Immobilization

Immobilization is another common cause of thrombosis. And this includes immobilization for a long trip, immobilization by a splint or a plaster cast on one leg, for a low back pain, after a trauma or also (and especially) for acute or chronic disease. All diseases requiring bed rest for a few days pose a risk of suffering a venous thromboembolism (VTE).

That is why, we, the doctors usually insist that patients get up from bed and walk, or that at least they sit on a chair or a couch as soon as possible.

Similarly, for this reason, when these patients are in hospital, they often have daily injections of heparin (or recently also new oral anticoagulants). But we should all be very clear in that walking is the best way to prevent a VTE.

The causes of immobilisation vary with age. In young people, the most frequent causes are trauma and low back pain, while in older people it is the progressive decrease in physical activity, sedentary lifestyles and bed rest.

In these cases we need to carefully weigh the convenience or inconvenience of anticoagulant use to prevent VTE. Although when immobilization lasts a few days (or few weeks) we should consider that an anticoagulant treatment may be beneficial, but there must be a balance between the risk of the patient suffering a VTE and the risk of bleeding.

Injuries

Another cause of immobilization are injuries. Leg injuries occur frequently in all ages, mostly due to the practice of sports among the young population, and especially if they are forced to not support their leg on the ground. They are injuries ranging from a broken femur, tibia, fibula or ankle to a rupture of the Achilles tendon, fracture of foot bones and even ankle sprains and breaks of muscle fibers.

When injuries require immobilization, with a cast, a splint or with bed rest, this can cause the formation of clots in deep leg veins, which in turn can lead to a lung embolism.

When the injury only requires rest and immobilization without surgery, no preventive treatment is necessary, unless if there are other circumstances that increase the risk of suffering a thrombosis, such as age (over 40), varicose veins in the legs, obesity or being on oral contraceptives, or a previous episode of venous thrombosis.

If you need surgery, medical guidelines recommend prevention of VTE by administering low molecular weight heparin subcutaneous injections (or recently also new oral anticoagulants), a substance that prevents the ability of the blood to thicken and solidify. This treatment must be taken for at least ten days, or until the patient can regain complete mobility.

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