Vice President Cheney is on Warfarin for a DVT

I know we doctors can be absent-minded, but I must be really out of it - I had no idea Vice President Cheney was diagnosed with a deep vein thrombosis (DVT) of the lower extremity in early March. He had a checkup yesterday which included a check of his INR (measuring the "thinness" of his blood while on warfarin) and a follow-up ultrasound of his leg, which revealed that the clot is "smaller."

Cheney has been taking blood-thinning medication since the clot was discovered in his left leg after he returned from a nine-day trip to Asia more than a month ago.

This is interesting because (as we all know) air travel is a risk factor for the development of venous thromboembolism (VTE), as is any event that immobilizes one for several hours or days, such as surgery, fractures or even car trips. Did the VP forget to exercise his legs while on the plane?

The 66-year-old Cheney has a history of heart problems. Blood clots that form deep in the legs can become killers if they break off and float into the lungs. This is called a pulmonary embolism. Deep vein thrombosis strikes an estimated 2 million Americans each year, killing 60,000.

Venous thromboembolism gets mentioned in the press when it afflicts a notable figure, but does Big Media realize that this condition has killed 240,000 Americans (if we're keeping track of cumulative numbers) since the war in Iraq began? The victims include noted NBC journalist David Bloom, who succumbed to a pulmonary embolus on April 6, 2003 after spending days riding in a cramped APC with the 3rd Infantry Divison. VTE is a serious, underreported health problem that is worth spending time and money to educate our increasingly overweight and globe-trotting citizens.

Ergo, to review - here are the risk factors for VTE:

1. Age - people over 40 are at greater risk of DVT
2. A past history of DVT
3. A family history of DVT
4. Any hereditary condition that makes the blood more likely to clot
5. Immobility
6. Obesity
7. Recent surgery or an injury, especially to the hips or knees
8. Pregnancy, or post-pregnancy
9. Having cancer and/or being on chemotherapy or certain targeted agents
10. Taking a contraceptive pill that contains estrogen - but most modern pills contain a low-dose, which increases the risk by an amount that is acceptable for most women
11. Hormone replacement therapy (HRT)
12. Treatment for other circulation or heart problems

Looking at the Vice President's case I would say he had at least four risk factors when he was diagnosed with DVT. Of course, one of those factors is as they say "not negiotiable," unless some late-night televison infomercial guru or email spammer has come up with the antidote to growing old.

The list of measures to prevent VTE is quite long, and is linked here. In my opinion the most important things to remember are these: don't smoke, keep your weight down and keep your legs moving, especially when stuck in bed or when required to sit for long stretches of time.