The study conducted by Andrew Muleledhu also revealed that “incidence of blood clots range between 16 percent and 36 percent” among general surgery patients. Photo | Shutterstock

Six in 10 patients nursing fractures died at the hands of blood clots, a 2021 report of a study conducted at Mulago hospital has revealed.

The study conducted by Andrew Muleledhu also revealed that “incidence of blood clots range between 16 percent and 36 percent” among general surgery patients.

The statistics underline the status of blood clots as one of the major causes of death and illnesses among patients who have undergone surgery.

On May 14, 2008, the Ugandan basketball fraternity was left in mourning after Wilbrod Okecho died. A first-time dad to a two-month-old daughter back then, Okecho had been discharged from Mulago hospital a couple of days before.

He was hospitalised after thugs shot him in the leg during a robbery. Okecho thought the worst was behind him after he was judged fit to leave hospital. He, however, presented with breathing problems and—tragically—died in the intensive care unit. A post-mortem later revealed that a four-inch blood clot caused his death.

“The biggest danger is dislodging that clot to the lungs where it blocks vessels in the lung and it causes what we called a pulmonary embolism and this causes death,” Dr John Omagino, the director of Uganda Heart Institute (UHI), says.

While Okecho’s death in 2008 seemed like a rarity, a deluge of blood clot deaths in recent times has reared an ugly head. The list of victims has been a who’s who. Just last year, Gen Paul Lokech and Archbishop Cyprian Kizito Lwanga were claimed by blood clots. A year before, in 2020, Maj Gen Kasirye Gwanga died following an operation that sought to remove a blood clot in his head.

In 2019, a cancer-stricken Apolo Nsibambi, who served as the eighth prime minister, died after a blood clot made its way to his lungs. In 2016, Maj Gen Julius Oketta’s post-mortem report also attributed his death to a massive pulmonary embolism. Maj Gen Oketta had been rushed to Kadic Hospital after he presented with chest pain.

What is a blood clot?

Clotting of blood is normal after a cut or injury and can be life-saving when it stops excessive bleeding. But when the clot dislodges and goes to the lungs and heart, or forms when it is not needed, the outcome can be fatal.

Dr Omagino says injured people, those suffering severe dehydration or having diseases such as sickle cell, should be on the lookout for symptoms of blood clots to prevent death.

“Ideally, any injury which involves a blood vessel like in the situation of fractures, we always suspect blood clots,” he says, adding, “So, we give preventive anti coagulation or we have to get the limbs to move as quickly as possible to prevent fatal outcomes.”

Dr Omagino says any pain along these vessels and difficulty in breathing are some of the dangers. Other known symptoms include pain around the affected area, swelling of the ankles, tenderness on skin surfaces, swelling, redness and warmth around the affected area.

Clots can also cause a heart attack or stroke. This often depends on the size of the clot. According to health experts, slow blood flow to the legs and feet because of physical inactivity, being confined in bed (hospitalisation) and sitting for long hours while on a plane, increase the risk of developing fatal blood clots.

Information from the UHI also indicates that other risk factors that can lead to slowed blood flow and cause blood clots include smoking, heart disease, diabetes, hypertension, cancers, certain medication and genetic disorders.

Dr Clement Okello of Uganda Cancer Institute notes in a 2021 report of a study done at the institute that patients with cancer have a four to seven-fold increased risk of suffering from blood clots and dying from the same. This can be a result of the disease itself, medicines used for treatment and a long stay in the hospital, according to experts.

Ms Joyce Letiru, a 59-year-old nurse in Kampala, says doctors told her to start exercising just a day after she underwent surgery for a total knee replacement.

“I experienced pain, but they told me it is part of the healing process,” she says.

Dr Omagino explains if a patient doesn’t move because of the high pain, the blood remains static and this can form clots.

“When you have a situation of increased blood thickness, which is common among sicklers, or in the situation of dehydration when people sweat a lot or they are in a very hot environment or situation that causes loss of fluids in the body but leaves the blood, this causes thickening of the blood and eventually it cannot move,” he says.

According to information from the UHI, a doctor can easily tell if you have a blood clot on the blood pathway by pressing on the part of the affected area or observing the above symptoms. It can also be diagnosed through ultrasound, X-ray or computed tomography (CT-scan), which can also be expensive.

Dr Omagino says treatment depends on the type and seriousness of the blood clots. He says medicines are given to dissolve the clots. Information from the UHI indicates that one may have to stay in bed and keep the legs raised for three to five days for better treatment outcomes. Moist heat and medicines can also be given to ease the pain and swelling. Sometimes, a filter can be inserted into the blood vessel to prevent the clots from reaching the lungs.

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