Blood clots in calf

Signs and Symptoms of Blood Clots

Signs and Symptoms of Blood Clots: Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)

Deep Vein Thrombosis:

Signs and Symptoms

Deep vein thrombosis (DVT) occurs when a blood clot forms in one of the deep veins of your body, usually in your legs, but sometimes in your arm. The signs and symptoms of a DVT include:

  • Swelling, usually in one leg (or arm)
  • Leg pain or tenderness often described as a cramp or Charley horse
  • Reddish or bluish skin discoloration
  • Leg (or arm) warm to touch

These symptoms of a blood clot may feel similar to a pulled muscle or a “Charley horse,” but may differ in that the leg (or arm) may be swollen, slightly discolored, and warm.

Contact your doctor as soon as you can if you have any of these symptoms, because you may need treatment right away. If you need help finding a doctor, please click here.

Learn more about how a DVT is diagnosed here.

Pulmonary Embolism:

Clots can break off from a DVT and travel to the lung, causing a pulmonary embolism (PE), which can be fatal. The signs and symptoms of a PE include:

  • Sudden shortness of breath
  • Chest pain-sharp, stabbing; may get worse with deep breath
  • Rapid heart rate
  • Unexplained cough, sometimes with bloody mucus

Call an ambulance or 911 immediately for treatment in the ER if you experience these PE symptoms.

Learn more about how a PE is diagnosed here.

Learn More

The most important thing you can do to prevent blood clots is to learn if you are at risk. Learn more about blood clot risks here: Know Your Risk

Blood clots are serious, but they can also be prevented. Find out how you can prevent blood clots here: Prevent Blood Clots

Blood clots by the numbers: Get the facts

Connect with others who have experienced a blood clot here: Patient Stories

Join our online discussion community and connect with other people who have experienced a blood clot.

DVT (deep vein thrombosis)

Treatment of DVT

You may have an injection of an anticoagulant (blood thinning) medicine called heparin while you’re waiting for an ultrasound scan to tell if you have a DVT.

After DVT is diagnosed, the main treatment is tablets of an anticoagulant medicine, such as warfarin and rivaroxaban. You will probably take the tablets for at least 3 months.

If anticoagulant medicines are not suitable, you may have a filter put into a large vein – the vena cava – in your tummy. The filter traps and stops a blood clot travelling to your heart and lungs.

A newer treatment involves breaking up and sucking out the clot through a small tube in the vein. You usually need to take anticoagulant medicine for several months after this treatment.

DVT in pregnancy is treated differently. It is treated with anticoagulant injections for the rest of the pregnancy and until the baby is 6 weeks old. Read more about DVT in pregnancy.

Recovery from DVT

Some lifestyle measures will help you recover from DVT.

After you leave hospital, you will be encouraged to:

  • walk regularly
  • keep your affected leg raised when you’re sitting
  • delay any flights or long journeys until at least 2 weeks after you start anticoagulant medicine

Deep vein thrombosis

  • not take herbal medicines
  • Warfarin isn’t recommended for pregnant women who are given heparin injections for the full length of treatment.

    Rivaroxaban

    Rivaroxaban is a medication recommended by the National Institute for Health and Care Excellence (NICE) as a possible treatment for adults with DVT, or to help prevent recurrent DVT and pulmonary embolism.

    Rivaroxaban comes in tablet form. It’s a type of anticoagulant known as a directly acting oral anticoagulant (DOAC). It prevents blood clots forming by inhibiting a substance called factor Xa and restricting the formation of thrombin (an enzyme that helps blood clot).

    Treatment usually lasts 3 months and involves taking rivaroxaban twice a day for the first 21 days and then once a day until the end of the course.

    Read the NICE guidance about rivaroxaban

    Apixaban

    NICE also recommends apixaban as a possible method of treatment and prevention for DVT and pulmonary embolism.

    Like rivaroxaban, apixaban is a DOAC that’s taken orally as a tablet, and prevents blood clots forming by hindering factor Xa and restricting the formation of thrombin.

    Treatment usually lasts at least 3 months and involves taking apixaban twice a day.

    Read the NICE guidance about apixaban

    Compression stockings

    Wearing compression stockings helps prevent calf pain and swelling, and lowers the risk of ulcers developing after having DVT.

    They can also help prevent post-thrombotic syndrome. This is damage to leg tissue caused by the increase in venous pressure that occurs when a vein is blocked by a clot and blood is diverted to the outer veins.

    After having DVT, stockings should be worn every day for at least 2 years. This is because symptoms of post-thrombotic syndrome may develop several months or even years after having a DVT.

    Compression stockings should be fitted professionally and your prescription should be reviewed every 3 to 6 months. The stockings need to be worn all day but can be taken off before going to bed or in the evening while you rest with your leg raised. A spare pair of compression stockings should also be provided.

    Exercise

    Your healthcare team will usually advise you to walk regularly once compression stockings have been prescribed. This can help prevent symptoms of DVT returning and may help to improve or prevent complications of DVT, such as post-thrombotic syndrome.

    Raising your leg

    As well as wearing compression stockings, you might be advised to raise your leg whenever you’re resting. This helps to relieve the pressure in the veins of the calf and stops blood and fluid pooling in the calf itself.

    When raising your leg, make sure your foot is higher than your hip. This will help the returning blood flow from your calf. Putting a cushion underneath your leg while you’re lying down should help raise your leg above the level of your hip.

    You can also slightly raise the end of your bed to ensure that your foot and calf are slightly higher than your hip.

    Read more about preventing DVT

    Inferior vena cava filters

    Although anticoagulant medicines and compression stockings are usually the only treatments needed for DVT, inferior vena cava (IVC) filters may be used as an alternative. This is usually because anticoagulant treatment needs to be stopped, isn’t suitable, or isn’t working.

    IVC filters are small mesh devices that can be placed in a vein. They trap large fragments of a blood clot and stop it travelling to the heart and lungs. They can be used to help prevent blood clots developing in the legs of people diagnosed with:

    • DVT
    • pulmonary embolism
    • multiple severe injuries

    IVCs can be placed in the vein permanently, or newer types of filters can be placed temporarily and removed after the risk of a blood clot has decreased.

    The procedure to insert an IVC filter is carried out using a local anaesthetic (where you’re awake but the area is numb). A small cut is made in the skin and a catheter (thin, flexible tube) is inserted into a vein in the neck or groin area. The catheter is guided using an ultrasound scan. The IVC filter is then inserted through the catheter and into the vein.

    Deep vein thrombosis

    Updated: October 31, 2018Published: December, 2014

    Blood clots are lifesavers when they seal a cut. They can be dangerous, even deadly, when they form inside an artery or vein. Deep vein thrombosis (sometimes called DVT) is the formation of a blood clot in a large leg vein. It can also occur in an arm vein. Deep vein thrombosis can lead to a stroke or pulmonary embolism. In the United States alone, deep vein thrombosis accounts for as many as 100,000 deaths a year. One-third of the survivors are left with long-term health problems.

    Blood that circulates to the legs and feet must flow against gravity on its journey back to the heart. The trip is aided by the contraction of leg muscles during walking or fidgeting. The contractions squeeze veins, pushing blood through them. Small flaps, or valves, inside the veins keep blood flowing in the direction of the heart.

    Anything that slows blood flow through the arms and legs can set the stage for a blood clot to form. This can range from having an arm or leg immobilized in a cast to prolonged sitting or being confined to bed. Things that make blood more likely to clot, such as genetic disorders and cancer, are other big triggers for deep-vein thrombosis.

    Symptoms of deep vein thrombosis and pulmonary embolism

    Deep vein thrombosis can develop silently. It can also cause:

    • pain or tenderness in a leg or arm that gets worse with time, not better
    • swelling in one leg or arm
    • a reddish or bluish tinge to the skin of one leg or arm
    • a leg or arm that feels warm to the touch.

    The symptoms of pulmonary embolism include:

    • difficulty breathing
    • chest pain or discomfort that worsens with a deep breath or cough
    • coughing up blood
    • a fast heart rate
    • sudden lightheadedness or fainting

    Diagnosing deep vein thrombosis and pulmonary embolism

    To diagnose DVT, your doctor will examine your legs to check for swelling and tenderness. He or she will ask about your symptoms and risk factors.

    Based on the findings, your doctor may order a D-Dimer blood test or an ultrasound of your legs.

    The blood test measures the level of a chemical called D-Dimer. It is almost always abnormally high when blood clots are actively forming in the body.

    An ultrasound of your legs is done to look for blood flow problems in your veins. This procedure is called a lower extremity non-invasive test, or LENI. If the LENI shows evidence of a blood clot, your doctor will diagnose DVT.

    If the initial LENI is negative, it does not mean that there is no clot. It may be too early to see the full effect of the clot. Your doctor may ask that you return in three to four days for a repeat LENI.

    If your doctor suspects you have a pulmonary embolism, he or she will first try to determine if you have DVT. If the LENI shows one or more blood clots in your leg veins, and you have symptoms of a pulmonary embolism, an embolism is the most likely diagnosis.

    Or your doctor may order computed tomography (CT) of the chest. The test requires an IV injection of dye to look for blood clots in the pulmonary arteries. People that have impaired kidney function or an allergy to the dye might need a different type of lung scan called a V/Q scan to examine lung blood flow.

    Treating deep vein thrombosis

    The initial treatment for a DVT or pulmonary embolism is heparin or one of the new novel oral anti-coagulant drugs. These medications act on certain blood proteins to prevent new blood clot formation and therefore help unwanted clots get smaller. They are commonly called “blood thinners.”

    There are two main types of heparin. The oldest type of heparin is best administered by a constant intravenous infusion. Another type of heparin is called low-molecular-weight heparin. It is injected under the skin once or twice per day.

    Some of the newer anti-coagulant drugs are approved for initial treatment of DVT and pulmonary embolism. Examples include rivaroxaban (Xarelto) and apixaban (Eliquis).

    If you have a DVT without a pulmonary embolism, you may not need to be hospitalized. You could be treated at home with injections of a low-molecular-weight heparin or either rivaroxaban or apixaban.

    Some people may need to start therapy in the hospital. In this case, the type of heparin used is determined by many factors. These include body weight, kidney function and other circumstances.

    If you have a pulmonary embolism, you will probably be hospitalized. If so, you likely will be treated with either type of heparin initially. But oral rivaroxaban or apixaban could be an option instead of heparin if your pulmonary embolism is small.

    If you are started on either IV heparin or low-molecular weight heparin shots under the skin, your doctor will transition you to an oral drug. Traditional oral therapy has been warfarin (Coumadin). For decades, it was the only oral drug to treat DVT and pulmonary embolism.

    Today, in addition to rivaroxaban and apixaban, another novel oral anti-coagulant can be used after heparin. It’s dabigatran (Pradaxa). More of these types of drugs will be approved soon.

    Warfarin takes a few days to start working. Once a blood test shows that warfarin is effective, you will stop taking heparin. You will continue taking warfarin for several months or longer.

    During the first few weeks that you take warfarin, you will continue to need frequent blood tests to make sure you are taking the right amount. Once your blood test results consistently show that you are taking the right amount of medication, blood can be drawn every two to four weeks.

    Some foods—especially green, leafy vegetables that contain large amounts of vitamin K—can alter the blood-thinning action of warfarin. Ask your doctor or pharmacist for a list of these foods. You can continue to eat these foods as long as you eat approximately the same amount of them each day. That way, the effect on your medication will be consistent.

    Other medications can also affect how warfarin works in your body. Tell any doctor who is prescribing medications for you that you are taking warfarin.

    The new novel oral anti-coagulants don’t require regular blood testing. They are given in a fixed dose. The other advantage is not worrying about eating food with too much vitamin K.

    Disclaimer:
    As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

    How Do You Know if It’s Deep Vein Thrombosis?

    Making a Deep Vein Thrombosis Diagnosis

    Spotting deep vein thrombosis can be tricky. Only about half the people who get DVT show any symptoms at all, and the signs are sometimes mistaken for other conditions.

    Here are signs of DVT to look for:

    • Swelling in the leg, the most common symptom
    • Only one leg is affected
    • The area is painful and warm
    • Symptoms get worse over time, rather than dissipate as they would with a pulled muscle

    “The swelling usually does not subside when the leg is elevated for an hour or overnight,” Santora said. He added that injured muscles in the lower leg tend to cause pain on the right side of the calf, while DVT usually causes pain in the back of the calf.

    If you have a pain in your leg, consider whether you have any risk factors that make deep vein thrombosis a more likely cause.

    Risks for DVT include:

    • Recently surgery, particularly orthopedic surgery
    • Taking hormone medications like birth control pills or hormone replacement therapy
    • An illness that has caused you to be inactive for a long period of time

    “When we walk, our muscles contract and push the blood back to the heart,” said Andrew Olinde, MD, a vascular surgeon with Baton Rouge Vascular Specialty Center in Louisiana. “If you’re not mobile, your blood is more likely to get static and form a clot.”

    RELATED: Taking Birth Control Risks Deep Vein Thrombosis: Michelle Winters’ Story

    When you seek medical help for suspected DVT, your doctor will probably perform a physical examination of the affected leg to check for pain and swelling. He or she will also check for knots that can sometimes be felt from a blood clot. However, the best way to make a deep vein thrombosis diagnosis is through ultrasound, a test that uses sound waves to create pictures of the veins and arteries. An ultrasound is usually performed on both legs.

    “This will determine if the clots are in the deep veins and dangerous, or in the superficial veins, which is not dangerous,” Santora explained.

    5 FAQs of Calf Muscle Strain and Prevention

    Prevent calf muscle strain during training this spring with the help of Rothman Orthopaedic Institute.

    The calf muscle is one of the most critical yet neglected areas of an athlete’s body. As a result, a wide range of conditions anywhere from mild stretching and pain to a torn muscle can emerge and inhibit performance, particularly at the beginning of a new training season. If you or someone you love is beginning a new training or exercise regimen this spring, you may be at risk for calf muscle strain. Read on for an overview of the most commonly asked questions about this condition, with answers from the expert sports injury team at Rothman Orthopaedic Institute.

    What Is A Calf Muscle Strain?

    The calf muscle, on the back of the lower leg, is actually comprised of two muscles: the gastrocnemius (a larger muscle, forming the visible shape beneath the skin) and the soleus (a smaller, flat muscle underneath the gastrocnemius). These two muscles come together at their base where they are connected to the Achilles tendon.

    A calf muscle strain – sometimes also called a pulled calf or pulled muscle – refers to injury or tears in either part of the calf as the result of forcible stretching beyond the tissues’ limits. A tear in any muscle, including the calf, is categorized as a strain and will be classified as a first, second or third-degree strain, depending on its severity:

    • A first-degree strain involves damage only to a few muscle fibers.

    • A second-degree strain means damage to a more extensive group of muscle fibers.

    • A third-degree strain refers to a complete rupture of the muscle itself.

    What Are The Symptoms?

    A first-degree calf muscle strain may not present any symptoms until after activity has ceased. At that point, the athlete may feel only a sensation of cramping or tightness and mild pain when the muscles are stretched or contracted.

    With a second-degree strain, the athlete will experience immediate pain at a more severe level than the pain of a grade one strain. This level of strain is often sore to the touch, as well as emitting flares of pain on stretch and contraction of the muscle.

    Third-degree calf muscle strains are very serious. They bring an immediate burning or stabbing pain, and the athlete may be unable to walk without pain, if at all. In this injury, the muscle has been completely torn and may exhibit a depression with a large lump of muscle above it. Both grade two and three injuries typically develop significant bruising below the injury site due to bleeding within the tissues.

    How Is A Calf Muscle Strain Treated?

    Treatment for this condition typically mirrors that of any muscle strain injury, including:

    • The R.I.C.E. method: This stands for Rest, Ice, Compression, and Elevation. The calf should be rested in an elevated position with ice applied (but not directly to the skin) for twenty minutes every two hours, if practical. The addition of a compression bandage may help to limit bleeding and swelling in the tissues.

    • Medications: Anti-inflammatory medications either over the counter or as prescribed by a doctor can be effective in relieving pain. Topical anti-inflammatory gels may aid or speed this effect.

    • Physical therapy: Once your physician is comfortable with your progression of healing, physical therapy may be recommended to rebuild the muscle’s strength and begin to rehabilitate it for return to sports activity.

    Resting is is a treatment often ignored by athletes. This can not only inhibit the muscle’s ability to heal, but it can also increase the severity of the strain and its rating. To prevent this, grade one calf strains should be rested from activity for about 3 weeks, grade two for 4-6 weeks. Athletes should not return to play until cleared by their physicians.

    Are There Calf Strain Exercises Or Other Preventive Measures?

    Yes! The following measures may help reduce your chances of sustaining a calf muscle strain injury:

    • Warm up for at least 20 minutes prior to matches and training to improve extension and flexibility.

    • Don’t skip the cool-down stretches! This recovery period helps muscles distribute and eliminate waste products.

    • Incorporate strength training into your routine. Muscle strength allows a player to perform with control, decreasing the poor form which can lead to injury.

    • Eat for energy and muscle health. When the body is short on healthy fuel, fatigue can set and predispose a player to injury.

    The main goal of treatment for calf muscle strain is to minimize pain and improve functionality, especially for athletes anxious to return to participation. If you have any questions or if you are experiencing calf pain, your first step should be to consult your physician right away. For more specialized treatment, visit us hereor contact us at 1-800-321-9999.

    Summit Medical Group Web Site

    What is shin pain?

    Shin pain is pain on the front of your lower leg between the knee and the ankle. It can hurt directly over your shinbone (tibia) or over the muscles that are on the inner or outer side of the tibia. Shin pain has often been called shin splints.

    How does it occur?

    Shin pain generally occurs from overuse. This problem can come from irritation of the muscles or other tissues in the lower leg or from a stress fracture. This injury is most common in runners who increase their mileage or the intensity of their running, or who change the surface on which they are running.

    When you walk or run your foot normally flattens out a small amount when it strikes the ground. If your foot flattens out more than normal it is called over-pronation. Over-pronation can contribute to shin pain.

    Some specific conditions that cause shin pain include:

    • Stress fracture: This is a hairline crack in one of the lower leg bones, the tibia or fibula.
    • Medial tibial stress syndrome: This is when the muscles that attach to the inner side of your tibia are inflamed.
    • Compartment syndrome: Your anterior compartment is an area in your leg that contains the muscles that point your foot and toes toward your body. Your lateral compartment contains muscles that move your foot and ankle away from your body. Your posterior compartment contains the calf muscles which point your foot downwards. When a compartment is overused the muscles will become painful.

    What are the symptoms?

    You have pain over the front part of your lower leg. You may have pain during exercise, at rest, or both. Stress fractures of the tibia cause pain directly over your shinbone. It will hurt to touch the part of the bone that is fractured. Stress fractures of the fibula cause pain on the outer side of your lower leg. With medial tibial stress syndrome, you will have pain and tenderness along the edge of the shinbone, especially along the muscles. With compartment syndrome the muscles in that area will be painful. Blood vessels and nerves are also in the anterior compartment. If the muscles in this compartment become swollen during exercise they may irritate these nerves or blood vessels and your foot may become weak, numb, or cold.

    How is it diagnosed?

    Your healthcare provider will examine your lower leg. He or she will decide which part of your shin is the source of the pain. Your provider may watch you walk or run to see if you have problems with over-pronation. You may need an X-ray, MRI, or a bone scan to check for stress fractures. If your provider thinks you have compartment syndrome you may need a test that measures the pressure in your lower leg compartments. This is done using a needle attached to a measuring device. The test is done at rest and then again after exercise.

    How is it treated?

    Treatment may include:

    • Put an ice pack, gel pack, or package of frozen vegetables, wrapped in a cloth on the area every 3 to 4 hours, for up to 20 minutes at a time.
    • You could also do ice massage. To do this, first freeze water in a Styrofoam cup, then peel the top of the cup away to expose the ice. Hold the bottom of the cup and rub the ice over the area for 5 to 10 minutes. Do this several times a day while you have pain.
    • Raise your legs on a pillow when you sit or lie down.
    • Take an anti-inflammatory medicine such as ibuprofen, or other medicine as directed by your provider. Nonsteroidal anti-inflammatory medicines (NSAIDs) may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days.
    • Your healthcare provider may recommend arch supports, called orthotics. You can buy orthotics at a pharmacy or athletic shoe store or they can be custom-made. Arch supports (orthotics) help correct over-pronation.
    • Follow your provider’s instructions for doing exercises to help you recover.

    Surgery is sometimes needed for compartment syndrome or some types of stress fractures.

    While you are recovering from your injury, you will need to change your sport or activity to one that does not make your condition worse. For example, you may need to bicycle or swim instead of run. When you begin to run again, you should wear good shoes and run on soft surfaces.

    When can I return to my normal activities?

    Everyone recovers from an injury at a different rate. Return to your activities depends on how soon your leg recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal is to return to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.

    You may safely return to your activities when, starting from the top of the list and progressing to the end, each of the following is true:

    • You have full range of motion in the injured leg compared to the uninjured leg.
    • You have full strength of the injured leg compared to the uninjured leg.
    • You can walk straight ahead without pain or limping.

    How can I prevent shin pain?

    • Since shin pain usually occurs from overuse, be sure to start your activities gradually.
    • Wear shoes with proper padding and support.
    • Run on softer surfaces.
    • Warm up properly and stretch the muscles in the front of your leg and in your calf.
    • Do not keep running while you have shin pain or it will take longer for the pain to go away.
    • Try cross training to limit the stress on your shins. Do an exercise that does not place stress on the injured tissue, such as swimming. This will allow you to keep exercising while your injury heals.

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