Join Dr Beverley Hunt, leading Thrombosis expert and Andrea Croft, thrombosis nurse specialist, ahead of National Thrombosis Week (7-12 May) as they discuss Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) and offer advice that could save your life.

Many people seem to be under the impression that a DVT and PE (Pulmonary Embolism) are completely different medical conditions and unrelated. In fact, a DVT is a thrombosis, usually in the leg, this can breaks off and travel to the lungs and blocks the blood supply there- a PE. National Thrombosis Week (NTW) is helping people to find the information on all aspects of thrombosis.

Joins us live online on Friday 4th May at 1430 to answer all your blood clot questions

H: Host, Karen Kaye
B: Dr Beverly Hunt, medical director, Lifeblood
A: Andrea Croft, specialist thrombosis nurse

H: Hello and welcome to the Healthcare Show brought to you by Lifeblood, I’m Karen Kaye. Now, did you know that blood clots kill around 25,000 people a year in the UK, and possibly as many as 60,000, that’s a phenomenal figure, that’s actually at least 5 times as many people that die from the MRSA superbug. Staggering figures isn’t it? But do you know what Deep Vein Thrombosis is? Do you know what blood clots are? Do you have any idea what a pulmonary embolism is? Can’t even say it – pulmonary embolism. Do you have any idea? Not many people do. There’s lots of myths around it, a lot of it are aware of the risks of flying, but most of us don’t really know the facts. It’s National Thrombosis week, let’s have a talk to some experts to find out a little bit more about the basics of this problem, it is a national problem. I’m going to talk to Dr Beverly Hunt who is a medical director of Lifeblood, and Andrea Croft whose a specialist thrombosis nurse. Welcome to the show

A: Thank you

B: Thank you

H: Now can you tell us Beverly a little bit about what a blood clot is, or is there a difference between an embolism, a blood clot – what is DVT?

B: Ok, well a blood clot is when blood solidifies and the blood can’t continue to flow through a blood vessel, and a DVT is when you have a blood clot, usually in the leg and it can be starting in the calf and it can go up to the thigh or even higher. And when you have that, the blood, which normally comes out of the leg through the vein can’t flow and so the leg will swell up, you might get pain, you might change colour, might become blue and be quite tender and hot. The problem with the DVT is not only can it leave you with long term problems in your legs after it’s healed up, but when you’ve got it, part of it can break off, travel round the blood vessels and block the blood supply to the lungs. If it’s a little one then you get a bit of chest pain and shortness of breath, if it’s a really big one, stops all the blood supply then I’m afraid to say it’s fatal

H: That’s scary stuff actually

B: It is isn’t it?

H: So a blood clot, essentially, let’s summarise – a blood clot can happen anywhere in the body

B: Usually in the deep veins

H: But DVT is usually in the leg

B: Yes

H: But it will impact eventually on your heart and circulation

B: Yes

H: Potentially be fatal

B: Yes

H: Does it have to be fatal?

B: No, only about 10% of pulmonary emboli are fatal, it just depends on how big the bit of clot that breaks off is and how much of the blood circulation it does block

H: Now we all know that flying or travelling carries risks of DVT, there’s been a lot of awareness recently for people, especially long haul travellers. Is that specific to people who are flying – what are the risks involved Beverly?

B: Well it’s amazing that the general public really associate DVT with travellers’ thrombosis, and particularly with flying although if you get on a train, if you get on a bus, even if you sit at your desks for very prolonged periods, and you’re immobile then you’ve got a risk of DVT, but in fact what we want to do in National Thrombosis Week this year is draw attention to the fact that actually the biggest risk of DVT is hospital admission, you just have to pick up your bag, walk through the doors of a hospital, you’re not very well which makes your blood sticky and you lie immobile for a few days, you’ve got a 17% risk of a DVT, which is huge. And then if you have a surgical operation, if you have a hip replacement, you’ve got a 60% risk, you have a stroke you have a 60% risk, so it’s really a very very high risk, much greater than long haul flight where maybe 1 in a thousand maybe in 10,000 people might have a DVT

H: Well those are actually quite scary facts, I must admit. We are going to allay your fears and find out what you can do to avoid that. This is an interactive show, don’t forget that, if you’ve got questions you’d like to put to Dr Beverley Hunt from Lifeblood or Andrea Croft whose a specialist thrombosis nurse, do drop them in and we’ll try and get as many questions in the show as we can. Now tell me it’s important, I think, to understand – we’ve created quite a fear here I think by talking about these phenomenal statistics. Can you tell me, Andrea, are there symptoms to something like this? How would you know if you’ve got a blood clot, if you get off a plane or if you’ve spent a lot of time at a desk over the years for example – is there a sign that you can detect that you think oh dear I might have a blood clot, or oh dear I might have DVT?

A: Well one of the first signs that you might get is you might get some pain in your calf, might get some swelling ,some heat, maybe a red area on the back of your calf – but sometimes people don’t have any symptoms at all. Ladies, years ago used to suffer a thing called milk leg after they’d had a baby, where the leg went white, and that was down to a deep vein thrombosis from childbirth. Some people don’t have any symptoms at all with regard to the symptoms in the leg, and the first thing they may know about it is when a piece of that clot breaks off – as Beverley has said – travels up then into the lungs and it might cause shortness of breath, you know some chest pain, might cough up a little bit of blood. And at that point then they would need to get seen to very quickly. More serious than that is if it’s an acute onset of shortness of breath, chest pain, and possibly death

H: So classical medical symptoms that would – should alarm you anyway really

A: Yes

H: Those are the sorts of things that really you would be going to an A&E department or possibly your doctor just to say look this isn’t the norm, can you check me out and hopefully they would detect a problem

A: Yes

H: Don’t forget if you’ve got questions for Andrea or Beverley do drop them over and we will get some over as many as we can during the show. I’ve got one in from Mark Monroe who says, “can you tell me Andrea, are there particular people who are specifically at risk from DVT or blood clots?” Is it an age group, is it a social thing, what sort of people are more at risk?

A: Hi Mark. Really anybody’s at risk of developing a deep vein thrombosis but there are some risk factors that we may carry with those which will increase the chances of you developing deep vein thrombosis, in certain situations and one of those key situations is, your own personal risk factors and immobility or illness or surgery. So if you were going into hospital to have an operation and you have an abdominal surgery that increases your risk of developing the deep vein thrombosis, you’re going to be immobile, there’s going to be some stasis in your blood, you’re also going to have surgical intervention which increases your risk of developing a clot, then add to that any personal risks that you may have. Now it could be that you’re over the age of 40, you could be obese, you could have members of your family who had suffered from a blood clot. If you’re a lady which you’re obviously not, but if you’re a lady and you’re on the pill, if you were undertaking HRT therapy, if you’d had cancer or were undertaking cancer drugs such as Tamoxifen, then all these things added together create an environment for developing the deep vein thrombosis and what we would like to do is to try and increase, people like yourself awareness of what the deep vein thrombosis factors are, so that when you do go into hospital to have surgery or if you become ill, that you can speak to the doctors and say ok I believe I’ve got these risk factors, what are you going to do for me to make sure I don’t develop a deep vein thrombosis?

H: Gosh that’s quite a list actually I mean you’re talking about people who might be more vulnerable to it, and there’s quite a lot of different factors there involved. We’ve had John from Lincolnshire whose dropped us a question, and he says “aren’t women more likely to get a thrombosis than men?” I think he’s just trying to feel a bit more comfortable actually!

A: Sorry John but no there isn’t really a precedent in women. It’s possibly because of the association with pregnancy, the pill, HRT that perhaps that would be a misconception, and I think perhaps Beverly could explain about the pregnancy –

B: As soon as you get pregnant, your blood gets very sticky and the risk of dying of a clot in pregnancy is the number one cause of maternal mortality ie. blood clots in pregnancy are the number one cause of death in women during pregnancy, and in fact the Royal College of Obstetricians have brought out very good guidelines so a lot of obstetricians are very aware of this and the death rate’s gone down considerably in the last 10, 15 years

H: Ok so let’s talk a little bit more about how people can be more knowledgeable and look after themselves and hopefully prevent being one of these statistics, which we don’t like at all, that’s the whole point here I think of National Thrombosis Week. Luke from Bristol says “what should I be asking my doctor, how can I be more aware of what I should do for my body, how I can avoid suffering from a blood clot?” Beverley you’re a doctor

B: I mean from day-to-day, if you’re mobile and you’re slim and you’re active and you follow a good diet, and you do what the government say, you eat your vegetables, and you drink in moderation, you’re not really at much great risk. It’s when you become immobile, particularly when you go into hospital. For example long haul flights have got some slight increased risk, so you’d be sensible and you would, whilst you are on the aeroplane you would exercise your legs so you would move your calf up and down so that you didn’t actually have any stasis in your legs, you’re letting the blood flow. Perhaps stand up whilst you are in the flight. It’s quite good for you, because sometimes you have something called cocket syndrome when you sit down the blood can’t get past this part of the body and you need to stand up to let the blood flow up, so on an aeroplane you might do those exercises every half an hour, an hour and stand up every couple of hours. That’s it really

H: It’s quite a lot to take in. If you want to recap on that don’t forget you can send in more questions, we’re talking to Dr Beverley Hunt whose the medical director of Lifeblood, the thrombosis charity, and Andrea Croft whose a specialist thrombosis nurse, they’re the people with the knowledge, they’re experts so if you’ve got any questions or even if you just want to sort of talk a little bit about symptoms or someone you know whose suffered from this and what you might do to avoid it, drop us a note, there’s a box below the screen here, just drop us a question, press send and we’ll get as many in of them as we can before the end of the show, but do it now, don’t run out of time, don’t leave it to the end. Now tell me a little bit, Beverley, there’s been all sorts of reports with statistics coming out – I know there was one recently by NICE –

B: Yes

H: Tell us a little bit about that, now NICE probably sounds better than it is –

B: Well NICE have been campaigning for quite a while now about the risks of hospital admission, and what we want is that every adult that goes into a hospital is risk assessed with a risk of deep vein thrombosis, and they get stockings, and or they get blood thinners so that they reduce their risk. And the chief medical officer has just come up a fortnight ago with some guidance and recommends that that is done, and is setting up a committee to actually implement this so that each trust will have to make sure every patient is risk assessed. And then NICE which set all the guidelines up for health professionals, they have produced some guidelines, and the guidelines are for reducing the risk in surgical patients, which is great, and they’ve recommended blood thinners and stockings, and they also, for the first time have said not to use aspirin, and it’s this strange fallacy, that a lot of people think aspirin reduces your risk of DVT, and it doesn’t really, it’s got a very poor effect, and you’ve got an increased risk of having gastric haemorrhage, so it’s said not to do that, and for the first time in England and Wales it said if you have a really big operation, so if you have a hip replacement, or you’ve got cancer and you have cancer surgery, that you should have the blood thinners for a month after you have had surgery to really reduce the risk down, because once your blood gets sticky after an operation, it stays sticky for quite a while afterwards, and you’re not really very mobile, are you, if you have a big operation, so you need to take the blood thinners for an extended period

H: In fact I think you’ve just answered Mike’s question, who sent us a question while you were doing that, saying “why don’t the current guidelines about thrombosis risk assessment in hospital go far enough in some ways?” And he wanted to know what they were, but do you think they go far enough?

B: They don’t go far enough because this is just surgical admissions, and the real problem is that there’s many more medical patients coming to hospital, so medical patients come in, they’ve got an acute illness that they don’t need surgery, and they sit in bed, and that’s the major cause of death in hospital, so we have lots of evidence out there, lots of studies which say these people should have blood thinners, and they’re not getting them. You know about 30% are getting them. And the Chief Medical Officer in his recent release did encourage everyone to use them. I think our concern as a charity is that some hospitals will be marvellous at doing it, and others won’t be as good and we want to make sure that every single patient in England and Wales gets these blood thinners

H: It’s always the case isn’t it, in hospitals, it’s always a little bit of a lottery

B: Yes

H: That’s healthcare in this country I think. Tell me a little bit, is there something that you can do if you are admitted to hospital and obviously you have lots of care going on. We know that the health service is under pressure. If you are a patient or one of your family members is a patient, would you encourage them if you can to just do these sorts of exercises and perhaps be as mobile as possible Andrea within the confines of their treatment?

A: Well certainly, but there needs to be more awareness, there needs to be more publicity so that the public can assess what their risk factors may be. When they go into hospital then, or when they are going travelling, they can identify those risk factors, they can discuss any concerns or issues they may have with their healthcare professional, with their surgeon, with their doctor, and say, “I think I might have risk factors here, do I need some blood thinning drugs?” We need to empower patients to be asking the question, should I be taking these drugs? There’s a huge amount of work going on around the country with different trusts, implementing thrombosis committees which are made up of multi disciplinary teams of hospital staff, and we’re developing our own assessment towards, you know for us in the hospital, so things are moving slowly forward, but we also need a patient to be asking the question, should I be getting some blood thinning drug? You know they can ask that question; it’s their right to ask

H: Well it is your right to ask a question, if you’ve got any more questions for Dr Beverley Hunt and Andrea Croft please drop them over to us, we’re running out of time but we can still squeeze a few in, so please don’t be afraid, be empowered as Andrea says, ask us questions, you’ve got the experts here at hand, but also feel empowered afterwards to talk to your doctor, or if you’re in hospital talk to your consultant and ask the questions that you perhaps need answering, because it can be frightening to be in hospital. Don’t be intimidated. Martine has sent us a question; she says, “I sometimes get achy legs” – now lots of people get that – “could this be a sign of DVT?” She says “I’m slightly concerned, what should I do, should I seek medical advice, what should I do if I get achy legs?”

B: Most people with achy legs don’t have DVT. Achy legs are due to all sorts of other things, so unless it comes on suddenly, just like that, I think it’s rather unlikely

H: Ok so it’s not necessarily a symptom?

B: No

H: Ok. Jamie Short has sent us a question as well, he says “my mum’s in a wheelchair and therefore not moving about very much. What should she be doing to prevent DVT?” Now that obviously she can’t necessarily get up and walk around, which is what Beverley was suggesting if you are able to do that, so what could she do to prevent any potential problems?

A: Well if she’s able to move from the waist down, she could do upper arm exercises, to increase the circulation from the upper part of her body which ultimately will affect the circulation all around. With patients who are immobile before they go into hospital, generally we wouldn’t be looking to treat those patients any differently, unless they had an exacerbation, an increased risk of developing a blood clot while they were in hospital. So really she needs to remain hydrated, doing her upper body exercises to keep the circulation going and unless they have any particular worries, if mum was to develop any swelling or any pain anywhere that she was aware of, then they just continue as they are

H: We have another question; Geraldine from Sutton says, “Are there any specialist thrombosis units in London?” Now I think this probably applies to lots of people watching today, how can you find out about specialist units in your area, presumably Lifeblood can put you in touch or there’s a reference source for them?

B: There used to be a shortage of experts in thrombosis, I think there’s now an increasing number these days, yes there are lots of centres now in London that particularly specialise in thrombosis, so she shouldn’t worry, she should go to her GP and get a referral

H: So it would be a case of going to your GP if you have concerns

B: Yes

H: Asking for a referral

B: Asking for a referral

H: Again, don’t be intimidated; ask the questions, that’s what specialists are always there for, so that’s an important factor. Johnny Brown from Whitley has sent us an email; he says, “I know that aeroplanes are common places to get DVT, but where are the other likely places?” Now you did cover this a little bit earlier in some form, but can you just reiterate – it’s not just aeroplanes is it?

B: I think the number one is hospital admission really because the risk is so high, especially if you have surgery or you’re very immobile. For example if you have something like a motorbike accident and you’re in intensive care and you’re ventilated and you’ve got lots of broken limbs, you’ve got nearly 100% risk, and it doesn’t matter what your risk factors were before, there’s such a powerful stimulus there because first of your injuries, so it has to be hospital.

H: Ok, tell me a little bit more about where people can get information, because obviously you’ve covered lots today, but it will have raised questions and people might be pondering this a little bit more, I think it’s quite important that they can find out more. Can you tell us how they go about, obviously GPs are a great port of call, but if you don’t want to go just to ask questions, how can you find out a little bit more about thrombosis and DVT?

A: Well you can go onto the Thrombosis Charity website which is thrombosis-charity.org.uk and there’s lots and lots of information on there, the risk factors are listed on there so they can have a look, they can download it, there’s information on pregnancy, there’s information on inherited conditions which increase the potential for sticky blood, there’s lots of information on there, there’s lots of activities going on during Thrombosis Week, lots of hospitals have anti-coagulation and thrombosis nurses, so if patients have got concerns, give a call to your local hospital, ask to speak to the anti-coagulation nurse or the thrombosis nurse, ask them if they can have any information, find out in Thrombosis Week if your GP surgery or your local hospital are giving out information, if there’s any paperwork. There’s lots and lots of places that you can get information, or you can contact the charity and pick up links from there, or download their information and take it from there

H: It’s a phenomenal amount of information to absorb. Beverley, just to reiterate, we’re talking really not just airlines aren’t we –

B: Yes

H: We’re talking travel generally –

B: And we’re talking about the 3.8 million people in this country that have an operation every year, and they are at risk of DVT and those that go into hospital with all sorts of other things are at risk. Please ask, please ask for blood thinners and stockings if you think you need them and discuss it with your doctor when you’re an inpatient

H: Well you’ve been privy to wonderful information here and a lot of expertise, but don’t forget if you’ve got any further questions do seek out help and look for that information, it’s all about awareness. Thank you very much to Dr Beverley Hunt and Andrea Croft for joining us today, it’s been very informative. Don’t forget click on the link at the bottom of the page, it’s been great to have you with us, this is the Health Show, I’m Karen Kaye

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