Dr. Madhu Badireddy – Awareness is essential to prevent deadly DVT and VTE
By Faruque Ahmed
Venous thromboembolism (VTE) is one of the most known diseases that affect inpatients admitted to hospitals or other healthcare institutes. When the clots that form in the leg veins dislodge to the lungs, it causes a pulmonary embolism (PE).
Pulmonary embolism is common in a hospital setting and its complications are instrumental causing five to 10 percent of deaths in admitted patients. It is a challenging health problem, especially for patients undergoing treatment in hospitals.
Dr Madhu Badireddy, NRI physician attached with Christus Santa Rosa Hospital, Texax in US, said that health care providers in all clinical set ups will face some difficulties while managing patients with this illness.
“VTE has many risk factors elderly patients with immobility, surgical complications, trauma, malignancy, pregnancy, congestive heart failure and acquired defects in blood coagulation factors.
These risks are cumulative, putting most hospitalized patients at greater risk of having a pulmonary embolism. DVT (Deep Vein Thrombosis) is denied as blood clots in the pelvis, leg, or major upper-extremity veins. These clots can break off from the veins, travel through the heart, and lodge in the lung arteries, causing potentially deadly PE,” Dr. Badireddy said.
“A common parameter that makes the blood cells sticky is diabetes. A person who is both overweight and diabetic and one who does not move around a lot will have clots formed within the blood vessels, despite no injury in the wall of the blood vessel,” young Dr. Badireddy whose pioneering research works on DVT and VTE have been published in different medical journals felt.
His research papers have thrown lights in educating about DVT and its prevention in healthcare institutes for improving patients suffering from chronic illnesses for their fast recovery.
The greatest risk of pulmonary embolism occurs when a clot has formed in the thighs, calf muscles or pelvis. The blood flow s from these areas and then leads towards the lungs, where a detached clot can lodge in the pulmonary arteries. Clots in the veins of the calves or arms may also be associated with pulmonary embolism.
According to him, the gold standard for diagnosis of PE is CT pulmonary angiography CTPA, also called CECT (contrast-enhanced CT scan). Risk assessment for patients with morbid clots is a complex clinical challenge. If every patient admitted in the hospital and with potential risk factors for thrombosis were to be evaluated for pulmonary embolism, this would significantly contribute to hospital waste.
Significant clinical judgemental skills are required to evaluate at-risk patients. Furthermore, the use of X-rays in imaging and the use of toxic agents which can potentially harm the kidneys poses a significant challenge to precisely identify the at-risk patients. Frontline pioneering work was done for the first time in an original analysis by Dr. Badireddy and his team while serving his residency in Internal Medicine at St. Luke’s Hospital in Bethlehem, Pennsylvania.
In his innovative study published in The Journal of Community Hospital Internal Medicine Perspectives Dr. Badireddy has helped in establishing that computed tomographic pulmonary angiography (CTPA) was over employed in the evaluation of hospitalized patients with suspected acute pulmonary embolism (PE).
This was the first original study which identified the algorithm for patient evaluation.
In the latest published this year he has also replicated the earlier findings, attesting to the tremendously insightful data provided initially by him.Dr. Badireddy. The study involving cohorts of patients in the emergency room stated that 99 % of CTPA were negative.
The work of Dr. Badireddy has shown the medical community in thoroughly assessing DVT and PE, while at the same time using clinical methods. The major aim of treatment is to resist PE by reducing the propagation of an existing clot or preventing a new clot from forming and embolizing. A patient with confirmed PE may receive anticoagulants or thrombolytics or may undergo surgery.
PE remains the third commonest hospital-related deaths in most of the countries like the US. Half a million people are affected every year.
His intensive review elaborated on the treatment and prognosis of DVT. He suggested that venous stasis (immobility and congestive heart failure), endothelial injury (Surgery and trauma), and hypercoagulability (cancer, thrombophilia) can increase the risk of DVT. PE is one of the most common, but preventable, causes of death in hospitalized patients.
Only 50% of hospitalized patients receive DVT prophylaxis. Prevention of DVT in hospitalized patients decreases the risk of DVT and PE, which in turn decreases mortality and morbidity. DVT prophylaxis may be primary or secondary. Primary prophylaxis is the preferred method with the use of medications and mechanical methods to prevent DVT. Secondary prophylaxis is a less commonly used method that includes early detection with screening methods and the treatment of subclinical DVT.
DVT can be prevented and the ways are people should avoid situations where blood clots might form, such as while staying in a relaxed position in a seat for a long duration in a plane or car. Travelers are advised to leave the car or walk around the plane every hour or two and to exercise and relax their calf muscles to prevent blood stasis in veins.
Hospitalized patients are also advised to get out of bed as soon as possible. Compression stockings are applied to regularly squeeze the veins in the calf muscles of patients who are unable to walk.
Patients are treated with anticoagulants that inhibit one or more of the clotting factors. Although the potential side effects of these measures include bleeding, they have been shown to prevent thrombosis and save lives. Awareness of DVT and PE can be the best way to prevent this condition. Medical professionals have recognized DVT for almost 2 centuries, but till recently, only about half of Americans were informed about the disease, he added.
Historically, many prominent public figures have been afflicted with DVT but received little attention.
Lifestyle changes can avert the risk factors for venous thromboembolism. Problems are obesity, inactivity, and cigarette smoking. Nevertheless, most inquiries about DVT prevention come from patients who are in long haul air travel. Physician efforts, such as those advocated by Dr. Badireddy, are key to prevent morbidity arising out of this preventable condition.