This October 13, the eighth edition of the World Thrombosis Day, a global initiative created by the International Society of Thrombosis and Haemostasis (ISTH), seeks to raise awareness about the disease. From sunset to midnight the Women’s Bridge, the Floralis Generic, the Monumental Tower in Retiro and the Buenos Aires Planetarium will remain illuminated in red and blue, in honor of the campaign’s colors. In addition, this year the ISTH has the support of the Boca Juniors Athletic Club, the Peñarol and National Athletic Club of Uruguay, as well as the Ministry of Health of that country.
The campaign seeks to encourage the Argentine public, health professionals, and legislators of health policies in the country to keep their “Eyes Open to Thrombosis”; and join this project to draw attention to the disease, which is a growing scourge nationally and globally.
Thrombosis is the formation of a clot within a vein (venous thrombosis) or an artery (arterial thrombosis). This clot, called a thrombus, can either fixate where it formed or break off and travel to certain organs, such as the lungs (a condition known as pulmonary thromboembolism), where it reduces or completely blocks blood flow.
General risk factors for it are obesity, cancer, severe thrombophilia (the genetic predisposition to thrombus problems), recent surgery or long hospitalization, pregnancy, taking hormonal drugs, or fibrillation. atrial (a type of irregular heart rhythm).
Factors are added to the COVID-19, which in severe cases increases the risk of thrombosis by forcing long periods of immobility and favoring excess blood clotting. According to the study published by Dr. Erik Klok and his collaborators in the journal Thrombosis Research, it is estimated that between 25% and 31% of patients admitted to an Intensive Care Unit for coronavirus will develop a thrombosis.
According to Professor Beverley Hunt, Officer of the Order of the British Empire and Chairperson of the World Thrombosis Day Steering Committee, “Despite the fact that one in four people worldwide dies from problems caused by thrombi, these are frequently overlooked, and constitute an urgent matter for public health.” That is why making this disease visible is so necessary.
Professor Hunt acknowledges that while we have had “a turbulent year caused by the COVID-19 pandemic, where we have unfortunately seen an increase in coronavirus-related thrombosis and, in turn, thrombosis in general”, the situation can be reversed: “These cases, along with other factors that cause blood clots, will be preventable if patients and the medical community are vigilant in recognizing and treating the symptoms of the disease.”
Main signs of a deep vein thrombosis
Pain and/or tenderness in the calf or thigh.
Swelling of the leg, foot, and/or ankle.
Noticeable redness and/or discoloration.
Heat in the affected area.
In the case of a pulmonary embolism, patients may feel:
Chest pain (which may be worse with deep breathing).
Elevated heart rate
Lightheadedness and/or fainting.
The condition can be prevented by being physically active, drinking copious amounts of water, following a healthy diet, and avoiding being overweight and smoking. In addition, if you are part of the population at risk or must be admitted to the hospital, you can also ask your doctor for more information and specific preventive treatments. Also to prevent thrombosis in hospitalized patients, a risk assessment for VTE (venous thromboembolism) can be performed.
The World Thrombosis Day campaign seeks to raise awareness especially in the following areas:
Thrombosis associated with hospitalization: Hospitalized patients have an increased risk of blood clots due to the immobility to which they are subjected, in addition to other diseases or surgeries they have suffered. Clots associated with hospitalizations can occur during hospitalization or within 90 days after discharge, and represent 60% of all cases of venous thromboembolism, being the main preventable cause of death in hospital admissions.
COVID-19-related thrombosis: Research shows that COVID-19 increases the risk of blood clots by making it difficult for the blood to circulate.
Cancer-associated thrombosis: Cancer patients are four times more likely to develop a severe blood clot than the general population. This increased risk is due to factors such as having surgeries, hospitalizations, infections, and genetic clotting disorders due to cancer-specific factors, such as its type, histology, stage of malignancy, cancer treatment, and certain biomarkers.
Gender-related thrombosis: estrogen-based oral contraceptives, hormone replacement therapy pills, and pregnancy are risk factors for blood clots for women. They are five times more likely to develop a blood clot during pregnancy, and about one in 1,000 pregnant women could develop thrombosis according to research from Cardinal Health (2019) and the Centers for Disease Control and Prevention (2020) research.
Currently, it is estimated that around the world 10 million cases of VTE are diagnosed per year. However, the condition can be prevented through early detection and provision of blood thinners. The World Thrombosis Day campaign urges that healthcare professionals consider the possibility of thrombosis in all their hospitalized patients and that the general population request a VTE risk assessment if admitted to the hospital.
Dr. Alicia Blanco, clinical biochemist (MN 6903), president of the Latin American Cooperative Group of Haemostasis and Thrombosis and member of the International Society of Thrombosis and Haemostasis (ISTH), explained: “In Argentina, we have very important prevention actions. The problem of the lack of knowledge of thrombosis transcends socio-cultural and geographical borders: the Netherlands and the United States have very low knowledge rates. In Argentina and Uruguay, and this is important and positive, there are protocols to determine the risk of thrombosis in hospitalizations. That is why it is very important to apply it, and that if an individual is going to be hospitalized, their risk of thrombosis is evaluated, and anticoagulants or mechanical prevention measures can be provided if necessary”.
Blanco said in turn that, in terms of public policies and the registry of mortality due to thrombosis in Latin American countries, there is still a way to go. “Statistics are scarce. Yes, there are some public policies, for example in Uruguay, but obviously, this is not generalized or systematic, but they come from some government entities”, said.
There are several specialists who affirm that there is little knowledge of thrombosis in relation to other cardiovascular diseases. “It has no diffusion, this is what prompted the launch of the World Thrombosis Day 2014 campaign by ISTH. There is much more awareness about strokes, or myocardium, but not about thrombosis, which kills more than car accidents, “said the clinical biochemist Blanco.
Dr. Alex Spyropoulos, Professor of Medicine at the Donald and Barbara Zucker School of Medicine in Hofstra / Northwell and Director of the Anticoagulation and Clinical Thrombosis Services System at Northwell Health, said: “At ISTH we have conducted a survey that shows that thrombosis is the most underrated and least recognized cardiovascular disease, both in terms of awareness of symptoms and public awareness of the risk it carries. Therefore, awareness is a fundamental first step to save lives, reduce cases of thrombosis and its consequences. Latin America is a very important region for ISTH and WTD (World Thrombosis Day) to promote this global awareness ”.
For her part, Dr. Gabriela Cesarman-Maus, head of cancer and thrombosis service at the National Cancer Institute in Mexico, said: “Awareness of thrombosis has been increased particularly by the COVID-19 pandemic, now there is widespread knowledge that the coronavirus is a disease with a high risk of thrombosis ”
There are several actions that specialists believe are necessary for the prevention of thrombosis in Latin America. “We need a regional strategy to prevent thrombosis, especially in hospitalizations, and that it must be adapted to each country on the continent, as well as to each patient and institution that provides medical care ”, Spyropoulos warned
“Several hospitals in Latin America have already been implementing new forms of thromboprophylaxis or strengthening existing ones. Both in the United States and in Latin America, some hospitals have strict protocols to measure the risk of thrombosis in patients, and others do not: that is a reality that we must change, ”said Cesarman-Maus.
In Latin America, the CLAHT (Latin American Cooperative Group for Haemostasis and Thrombosis) has been one of the societies that most disseminated information about the disease through academic symposia and press releases around the World Thrombosis Day. “In Mexico particularly, the SOMETH (Mexican Society of Thrombosis and Haemostasis) has been active in providing guidance on the use of thromboprophylaxis in COVID and in promoting the creation of thromboprophylaxis pathways. We believe that all Latin American countries have been doing a great job in establishing the causes of thrombosis in COVID and in making sure that hospitalized patients with COVID receive preventive treatments. The positive impact of these measures will be evident in the coming months ”, added Cesarman-Maus.
“About, Recent studies show that around 66.8% of hospitalized patients at risk of thrombosis in Europe are treated with preventive measures, 44.9% in Africa and 37.6% in Asia, while in South America 58, 3% and 68.6% in the United States and Canada. These statistics show an advance over previous years”, continued Cesarman-Maus.
What then, in this context, are the challenges you see for thrombosis prevention around the world? “Mainly, ensure that the risk of VTE (venous thromboembolism) is considered by health professionals and that VTE risk assessment models are always used in hospitalized patients, ”said Spyropoulos.
“We still have to work so that all patients with thrombosis are notified and that, in the event of death, this is included in the statistics of deaths from thrombosis. Progress in this regard varies greatly in each country, but they are essential to study the real impact of prophylaxis and implement more effective prevention measures”, Cesarman-Maus added.
Regarding the relationship between COVID-19 vaccines and thrombosis, Spyropoulos stated that “the incidence of vaccine-induced thrombosis is extremely rare: 1 in every million people vaccinated. But the incidence of COVID-19-induced thrombosis, especially in those over the age of 50, can be as high as 1 in 100 patients. It is remarkable that these are many different orders of magnitude”.
Now, given the inequality in medical treatment in Latin America, what measures can be implemented so that access to treatment for thrombosis is accessible to all? “It is a very difficult question. Probably the hardest to answer, ”Cesarman-Maus argued. Inequality includes the treatment of all diseases, including thrombosis. However, there are measures that can reduce the risk of thrombosis and that do not entail any cost, such as early mobilization after surgery, reducing prolonged bed rest, maintaining good hydration. There are diseases that increase the probability of thrombosis such as obesity or diabetes, and the prevention of these is a matter of public health, which involves childhood and continues throughout life, exercising daily even if it is moderate and avoiding foods with high content of sugar”
Regarding recommendations about thrombosis, Cesarman-Maus closed: “The recommendation is to be proactive. Ask your doctor if you need prophylaxis when you are in the hospital or after you leave the hospital for admission. 60% of all thromboses are associated with hospitalization, either during the hospital stay or in the next few weeks. Not everyone should receive prophylaxis since, for example, anticoagulants can increase the risk of bleeding, however, all people in a hospital should be evaluated to consider whether they should receive thromboprophylaxis or not. Regarding those hospitalized for COVID-19, all should receive anticoagulants, and those patients with cancer or autoimmune diseases should consult with their medical team about the possibility of developing thrombi in a hospitalization. The most common symptoms of thrombosis are swelling or pain in a limb (usually only on one side) and acute shortness of breath or chest pain”.