoagulant properties. These help to prevent blood clots. The vitamin inhibits platelet aggregation and thus combats the effects of clotting factors. Ginger also plays an important role. It contains a natural salicylate and can thus block vitamin K, thinning the blood. It also promotes blood flow in the vessels. In addition, it is advisable to prevent high cholesterol levels. This is because they cause plaque buildup and thus inhibit blood flow. The active ingredient capsaicin, which is contained in cayenne pepper, also promotes blood circulation. It strengthens capillaries and arteries. Another great natural remedy is apple cider vinegar. This improves blood circulation as well as blood flow, reducing blood clotting.
