Prevention of Embolic Attacks
Prevention of embolic attacks on the lungs (venous) or other organs (arterial) is accomplished via long-term maintenance anticoagulation therapy for those already diagnosed with thrombotic disease. Even so, there are those who have recurrences of thrombosis or embolism, and their prevention can necessitate invasive procedures such as an inferior vena cava filter to catch migrating venous emboli before they get to the heart. Blockage of coronary arteries may require stenting (revascularization).
Those at risk for thromboembolic disease, whether or not they are on anticoagulants, should alter their day-to-day activities to hedge their risks:
- A strong family history of thrombosis, hypertension, or cardiovascular disease should alert someone to undergo blood tests for gene mutations before getting pregnant or beginning any hormonal medications (post-menopausal estrogen replacement or oral contraceptives). The same prevention strategy is advised for elderly patients with such a family history.
- Anti-embolic stockings should be worn for those suffering from varicosities or venous stasis/insufficiency.
- Implement a “stand goal” during office hours in sedentary clerical professions or during long air travel.
- Avoid sedentary activity or prolonged immobilization by either routine exercise and weight management or by incorporating physical therapy into convalescence during lengthy hospitalizations or recovery from surgery or bone fractures.
- Permanent anticoagulation may be indicated in those with a previous history of a thromboembolic event to prevent a recurrence.
- An inferior vena cava screen-like filter can be life-saving for those who have frequent pulmonary emboli.
- In patients who have suffered strokes or TIAs, prevention includes investigation into thrombi that might be responsible.
- Patients with atrial fibrillation, a high risk factor for arterial embolism, should be on continuous anticoagulation.
- Smokers should quit, to prevent a powerful cofactor in the smoking-hypertension-atherosclerosis vicious cycle of blood vessel damage.
- Aggressively treat any causes of secondary hypertension, such as kidney disease or hyperthyroidism.
- If on anticoagulants for prevention of thrombus recurrence, prevention also relies on compliance with scheduled, interim office visits for reevaluations and blood work.