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Pathophysiology Of Dvt Formation Health And Social Care Essay
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Deep Vein Thrombosis, also called (DVT or blood clots) occurs when a blood clot forms in a deep vein. Thus, that’s where it gets its name from. Part of a clot may break off and travel through the bloodstream to the lungs causing a pulmonary embolism (PE) and possibly, death. Both Deep Vein Thrombosis and Pulmonary Embolism are a major public health problem in the United
States. Estimates show that thousands of Americans have a DVT
or PE each year and that at least 100,000 people die as a result. (cdc.gov) Lots of people who have a DVT or PE also have other complications that can greatly impact their quality of life.
DVT is the result of a number of factors that include stasis of blood, endothelial injury and hypercoagulability of blood. PE is a major complication of DVT and occurs when a thrombus or blood clot detaches itself and is carried by the blood stream to the lungs.
Deep vein thrombosis is a cardiovascular disease in which a blood clot forms in a vein deep in the body. It is most commonly found in the lower leg or thigh. This disease is extremely dangerous because if the clot breaks loose, the embolus (loose clot) can travel into the pulmonary circulation where it gets stuck in the lungs, blocking blood flow back to the heart, also known as pulmonary embolism. Pulmonary embolism is defined as when a blood clot forms a blockage to any artery or vein that feeds the lungs. Blood clots inside a vein when a person becomes
immobilized and muscles are not contracting to push blood back to the heart. Because the blood is not moving fast enough, clots begin to form on the wall of the vein, which may grow to the point of completely blocking the blood from returning to the heart. Some other common names to DVT are: blood clot in the leg, Thrombophlebitis, Venous thrombosis, and Venous thromboembolism; this term is used for deep vein thrombosis and pulmonary embolism.
Proximal DVT carries a higher risk of PE than distal DVT. [J30, Havig]
We focused on proximal DVT because it is much more reliably detected by ultrasonography and is considered to be clinically more important.
[J53: 11,12, ç„¡è½K list,çœŸä¿‚ç”¨å…ˆæ”¹]
DVT can occur in any veins. (near neck, etc) However, it is not including in this literature review becauseâ€¦
Upper limb DVT is being reported, particularly associated with central venous catheters.
(K66, from J20:54)
After a stroke, blood clots can form in the veins of the legs (deep vein thrombosis, or DVT).
These clots can break off and be carried in the blood stream to the heart and lungs (causing pulmonary embolism).
What cause deep vein clots to form? Blood clot can form in veins when you are inactive. For instant, clots can form if you are paralyzed or sit while on a long journey. Surgery, injury and cancer also can damage your blood vessel and lead to blood clot. If DVT remain in the legs it can cause a few complications including phlebitis and leg ulcer also can lead to pulmonary embolism. Phlebitis is a condition which blood clots with inflammation in superficial vein was rarely cause serious problem but if blood
clot in deep veins happen require instant attention because it can lead to embolism.
This can be life threatening. [J30]
Deep venous thrombosis may lead to pulmonary emboli, a frequent cause of avoidable deaths. [K52, from J53:1]
The pathophysiological mechanisms underlying DVT include venous stasis and hypercoagulability linked to an increase in thrombin formation and platelet hyperactivity (Virchow 1858). [J30]
The occurrence of one or more factors of Virchow's triad (stasis of blood, endothelial injury and hypercoagulability of blood) in the venous system often leads to deep vein thrombosis (DVT) (Virchow 1858).
(å¦‚è¦æ‰¾PEçš„incidence & mortality rate (acute + Rehab) J43 P263 have)
Lower extremity DVT can be anatomically be divided into proximal DVT involving the popliteal vein and proximal veins or distal DVT involving the calf vein and distal veins.
DVT in the paralyzed legs of patients with stroke was reported as early as 1810 by Ferriar and again by Lobstein in 1833.
Pathophysiology of DVT formation
According to the Medsurg, Venous return is aided by the calf muscle pump. When the legs are inactive or the pump is ineffective, blood pools by gravity in the veins.
However, CT and MRI just such a waste when the disease is at an advanced stage because any of these examinations should be done in the early stage of disease. Based on Phlebol (2006), soleal vein was the most frequent site of DVT. At first, primary thrombi would be formed at soleal veins, then its will propagate to proximal veins. The proximal veins would be occluded by fresh thrombi, thereafter secondary thrombi were made at non-drainage calf veins. Paterson and McLachlin found that most venous thrombi consisted of two regions. One of it is composed predominantly of fibrin and trapped erythrocyte while the other one are composed mostly by aggregated platelets. The fibrin-rich regions that attached the thrombi to the vessel wall, while the platelet-rich regions localized further from the site of attachment. These show that activation of coagulation system come before
platelet activation and collection during the formation of venous thrombi (Lopez et al, n.d). Based on that information
, we know that the use of anti-platelets drug in venous thrombosis is very limited. Histopathology evidence in DVT shows that coagulation occurs on or nearer to the endothelial surface. When coagulation starts on the endothelial surface, platelets may be regrouped to the fibrin clot rich in thrombin through adhesive interactions and it will result to further thrombus growth.
Thrombus development is a local process. It begins by platelet adherence to the endothelium. Several factors promote platelet aggregation, including thrombin, fibrin, activated factor X, and catecholamines.
Deep Vein Thrombosis occurs when a blood clots forms in a deep vein in our body. DVT always happen in the legs but it can still happen in your arms, chest, or other areas of your body. The blood clot can block our circulation or lodge in a blood vessel in our lungs, heart, or other part of our body and can cause severe organ damage and can lead to death. This topic will reveal about every causes and risk factors that can lead
In addition, where the platelets adhere to collagen, adenosine diphosphate (ADP) is released. ADP is also released from the damaged tissues and disrupted platelets. ADP produces platelet aggregation that results in a platelet plug.
What is Deep Vein Thrombosis or well known as DVT. Did you ever heard about blood clot? A condition which a blood clot thrombus forms in a vein is known as venous thrombosis. Blood flow through the vein can be limited by the blood
clot, resulting in swelling and pain. Most commonly occurs in the deep vein in the legs, thigh or pelvis but it can still happen elsewhere in the body (Pai and Douketis, 2012). The larger veins that go through the muscles of the calf and thigh are deep leg veins. They are not the veins that we can see just below our skins, neither are the same as varicose vein. Deep Vein Thrombosis is most common in adults over age 60 but it can happen at any age as well. DVT usually can cause embolism when a part or all of the blood clot in the vein breaks off from the site where it is formed and travel along the venous system. DVT can lead to long lasting problem
. It can damage the vein and cause the leg to ace, swell, change color and leg
sores after years.
Deep vein thrombi vary from 1mm in diameter to long tubular masses filing main veins. Small thrombi are found commonly in the pocket of deep vein valves. As thrombi become larger in diameter and length, they obstruct the veins, the resulting inflammatory process can destroy the valves of the veins; thus; venous insufficiency and postphlebitic syndrome are initiated.
Regarding with DVT, its histopathology is quite complex to understand. Differential diagnostic considerations prior to thrombolytic treatment and surgery should include tumours. Definitive diagnosis can be achieved by a biopsy but CT and MRI also bring quite a role in diagnosing DVT
Newly formed thrombi may become pulmonary emboli. Probably 24 to 48 hours after formation, thrombi undergo lysis or become organized and adhere to the vessel wall. Lysis diminishes the risk of embolization.
Superficial thrombophlebitis (blood clot that forms in an inflamed part of a vein near the surface of the body)
Pulmonary emboli, most of which start as thrombi in the large deep veins of the leg, are an acute and potentially lethal complication of DVT.
Venous thrombosis is the process of clot (thrombus) formation within veins.
The exact incidence of DVT isn’t known, mainly because most studies done are limited by the innate inaccuracy of clinical diagnosis. Most DVT is unexplainable and usually resolves spontaneously without complications. Current information available
(prone to underestimate the true cases of DVT), say about 80 cases per 100,000 of the population occur yearly.(emedicine.medscape.com) That is equivalent to about 1 in 20 people that will develop a DVT at some point in their lives. Approximately 600,000 people are
hospitalized yearly with DVT in the United States. (cdc.gov)
Although this can occur in any venous system, the predominant clinical events occur in the vessels of the leg, giving rise to deep vein thrombosis, or in the lungs, resulting in a pulmonary embolus (PE).
Deep Vein Thrombosis can cause the blood flow in the vein is partially or completely blocked by the blood clot. The common site for DVT is in calf vein and a thigh vein is less commonly affected while DVT is rarely happen in other deep veins. There are few alternative names for
DVT such as thromboembolism, post-phlebitic syndrome or post-thrombotic syndrome. A pulmonary embolism is a life-threatening complication and long-distance flights may contribute to the risk of DVT or also known as economy-class syndrome. Coronary heart disease
, being overweight or obese, cigarette smoking, pregnancy, family history of DVT or
recent surgery or injury also can lead for DVT to happen. A DVT is often just a one-of event after a major operation has been done. However, some people who develop a DVT have an ongoing risk of a further DVT. If have a blood clotting problem or continued
immobility, then everybody are advised to seek for a medical care or take
anticoagulation such as heparin injection (after which they are prescribed warfarin) to avoid further complication.
In fact, about 90% of DVT are of the ascending type. The potential for embolism depends on the speed and the extent of the dynamic, ascending clot growing process. Almost all clinical PE originate from distal DVT.
Histopathology refers to the microscopic examination of tissue in order to study the manifestations of disease. Examination of a biopsy or surgical specimen by pathologist, after the specimen has been processed and
histological sections have been places onto glass slides also can well describe about the histopathology.
Only the remaining 10% are derived from clots without connection to the lower leg veins (eg. isolated iliac vein thrombosis, transfascial great or small saphenous vein thrombosis, subclavian vein thrombosis, or catheter-related thrombosis). [J58]
Damage to the epithelial cell lining of the blood vessel is one of the extrinsic factors triggering the clotting cascade.
There are three main ways in which DVT occurs. The first consists of decreased flow rate of the blood, secondly, damage to the blood vessels and lastly, an increased tendency of the blood to clot called (hypercoagulability). Aside from these three causes of DVT, there are several medical conditions
that can lead to this condition such as compression of veins, physical trauma, cancer, infections, certain inflammatory diseases as well as specific conditions such as stroke, heart failure or nephrotic syndrome (kidney disease
). There are several factors that can
increase a person’s risk for DVT
, including surgery, hospitalization, immobilization (such as having casts on), or during long haul flights. Other factors include smoking, being overweight, a person’s age and certain drugs (such as Estrogen). Pregnant women have an increased risk during pregnancy and during the postnatal period.
The damaged endothelium attempts to maintain vascular integrity by adhesion and aggregation of platelets. As the clotting cascade continues, the final step is the formation of thrombin, which leads to the conversion of fibrinogen to fibrin and the formation of a fibrin clot.
A condition which blood is thicker or more likely tend to clot than normal (thrombophilia) also can result in DVT. This is due to inherited condition such as V Leiden factor that increase the risk of blood clotting. Apart from that, hormone therapy or birth control pills also can increase the risk of blood clot.
(Arcangelo & Peterson, 2006) (from K84, J40: Arcangelo)
Abnormal blood clots that adhere to the vessel wall are known as thrombi. These are composed of blood cells, platelets, and fibrin. Arterial thrombi are composed mainly of platelet aggregates and fibrin.
When blood is not flowing as it should, there is a potential for it to clot. Blood in veins are continuously creating clots that are broken down by the body. If this balance is broken, significant clotting can occur. There are many situations where you
can be made susceptible to developing deep vein thrombosis. Times of immobilization such as sitting for long periods of time, hospitalization/surgery, lower leg...
Venous thrombi are composed of mainly red blood cells. The difference in composition is caused by the conditions in which the thrombus forms. In the artery, the blood flow is high in comparison with the low flow conditions in the vein.
DVT can also happen when the blood flow is sluggish or slow. Immobility or lack of motion can cause sluggish or slow blood flow. This condition always occurs after the surgery, bed rest for a long period and having a long journey that take a long time.
The thrombus may become large enough to interfere with blood flow within the vein or artery. (Mansen & McCance, 2002) (from K85, J40: Mansen)
If the thrombus detaches from the vessel wall, it becomes an embolus.
In Western countries, DVT occurs in 45% to 84% of patients after hip and knee surgery in the absence of prophylaxis (Stulberg et al, 1984) but there is a firm belief that the complications is quite rare in Asian patients
. Lack of awareness in Asia of a condition that become one of the main killer factors in West is due
to the faith that thromboembolic disease is rare in Asia. Since DVT always have been linked with post-operative so every patient that have undergoes surgery should take a good care of their health to avoid DVT. However, there are few opinions that stated DVT is rare in Asians and the first report was made by
Tinckler in 1964 stated that there is rarity of post-operative DVT and pulmonary embolism in Asians (Tun et al, 2004). A study that has been made in a few Asians country like Malaysia, Hong Kong and Japan also show that there is low incidence post-operative DVT has happened around this country.
This mobile clot travels thought the circulation until it lodges in a blood vessel that is smaller than the clot. Distal to this point, blood flow is blocked and tissues or organs are deprived of oxygen and nutrition.
There are several ways in which a physical examination can help to detect DVT. Some examples would be: measuring the circumference of the affected limb at a fixed point, (this would rule out edema), and touching the area of the stomach and intestines which often are tender. You can’t however, count on a physical exam to rule out the diagnosis of Deep Vein
(Mansen & McCance, 2002). The signs and symptoms associated with an embolus depend on the vein or artery where th clot becomes lodged. (from K85, J40: Mansen)
In 1856, Virchow described the factors that predispose to venous thrombosis, including stasis, vascular damage, and hypercoagulability.
A person will have DVT when a veinâ€™s inner lining is damaged. There are many factors that can lead to this injury. For instant it can be cause by physical, chemical, or biological factors. Besides, surgery, serious injuries, inflammation and immune responses also can be
the causes to it.
These three factors are referred to as Virchow's triad. Stasis of blood may occur because of immobility, age, obesity, or disease processes. Trauma (including surgery), intravenous (IV) cannulation, medications, and toxins are some of the many sources that may precipitate vascular damage.
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Hypercoagulability of the blood may be caused by various disease processes and medications. (Mansen & McCance, 2002) (from K85, J40: Mansen)
Why focus on DVT rather than PE and VTE?
A high proportion of patients with DVT also have subclinical PE. [K15, from J45:14]
Most of the PE results from DVT (please find literature to support)
Since lower limb DVT is the major origin of PE, and the characteristic of prolong bed rest of stroke, this literature review will mainly focus on the DVT at lower limbs.
The dose is appropriate because enoxaparin may be given at rate of 1mg/kg every 12 hours for acute impatient DVT treatment. Pt is 156lb which is approx. 70kg making this his appropriate dose.
Approximately two thirds of these are below-knee DVTs, in contrast to unselected (nonstroke) patients presenting with symptomatic DVT, in whom the majority are proximal. [J43]
Most studies show that PE seems to be much more common in patients with proximal and symptomatic DVT.
As a male, precaution should be taken because men tend to develop a DVT more often than women.
[K41, from J46:1]
Clinical symptoms of DVT were developed by six patients (oedema or pain of the lower extremity, no cases of PE). (out of 28, =214%) (J48's result)
Why stroke patient easy to have DVT
The general stroke population is at risk for DVT because of the following factors. First, there is an alteration in blood flow due to weakness in the lower limb and a resulting hypercoagulable state related to changes in the blood.
A study has been made in United Kingdom to represent Western hemisphere and Malaysia as Asianâ€™s representator. In UK, Sandler and Martin found that 9% of patients admitted to a general hospital died and 10% of these deaths were due to pulmonary embolism that originated from DVT of lower limb. Based on a study made in Hospital Universiti Sains
Malaysia, Malaysia on 45 patients, only one positive DVT confirm among 45 patients that have been observed. There is only 2.2% and this good result show incidence of DVT among patient in Asia is still low (Tun et al, 2004).
Second, vessel wall intimal injury occurs related to changes in blood and blood flow. Stroke patients may also have similar symptoms associated with DVT, such as swelling and Homan's sign, that may be misinterpreted as being related to the stroke.
While aPTT may be monitored in obese or patients with renal insufficiency, it is not typically necessary for deciding dosages. Instead patient weight typically is used to decide appropriate drug dosing for Enoxaparin.
Stroke patients are often bed-ridden, especially during the acute phase, because of paresis. [J50]
Most of the stroke patients are elderly. (age > ), while aging is a significant factors of the occurrence of DVT.
Patients with stroke are at particular risk for developing deep venous thrombosis (DVT) and pulmonary embolism (PE) because of limb paralysis, prolonged bed rest, and increased prothrombotic activity.
There are many people around this world that have experience DVT. About 2 million Americans have experienced DVT each year without they are realizing it. Based on Convenient option for DVT (2012), the exact incidence of DVT is still unknown in Malaysia but there is growing evidence that DVT is not uncommon in Asians. Based on autopsy studies, hospital audits of admission to major
hospitals and also subclinical DVT in high risk situations such as after major joint surgeries show that there is increment of the incidence. According to Prof Hatem Salem, Head of Department, Australian Centre for Blood
Diseases, there is grave misconception that DVT is rare in Asians because he finds out that Asians too are at risk of DVT (Convenient option for DVT, 2012). Commonly, DVT happen after post-surgeries and a few reports have appeared
with high incidence of DVT in orthopedic patients comparable to Western study. Dhillon, Askander and Doraisamy (1996) suggest that the present practice of withholding routine prophylaxis against thromboembolism in Asian patients undergoing
high-risk orthopaedic procedure should be reconsidered.
[J45 (also code at J51)]
Sioson et al.  reported 19 DVT events in the paretic limb, nine bilateral events and four contralateral in 32 patients prospectively followed. (K49 from J46:46)
Why important to prevent
WHO estimates that 15 million people have a stroke every year, and this number is rising. (K91, from J39:2)
Venous thromboembolism is a common but preventable complication of acute ischaemic stroke, and is associated with increased mortality and long-term morbidity and substantial health-care costs for its management.
Deep Vein Thrombosis is most common in the deep veins of the lower leg, (calf) area, and can spread up to the veins in your thigh. On the contrary, DVT can also first develop in the deep vein of your thigh, even more uncommon in other deep veins such as ones in your arm. Different people experience
different complications and symptoms.
(K92, from J39:6)
Without venous thromboembolism prophylaxis, up to 75% of patients with hemiplegia after stroke develop deep vein thrombosis and 20% develop pulmonary embolism, (K93, from J39:8) which is fatal in 1-2% of patients with acute ischaemic stroke and causes up to 25% of early deaths after strokes.
Main cause for stroke is blood vessel injury such as occlusion by thrombus or embolism, rupture of vessel wall due to aneurysm, disease of vessel wall or disturbance of normal properties of blood which leads to atherosclerosis. Of all strokes, 80% is due to infarction and 20% is due to hemorrhage (Fermie, 88).
(K94, from J39:9)
low molecular weight heparin and unfractionated heparin are therefore recommended in guidelines from expert consensus groups.10-14 (K95, from J39:10-14)
The best treatment for VTE is prevention. [J34]
Cause preventable death [J06]
Deep venous thromboembolism (DVT) is an important health issue in the hospitalized patients that leads to increased length of stay, morbidity, and mortality.
There are few symptoms to recognize DVT but often DVT occurs without any symptoms. The symptoms of DVT are related to obstruction of blood returning to the heart and causing a pooling of blood in the leg. Patient with DVT will
undergo swelling of the affected leg and the
leg may feel warm and look reddish. Apart from that, patient calf or thigh may ache or feel tender if it is been touch or squeeze or when stand or move. There are no symptoms appear if the blood clot is small and for some cases, Pulmonary Embolism is the first sign that confirm for DVT. Basically, it can be hard to detect DVT since some of the symptoms are same with other health problems
. Sign and symptoms alone are not enough to determine the DVT but when risk factor is take under considerable, then it can help to determine likelihood of DVT.
Early detection of DVT is important because of the risk of pulmonary embolism and its potentially fatal consequences. However, it is well known that clinical features of DVT and PE are notoriously nonspecific. [J09]
Despite improvements in prevention (SPARCL 2006), little progress has been made in treating stroke with specific interventions once it has occurred.
Since DVT symptoms are quite same like other health problem, patient need to undergo specific procedure and special test to confirm the diagnosis or rule out the other problem.
(K72, from J44)
the occurrence of venous thromboembolism was about two-fold higher in patients with an NIHSS score of 14 or more than in those with a score less than 14 (in line with previous studies25) (K99, from J39:25 + J39self)
Patients with intracerebral hemorrhage (ICH) or ischemic stroke are at high risk for development of venous thromboembolism (VTE).
A few incidences in Asians can be taken to make a comparison with the Western to show differences in frequency of DVT in this world. In developed countries of the Western area show that DVT and consequent pulmonary embolism is still becomes the number one threat to post-surgery while in Asian specifically in Malaysia show that there is still low incidence of DVT after the operation done.
(K103, from J29:1)
In comparison to patients with ischemic stroke, the risk for VTE is higher in the hemorrhagic stroke population. (K104, from J29:2)
Without preventative measures, 53% and 16% of immobilized patients develop deep venous thrombosis (DVT) or pulmonary embolism (PE), respectively, in this population.
There are many causes and risk of DVT that we are unaware of it for the certain time.DVT can happen anywhere in our body part and also can attack everybody in different ages but older people are more vulnerable to it. The most risky patient to have DVT is
after having a surgery because the blood can easily clot if it not cared in a good ways. Lack active persons also are in a
high risk of DVT since it will cause the blood to flow slowly and easily to clot. DVT also can be inherited and wrong pill intake also can result in DVT. In easy word, there are many causes and risks that can lead to DVT and every citizen around this world should take every safety precaution to avoid DVT.
(K105, from J29:3)
One study detected DVT in 40% of patients with ICH within 2 weeks and 1.9% of those patients had a PE.4 (K106, from J29:4)
Development of VTE in the patient with ICH adds further detrimental complications to an already lethal disease with a 1-month case-fatality rate of 35% to 52%.
In a nut shell, the incidence of postoperative DVT in Asian patients is not low as is commonly believed and also it is not high like we know. Larger studies are needed to settle this controversy and find out all the true fact regarding this matter. Based on study that has been made above, routine practice of withholding prophylaxis in Asian patients undergoing high-risk orthopaedic procedure should be reconsidered. We can conclude that DVT is
still low in Asians but we should be aware of DVT in the future because it is too risky to take this matter as small things.
5 (K107, from J29:5)
DVT also prolongs the length of hospital stays, delays rehabilitation programs, and introduces a potential risk for PE. (K108, from J29:6)
DVT prolongs hospitalization and increases healthcare costs.
Only half of the people that have deep vein thrombosis have the actual symptoms to indicate this disease. Common signs include swelling in the leg or along a vein in the leg, increased warmth in the swollen area, pain or tenderness in the leg when standing or walking, or red/discolored skin on the leg. Some people on the other
hand, are not aware of the deep vein clot until they have signs of pulmonary embolism such as shortness of breath, rapid breathing and/or rapid heartbeat, pain with deep breathing, light-headedness, chest pain, or coughing up blood.
DVT is the pathophysiological precursor of pulmonary embolism (PE). However, half of the DVT cases were asymptomatic. [J01, K1 from J37:18, J37,J27]. Approximately one third of patients with symptomatic venous thromboembolism (VTE) manifest pulmonary embolism (PE), whereas two thirds manifest deep vein thrombosis (DVT) alone.
Signs and symptoms occur vary depending on the severity of the condition and not all of these symptoms have to occur with deep vein thrombosis.
Moreover, death occurs in 6% of DVT cases and 12% of PE cases within 1 month of diagnosis. [J46, J27]
Clinically apparent DVT was reported in 1.7% to 5.0% of patients with stroke. Subclinical DVT occurred in 28% to 73% of patients with stroke, usually in the paralyzed limb. [J45]
The frequency of asymptomatic PE in patients with DVT to be 40%. [J50]
Prevention of VTE is highly effective in lowering the morbidity and mortality rate of stroke patients since PE accounts for up to 25% of post-stroke early deaths.
Patient is advised not to make any early assumption in having Deep Vein Thrombosis if they are undergo the symptom that stated above since there are a number of different conditions that can cause the same sign and symptoms like DVT.
Bounds JV, Wiebers DO, Whisnant JP, Okazaki H: Mechanisms and timing of deaths from cerebral infarction. Stroke 1981, 12:474-477.The rate of PE is likely to be underestimated because they are not routinely screened for, and autopsies are rarely performed.
Some of the symptoms are that one gets sudden and severe headache at any time of the day, one can feel dizziness. Loss of consciousness is mainly seen, confusion and slurred speech which can be mistaken as drunkenness, dribbling when trying to smile, speak or swallow due to paralysis or weakness of facial muscles, inability to speak and understand words when the frontal lobe of the brain is involved, weakness or complete loss of
ability to use one side of the body. Person can also suffer
from copious vomiting. The part of the body affected is the opposite side of the affected brain, so if the person is right handed, left sided stroke will affect...
Fifty percent of patients who die following an acute stroke showed evidence of PE on autopsy. [K68, from J13:7]
The annual incidence of DVT in the general population is estimated to be about 1 per 1000 (8), however, it should be noted that much of the published data are derived from patients who present with symptoms at medical institutions. Diagnosis of DVT has traditionally been based on clinical presentation, however, evidence from postmortem studies indicates that a substantial proportion of VTE cases are asymptomatic. [K10 from J55]
Clinically apparent DVT confirmed on investigation is less common but DVTs may not be recognised and may still cause important complications.
People with cancer or heart failure can also increase the risk for DVT. Usually, investigation looking for the cause of DVT may show cancer to be the underlying cause.
Pulmonary embolism (PE) is an important cause of preventable death after stroke [K67, from J13:4]
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