In most peoples eyes deep vein thrombosis (DVT) and pulmonary embolisms (PE) are relatively new risks to our health. It’s a view no doubt fuelled by the fairly recent increase in international flights which has raised our awareness.
As most of you know I love old medical books as I find they have much more useful ‘hands on’ knowledge rather than pharmaceutical led education. My latest book is a 2nd issue that was printed in 1939. Naturally I’ve been keen to read up on any mention of blood clotting as I’ve heard that many modern doctors claim to be unaware of the thrombosis risk after surgery.
Back in the 30’s it was noted that lower limb surgery is always a cause of anxiety to the surgeon on account of the danger of the clot becoming detached and carried to the lung where it may block a branch of the pulmonary artery (PE).
Possible mechanisms were;
Slowing of the blood stream as a result of lowered heart action, prolonged confinement to bed, low metabolic rate and hypotension diseases and immobility.
Blood changes in which the platelets are increased post operation. Fibrinogen is also increased to help clot the wound.
Decreased coagulation time after the operation as the body attempts to close the wound.
The book suggests various methods to avoid post-operative thrombosis;
Early movement of limbs to enhance venous flow.
Avoidance of restriction to respiration which aides venous return from the limbs.
Thyroid extract to raise the metabolism and increase circulation.
Adequate fluid to avoid dehydration and the avoidance of high protein diets which raise platelet count and fibrinogen production.
The use of anticoagulant medication by continuous administration.
It’s seems that the recommendations of the 1930’s are still current today, although not always followed.