Home jabs to prevent blood clots (The Straits Times, Mind Your Body, 28 July 2011, Pg 16)

By Joan Chew
 
Cover Story CASE #2: DEEP VEIN THROMBOSIS

When housewife Choi Indirabai, 60, was getting out of a car in May, she felt a sudden sharp pain in her right knee.

Months before, she experienced warmth, tenderness and swelling in her right leg but did not take these seriously, she said.

She was diagnosed with deep vein thrombosis (DVT), which results from a blood clot forming in a deep vein. A major complication arises when a piece of this clot breaks off, travels to the lungs and results in pulmonary embolism, which can be life-threatening.

Dr Veerendra Chadachan, a consultant from the general medicine department at Tan Tock Seng Hospital (TTSH), said its causes include situations of immobility such as prolonged air travel and medical conditions like cancer.

Madam Choi’s frequent long flights to visit her 35-year-old son in Germany could have been a factor.

Previously, patients like her were hospitalised in TTSH for five to 11days so nurses could jab them twice daily with a blood thinner such as low-molecular-weight heparin and give them tablets of warfarin, another blood thinner.

These keep blood clots from growing and prevent the clots from breaking and travelling to the lungs, said Dr Chadachan.

Since April 2008, some of these patients can opt to be treated at home instead and return to TTSH three to five days later
for reviews, under an initiative by the hospital’s emergency department.

Patients who just underwent surgery, have severe DVT symptoms, high risk of bleeding or other conditions that require hospitalisation are not eligible.

Madam Choi was found to be suitable for home treatment and she opted for it. Her husband and younger son felt that it was best for her to be treated at home where she would be most comfortable, she said.

Both she and her retiree husband, Mr D. Sellakannu, 63, were taught how to inject the drug into her abdomen. But in the end, he gave her the jabs for a week as she found it hard to position the needle.

After a check-up, she is now taking warfarin.

Dr Chadachan said one to two patients per month – more than before – opt for home treatment now.

Singapore General Hospital has treated most of its DVT patients at home for more than 10 years.

Dr Ng Heng Joo, senior consultant at its department of haematology, said: “It is intuitive that such a practice be encouraged as most DVT patients are stable and do not need to be managed at the level of intensity accorded to inpatients.”

Those who are unwilling to jab themselves or unable to get relatives to help are asked to go to a general practitioner or polyclinic.

But one in 10 patients is unsuitable to be treated at home for reasons such as high risk of bleeding, kidney failure or recent major trauma.

Patients on home treatment are told to watch for symptoms of worsening DVT that would warrant a trip to the hospital, such as progressive swelling and pain in the affected limb, shortness of breath and chest pain.

At National University Heart Centre Singapore, about 30 DVT patients have been put on a scheme started in 2009 that helps them monitor their blood clotting ability using a home meter.

They or their relatives learn how to administer low-molecular-weight heparin jabs and after passing a test on the use of the home meter, rent it for a month or two to test their blood clotting ability.

Test results are sent via SMS to the hospital where nurses will adjust the dosage of the blood-thinning drug if required.

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