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TREATING
BLOOD CLOTS
REQUIRES FAST ACTION
People who have
been still for a long
period of time, such
as surgical patients,
are at risk for blood
clots. Compression
socks or stockings
help prevent clots
from forming.
14
HEARTBEAT
MAY/JUNE 2016
Photo: iStockphoto
Heart patients young and old are at risk
for blood clots, including those with
congenital heart defects. Know the
warning signs and get medical help fast if
you think you have one. By Scotty Fletcher
A blood clot is a gelatinous mass of
blood that changes from liquid form
to a semisolid state. Blood clots can be
life-saving when they help stop bleeding
— for instance after an injury. But when
they form inside a vein and don’t dissolve
on their own, blood clots can get into the
bloodstream and block the flow of blood
to the heart or brain, leading to a heart
attack or stroke. Clots can also form
when plaque deposits in the blood vessel
walls rupture.
In the medical field, a blood clot is
known as VTE, or Venous Thromboembolism. If the clot forms in the leg
or another deep vein, it is called Deep
Veinous Thrombosis or DVT.
Who’s At Risk?
Though VTE is most common in adults
60 and older, blood clots can occur at
any age, including in children. Clotting
When the clot
dissolved and the
bottom of my leg
got the rush of
blood it needed, it
was very painful.
— Lucien Dusablon
Photo courtesy of Sue Trinque
What Are Blood Clots?
A blood clot that breaks loose and
travels to the lungs is a Pulmonary
Embolism or PE. This typically occurs
after someone has been still for a long
period of time, such as during a long
flight or surgery, and can be deadly. DVT
is the main cause of pulmonary emboli.
Blood clots become dangerous when
they get into the bloodstream because they
can block the flow of blood to the heart or
brain and cause a heart attack or stroke.
Photo courtesy of Sue Trinque
W
hen Lucien Dusablon , of Mended
Hearts chapter 338
in Woonsocket, R.I., noticed the toes
on his left foot were changing colors,
he thought it was just a symptom of his
diabetes.
Dusablon, who became a member of
Mended Hearts in 2010 after recovering
from a blocked artery, has suffered from
diabetes for many years and chalked
the discoloration and leg pain up to the
disease.
“I thought it was the diabetes, but
when the doctor did a sonogram on my
leg, he saw that I had a blood clot behind
my left knee,” Dusablon says.
Dusablon was immediately admitted to
the hospital and given blood thinners. He
stayed hospitalized for six days until the
clot dissipated and he regained feeling in
his leg.
“When the clot dissolved and the
bottom of my leg got the rush of blood
it needed, it was very painful,” says
Dusablon.
From left: Raul Fernandes, Mended Hearts past president; Sue Trinque,
Northeast Assistant Regional Director; and Lucien and Colleen Dusablon
pose for a photo at a summer gathering.
MAY/JUNE 2016
HEARTBEAT
15
is more likely to happen in people who
are obese, smoke, take estrogens or birth
control pills, or have underlying conditions such as cancer or certain autoimmune disorders. Recent surgeries can also
increase risk.
Some people are more likely to form
blood clots because their blood is thicker
than normal because too many blood
cells are made by bone marrow. Others
are genetically predisposed to clotting,
though this is less common.
Seeking Treatment
Photo courtesy of Joseph Glaser, M.D.
The primary method of
diagnosing DVTs is an
ultrasound examination of
the leg veins called a lower
extremity venous duplex.
This exam checks the
leg for clots and tells the
patient’s doctor where the
clot is, how extensive it is,
and in some cases, how long
it has been there. It can also
be used to follow-up with
patients with existing clots
to see if they are improving,
stable or worsening.
The lower extremity
venous duplex is typically performed by a
trained ultrasound technologist and uses an
ultrasound probe to directly check the veins
in the legs. The exam involves no radiation
exposure and can be done in a variety of
locations. It is typically interpreted by
physicians with special training such as
radiologists, vascular surgeons, cardiologists
and certified vascular medicine experts.
Joseph Glaser, M.D.
“The presentation of DVT can vary,
but one of the most common presentations is leg pain,” says Dr. Joseph
Glaser, a nuclear medicine and vascular
ultrasound specialist with Radiologic
Associates, PC. “The patient’s legs
may be swollen or discolored, but that
doesn’t always happen. If you speak to
your doctor about persistent leg pain
and they send you for one of these
exams, it is a potential emergency and
should not be delayed so that if a clot
is found, treatment can be promptly
started.”
Though further work-up and treatment
may depend on other factors, the standard treatment for blood clots is to put
the patient on blood thinners for several
months, Dr. Glaser says.
Children and Blood Clots
Though blood clots are more common
in adults, children are also at risk for
developing clots — especially kids with
congenital heart defects. About 1 in
10,000 children get blood clots, including
as many as 1 in 200 children in hospitals,
according to Johns Hopkins University
School of Medicine.
Lindsey Bilodeau’s daughter, Madeleine, was born with a several heart
defects: Ebstein’s anomaly (which
involves a malformed tricuspid valve),
ventricular septal defect and coarctation
of the aorta. Madeleine had her first
heart surgery just five days after she
was born. One month after surgery, her
parents noticed that her heart rate and
breathing were elevated and pushed
Blood Clots
and Cancer:
Know the Risks
LEARN!
LEARN • ASK •
PREVENT
No Worrie
s:
What are the symptoms and
Patients with cancer are
at risk for developing blood
signs of DVT/PE?
clots.
This condition is called deep
vein thrombosis, or DVT.
DVT Often DVT/PE are silent and go undetected, but
occurs when a blood clot
typical
forms in a large vein. These
symptoms include:
clots
usually develop in the lower
leg, thigh or pelvis. Occasionally,
portions of the blood clot
Symptoms for DVT can
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include:
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16
HEARTBEAT
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Feeling Blue?
Why Does
My Baby
When too
much bilirubinLook Yellow?
body, the
builds up
skin
in your baby's
to be yellow. and the whites
of
these signs, This is known as the eyes may appear
jaundice.
contact your
pediatrician If you notice
Spit Up –
immediately.
Spitting up What’s Normal
As long as is a right of passage?
the baby
for many
gaining weight,
seems
newborns.
you shouldn’tcomfortable and
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is still
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baby shows
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How Can
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ms.
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Reduce the
risk of SIDS e (SIDS)?
backs to
by placing
sleep. Place
babies
and keep
them on
the sleep
a firm sleep on their
area. Be sure soft and loose objects
surface
not to let
your baby like bedding out
of
overheat.
How Much
Should
Newborn
babies sleep My Baby Sleep?
usually one
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Why Are
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Vaccines Immunizations
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If you don't very important to
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Is My Baby
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MAY/JUNE 2016
Congratulati
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Keep this resour
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ensure that
you
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y and safe.
Feeling Cooped
Up?
You can still
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with your for your precious even now that you're
pediatrici
bundle of
an
baby safe
joy. Consult
outside the for tips on how to
keep your
home.
Disease Control
and Prevention
Look for four special inserts about blood clots in this issue
of Heartbeat. You can also learn more about DVT and PE at
www.thisisserious.org.
Photos courtesy of Lindsey Bilodeau
Photo courtesy of Jennifer DeBouver
(Above, above right ) Children born with
congenital heart defects are at a higher
risk for developing blood clots than others.
Madeleine Bilodeau, who has Ebstein’s
anomaly, ventricular septal defect and a
repaired coarctation, developed a blood
clot one month after her first heart surgery.
Bilodeau recovered from the clot and will
celebrate her third birthday in December.
A blood clot may not be
the first thing that comes
to mind, and doctors
often misdiagnose the
symptoms [in children] as
a cold or the flu.
— Jennifer DeBouver
doctors to do an echocardiogram, which
uses sound waves to produce images of
the heart.
The test revealed that a blood clot had
formed on top of the Gore-Tex patch
that had been used to repair Madeleine’s
tricuspid valve. Within 24 hours of doctors finding the clot, Madeleine was back
in surgery to remove it.
“It was the most urgent we had seen
the doctors react,” says Bilodeau. “They
Jennifer DeBouver lost her son, Asher, to blood clots he developed from
his pic line after heart surgery. The DeBouver family now runs The Asher
James Congenital Heart Disease & Thrombosis Foundation to spread
awareness and fund research on children’s blood clots.
said that if the clot were to break off,
she could have brain damage or a stroke,
which could be fatal.”
Madeline, who will be three in
December, has not had another clot since
and is on a preventative aspirin regimen.
Jennifer DeBouver, MLH Bereavement Chair, lost her son, Asher, to blood
clots he developed from his pic line after
heart surgery. He was just six weeks old.
“Asher was born with several congenital
heart defects, but the clots turned out
to be a bigger issue than all of the heart
conditions combined,” she says. “Once he
developed the clots, the hematologist came
in and said that even though blood clots in
infant heart patients is somewhat common,
there is little research on how to best treat
them.”
Today, Jennifer and her husband run a
foundation — The Asher James Congenital
MAY/JUNE 2016
HEARTBEAT
17
Photos courtesy of Fredonia Williams
I didn’t know what a blood clot felt like —
I just knew that I didn’t feel right.
— Fredonia Williams
Heart Disease &
Thrombosis Foundation — to spread
awareness and fund
research on children’s
blood clots.
“I didn’t know what a blood clot felt like — I
The foundation
just knew that I didn’t feel right,” says Fredonia
worked with a
Williams, Ph.D. Her husband, Lincoln, urged
hematologist
her to go to the hospital. Not long after she
to create a card
arrived, physicians noticed that she had a
blood clot. She was treated by Dr. Warren
that explains the
Strickland (on left), her cardiologist and friend.
warning signs and
risks of blood clots
in children. They partner with Mended
Little Hearts of Chicago to include the
cards in hospital Bravery Bags for parents
of children with congenital heart defects.
“A blood clot may not be the first thing
that comes to mind and doctors often
misdiagnose the symptoms as a cold or
the flu,” says DeBouver. “We wanted to
give parents a heads-up so that they can
recognize the signs and symptoms.”
The cards, which are currently
distributed to five hospitals in Chicago,
are available through the foundation’s
website at www.asherjamesfoundation.org.
Don’t Wait. Be Proactive!
In May of 2008, after feeling unusually
fatigued, Fredonia Williams, Ph.D., President and Newsletter Editor of Chapter
260 in Huntsville, Ala., underwent a
cauterization for a leak in one of her heart
valves. She was scheduled to have the valve
surgically repaired in June. But on Mother’s
Day, when the preacher asked all of the
mothers to stand at church, Williams felt
an unusual pain when she stood up.
“I thought I had pulled a muscle in my
18
HEARTBEAT
MAY/JUNE 2016
groin area,” she says. “It just didn’t feel right.”
She still felt a little “off ” on Monday
and stayed home from work. Her husband urged her to call the doctor. After
examining Williams, the doctor immediately admitted her to the hospital, where
she stayed for five days on blood thinners.
“They did a sonogram and saw the
clot,” she says. “They wouldn’t even let
me get off the table. They rolled me on a
gurney to the hospital.”
The clot eventually dissipated and
the surgery to repair the heart valve
was done on schedule. Three days after
surgery, while in ICU recovering, Fredonia noticed some unusual bleeding. The
doctors discovered she had developed a
clot on the lining of her heart.
Fredonia went into sudden cardiac
arrest and was revived by a nurse. She
spent 28 days in the hospital recovering
— 21 of those days in ICU.
“I didn’t know what a blood clot felt
like — I just knew that I didn’t feel
right,” she says. “I was very lucky.”
When it comes to blood clots, listening to your body and being proactive is
critically important.
“When you notice something different
with your body — even it doesn’t seem
related to a blood clot — don’t ignore
it,” says Dusablon. “If something isn’t
normal, don’t wait. Tell someone and get
it checked out.”
For more information about deep vein
thrombosis and pulmonary embolism,
please go to www.thisisserious.org.