Blood clots and surgery. Why we care so much.

Why do people die after surgery? One of the most common issues is from a blood clot. The clot forms in the leg and then travels to the lungs. If big enough, you can’t exchange oxygen in the lungs.  Without oxygen, you can die.

So we care about it. A lot.

Please see all my blogs on DVT, PE, Caprini risk score HERE.

I just was reading some science literature, and they had an article “the role of pretest probability in the evaluation of suspected venous thromboembolism.” Not a catchy title, but they were summarizing blood clot risk. Pearls from the article:

• 60-100,000 people die of blood clots yearly
• The presenting signs and symptoms are often vague and nonspecific
  • • in DVT, the finding of leg swelling is 97% sensitive but only 33% specific (meaning most people with swelling in their leg do NOT have a blood clot)
    • Pain is 86% sensitive, but only 19% specific
    • Warmth is 72% sensitive and 48% specific
    • PE (pulmonary embolus) symptoms are all nonspecific: cough, chest pain, pain with breathing. 50% of these patients have leg blood clot findings. Oxygen saturation may be NORMAL. Pulse may get faster and there may be nonspecific EKG changes.
• How do you test for it?
  • • Bloodwork like D dimer (this can be seen for other things, better for use in outpatient setting and should be adjusted for age, as D dimer goes up with age)
    • CT pulmonary angiogram,
    • Venous complete duplex ultrasound of the legs showing clots. Highly accurate.
• Risk factors: recent surgery, obesity, previous clot, malignancy, estrogen therapy (hormone replacement, birth control, any form of hormone), and possibly testosterone therapy.
• Look at the Wells test.
  • • DVT Wells test: Wells’ Criteria for DVT – MDCalc Score of 3 or higher is high risk for DVT.
    • PE Wells test: Wells’ Criteria for Pulmonary Embolism – MDCalc Score of 4 or higher PE is likely.

For more on the Wells criteria, see my other blogs.