DVT from TV? A case of binge watching and blood clotting

Can too much TV result in venous thrombosis (VT)? That was the question that emergency physician assistant Lindsey Ackley, PA-C, asked herself when a 59-year-old female with leg swelling came to the Jefferson Health-Stratford emergency department (ED), Stratford, NJ. The patient said that she’d been watching television all day.

The woman’s complaints of pain as well as swelling in her right calf raised the same concern when Ackley consulted attending physician James Espinosa, MD, who is also associate professor and clinical research director in emergency medicine at Rowan University School of Osteopathic Medicine (SOM), Stratford, NJ.

The patient explained that the leg pain started after watching television for 8 hours straight. But she was so absorbed in national election coverage that she continued watching for another 8 hours the next day. She got up only once for a bathroom break, she recalled.

“She found the coverage of the 2016 political conventions so extremely interesting that she could not look away,” said Alan Lucerna, DO, assistant director of the ED at Jefferson Health-Stratford and program director of combined Emergency Medicine/Internal Medicine residency at Rowan University SOM.

After 2 days of mild throbbing pain and swelling in her leg, she went to the ED, where she reported occasional dizziness and shortness of breath on exertion. Her swollen leg and prolonged inertness raised the possibility of deep vein thrombosis (DVT) and pulmonary embolism (PE). The patient’s medical history included obesity, autoimmune hepatitis, and osteoporosis, but not VT.

“Taking her symptoms at face value, she definitely had the risk factors for DVT and PE,” Dr. Lucerna said. “We’ve known about a Japanese study associating binge TV watching and DVT, but we were amazed to diagnose one in the flesh because it’s rare to see it.”

An ultrasound of her right calf revealed an occlusive thrombus of the right popliteal vein. Computed tomography angiography of her chest showed pulmonary emboli in both lungs. The ED team treated her with intravenous anticoagulant therapy (heparin). She was later transferred to the intensive care unit where she was given a different anticoagulant (rivaroxaban) the following day. She was discharged 3 days later with no complications.

Too much TV can kill you

We now know that watching a lot of TV does, in fact, increase the risk for venous thromboembolism (VTE), according to researchers at a November 12 presentation at the American Heart Association’s Scientific Sessions 2017, in Anaheim, CA.

This study, which involved 15,158 middle-aged (45-64 years) participants in the Atherosclerosis Risk in Communities Study, is the first to specifically investigate the risk of VTE in relation to TV viewing in a US population.

“Those who watched the most television…were at higher risk of venous thromboembolism—about 70% higher risk—than people who watched television infrequently,” said study co-author Mary Cushman, MD, MSc, professor of medicine at the University of Vermont’s Larner College of Medicine, Burlington, VT.

“Avoiding frequent TV viewing, as well as increasing physical activity and controlling body weight, might be beneficial for VTE prevention,” Dr. Cushman and her fellow researchers concluded.

“We definitely have been more aware of our TV habits,” said Dr. Lucerna, after his team diagnosed the woman obsessed with political convention coverage.

They recently published a report of this patient encounter in Case Reports in Pulmonology, and have since diagnosed another case of DVT/PE in a patient who played a video game for 8 consecutive hours.

“It is very easy to see whole seasons of a show or shows in one day without ever leaving a bed or couch,” Dr. Lucerna said. “About 90 years ago, we had one or two channels. Now  we have thousands. A decade or less ago, you had to go to a store to get DVDs. That alone prompted people to get up and move around. Now you don’t even need a TV to watch a show.”

“Technology was created to make our lives better,” he added. “But in the case of prolonged TV watching, the consequences can be lethal.”