Thursday, June 9, 2011

Thromboembolic State - Thromboembolism

Overview, Causes, & Risk Factors

A thromboembolism is a blood clot that forms and then breaks off and travels through the bloodstream to another part of the body.
What is going on in the body?
When a person is cut or injured, the blood clots, or clumps together. This helps to stop the bleeding. Blood may sometimes clot when it is not supposed to, however. For example, a blood clot may form inside a blood vessel or the heart.
A thromboembolism occurs when a blood clot breaks off from where it has formed and travels through the bloodstream. Eventually, the blood clot will get trapped inside a blood vessel that is too small to let it pass. Blood is then unable to flow through this vessel. The lack of blood flow can damage the body parts that normally receive blood from this vessel.
What are the causes and risks of the disease?
The blood clots that break off and form a thromboembolism can be caused by a number of disorders, including:
  • damage to the blood vessels or heart, which can occur from injury, surgery, infections, heart attacks, and other causes

  • poor blood circulation, which can occur from severe congestive heart failure, severe varicose veins, and certain irregular heartbeats, called arrhythmias

  • lack of activity, which can occur during any prolonged illness, surgery, travel, or injury

  • "thick" blood that has a tendency to form clots. This condition may occur due to cancer, certain medications, pregnancy, and some inherited conditions.

  • Symptoms & Signs

    What are the signs and symptoms of the disease?
    The symptoms of a thromboembolism depend on the organ or blood vessel that has lost blood supply. Blood clots in an arm or leg may cause pain, swelling, and increased temperature in the affected area.
    A clot that travels to the lung is called a pulmonary embolus. This condition can cause:
  • chest pain

  • shortness of breath

  • rapid heartbeat, known as tachycardia

  • fainting

  • death

  • If a blood clot is formed in the heart, it can travel to almost any organ in the body. This could cause a stroke, which is a type of damage to the brain from lack of blood circulation. In other cases, damage may be done to an arm or leg, or a heart attack or kidney damage may occur. Other areas of the body can also be affected.

    Diagnosis & Tests

    How is the disease diagnosed?
    A thromboembolism is diagnosed based on a person's symptoms. Different imaging tests are done depending on where the clot is thought to be. An ultrasound test, called echocardiography, can often confirm a blood clot in the heart.
    If the person is having any trouble breathing or chest pain, a pulmonary embolus, is often suspected. In this case, the provider may order:
  • a chest x-ray to see if areas of the lung have collapsed

  • a pulmonary ventilation scan to see how gases are being transferred across the lungs

  • a pulmonary perfusion scan to check the blood supply to the lungs

  • If a stroke is suspected, the provider may order:
  • cerebral angiography, which shows the blood supply to the brain

  • a cranial CT scan

  • a cranial MRI

  • Once the diagnosis is confirmed, other tests are often done to figure out what caused the initial blood clot. Blood tests called the prothrombin time (PT) and partial thromboplastin time (PTT) are commonly done to check the blood's ability to clot.

    Prevention & Expectations

    What can be done to prevent the disease?
    Regular movement of the arms and legs, blood thinners, or special stockings are often used to help prevent blood clots in someone who is bedridden. A person with inherited causes of "thick" blood or arrhythmias is often given blood-thinning medications.
    What are the long-term effects of the disease?
    A thromboembolism can cause permanent organ damage and even death. Blood clots in the leg may cause long-term swelling and pain in the leg even after the clot goes away. Permanent brain damage from a stroke can leave people unable to walk, talk, or take care of themselves.
    What are the risks to others?
    A thromboembolism is not contagious and poses no risks to others.

    Treatment & Monitoring

    What are the treatments for the disease?
    Once the diagnosis of thromboembolism is made, medications are usually given to help treat the disorder. These may include "clot busting" medications known as thrombolytics. Blood-thinners, such as heparin or coumadin, may also be given to help reduce the chance of new blood clots forming.
    In some people, a special filter device is placed inside the main vein below the heart. This can help keep blood clots in the legs from traveling to the lungs and causing death.
    In some cases, surgery is needed to manually remove a blood clot. Other care may be needed for damage to different parts of the body. For example, those with a stroke may need someone to feed them or physical therapy for weakness.
    What are the side effects of the treatments?
    The most worrisome side effect of clot-busting or blood-thinning medications is serious bleeding. Sometimes this can cause bleeding into the brain. The filter procedure and surgery carry a risk of bleeding and infection.
    What happens after treatment for the disease?
    Further treatment may be needed for damage to different areas of the body in some cases. The cause of the thromboembolism may also need further treatment.
    How is the disease monitored?
    An individual on blood-thinning medications will be tested periodically with clotting tests. Any new or worsening symptoms should be reported to the healthcare provider.


    Author:Bill Harrison, MD
    Date Written:
    Editor:Smith, Mary Ellen, BS
    Edit Date:09/16/00
    Reviewer:Adam Brochert, MD
    Date Reviewed:07/01/01

    Harrison's Principles of Internal Medicine, 1998, Fauci et al.