Venous Thromboembolism (VTE)
A man admitted into hospital following a road traffic accident appeared to be making an excellent recovery. He was well-known locally and was chatting heartily with visitors one afternoon but by dusk he had died suddenly. I observed this as a medical student and was shocked. I have since encountered similar cases involving relatives and colleagues of mine.
A doctor recovering from an operation that went well died unexpectedly while in hospital. Another doctor died suddenly while recovering at home with one leg in an orthopaedic plaster. A woman recovering smoothly from a brain operation was about to be discharged home when she suddenly died.
The clinical explanation for these deaths is venous thromboembolism (VTE). This is a condition in which a blood clot (thrombosis) forms in a vein. A chunk of this clot may break off and be carried in the blood stream to the lungs (this is called ‘pulmonary embolism’, PE). Immobilisation due to surgery or other medical conditions predisposes to clot formation. Obesity and genetic factors increase the risk but VTE could happen to anybody. If the dislodged clot is large enough it will cause instant death. If it isn’t, there may be time to treat PE. If untreated, death will occur in 1 in 3 cases; the death rate in treated cases is 1 in 50.
It is not only after a surgical operation that VTE may occur. Resulting from prolonged immobilisation, it could occur after a long-distance travel (more than 4 hours by air or motor vehicle) or after a long period of bed rest in persons who are chronically ill.
Globally, venous thromboembolism (VTE) commands insufficient attention. This is regrettable because it carries a high mortality rate. The best treatment is prevention; this includes ambulation, hydration, use of compression stockings and blood-thinning injections. These measures have been shown to be very effective but under-utilised.
The first step towards reducing the number of deaths from thromboembolism is AWARENESS. Unfortunately awareness of VTE in Nigeria (as in many countries across the world) is low, among health professionals and the public at large.
PROTRAIN’s proposals for promoting awareness and good clinical practice include:
(a) a public campaign through the mass media and social media
(b) a campaign targeting health professionals through professional and educational meetings
(c) the convening of a multi-disciplinary national expert group to produce national guidelines for VTE prophylaxis
(d) the dissemination of good practice guidance through the postgraduate medical colleges and national specialist societies
Let us start today to raise awareness of VTE among Nigerians. If you are a Nigerian reading this post please share it with your friends (health professionals and the public) and encourage them to spread it in their own networks. Together we can generate swirls of AWARENESS and, who knows, a life saved could be that of your parent, spouse, sibling, friend – or your own.