Exercise and blood clots

For Patients

A common question following a clot is “How soon can I be active?” and “How soon can I exercise?”

Patients with a newly diagnosed deep vein thrombosis (DVT) or pulmonary embolism (PE) should use common sense and listen to their body. Physically, they should only do what they feel comfortable doing. They do not speed up recovery by pushing themselves aggressively through symptoms of pain and swelling. But they also do not make things worse by being active.

For most patients, it is fine to be physically active right after the diagnosis of an acute DVT or PE – walking, doing light household or other light work. However, if somebody has a lot of leg pain from the DVT or shortness of breath from the PE, the person should take it easy. Having a blood clot is a stress to the body and the body needs time to heal and recover. It is appropriate to take time off from work and let the body recover if needed. However, if the DVT or PE was small and the patient feels fine and wants to go back to work, then that is certainly fine, too.

Many patients worry that by being physically active, it will cause a DVT to break off and become a PE. The risk of clot breaking off and forming a PE is mostly present in the first few days, up to approximately 4 weeks, while the clot is still fresh and fragile and not scarred. However, study has shown that patients who do light activity following a clot are no more likely to develop PE than those who don’t. (ref 1)

You should discuss with your physician whether or not physical activity is appropriate for you, how much activity is recommended, and how soon you can begin.

It appears that being highly active one month after a DVT is not detrimental; it may, actually be beneficial and lead to less symptoms of post-thrombotic syndrome. This can be used as an argument to encourage individuals to return to physical activity relatively soon after a DVT.

Exercise, sports, yoga

No official guidelines exist as to when and how quickly an athlete might return to exercising. Each patient will need an individualized exercise plan. It seems appropriate to refrain from any athletic activities for the first 10-14 days after an acute DVT or PE until the clot is more attached to the blood vessel wall and the risk of having the clot break loose (causing a PE) has decreased. To lessen deconditioning during this period of relative inactivity, the athlete may do some strength training – arm and trunk exercises in the case of a leg DVT, leg and trunk exercises in the case of an arm DVT. The athlete may then increase activity between week 2 and 4 and return to pre-clot activity levels by week 4, if the body lets him/her. A similar approach is probably wise regarding yoga: it seems safest to take it easy and avoid yoga activities associated with more extreme body positions in the first 4 weeks after a clot.

Athletes: read about special considerations related to clotting in athletes

1. Aschwanden M et al. Acute deep vein thrombosis: early mobilization does not increase the frequency of pulmonary embolism. Journal of Thrombosis and Haemostasis 2001;volume 85:pages 42–6.

Long Flight? Bed Rest? Easy Exercises Prevent Blood Clots

It’s frightening to know that you could get a blood clot in your leg, called deep vein thrombosis, when you’re recovering from surgery or stuck in a car or airplane for hours. Well, here’s something that will make you feel more in control: If you spend a few minutes on movement and prevention exercises, you may be able to avert dangerous clots.

Deep vein thrombosis (DVT) develops when your blood pools during inactivity and thickens into a clot. It’s more likely to happen in the lower part of your body, but it can also happen in your arm or other areas. If the clot begins to travel, it could make its way to your lungs and lead to pulmonary embolism, in which the clot blocks the flow of blood. If that happens, your lungs could be seriously damaged, and it could even lead to death.

One way to avoid DVT is through movement, said Eric Robertson, PT, DPT, a physical therapist, assistant professor of physical therapy at Regis University in Denver, and a spokesman for the American Physical Therapy Association.

Once you have a clot, you need an anti-coagulant or another medication to treat blood clots. Check with your doctor before you do any of these movements to make sure they’re safe for you.

Who Should Think About DVT Prevention?

Some people have a clotting disorder in which their blood clots more easily, but anyone who is inactive can get a blood clot. People at particular risk have had a recent injury or surgery, are on prolonged bed rest, or are experiencing swelling, or edema.

Cancer treatments, birth control pills, and hormone therapy can make it easier for your blood to clot. And women who are pregnant or who have just given birth are at risk because of the added pressure on their veins.

Being immobile on long air flights and riding in a car or train for several hours also increases your DVT risk.

RELATED: Air Travel and Your Risk of a Blood Clot

Smoking raises your risk of clots because it negatively impacts circulation.

Doctors worry most about people who are older and have had a fracture or illness and have been in the hospital. “Your body is in a state where your blood may clot,” Robertson said, and being immobile makes it worse. When your heart pumps blood to your veins, muscle activity keeps the blood flowing. But when you’re sedentary, a clot could form.

Hospital staff will actively work to lower your risk of clots during surgery and afterward, Robertson said. There are also steps you can take yourself to help lower your risk.

Deep Vein Thrombosis Prevention Movements

The following moves don’t really hit the threshold of intensity to be considered exercises, Robertson said. But these movements and stretches are enough to keep your blood flowing and your risk for clots lower.

Walking

If you’re able, simply getting up for a short walk is a great thing to do, Robertson said. When you’re in the hospital, don’t be afraid to tell your nurse you want to take a walk. And just moving from your bed to a chair will help your circulation. When you’re on an airplane, take a trip to the restroom or stand up and stretch when possible. On a road trip, stop frequently to walk and stretch your legs.

Chair Exercises

When you can’t walk, here are movements you can do while seated. Robertson recommends doing a set of five repetitions of each about every half hour, 10 if you’re in a high-risk group.

Foot pumps. Place your feet flat on the floor, and then raise your toes toward you and hold for a few seconds. Lower your toes and balls of your feet to the floor, then raise your heels and hold for another few seconds.

Ankle circles. Raise both feet off the floor and trace a circle with your toes. You could also trace each letter of the alphabet to keep yourself occupied, Robertson said.

Leg raises. If you have room in front of you, raise your left foot off the floor. Straighten the leg slowly, then return your foot back on the floor. Repeat with your right leg. Alternatively, slowly lift your left knee up to your chest, then bring your foot back to the floor; repeat with your right leg.

Shoulder rolls. Although you’re less likely to form a clot in your upper body, it doesn’t hurt to keep your blood flowing there. Simply raise your shoulders and circle them back and down five times. Then reverse direction for five more repetitions.

Stretching While Lying Down

Here are movements to do when you’re lying in bed or on a couch.

Foot pumps. Although this can be done in a chair, these are especially beneficial when your legs are elevated, Robertson said. To do them in this position, stretch your toes up and back, flexing your feet, and hold for a few seconds. Then point your toes and hold before repeating.

Thigh stretches. The Coalition to Prevent Deep Vein Thrombosis recommends stretching your hamstrings, the muscles on the back of the thighs, to help prevent clots. Lie on your back with your legs straight and raise one leg to a 90-degree angle with your body. Pull the leg gently toward you and hold for up to 30 seconds. Then slowly bring your leg back down to a flat position, and repeat with your other leg.

Here’s a second thigh stretch. From the same flat starting position, bring one knee into your chest, hold with your hands for 15 seconds, and then return leg to a straight position. Repeat with the other knee.

The bottom line is the more you move, the better. Once you’re able, take on higher intensity activities, and you’ll continue to lower your risk for DVT.

What exercises help prevent blood clots?

Whether you’re laid up in bed recovering from surgery or on a long flight or car ride, these exercises promote circulation and may help reduce your risk of blood clots. Perform each of these exercises for 10 to 15 seconds, in each direction when appropriate, or do each stretch 3 or 4 times per session.

  • Wrists and Ankles. Holding your legs and arms steady, draw circles in the air with your toes and fingers, rolling your wrists and ankles first in one direction and then the other to reduce stress and improve circulation.
  • Arms and Trunk. Give them a good stretch by reaching up over your head, extending your fingertips away from your body and holding.
  • Calves and Feet. If you have an opportunity to stand up, give your calves a mini workout by pushing up on your toes and holding. Then roll back on your heels, pointing your toes up toward the ceiling. This can be done while sitting, too.
  • Head and Shoulders. While standing or sitting upright, turn your head and look right, then turn your head to look left, pointing your nose toward each shoulder as much as possible without discomfort. Do not perform this stretch if you have neck problems.
  • All Muscles. Tensing and relaxing different muscle groups aids circulation and eases tension. Curling your arms toward your body will help tense your biceps, pulling your shoulders toward your ears will help tense your shoulders, flexing your feet will tense your calf muscles, and pulling your belly button toward your spine will help tense your abdominal muscles. You also can tense and release your buttocks and thigh muscles.

Prevention of Deep Vein Thrombosis & Pulmonary Embolism

Symptoms and Signs of Deep Vein Thrombosis (Blood Clot in Leg)

  • Swelling, usually in one leg
  • Leg pain or tenderness
  • Reddish or bluish skin discoloration
  • Leg warm to touch

The symptoms of a blood clot may feel similar to a pulled muscle or a “Charlie horse,” but may also differ in that the leg may be swollen, slightly discolored, and warm. Contact your doctor if you have these symptoms, because you may need treatment right away.

Symptoms of Pulmonary Embolism (PE; Blood Clot that Travels to Your Lungs)

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

Go to an Emergency Department immediately to be diagnosed and treated

Practical Steps to Keep DVT Risk Low

  • Ask your doctor about need for “blood thinners” or compression stockings to prevent clots, whenever you go to the hospital
  • Lose weight, if you are overweight
  • Stay active
  • Exercise regularly; walking is fine
  • Avoid long periods of staying still
  • Get up and move around at least every hour whenever you travel on a plane, train, or bus, particularly if the trip is longer than 4 hours
  • Do heel toe exercises or circle your feet if you cannot move around
  • Stop at least every two hours when you drive, and get out and move around
  • Drink a lot of water and wear loose fitted clothing when you travel
  • Talk to your doctor about your risk of clotting whenever you take hormones, whether for birth control or replacement therapy, or during and right after any pregnancy
  • Follow any self-care measures to keep heart failure, diabetes, or any other health issues as stable as possible

Claire Benoist for Reader’s Digest

When she was 42, Tina Theobald suddenly developed a charley horse that wouldn’t ease. She had recently started jogging and thought nothing of the sore calf muscle. She iced it and hobbled through a short trip to Mexico as her leg swelled. Theobald happened to be scheduled to see her doctor for a sprained thumb upon her return, and she was diagnosed with—and immediately hospitalized for—a large blood clot in her leg. Two days later, Theobald struggled to breathe and was hit with chest pain so excruciating, she needed morphine. A portion of the clot had broken off and was blocking the blood supply to part of her lung, a life-threatening condition called pulmonary embolism.

Theobald always thought blood clots affected older people—and it’s true that their risk is far higher—but she quickly discovered that young and middle-aged people are vulnerable too. A number of risk factors play a role, including certain medications, pregnancy, immobility that allows blood to pool (prolonged sitting, say, during a long flight), surgery or trauma (such as a car accident) that can injure veins, and conditions that increase blood clotting (such as cancer and auto­immune disorders).

By conservative estimates, each year as many as 600,000 people in the United States develop deep vein thrombosis (DVT)—clots most common in leg veins, where they can cause pain, swelling, and redness. More than one in four adults struck by a first DVT or pulmonary embolism are under 50, according to a population study of Minnesota adults. One third of DVTs are followed by pulmonary embolism, which kills as many as 100,000 people each year, often suddenly, says the CDC. A 2013 report from Australia indicates that deaths from pulmonary embolism are on the rise in women 25 to 44.

“Symptoms can be vague, such as pain or feeling like you just can’t get enough air. As a doctor, if you’re not suspicious, you can miss a lot of cases,” says Bengt Zöller, MD, an associate professor of internal medicine at Lund University in Sweden.

A 2010 Danish study found that most younger adults with fatal pulmonary embolisms had told doctors about symptoms days or weeks before their deaths, only to have their complaints misinterpreted.

“Because DVTs and pulmonary embolisms can be difficult to recognize, we need to emphasize prevention,” says Nigel Key, MD, a professor of medicine at the University of North Carolina at Chapel Hill. These measures can help you avoid life-threatening clotting.

1. Review Your Meds

A few months prior to her DVT, Theobald had been prescribed birth control pills to regulate her period. All estrogen-containing medication (as well as the vaginal device NuvaRing and newer birth control pills containing drospirenone) may increase clot risk (as does pregnancy, with risk returning to normal about 12 weeks after delivery). Newer-generation birth control pills are one suspected reason for the rising pulmonary embolism deaths in young Australian women. If your doctor is worried about your clotting risk, she may recommend nonhormonal contraception such as a barrier method or a copper IUD.

The American College of Obstetricians and Gynecologists urges physicians to consider prescribing a patch rather than a pill for postmenopausal women on hormone replacement therapy. Taking pills raises DVT risk up to fivefold compared with not taking hormones, but delivering hormones through the skin doesn’t seem to affect clotting risk.

In June 2014, the FDA announced that prescription testosterone products must carry a warning that they raise DVT risk. Prednisone and other steroids, especially at high doses, also increase DVT risk in both men and women.

2. Know Your Family History

As the number of your close relatives who’ve had a clot rises, so does your own DVT risk, found Swedish research. Having two or more siblings with DVT raises your risk 50-fold compared with someone who has no affected siblings. “If you have a strong family history, your doctor may think twice about prescribing hormones or may give a longer course of anticlotting drugs after surgery,” says Dr. Zöller.

3. Lose Weight

Obesity can more than double DVT risk, especially in women over five foot six and men six feet or taller. “Tall people have to pump blood farther against the force of gravity, which may reduce flow in the legs and raise the risk of clotting,” explains Sigrid Brækkan, PhD, a researcher at the University of Tromsø in Norway. Theobald, who is five foot seven, weighed near her heaviest, at 190 pounds, when her clot occurred.

4. Get Moving

Walking, or raising and lowering your heels while sitting, engages your calf muscles, squeezing veins and propelling blood upward, which helps prevent DVT. Immobility is why long flights are a risk. The American College of Chest Physicians recommends you get up once every hour or so and raise and lower your heels or rotate your ankles when seated. If you’re at high risk, ask your doctor about wearing compression stockings or taking preventive blood-thinning medication for flights or car trips of more than four hours.

5. Eat Fish

In a large Swedish study from 2014, people who took fish oil capsules and ate fish three or more times a week had a 48 percent lower chance of developing DVT than those who ate fish less often and didn’t supplement with fish oil.

6. Be Vigilant at the Hospital

Sixty percent of DVTs occur in people who have recently been hospitalized, whether for surgery (general anesthesia temporarily widens veins, which can allow blood to pool and clot), trauma (anything that damages veins can slow blood flow, increasing risk), or illness (which can lead to prolonged bed rest).

Make sure doctors know about your medications and any DVT risks, such as a significant family history. You should be encouraged to move around, and you may need compression stockings or anticlotting drugs. Last June, Boston Medical Center reported that it had reduced postsurgery DVTs by 84 percent (from an admittedly lousy record) by tailoring preventive treatment to patients’ risks and by getting patients walking soon after operations. Also, follow medical advice before and after your discharge. Missed doses of preventive drugs are to blame for many clots.

Theobald, for one, is diligent about taking anticlotting meds because she knows that DVTs can return with a vengeance. Five months after her initial 13-day hospital stay, doctors weaned her off the blood thinner warfarin, but a new clot formed months later, enlarging her leg to almost the size of her waist. The resulting ten-day hospital stint brought new tortures, including shots of clot-busting drugs into the affected thigh that Theobald’s doctor likened to Roto-Rootering her veins.

Now she is committed to taking warfarin—or whatever easier treatment comes along—for the rest of her life. She wears compression stockings when sitting at her desk at a software company in Melbourne, Florida. In her free time, she keeps moving—she’s proud to have just completed her fifth triathlon.

Act Fast On These Symptoms

A blood clot is a medical emergency because of the possibility of a pulmonary embolism. If you experience any of the symptoms below, seek medical aid right away, especially if you might be at increased risk because of recent immobility, pregnancy, surgery, or cancer.

Signs of DVT in a Leg:

  • Pain (like a pulled muscle or a charley horse)
  • Swelling
  • Discoloration (red or blue)
  • Warm to touch

Signs of Pulmonary Embolism:

  • Shortness of breath
  • Chest pain
  • Unexplained cough (may cough up blood)
  • Rapid heartbeat

Preventing Deep Vein Thrombosis From Travel

Topic Overview

What is deep vein thrombosis (DVT)?

Deep vein thrombosis (DVT) is a blood clot in a deep vein, usually in a leg. A DVT is dangerous because the clot can break loose, travel through the bloodstream, and block blood flow to the lungs (pulmonary embolism). Without treatment, this can be deadly.

Why does travel raise your risk of DVT?

Sitting still for 4 or more hours slows down the blood flow in your legs. This makes your blood more likely to clot. And for the next few weeks, your blood clot risk stays higher than normal.

Even if you are healthy and have a low risk of blood clots, a long flight or road trip raises your risk of DVT.

If you already have a risk of blood clots, prolonged sitting raises your risk even more. Things that can already be raising your risk for DVT include a past DVT or pulmonary embolism, a recent surgery or injury, a blood clotting disorder, and cancer. Things that pose a small risk of DVT include pregnancy, taking hormones for birth control, or hormone therapy.

How can you prevent DVT from travel?

During a long trip (such as 4 or more hours):

  • If you are traveling by car, stop every hour or so. Get out and walk around for a few minutes. If you are traveling by bus, train, or plane, get out of your seat and walk up and down the aisle every hour or so.
  • While you’re sitting, raise and lower your toes, keeping your heels on the floor. Then raise and lower your heels, keeping your toes on the floor. Do this every 20 minutes.
  • Wear loose-fitting clothes that aren’t tight around your waist or your legs.

If you already have a risk of blood clots, talk to your doctor before taking a long trip. Your doctor may want you to wear compression stockings or take blood-thinning medicine.

When to call a doctor

For a few weeks after a long flight or trip, be alert for signs of a blood clot. A DVT needs treatment right away.

Call 911 or other emergency services if you:

  • Suddenly have shortness of breath and/or chest pain. Chest pain from a blood clot that travels to the lungs (pulmonary embolism) often gets worse with deep breathing.
  • Cough up blood.
  • Faint or lose consciousness.

Call your doctor right away if you have:

  • Swelling, warmth, or tenderness in the soft tissues of your leg.
  • Pain in your leg that gets worse when you stand or walk. This is especially important if there is also swelling or redness in your leg.

Blood Clots and Travel: What You Need to Know

More than 300 million people travel on long-distance flights (generally more than four hours) each year.1 Blood clots, also called deep vein thrombosis (DVT), can be a serious risk for some long-distance travelers. Most information about blood clots and long-distance travel comes from information that has been gathered about air travel. However, anyone traveling more than four hours, whether by air, car, bus, or train, can be at risk for blood clots.

Blood clots can form in the deep veins (veins below the surface that are not visible through the skin) of your legs during travel because you are sitting still in a confined space for long periods of time. The longer you are immobile, the greater is your risk of developing a blood clot. Many times the blood clot will dissolve on its own. However, a serious health problem can occur when a part of the blood clot breaks off and travels to the lungs causing a blockage. This is called a pulmonary embolism, and it may be fatal. The good news is there are things you can do to protect your health and reduce your risk of blood clots during a long-distance trip.

Blood Clots and Travel: What You Should Know

This podcast is designed to help people reduce their risk of blood clots during long-distance travel of four hours or more.

Understand What Can Increase Your Risk for Blood Clots

Even if you travel a long distance, the risk of developing a blood clot is generally very small. Your level of risk depends on the duration of travel as well as whether you have any other risks for blood clots. Most people who develop travel-associated blood clots have one or more other risks for blood clots, such as:

  • Older age (risk increases after age 40)
  • Obesity (body mass index greater than 30kg/m2)
  • Recent surgery or injury (within 3 months)
  • Use of estrogen-containing contraceptives (for example, birth control pills, rings,patches)
  • Hormone replacement therapy (medical treatment in which hormones are given to reduce the effects of menopause)
  • Pregnancy and the postpartum period (up to 3 months after childbirth)
  • Previous blood clot or a family history of blood clots
  • Active cancer or recent cancer treatment
  • Limited mobility (for example, a leg cast)
  • Catheter placed in a large vein
  • Varicose veins

The combination of long-distance travel with one or more of these risks may increase the likelihood of developing a blood clot. The more risks you have, the greater your chances of experiencing a blood clot. If you plan on traveling soon, talk with your doctor to learn more about what you can do to protect your health. The most important thing you can do is to learn and recognize the symptoms of blood clots.

Personal Stories

My name is Amaris White and I want to share my personal experience with blood clots. My hope is that by sharing this information, you will learn the signs and symptoms of this potentially fatal condition and know how to protect yourself and others.

Recognize the Symptoms

Deep Vein Thrombosis (DVT)

About half of people with DVT have no symptoms at all. The following are the most common symptoms of DVT that occur in the affected part of the body (usually the leg or arm):

  1. Swelling of your leg or arm
  2. Pain or tenderness that you can’t explain
  3. Skin that is warm to the touch
  4. Redness of the skin

If you have any of these symptoms, contact your doctor as soon as possible.

Pulmonary Embolism (PE)

You can have a PE without any symptoms of a DVT. Symptoms of a PE can include:

  1. Difficulty breathing
  2. Faster than normal or irregular heartbeat
  3. Chest pain or discomfort, which usually worsens with a deep breath or coughing
  4. Anxiety
  5. Coughing up blood
  6. Lightheadedness, or fainting

If you have any of these symptoms, seek medical help immediately.

For more information on blood clots

CDC Expert Commentary

Blood Clots and Long Distance Travel: Advising Patients

View this videoexternal icon to learn more about how healthcare providers can advise their patients on long-distance travel and blood clots.

Protect Yourself and Reduce Your Risk of Blood Clots During Travel

  • Know what to look for. Be alert to the signs and symptoms of blood clots.
  • Talk with your doctor if you think you may be at risk for blood clots. If you have had a previous blood clot, or if a family member has a history of blood clots or an inherited clotting disorder, talk with your doctor to learn more about your individual risks.
  • Move your legs frequently when on long trips and exercise your calf muscles to improve the flow of blood. If you’ve been sitting for a long time, take a break to stretch your legs. Extend your legs straight out and flex your ankles (pulling your toes toward you). Some airlines suggest pulling each knee up toward the chest and holding it there with your hands on your lower leg for 15 seconds, and repeat up to 10 times. These types of activities help to improve the flow of blood in your legs.
  • If you are at risk, talk with your doctor to learn more about how to prevent blood clots. For example, some people may benefit by wearing graduated compression stockings.
  • If you are on blood thinners, also known as anticoagulants, be sure to follow your doctor’s recommendations on medication use.

Reference

1Gavish I, Brenner B. Air travel and the risk of thromboembolism. Intern Emerg Med 2011 Apr;6(2):113-6.

Related Links

Avoiding Blood Clotting Complications When Flying Long Distances Before Surgery

    Clotting Complications: Deep Vein Thrombosis (DVT) and Pulmonary Embolism

    Deep Vein Thrombosis (DVT) is a blood clot, commonly found in the leg or thigh, that can form as a result of stagnant blood flow, coagulation, and damage to vein walls.

    According to Dr. Anne Bass, chairperson of the Deep Venous Thrombosis Prevention Committee at HSS, “DVTs can cause leg pain and swelling. Clots can also travel to the lung, causing a pulmonary embolism, which is a blockage of arteries that traverse the lung.

    “When left untreated, DVTs can inflict damage on the vein where the clot is located, causing chronic swelling and even ulceration,” she explains. “Pulmonary emboli can produce symptoms of shortness of breath, chest pains, a rapid heart rate, or fainting. In very rare cases, a fatal blockage of pulmonary arteries may occur.”

    Long-Distance Travel and How it Relates to Clotting and DVT

    Although it is very rare for a patient to develop DVT from a long flight, Dr. Bass explains that the following factors may contribute to blood clot formation:

  • When flying, passengers are normally sedentary and immobilized. This is a problem because it is the contraction of muscles in the legs, normally caused by motion and movement, that allows blood to circulate back to the heart. When the body is immobilized, blood pools in the legs, and this increases the risk of clotting. Additionally, when seated for a lengthy amount of time, the knees remain at a right angle, resulting in a “kink” in the veins of the legs, preventing proper circulation.
  • The dryness of the recirculated air on planes can leave its passengers dehydrated. This leads to the blood to become concentrated and more prone to clotting without the proper amount of hydrating fluids.

Blood Clotting Prevention on Long Flights

To combat poor circulation on long flights, Dr. Bass recommends:

  1. Standing, stretching, and walking up and down the aisle as frequently as possible to get the blood moving and to “get the kinks out.”
  2. In addition to exercising, graduated compression stockings are also recommended to help prevent blood pooling in the legs. They can be found at surgical supply stores and pharmacies.
  3. Prevention of dehydration on flights is as easy as drinking a steady amount of water or other non-alcoholic beverages.

Anticoagulants

Anticoagulants would seem to be a simple solution to blood clotting, but when taken preoperatively, they can thin the blood and increase the risk of bleeding at surgery.

Dr. Bass explains that anticoagulants should only be given to patients who are known to be at high risk for clotting (DVT, or pulmonary embolisms), either based on their medical history or their having a known genetic risk factor for clotting. Although Lovenox or heparin injections – and their effects – can wear off before surgery, the risk/benefit ratio of giving these injections to patients without an established elevated clotting risk is too high.

If a patient has a history of clotting risk, DVT, or pulmonary embolism in him/herself or his/her family, the patient should talk to a doctor in their own country as well as to their HSS doctor about treatment options before traveling to HSS for their surgical procedure.

A history of clotting and its resulting complications does not prohibit patients from traveling by air, however. Dr. Bass notes, “Even those with an elevated risk of clotting complications will be able to travel to HSS as long as preventive measures are taken.”

Surgery and Clotting Complications

A very long flight prior to surgery can increase the probability of complications for patients undergoing hip and knee replacements when preventive measures are neglected.

In orthopedic surgery, the cutting of bones prompts the body to respond by revving up its clotting system, a response that mirrors its reaction to a bodily injury. Due to the size of the bones involved in hip and knee replacements, there is a higher risk of blood clotting than other orthopedic surgeries. Dr. Bass also adds that in patients with hip fracture, the risk is further increased because of the immobilization of patients prior to surgery.

Risks of Clotting After Surgery

There is a risk of clotting for up to 4-6 weeks after surgery for all patients, but flying long distances aggravates this problem further. As a result, those who travel such distances may be subject to enhanced preventive measures after their procedure.

For example, after hip and knee surgeries, blood thinners are typically administered to patients. If there is a long plane flight in the patient’s future, their doctor will choose an appropriate type of blood thinner to accommodate those plans. Patients can be given anticoagulants following surgery, and the choice of blood thinner includes balancing the risk of clotting with the risk of bleeding after surgery. The risk of bleeding after surgery diminishes with time, and one option is the use of warfarin (Coumadin®) which develops its blood thinning effect over several days.

Solutions for DVT

When DVT is detected in patients, they are treated with blood thinners, including heparin injection, twice a day. These work quickly to help dissolve the blood clot and prevent the formation of new clot. Simultaneously, the doctor will initiate an oral blood thinner like warfarin (Coumadin®), which is continued for 3 months if a clot is found in the leg, and six months if the clot is in the lung.

Although there are solutions to dealing with DVT, especially when discovered early, effective prevention is always a good policy.

Updated: 3/26/2019

Summary by Mike Elvin

Authors

Anne R. Bass, MD
Program Director, Rheumatology Fellowship Program, Hospital for Special Surgery
Attending Physician, Hospital for Special Surgery &nbsp

Blood Clot Risk and What You Can Do

Risk Factors

Estimated risk for developing a DVT (blood clot in the leg) or PE (blood clot in the lung):

High Risk

  • Hospital stay
  • Major surgery, such as abdominal/pelvic surgery
  • Knee or hip replacement
  • Major trauma: automobile accident or fall
  • Nursing home living
  • Leg paralysis

Moderate Risk

  • Older than age 65
  • Trips over 4 hours by plane, car, train, or bus
  • Active cancer/chemotherapy
  • Bone fracture or cast
  • Birth control pills, patch, or ring
  • Hormone replacement therapy
  • Pregnancy or recently gave birth
  • Prior blood clot or family history of clot
  • Heart failure
  • Bed rest over 3 days
  • Obesity
  • Genetic/hereditary or acquired blood clotting disorder

Average Risk

  • Active
  • Younger than age 40
  • No history of blood clots in immediate family
  • No conditions or illnesses that heighten clotting risk

Practical Steps to Lower Your Risk for a Blood Clot

  • Ask your doctor about need for “blood thinners” or compression stockings to prevent clots, whenever you are admitted to the hospital
  • Lose weight, if you are overweight
  • Stay active
  • Exercise regularly; walking is fine
  • Avoid long periods of staying still
  • Get up and move around at least every hour whenever you travel on a plane, train, or bus, particularly if the trip is longer than 4 hours
  • Point and flex your toes and make circles with your feet if you cannot move around while sitting for prolonged periods to get your blood circulating
  • Stop at least every two hours when you drive, and get out and move around
  • Drink a lot of water and wear loose fitted clothing when you travel
  • Talk to your doctor about your risk of clotting whenever you take hormones, whether for birth control or replacement therapy, or during and right after any pregnancy
  • Follow any self-care measures to keep heart failure, diabetes, or any other health issues as stable as possible

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