I'm frequently asked if taking aspirin will help prevent Deep Vein Thrombosis (DVT) in situations such as long haul international flights where there is a known increased risk of DVT.  Before answering this question it is helpful to understand some basic information about blood clots.

Blood clots arise due to thrombosis anywhere in the arterial or venous circulation. DVTs occur in the venous circulation.  Heart attacks and strokes occur due to blood clots in the arterial circulation.  Venous and arterial blood clots are very different.  

The process of blood clotting is thought to have evolved at least 50 million years ago.  Blood clots are composed of two components; a blood protein called Fibrin and particles in the blood called Platelets. Platelets aggregate together like a mesh and Fibrin acts like glue to hold it all together to form a blood clot.

Anything that might inhibit the development or activity of either Fibrin or Platelets will impair the formation of a blood clot. Modern medicine has come up with therapeutic methods that do this because a blood clot can be life threatening. Think Heart Attack, Stroke or Pulmonary Embolus. 

Aspirin interferes with Platelet aggregation by irreversibly inhibiting Thromboxane A2, which makes it useful in preventing arterial blood clots which cause heart attacks and strokes.  But Aspirin does not interfere with Platelet aggregation mediated by Thrombin which explains why it is not effective in preventing DVT which occurs in the venous system. 

Heparin and Clexane do interfere with Thrombin generation and therefore are effective in preventing DVT. 

If you are going on a long haul flight and want to minimize the risk of DVT then wear compression stockings, take a walk up and down the aisle for ten minutes every few hours.  Also, make sure you drink plenty of fluids - that way you'll need to walk down the aisle to go and visit the loo!

Posted
AuthorNicholas Kemp

A person aged 65 years can now often look forward to a life expectancy well into or beyond their 80's.  Varicose veins might not cause any physical symptoms however over time they will become progressively larger.  

This can result in tissue damage to the skin around the feet and ankles because of the lack of oxygen and the buildup of toxic waste metabolites. The concern about this is that the skin may breakdown and ulcerate.  

Varicose ulceration is the end stage of varicose vein disease and it is a debilitating complication because of the discomfort and substantial inconvenience (if left untreated) required due to the long term involvement of nursing care in wound management.  

Fortunately The Leg Vein Doctor at its Brisbane and Toowoomba clinics offers various treatment options that can prevent the eventual complication of varicose ulceration.  Age is hardly ever a barrier for appropriate treatment if there is a risk of venous ulceration of the legs. 

Patients already presenting with venous ulcers can still undertake treatment, if recommended. The venous ulcer is carefully monitored post treatment and healing should be complete in 6-12 weeks  given the correct selection of dressings and compression therapy.  

Compression therapy is considered the most important conservative modality in the treatment of venous ulcers, this has been well established by a number of randomised controlled trials* . This is not new news! Hippocrates (450-350 BC) treated leg ulcers with strong bandaging as described in his book Corpus Hippocraticum**.

Sadly many suffering with venous ulcers remain confused about the treatment options available to them. Often believing that an ulcer is just something they need to tolerate for the rest of their lives.

Photographs of venous ulcers
 

* Goldman M.P, Bergan J.J, Guex J-J. et al. (2001) Sclerotherapy Mosby Elsevier

** Myers K, Hannah P.  (2018) Manual of Venous and Lymphatic Diseases  CRC Press

 

Posted
AuthorNicholas Kemp

The most common type of sclerosants used in Australia today for the treatment of varicose veins and spider veins involving the legs are the detergent sclerosants. These are small lipid soluble molecules which can theoretically pass into breast milk in minute amounts. There is no evidence that they will do any harm to the baby but then again there is no conclusive evidence regarding their safety. 

However detergent sclerosants are very quickly metabolized by the liver and excreted by the kidney, so it is safe to resume breast feeding very soon after treatment.  At The Leg Vein Doctor we recommend to breast feeding mothers that they use a breast pump and store expressed breast milk prior to treatment which can then be used for the first feed after treatment. Normal breast feeding can resume twelve-twenty four hours after treatment.

Hypertonic saline is a less commonly used sclerosing agent, but it is safe to use during breast feeding.   

Posted
AuthorNicholas Kemp

The Leg Vein Doctor has been recognised with an annual award based on patient service excellence ratings from healthcare search engine WhatClinic.

WhatClinic looked at 12 months of data from users of its site, in relation to Dr Kemp's practice including patient review scores, feedback data and clinic contact rates. In 2017 over 15 million people visited the comparison site to find and compare clinics.

The Leg Vein Doctor in Brisbane & Toowoomba was only one of a small number of clinics on the site that met the exacting standards needed to qualify for the award. Not only must the clinic have a consistently high ServiceScore™ rating to qualify, the rating measures the clinic’s commitment to customer service over a whole year, and so represents long term commitment dealing with patients. Less than 2% of clinics on the site qualified for the award this year.

Dr Nicholas Kemp today said; “We are delighted to be recognised for our commitment to customer service by WhatClinic for the 4th consecutive year. Quality and care are the cornerstones of our phlebology practice and we pride ourselves on being able to offer the best service we can to each and every patient. It is wonderful to get feedback first hand from our patients that we are meeting these goals ”

WhatClinic CEO David Roe congratulated The Leg Vein Doctor and said “The WhatClinic Customer Service awards have now run for nine years.  In 2018 we are now including tens of thousands of ratings of patient to clinic phone calls, rating clinics on their politeness, helpfulness and customer service over the phone, as well as through email, online and in person.

Ratings are useful to both consumers and clinics. Consumers can see which clinics have rated well with lots of other users, and Clinics can evaluate their own performance against others in their market, ideally with the goal of getting better and better at serving their patients, which is ultimately good for everybody. "

Posted
AuthorNicholas Kemp

The speciality of phlebology has developed to enable physicians sharing an interest in venous disease and health to share knowledge and experience despite being trained in a variety of backgrounds such as dermatologyvascular surgeryhaematology, interventional radiology or general medicine. Diagnostic techniques used include the patient's history and physical examination, venous imaging techniques in particular vascular ultrasound and laboratory evaluation related to venous thromboembolism.

A significant part of a phlebology is involved with the treatment of superficial venous disease, frequently of the leg. Conditions often treated include venous stasis ulcers, varicose veins and spider veins (telangiectasia). Other conditions managed by phlebologists include deep venous thrombosis (DVT), superficial thrombophlebitis, and venous malformations.

From WikiPedia

Posted
AuthorNicholas Kemp