Treatment of Deep Venous Thrombosis in a Female Thriathlete

Deep venous thrombosis (DVT) is a medical condition, which is characterized by a blood clot in the deep venous system. Deep venous thrombosis is a prevalent clinical issue that has affect on more than 250,000 people in the United States and 25,000 people in Canada every year. In spite of getting relevant anticoagulant treatment, it can take weeks to diminish symptoms of severe deep venous thrombosis, including leg swelling or ache (Kahn, M’Lan, Lamping, Kurz,

Berard, Abenhaim, 2004).

According to O’Donovan (2012), the failure to exercise the calf muscles for protracted intervals may cause restricted or poor blood circulation in the lower leg and heighten the chances of deep vein thrombosis (DVT). Also, heel rise exercises were shown to induce highest levels of calf muscle pump activity (CMPA) which includes the superficial and deep veins. Heel rise, knee flexion combined with plantar flexion and ankle rotations, may be considered as the most suitable exercises for optimal CMPA (Kanaan, Lepage, Djazayeri, O’Donovan, 2012).

As a result, approximately 40% of patients with deep venous thrombosis tend to develop the postthrombotic syndrome (PTS). It is considered to be a typical and serious complication of DVT that appears regardless optimal anticoagulant therapy in 20% – 40% of patients during the first two years after DVT. Since there is no test available for establishing the presence of DVT, it is diagnosed considering the presence of common symptoms and clinical signs in a limb that was affected by DVT. Acute PTS, which may involve ulceration, happens in 5% – 10% of DVT patients (Kanaan, Lepage, Djazayeri, Donovan, 2012).

Postthrombotic syndrome brings people a lot of sufferings and makes them disabled in the society. According to recent research, the level of life among people with PTS is considerably poorer comparing with those, for example, who suffer from arthritis or diabetes. Moreover, patients with PTS compare themselves with those people with angina, congestive heart failure and even cancer.

Palamone & Brunosvky (2011) reached a similar conclusion which states that “foot and ankle range of motion exercises may play a considerable role in decreasing the chances of DVT in patients when there is conscientious interpretation of the exercises”. In patients with previous DVT, a six month exercise training activities enhanced calf muscle toughness and pump function; and extreme levels of physical activities at one month considered to be connected with decreased severity of post thrombotic symptoms during the following three months.

PTS is called a “syndrome” since it is connected with groups of symptoms and clinical signs that typically alter from patient to patient. Patients with PTS suffer from acute pain, cramps, swelling, heaviness, itching, or tingling in the affected limb. Symptoms may be present in different mixtures and may be permanent or occasional. Typically, symptoms are exacerbated by standing or walking and enhanced with resting, leg elevation, or lying down. Signs that may be noticeable during physical analysis of the limb involve venous eczema, perimalleolar, edema, telangiectasia, and brownish pigmentation (Bernardi, Bagatella, Frulla, Simioni, Prandoni, 2001). Secondary varicose veins can appear, and brawny, sore concretion of the hypodermic tissues of the medial lower limb that are called lipodermatosclerosis can expand. The most serious aftereffect is considered to be the appearance of venous leg ulcers, which needs thorough medical investigation and can often reappear. Leg ulcers may be caused by minor injuries and in most cases are chronic, painful, and tend to slow process of healing (Padberg, Johnston, Sisto, 2004).

There were several studies that tried to find out what is the connection between age, sex and PTS. Two studies have found that elder people succumb to a greater risk of developing PTS, but other studies did not agree with that. Furthermore, one of those studies has made a conclusion that male sex was a poor risk factor for PTS. To sum up, despite these facts, there are no obvious connection between age, sex and the establishment of PTS (Padberg, Johnston, Sisto, 2004).

Apart from that, the results of studies state that high BMI increase the risk of PTS. In a small group study of patients with symptomatic proximal DVT who were examined for 12 months, those people who progressed PTS had sufficiently greater mean BMI than those who did not progress PTS and BMI >28 was connected with an odds ratio for PTS of 3Æ5 (Ageno,

Piantanida, Dentali, Steidl, Mera, Squizzato, Marchesi, Venco, 2003).

Effective treatment of deep venous thrombosis is significant in reducing the prevalence of PTS. Optimal anticoagulation, in most cases with heparins at the beginning and then with oral warfarin, is pivotal to prevent repeated DVT, which is the greatest risk factor for PTS. After continued taking anticoagulation for at least three months, patients with proximate idiopathic DVT should be separately evaluated for the advantages and danger of prolonged oral anticoagulation, regarding patient preferences. Risk factors for repeated DVT involve pregnancy, obesity, active cancer, continued use of oral oestrogens, established PTS, male sex, high %uFB01brin D-dimer, recurrent thrombosis, residual DVT, and other thrombophilias. Early constant walking, frequent physical activities and utilization of compression stockings for at least two years can also lead to reduction of the risk of PTS (Shrier, Kahn, 2005).

Reducing the prevalence of PTS by optimal methods of treatment of DVT includes three

national strategies:

(a) Optimal precaution of DVT. Around 50% of cases of DVT include subsequent hospitalization (hospital-acquired DVT), and most of these could be stopped by routine risk assessment of all patients admitted to hospital, followed by prescription of effective thromboprecaution to all patients at high risk;

(b) Antithrombotic treatment of DVT;

(c) Physical activity and elastic compression stockings usage by patients with DVT. Elastic compression stockings (ECSs) lessen venous hypertension, lower edema, and ameliorate tissue microcirculation. Three examinations have assessed the productiveness of frequent use of ECSs for the PTS prevention after symptomatic proximal DVT. For instance, 194 patients of a Dutch study who were assigned to the everyday use of those stockings showed a considerable reduction of prevalence of PTS from 47% to 20% (Kahn, 2006).

While drug treatment plays a crucial role, the utalization of medical decision rules recommended by Wells and colleagues are also of great importance for providing clinicians with a method for making reasonable accurate assesments of the likelihood of a recurring DVT or PTS (Riddle, 2004). Once the patient is medically stable, early mobilization and physical activity may have a protective and preventive role following a DVT or PTS episode (Brandjes, Buller, Heijboer, Hulsman, Jagt, 1997).

There exist certain specific ways to reduce or prevent DVT and PTS in athletic participants and still to reach the desirable goals. One of the most vital recommendations is to avoid protracted intervals of venous stasis. This means that instead of lying down all the time during the process of convalescence, one should resort to active methods of recovery, previously consulting with the physician. Another tip sais that it is crucial to neutralize the effects of air travelling with the help of continuous leg exercises, crossed legs avoidance, and sustaining the level of hydration during the post-exercise flights (Kahn, Azoulay, Hirsch, 2007). Additionally, those who suffer from thrombophilic disease need to take more significant preventive measures including refraining from estrogenic medication usage, taking aspirin or low molecular weight heparin before travelling, and staying away from exercising during very cold weather, that heighten the DVT risks.

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