Immobilization and VTE
Immobilization due to a sedentary lifestyle, after trauma or because of acute or chronic disease promotes thrombosis and pulmonary embolism.
Immobilization is another common cause of thrombosis. All diseases requiring bed rest for a few days pose a risk of suffering VTE. This includes immobilization for a splint or a plaster cast on a leg, low back pain, an acute or chronic disease, after a trauma or a long trip.
That is why, doctors usually urge patients get out of bed and walk, or at least sit up on a chair or a couch as soon as possible.
The causes for immobilization vary with age. In young people the most common causes are injuries, while in the elderly the progressive decrease of physical activity, i.e. a sedentary lifestyle or being bedridden are the most common reasons.
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 DVT and the risk of bleeding.
Another cause of immobilization are injuries. Leg injuries, such as a broken femur, tibia, fibula or ankle, rupture of the Achilles tendon, fracture of foot bones, even ankle sprains, and tears in muscle fibers, often occur at all ages. In the young, mostly due to the practice of certain sports.
When injuries require immobilization, it may cause clot formation 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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