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Tara Lipinski Skates Past DVT

By Mike Falcon, Spotlight Health
With medical adviser Stephen A. Shoop, M.D.

Figure skating diva Tara Lipinski accepted her Olympic gold medal with total elation. But her joyous smile hid the pain caused by a damaged hip that later would require surgery - and put her at risk for a little known but potentially deadly condition called deep vein thrombosis (DVT).

"I was skating in pain at the Olympics, but I didn't want to say anything," says Lipinski. "There was so much media attention; I didn't need something else about an injury out there."

Two years after her 1998 Olympic triumph at age 15, Lipinski and her body could endure no longer. Her signature triple-triple jumps had taken their toll.

"I was feeling some aches and pains but was still able to skate," says Lipinski, recalling the events leading to her operation. "This was going on for a month or two. But then I went into a jump in practice and it just popped and my whole leg went numb. At first I thought that my leg was paralyzed. I couldn't get off the ice. They had to carry me off."

Preparing herself for hip surgery to repair a torn labrum, Lipinski learned that a possible surgical complication was developing a DVT. Such a thrombus, or blood clot, usually occurs in the legs, but is also seen in the pelvic, arm, or neck veins. The term "deep" is used to distinguish from the superficial veins that lie just beneath the skin. DVT refers to clots in the larger, major veins located deep in the muscle layers of the body.

"Frankly, I had never heard of DVT before," says Lipinski, who is part of a national campaign sponsored by Aventis Pharmaceuticals to help raise awareness of this life threatening condition.  Aventis manufactures one of the medications that is used to treat and prevent DVT.

Nor was she previously aware of how serious a DVT can be. When a clot forms in deep veins, pieces can break off and go through the heart and into the lungs to obstruct a pulmonary artery. This can produce a fatal pulmonary embolism (PE) as the patient dies of oxygen deprivation.

DVT basics

Approximately 2 million people in the USA develop a DVT each year, according to the American Heart Association.

During the same period about 600,000 will be hospitalized for a PE, according to Dr. Donald Schreiber, research director, division of emergency medicine, Stanford University Hospital.

Estimates from various sources show that up to 200,000 people in the USA die each year from a PE.

Writing in the January 14 issue of eMedicine Journal, Schreiber notes that approximately one person in 20 develops a DVT at some time in their life. While "most are undetected, small, and dissolve on their own without incident, approximately 10% result in a pulmonary embolism," according to Schreiber.

There are over two dozen documented risk factors for developing a DVT. According to Dr. Joseph A. Caprini, director of surgical research at Evanston Hospital and professor of surgery at Northwestern University Medical School, the most common ones include:

  • History of DVT
  • Cancer
  • Immobility
  • 40 years of age or older
  • Surgery, especially hip or knee, within the past month
  • Long bone fractures or other trauma within the past month
  • Illnesses such as inflammatory bowel disease, emphysema, pneumonia, and lung disorders
  • Oral contraceptives and many hormone replacement therapies

Caprini notes that age is also a risk factor for developing a DVT, although that needs a little clarification: the older we are, the more likely it is we will have had surgery, thus increasing our risk for DVT.

"Over 1% of all people over age 75 will develop a clot," notes Caprini. "Young healthy people under 40 with no other risk factor have a 1-in-20,000 chance of developing one." 

Why, then, would Lipinski and her doctors be concerned?

Lipinski's deep tissue hip surgery is just one risk factor, but it's a leading one. Caprini says about 80% of hip replacement operations result in a clot, making that procedure and other deep-tissue hip operations statistical risk leaders.

Possible internal bleeding from Lipinski's injury was another risk factor. Additionally, she knew she had extensive air travel in front of her. "My doctor made it very clear that he did not want me to fly," says Lipinski.

Many experts caution that air travel over four hours and confined seating where legs and feet are tucked under and immobilized are significant risk factors.

"Air travel is one area we are particularly interested in," says Caprini. He is currently conducting an online DVT risk assessment involving people who fly. "Risk assessment is the key in preventing deep vein thrombosis, if you're getting on a plane, or having an operation."

Preventing DVT

Calf-length anti-embolism stockings and a manual exercise foot pillow - along with more legroom - are recommended by Caprini for people with three or more risk factors who do lengthy travel by air. Special foot and calf pneumatic compression devices also help. Oral anti-coagulants like coumadin may prevent DVT as well.

Caprini suggests that some air travelers with three or more risk factors might consider with their physician taking low molecular weight heparin (LMWH), a few hours before flight, although this "off label" application has yet to been approved by the Food and Drug Administration.

Lipinski took a LMWH for two weeks following her surgery.

LMWH's are anti-coagulants derived from unfractionated heparin.  According to Caprini, while unfractionated heparin is also an anticoagulant, "it can take a bit of adjustment to get people into appropriate range." Unfractionated heparin additionally requires intravenous administration and as long as a two-day hospital stay.

"It [LMWH] is a more pure product that focuses on its anticoagulant properties," explains Caprini. "One subcutaneous injection of low molecular weight heparin at the right weight base for the patent will completely protect that patient within four hours -- without an I.V. and without any blood tests."

In the USA, LMWH's are now routinely given after certain surgeries - hip and leg operations among them -- in order to minimize the risk of bleeding.

But this post-surgical practice isn't uniform. A 2000 study found that 48% of hospitalized patients who developed DVT or pulmonary embolism did not receive preventive treatment.

"I had no idea about any of this - the risk of clotting and what could be used to prevent it - before this," says Lipinski. "But the surgeon sat down with me and he told me how very important it was I take these shots in my leg."

Lipinski followed her surgeon's instructions and came through her operation without a hitch. Just two months after the operation, she was back skating - with the possibility of a DVT safely put on ice.

Still, "Going through this experience, living with the threat of DVT, helps me relate to everyone who is in danger," says Lipinski. "I didn't have any idea about it. My parents didn't have any idea about it. And it affects millions of Americans who don't know anything about it either. So I want to spread the word."

For more information about blood clots, click here.

Spotlight Health is the leading creator of celebrity-featured health-issue awareness campaigns, connecting consumers with impassioned celebrities whose personal health battles can open eyes, dispel myths and change lives. Spotlight Health helps sufferers and caregivers meet the challenges of difficult health circumstances with understandable, in-depth medical information, compassionate support and the inspiration needed to make informed healthcare choices.

Created: 10/30/2002  -  Mike Falcon and Stephen A. Shoop, M.D.

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