Every year, approximately 10 million cases of venous thromboembolic disease (VTE) occur worldwide and one in 4 people dies from causes related to thrombosis. It is the third most frequent cardiovascular disease (after heart attacks and strokes) and is also one of the most common causes of mortality and disability worldwide. But it is a largely preventable and treatable condition. As long as you know and recognize it. Women are at greatest risk of thrombosis.
Because women are more at risk
“In a woman’s life there are peculiar conditions that place her at risk of thrombosis – explains Roberto Pola, professor of internal medicine at the Catholic University of Rome, director of the Uosd Thrombosis Path of Fondazione Policlinico Gemelli Irccs and national secretary of the Italian Society of Angiology and vascular pathology (Siapav) – taking estrogen-progestin pills for hormonal therapy can increase the risk of thrombosis, particularly if associated with smoking; pregnancy and the puerperium are periods of thrombotic risk; Menopause becomes a period of increased risk again.”
What to do to reduce thrombotic risk and symptoms
What to do to reduce the risk? “Movement, avoid venous stasis, don’t gain too much weight – continues Pola – In women with signs of chronic venous insufficiency (varices, telangiectasias, superficial reticular veins) an elastic stocking is advisable. While the alarm bells to be evaluated for performing a venous Doppler scan quickly is a leg that swells, becomes red or hurts.” Continuing the natural history of a woman’s life, we reach menopause; and here, the thrombotic risk increases again alterations that occur in this period – remember – there are also those of the coagulative and haemostatic balance.
Weight gain, reduction in physical activity and increased plasma concentration of some coagulative proteins also contribute to the increase in thrombotic risk. Hormone replacement therapy can also play a role in predisposed women. Then of course there is the whole issue of thrombosis in patients with some female tumors, such as those with ovarian cancer, even if the risk increases in general for all tumors, with an increase in risk of approximately 4 times”.
The risk of thrombosis and its management at different ages of women is the central theme of the III Gemelli Thrombosis Day (GTD), a scientific conference scheduled for Monday 14 October, with which Gemelli takes part in the celebrations of the World Day dedicated to this pathology, which occurs on October 13, the birthday of Rudolf Virchow, discoverer of the causes of thrombosis.
“While women have a stigma of increased thrombotic risk that accompanies them throughout their lives – underlines Valerio De Stefano, professor of Hematology at the Catholic University and president of the Italian Society for the study of haemostasis and thrombosis – in reality, for regarding anti-coagulant therapy there are no substantial gender differences compared to that reserved for men. A lower incidence of major haemorrhagic events is reported, but the woman who must undergo anticoagulant therapy, of childbearing age, has a further problem linked to the fact that especially the new direct oral anticoagulants have an important effect on menstrual flow, increasing it significantly and this can naturally have a significant impact on the quality of life, particularly in patients who are indicated for long-term treatment term”.
“We believe that the management of the treatment of thrombosis and above all of the ‘post-thrombosis’ period must be managed by the specialist – underlines the expert – because we always move between the Scylla of hemorrhages and the Charybdis of increased thrombotic risk. These considerations are shared by all the scientific societies involved in the management of TEV, and an initial AIFA hypothesis of general prescriptive possibility for all doctors (note 101) has now been suspended, after the publication of a document signed by 8 scientific societies, maintaining the management in charge of the sector specialists. Here at Gemelli we have created an alliance between hematologists and internal medicine specialists for the management of thromboembolic diseases, the specialists who primarily deal with the treatment of venous thrombosis. A close collaboration, unfortunately not present everywhere and which represents a multidisciplinary, integrated, virtuous healthcare model”.