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					THE PATIENT CHANNEL PRESENTS: THE DANGERS OF BLOOD CLOTS                                              1



Narrator
Every year, nearly a million people in the United States develop a problem with a blood clot
forming in a vein, which may put them at risk for serious consequences. An estimated 300,000
people die each year from the consequences of these blood clots.

The medical term for a blood clot forming in vein is a thrombus. A blood clot that obstructs the
blood flow in a major vein is called a Deep Vein Thrombosis or DVT. Often this occurs in a vein
in the leg.

Richard Friedman, MD Charleston Orthopedic Associates
“So depending on where the clot is it can fill the whole width of the vein. It can be a short
distance or can sometimes be the complete length of the vein in that segment of the leg - so they
can vary in size tremendously.”

Narrator
If a blood clot breaks off from a vein and travels in the bloodstream to another part of the body
it‟s referred to as an embolism. If it travels to the lungs it‟s called a Pulmonary Embolism.

A pulmonary embolism cuts off vital blood supply in the lungs and can be extremely serious or
even fatal if it goes undiagnosed or untreated. Each year nearly 200,000 people die as a result of
blood clots to the lungs.

Stephan Moll, MD University of North Carolina
“About a third of these deaths are sudden deaths where there‟s no warning but risk factors may
have been present. Two thirds of the clots have some symptoms beforehand but many of these
symptoms are not recognized and the diagnosis is delayed.”


Narrator
In order to diagnose Deep Vein Thrombosis or Pulmonary Embolism, a physician must first have
a high index of suspicion and that comes from thinking about the possible risk factors.

Stephan Moll, MD University of North Carolina – 2D Graphic
“I think the most important risk factors that people should be aware of are recent hospitalization
or major trauma. Two thirds of all clots happen in people who had a recent hospitalization.”

Alan Brownstein, National Alliance for Thrombosis and Thrombophilia
“Just being admitted to the hospital, where there's the potential for being immobilized increases
risk. These are individuals who need immediate attention, and immediate preventive measures
need to be taken to prevent clots in these individuals.”

Narrator
 For example: approximately 1. 2 million people will have hip or knee replacement surgery this
year. Since these patients will be hospitalized, it‟s important they discuss with their doctors how
best to prevent deep vein thrombosis. Quite often patients are treated ahead of time with
THE PATIENT CHANNEL PRESENTS: THE DANGERS OF BLOOD CLOTS                                             2


anticoagulant medicines, so-called “blood thinners” to help prevent clotting or they may be given
compression stockings to help the circulation in the legs. These prevention methods known as
“prophylaxis treatments” are so effective that without them a patient can be a great risk.

Richard Friedman, MD Charleston Orthopedic Associates
“In fact without any type of prophylaxis or prevention if you have a hip or knee replacement,
your risk of developing a clot is between 40 and 85%.”

Narrator
But with clearly identified prevention methods the risk of developing a DVT or pulmonary
embolism drops to around 2%.

Immobilization in a hospital isn‟t the only factor that puts people at risk for developing blood
clots.

Stephen Moll, MD, University of North Carolina
“Now, a third of clots happen in people who didn‟t have a recent hospitalization and people need
to be aware of the risk factors for clots and those would be birth control pills, pregnancy and
hormone replacement therapy, overweight, a family history of blood clots, long travel.”

Narrator – 2D Graphic
The symptoms and signs of DVT include:
      Swelling
      Pain and/or tenderness to touch
      Reddish or bluish discoloration
      And Skin warmth in the area of the clot

Natural Sound

Narrator
 Traci Wilkes Smith is an entertainment lawyer who lives in Brooklyn. About 8 years ago. Traci
was finishing law school, when she began to experience some unusual discomfort...

Traci Wilkes Smith, Patient
“The first symptoms that I had before I found out that I had a pulmonary embolism down the
road was a pain in my left leg. It was burning pain that was just low grade and continuous.”

Narrator
Traci‟s first diagnosis was a pulled muscle. But despite taking over-the-counter and prescription
pain relievers, her discomfort persisted.

Traci Wilkes Smith, Patient
“It was very restrictive for me because I wasn‟t able to walk and I started to have to drag my leg
around as a result of it. I knew that it was something that was not that normal to have because
I‟m thinking „I'm 25 why would I have this weird burning feeling in my leg?‟”.
THE PATIENT CHANNEL PRESENTS: THE DANGERS OF BLOOD CLOTS                                              3


Narrator
Doctors were unable to identify the cause of Traci‟s pain and she was left to wonder what was
wrong with her.

Up next we‟ll hear more about Traci‟s search for answers plus we‟ll list the warning signs of a
potentially fatal pulmonary embolism.

###

Narrator
Traci Wilkes Smith couldn‟t figure out why she had such persistent pain in her leg. She thought
perhaps a vacation trip to Florida would help relieve some of her stress and make the burning
feeling in her leg go away. But that‟s not what happened.

Traci Wilkes Smith, Patient
“And when I got down there I wound up on my back, lying on my back for the next couple days
in extreme pain. When I left Florida I was having shortness of breath. I couldn't walk that much.
So I was in a lot of physical pain. Couple of weeks later, I found myself sitting at home and
trying to breathe and I'm having a really difficult time breathing. And I thought to myself „You
know I have to go to the hospital again I can‟t just sit here and die.‟”

Narrator
Traci took one more trip to the ER. Doctors did a lung scan and saw that Traci had blood clots in
her lung that must have traveled there from somewhere else in her body. The news shocked her,
but she says she was grateful to finally know what was going on.

Traci Wilkes Smith, Patient
“When I got the diagnosis that I had clots in my lungs as well as in my abdomen I knew that I
was extremely lucky to be alive. Because I walked around for months in pain. So to get this
diagnosis it was more of a relief and I knew that I could be dead. So that‟s what was going on in
my head at that time.”

Narrator
What had happened in Traci‟s case was a clot developed in the deep veins of her legs. A piece of
that clot had broken off and traveled to her lungs causing a pulmonary embolism.

3D Graphic - Richard Friedman, MD Charleston Orthopedic Associates
“And so if the clot is large enough it can block off one complete lung and if the clot is larger it
can block off both lungs. And the real issue here is that sometimes the very first sign that you
have any type of venous thromboembolic episode going on is when a large clot heads to the
lungs and you drop dead suddenly.”

Narrator
However, there are warnings signs in people who have a pulmonary embolism.

2D Graphic - Jack Ansell, MD Lenox Hill Hospital
THE PATIENT CHANNEL PRESENTS: THE DANGERS OF BLOOD CLOTS                                              4


“Well, patients with pulmonary embolism can be quite sick. They have problems of severe
shortness of breath, they have chest pain, and they can be coughing up blood. If it's a major
obstruction it can lead to heart failure and it can be fatal.”

Natural Sound

Narrator
In Chapel Hill North Carolina, 40 year old Beth Waldron enjoys spending time with her family.
But when her son Evan was in pre-school, Beth developed some trouble walking and moving
around. She didn‟t know it then, but these were actually symptoms of deep vein thrombosis.

Beth Waldron, Patient
“I was the mother of a four year old at the time; I didn‟t have time to be sick. You know I can‟t
just stop because I don‟t feel well. The symptoms of deep vein thrombosis, which I had first,
began as just a very mild, muscle cramp feeling in my left leg, sort of the back of the calf. I
really thought I had just overdone it in the gym exercising. But as the days went on it became
more uncomfortable and more uncomfortable until eventually it was difficult to walk; it actually
caused me pain to walk.”

Narrator
A few weeks later, Beth began to feel chest pains. What she didn‟t realize was that she was
experiencing symptoms of a pulmonary embolism.

Beth Waldron, Patient
“When I came home from the gym, I went upstairs to change clothes and as soon as I got to the
top of the stairs, I felt a really sharp pain in my chest. My heart began beating very heavily, you
know I could really feel my heart beating in my chest and it became difficult to breathe.”

Narrator
Often patients with chest pain are first tested to see if the discomfort is related to their hearts. But
the possibility that the pain is caused by pulmonary embolism is often overlooked, and patients
may be sent home without an explanation for their symptoms. That misdiagnosis can be life-
threatening.
Still ahead we‟ll see what doctors found when Beth finally went to the emergency room because
of the pain in her leg and her trouble breathing.

###

Narrator
After several missed diagnoses Beth finally had the right tests that identified the cause of her
severe leg pain and difficulty breathing.

Beth Waldron, Patient
“So that‟s when the emergency room physicians did a Doppler ultrasound of my leg and found
that in fact I had a blood clot in my leg that stretched from midway my calf all the way up
through my thigh up into my hip area. So I had an enormous blood clot in my leg that was
THE PATIENT CHANNEL PRESENTS: THE DANGERS OF BLOOD CLOTS                                               5


basically breaking off in small bits and traveling through the heart and lodging in the lungs and
that‟s where the pulmonary embolism was coming from.”

Narrator
After receiving the news about her blood clot developing into a Pulmonary Embolism Beth was
devastated emotionally, but mentally determined to survive.

Beth Waldron, Patient
“And my first thought was wait a minute, I can‟t die, I‟ve got a four year old who needs me, you
know, this just cant be happening to me. So that for me personally was the most frightening
moment when I realized that here I have been walking around for several weeks with a blood
clot and at any moment I could die from it. That was just a very harsh realization.”

Narrator
Beth remembered one risk factor that increased her chances for deep vein thrombosis.

Beth Waldron, Patient
“About 6 weeks prior to my clot forming, I had started taking oral contraceptives. And what I
didn‟t understand then was that estrogen increases the propensity of the blood to clot and you get
the little insert with your birth control pills and it lists all the possible things that can happen and
blood clots is one of them but its not something that I really paid attention to or thought that it
applied to me because those inserts contain lots of warnings and instructions.”

Narrator
Beth also learned she has a genetic factor which increased her risk.

Jack Ansell, MD Lenox Hill Hospital
“About 10 years ago a hereditary factor was discovered called factor-5-Leiden, and factor 5 is a
clotting factor, Leiden is the city in which it was discovered, this occurs in about 6% of the white
population of the United States.”

Beth Waldron, Patient
“And had I known that I had this genetic mutation I probably would have never taken oral
contraceptives. So oral contraceptives by themselves may have not presented a problem. Factor 5
Leiden by itself may not have presented a problem. But the two together really increased my risk
for a blood clot.”

Narrator
People can develop deep vein thrombosis or a pulmonary embolism without any obvious risk
factors. 67 year old Steve Rodner did not act on his spontaneous leg pain for 2 weeks, but finally
did, because of his wife and a national news story.

Steve Rodner, Patient
“I got a sore calf which I ignored more or less and my wife maybe a week or two later saw that I
was limping and she said „Why are you limping?‟ and I said „I don‟t know I probably pulled a
THE PATIENT CHANNEL PRESENTS: THE DANGERS OF BLOOD CLOTS                                             6


muscle at the gym‟ not thinking that there is any problem. And my wife practices law in some
medical-related areas and she looked at me and she said „I think you‟ve got a blood clot‟.

A few days later I was in my gym working out and I was watching the news channel and they
had a story about Vice President Cheney and the story involved a DVT that he acquired on a
plane trip. And it gave the symptoms. And I said to myself okay maybe I should check it out.
Just to be on the safe side.”

Narrator
A Doppler ultrasound confirmed Steve had developed a blood clot in the deep veins of his legs.
He knew he faced a life-threatening situation, so he immediately went to the hospital. .

Steve Rodner, Patient
“When I first heard that I had a blood clot in my leg it was pretty scary because it's something I
had not had any experience with except that I was told that it can move up to my lung and
become a pulmonary embolism which is the big danger in having a DVT.”

Narrator
Being diagnosed with any type of potentially fatal condition can be frightening. Early diagnosis
and early initiation of therapy are key. Coming up, we‟ll discuss treatments for blood clots plus
find out about organizations that can be a resource for patients.

###

Narrator
The immediate goal of treatment for Deep Vein Thrombosis or Pulmonary Embolism is to keep
the clots from getting any bigger. With the number of anti-coagulants and medical therapies
available it is important that the proper method of treatment is selected because some blood clots
can be of greater significance than others.

Various anticoagulants … also known as blood thinners can be given to patients to help reduce
the risk of blood clots forming. But if a blood clot has already formed…either a deep vein
thrombosis or a pulmonary embolism, immediate action is necessary.

Stephan Moll, MD University of North Carolina
“If the symptoms are truly due to DVT or PE, waiting for a few days could be fatal. A massive
PE could happen. The individual could die. So number one I want individuals to be empowered...
Number two is when the individual presents to the physician, the physician needs to think: could
these symptoms be due to DVT or PE? And if the individual has certain risk factors, recent
hospitalization, etc. the suspicion is higher and the physician typically gets a Doppler ultrasound
to diagnose DVT, or a CT scan or a nuclear medicine scan to look for PE.”


Narrator
THE PATIENT CHANNEL PRESENTS: THE DANGERS OF BLOOD CLOTS                                          7


If the diagnosis of DVT or Pulmonary Embolism is confirmed patients are often hospitalized so
they can be properly treated.

Jack Ansell, MD Lenox Hill Hospital
“Once a patient is diagnosed with a DVT or pulmonary embolism they are often admitted but
today for a short period of time. They are given either an intravenous blood thinner called
heparin or subcutaneous blood thinner called a low molecular weight heparin.”

Narrator
As an anticoagulant blood thinner low-molecular weight heparin is a fairly new class of
treatment for deep vein thrombosis. This form of therapy is good options for patients with deep
vein thrombosis because of its ability for patients to self administer the injection.

Stephan Moll, MD University of North Carolina

“The goal of the acute treatment with either iv heparin or subcutaneously heparin is two-fold.
Number one to prevent growth of the blood clot. And number two is to prevent blood clots from
breaking off and causing death.”

Narrator

There are many clinical advantages of using low-weight molecular heparin which include
predictable blood levels and low risk factors for bleeding. Other emergency treatments include
surgery.


Jack Ansell, MD Lenox Hill Hospital
“In some cases blood clots are treated by surgery where the surgeon will go in and try to remove
the blood clot. And in some cases some patients are treated with what's called a filter which is
placed in a large vessel in their abdomen and it prevents any blood clots from traveling from the
leg to the lungs.”


Narrator
Most patients will remain on long-term treatment for deep vein thrombosis and pulmonary
embolism. The treatment most commonly used is an anticoagulant called warfarin that also goes
by the brand name Coumadin. It‟s a prescription pill that patients generally take once a day.

Richard Friedman, MD Charleston Orthopedic Associates
“In general we are talking about pharmacologic or drugs: agents that can help thin the blood and
decrease the risk of blood clots forming. And so you have an oral agent out there and you have
some agents that are injectables. And so both of those have their plusses and minuses. For
example the oral agent that we have is called warfarin. We've had it around for about 60 years.
So warfarin we know works but it has some problems.”

Narrator
THE PATIENT CHANNEL PRESENTS: THE DANGERS OF BLOOD CLOTS                                              8


The window between enough blood thinning to prevent clotting and too much that can cause
excessive bleeding is narrow. So patients on warfarin need to have their blood clotting levels
monitored on a regular basis.

Richard Friedman, MD Charleston Orthopedic Associates
“The injectables however have a lot of advantages in the fact that it‟s a fixed dose, you don‟t
have to monitor you don‟t have adjust the dose. But it‟s an injectable, it‟s a shot. And so clearly
patients can't be on that for long extended periods of time.”

Narrator
Traci Wilkes Smith had surgery and takes anti coagulants to prevent any future blood clots. But
the experience certainly had a dramatic impact on her life.


Traci Wilkes Smith, Patient
“I think the scariest part is knowing what could have happened to me and the fact that I had gone
so long without being diagnosed correctly. Now I have a filter in place now I'm on the right
blood thinners to prevent me from getting another blood clot. I feel as though I‟m on the right
track to being healthy.”

Narrator
The experts say physicians and patients must work together to reduce the risk of people having
DVTs or Pulmonary Embolisms. And organizations like The National Alliance for Thrombosis
and Thrombophlia (on the web at stoptheclot.org) are working to increase the awareness of the
dangers of blood clots.

Alan Brownstein, National Alliance for Thrombosis and Thrombophilia
“The big problem is that this country needs a wake-up call about what blood clots are all about,
what the public health burden is of blood clots in terms of illness and death in the United States.”

Narrator
Members of the organization want Congress to take a more active role in educating the public.

Steve Rodner, Patient
“I went down to Washington DC to advocate more legislation and better legislation and funds to
fund the public awareness programs so that people wouldn‟t run the kind of risk that I had.”

Traci Wilkes Smith, Patient
“The fact that so many people are dying per year as a result of having a blood clot, a pulmonary
embolism which is what I had, I wanted to get involved in an organization that is so proactive
and making a difference and getting the awareness out about this really important issue.”

Narrator
The US Surgeon General began a campaign to prevent deep vein thrombosis and pulmonary
embolism which increased the momentum to educate the public.
THE PATIENT CHANNEL PRESENTS: THE DANGERS OF BLOOD CLOTS                                            9


Alan Brownstein, National Alliance for Thrombosis and Thrombophilia
“There is good news because most of these blood clots can be prevented. But only if healthcare
professionals and patients and public and policy leaders in government take the actions that are
necessary to make sure all of these parties are empowered with the information they need to
know to make the best decisions to prevent blood clots.”

Narrator
And patients like Beth and Traci have a message they want to share.

Beth Waldron, Patient
“So I just would like people to be more aware. And it can happen to them and if you even
remotely suspect that you have a blood clot, seek medical help, don‟t delay, because delay can be
deadly. And that‟s something that I wish I had done, you know I wish I had been more proactive
and gone to my doctor sooner.”

Traci Wilkes Smith, Patient
“A piece of advice that I would give to someone who had the symptoms that I had is to be an
advocate for yourself. When you go to the emergency room and they say, you know what you
have a muscle strain, and you have this really weird symptom similar to what I had - that doesn't
really feel like a muscle strain, say you know what please order another test. Just continue to
fight and push the doctors.”

Narrator
People who develop deep vein thrombosis and pulmonary embolism have many challenges to
face but with the treatments available the outlook is very positive.

Steve Roder, Patient
“In terms of my own life I look forward to at some point in the next few years retiring. Not sure
exactly when and I'm not sure exactly what I'm going to do but I have some hobbies. I play
music. I‟m in a couple of bands locally where I live. A swing band and a concert band so I‟m
into that.”

Beth Waldron, Patient
“So for me, having gone through a life threatening situation, I think it makes me appreciate the
little things in life a bit more than I did. You know I enjoy just simply spending time with my
son, just simply enjoy working in the flowers or watching the birds or being in touch with nature.
It sort of reprioritizes what‟s really important in your life…so I‟m in a good place right now.”

This program was reviewed by

Bruce B. Dan, MD
Executive Medical Editor
NBC Hospital Networks

Stephen Moll, MD
University of North Carolina
THE PATIENT CHANNEL PRESENTS: THE DANGERS OF BLOOD CLOTS      10



For more information on Blood Clots please visit


The National Alliance for Thrombosis and Thrombophlia
@
www.stoptheclot.org

For a transcript of this program please visit our website @
www.thepatientchannel.com

				
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