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
"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.
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
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
- 40 years of age or older
- Surgery, especially hip or knee, within the past month
- Long bone fractures or other trauma within the past
- 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
"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."
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
"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
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.
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Created: 10/30/2002  - Mike Falcon and Stephen A. Shoop, M.D.