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Leg Clots May Not Travel to Lungs
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Page: << Prev | 1 | 2 Ansell also pointed to what he believes are several shortcomings in the study.
"There are still some issues that could account for why they didn't see DVTs," Ansell said. "The screening methods may not be ideal [and] small clots in calf veins are difficult to visualize by various techniques."
"Having said that, there certainly is the possibility with certain types of injury that there could be clots formed just primarily in the lungs and not necessarily travel from other spots," he added.
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Velmahos felt that he had already excluded potential reasons for not seeing lower-extremity clots in pulmonary embolism patients, and said he is "very confident that a correlation cannot be established." Yet he also acknowledged that "every retrospective study [which this is] should be viewed with a grain of salt."
More studies need to be conducted, particularly to explore the hypothesis that pulmonary emboli actually form first in the lungs.
If it turns out that DVTs do not travel far from the legs, do tiny filters now used to trap them remain useful therapy? One expert said that issue may be a minor one.
"Pulmonary embolism and DVT are huge problems in trauma patients. The question is how to treat them," said Dr. David Gillespie, a professor of surgery at the University of Rochester Medical Center. "Anticoagulants such as heparin have been the standard of care... The interpretation here should not be that all filters are bad [but] anticoagulants should be the main therapy."
Finally, even if DVTs don't detach and travel to the lungs, "this does not mean that DVT is unimportant," Ansell said. "It is clearly established that most or many pulmonary emboli do originate in the legs in the lower extremities and one still needs to provide appropriate anticoagulant [blood-thinning] prophylaxis in patients who are at risk, whether they are trauma patients or just patients immobilized for other reasons in the hospital."
More information
There's more on deep vein thrombosis at the U.S. National Heart, Lung, and Blood Institute.
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Copyright © 2009 ScoutNews, LLC. All rights reserved.
Last updated 10/20/2009
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SOURCES: George Velmahos, M.D., Ph.D., chief, division of trauma, emergency surgery and surgical critical care, Massachusetts General Hospital, professor, surgery, Harvard Medical School, Boston; Jack Ansell, M.D., chairman, department of medicine, Lenox Hill Hospital, New York City;
David Gillespie, M.D., professor, surgery, University of Rochester Medical Center, New York; October 2009 Archives of Surgery
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