Knee surgery blood clot

Sharon Sullivan’s Blood Clot Story

Four years ago, I found out that taking birth control pills could almost take my life! Shortly after returning from my honeymoon in December 2007, I felt severe abdominal pain. My former primary doctor changed the brand of my birth control pills, prescribed ibuprofen for pain, and eventually sent me for a pelvic ultrasound that showed large fibroids, for which I needed major abdominal surgery. The operation to remove the fibroids was more complex than anticipated, so lasted several hours. Five days after my surgery, I was released to begin my six-week post-op recovery. I was progressing as expected for the first two weeks, and was even able to walk a few blocks twice a day.

I woke up suddenly in severe pain 14 days after the surgery, feeling as if I had shards of glass in my lungs whenever I took a deep breath. Foolishly, I assumed it would pass, but by evening my lung pain was unbearable and I was gasping for air. My husband took me to the Emergency Room (ER) where I was first treated for indigestion. Thankfully, the ER doctor ultimately sent me for a CT scan 5 hours later, and we learned that my lungs were loaded with pulmonary emboli (blood clots). I was scared to death.

At that time, I didn’t know much about pulmonary embolism (PE) and deep vein thrombosis (DVT), but knew enough to realize that my condition could be fatal. I was given blood thinner injections immediately, admitted to the cardiac ICU and taken for an echocardiogram to see whether any blood clots traveled to or damaged my heart. Other scans showed a massive DVT in three major veins of my right leg. The hospital hematologist tested me for genetic blood clotting disorders that were negative, despite a history of blood clots in my family, most notably my father’s history of a DVT.

I was taking the right dose of Coumadin® (my INR was at between 2.0 and 3.0) by the end of the week and released with instructions to continue blood thinner injections twice a day for 5 days, after which I could switch to blood thinner pills only.

Pulmonary function tests later showed I had diminished lung capacity (unable to breathe at normal level) as well as scar tissue that caused discomfort for some time. My DVT caused permanent damage in my leg veins. Their valves no longer open and close properly, which causes me a lot of leg pain, swelling and tenderness. I have to wear compression stockings for the rest of my life to help alleviate these symptoms. This complication of DVT is called Post-Thrombotic Syndrome (PTS). It has symptoms nearly identical to those of a new clot, so it’s difficult for me to assess if any leg pain I feel is caused by the PTS or if there is a new blood clot. Hence, I’ve been in and out of the ER multiple times over the last few years.

Despite all of this, I consider myself one of the lucky ones! I thank God every day for healing me and for providing me with an amazing pair of new doctors. Through my journey these last three years I’ve encountered numerous women in similar situations, and I’m saddened when I hear about those who did not survive.

Some doctors, including my former primary doctor, overlook any discussion of the serious risks associated with birth control pills with their patients. They may not consistently ask about individual family history of blood clots or clotting disorders, and stay resistant to change their usual approach. Despite my father’s DVT and other heart-related history in the family, my primary doctor didn’t raise any concerns about putting me on the pill, even though I was well into my 30s.

More women need to be aware that taking birth control pills can pose a risk for blood clots that may also be triggered by surgery or blood clotting disorders. Women with a blood clotting disorder carry a risk to develop a blood clot that is heightened when they are taking estrogen-containing birth control pills. Later and more specific genetic testing done by my new hematologist has since confirmed that my father and I have inherited clotting disorders. I have elevated Factor VIII (three times the normal) and I have heterozygous PAI- 1 Gene (Plasminogen Activator Inhibitor). My father has elevated Factor VIII with lab results similar to mine.

I believe that by sharing my story, others can learn from my situation and not end up like me. My husband and I have learned so much throughout this ordeal. We now know that as patients we have to educate ourselves by researching our own conditions. It’s my hope that everyone who reads my story will share it with family and friends in an effort to raise awareness about the signs symptoms of DVT and PE; the risks in taking birth control pills and the importance of knowing your family history of blood clots or clotting disorders and how it might affect your health.

In January 2011, my uterus showed more fibroids. I spent 2 ½ years trying to determine my pregnancy risk related to my blood clotting disorder and PEs, and another 4 ½ months trying to become pregnant. I worked with my hematologist and two experts in maternal fetal medicine, and took low molecular weight heparin injections twice a day.

After this, I was sent to a reproductive endocrinologist, who found a blockage in one of my fallopian tubes that would need to be cleared, as well as scar tissue in my uterus from my previous surgery. Any surgery is risky, because I have a strong tendency to clot, but it was necessary for my husband and me to consider IVF (in vitro or test tube fertilization), which was my only way to become pregnant. My abdominal pain increased dramatically while I was weighing my risks. In August, I found out that the fibroids were growing in number, so that meant an official end of the road for babies for me and my husband, because I needed to have my uterus removed, even though surgery poses a big risk. My hematologist placed an IVC (inferior vena cava) filter to block any clots from reaching my lungs before a planned abdominal hysterectomy. My estimated recovery period is 8 weeks that includes daily injections of low molecular weight heparin that were started 12 hours after surgery.

I am now relieved to say that 6 weeks have gone by and my surgery was a success. I was an in-patient at Georgetown Hospital for 6 days post-op. Other than PTS pain, I’ve been doing great this time. I will have the IVC filter removed soon and then stop low molecular weight heparin injections 4 weeks after the filter is removed.

Take Home Messages

  • Tell your doctors and other healthcare professionals about any family history of blood clots, particularly any in your birth family.
  • Ask about risk associated with birth control pills, if you are taking them or considering using them.
  • Seek emergency treatment for shortness of breath or chest pain.
  • Wear compression hose daily after a DVT to prevent complications such as PTS.
  • Surgery, especially abdominal and pelvic, pose risk for clots.
  • Make sure your family and friends know the sign and symptoms (S/S) of DVT and PE and to seek medical care right away if they notice the following S/S:

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.

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

These symptoms of a blood clot may feel similar to a pulled muscle or a “Charlie horse,” but may 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.

Pulmonary Embolism: Signs and Symptoms

Clots can break off from a DVT and travel to the lung, causing a pulmonary embolism (PE), which can be fatal

  • 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

350,000—600,000 people in the United States develop blood clots every year. About 100,000 people in the U.S. die each year from blood clots, which means that about 1 of 3 may die.

Reference: The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism, US Dept of Health and Human Services, 2008.

Total Knee Replacement Patient Story

Avoiding a Blood Clot After Total Knee Replacement Surgery: A Patient Story

My story is a little different from most total knee replacement (TKR) patients, but the lessons I learned pre and post-op will help anyone avoid blood clots.

I have a clotting disorder (protein C deficiency), which makes me an “Uber Clotter,” that was discovered several years ago when I had major clots in both of my lungs or pulmonary emboli (PE). It was the perfect storm that led to the discovery of my disorder was an arthroscopic knee surgery, birth control, and a cross-country flight. Any of those can cause blood clots, but add my disorder to the mix and that story ends with me getting off a flight unable to breathe and being rushed to an ER. I was a very active person in my forties.

So I went into my TKR as a patient who takes warfarin daily with the same fears everyone has undertaking a major surgery. I did a lot of pre-op online research, but I will tell you that unless information is coming from an organization like the Agency for Healthcare Research and Quality, or NBCA, you are going to find a lot of personal stories online that will most likely scare you. And don’t watch the Youtube videos unless you are a person who needs TMI.

What will help you is a plan, similar to the one I had.

Talk to your doctor and make sure your questions are answered.

Discuss your risks, and what you can do to lessen them. Blood clots are a risk with any type of surgery, and for people with limited mobility, so be sure to ask a lot of questions or take someone with you who can write instructions down. Click here are several great questions to ask your doctor.

Your doctor will have a plan and recommendations for you, knowing your current medications and history. Prevention is typically a three-pronged approach designed to address the issues of stasis (or inactivity) and coagulation. Typically several therapies are used in combination. For example, you may be fitted with graded compression elastic stockings and an external compression device upon admittance to the hospital. Movement and rehabilitation begin the first day after surgery and can continue for several months and anticoagulant therapy may begin the night before surgery and continue after you are discharged.

Exercise prior to surgery.

You are most likely having the surery because you are in pain, and therefore limited in the amount of exercise you are able to do. It is, however, truly important that you go into the surgery as aerobically fit as you can be, and with as much muscle as you can develop.

Click here for a video that will give you some aerobic training, without moving your legs.

Click here for another that will help you with upper body strength.

It is important that you do not try any new exercise without first consulting your doctor.

Attend a pre-op program many hospitals sponsor.

My hospital had a pre-op training session with a nurse for hip and knee replacement surgery patients. If you can, take someone with you as it never hurts to have a second set of ears. Ask questions about what therapies the hospital uses to decrease the likelihood of clots during your stay there.

Once you are post-surgery, get moving.

Believe it or not you will be standing and walking using an assisted device during the first 24 hours after surgery. The more active you are, the less likely you will clot. Do what the nurses tell you to.

for an example of how much activity you will be expected to perform post-op.

Develop an exercise regime with your physical therapist, and walk as much as you can tolerate.

This will help you heal and keep your blood flowing. It is very important to exercise, take your medicine as your doctor prescribes, or use the compression stockings during this time when you are healing. Enlist family and friends to help you with walks and exercises—you might need the additional motivation, and its best to walk with someone.

for an example of the exercises you will be doing with your physical therapist.

Know the symptoms of a blood clot.

After knee surgery, most DVTs occur in the calf. Although less likely to lead to PE, these clots are more difficult to detect. Less than one third of patients with DVT present with the classic signs of calf discomfort, edema, distended veins, or foot pain.

The risk of developing DVT extends for at least three months after TKR. The risk is greatest two to five days after surgery; and a second peak development period occurs about 10 days after surgery, so be aware.

You will be on pain medication, and your knee will be swollen. Call your doctor if you experience any symptoms of blood clots including shortness of breath, as this could be a sign of a life-threatening PE, cramping in your calf, or pain in your foot or ankle.

Preventing a Hidden Danger of Joint Surgery: Blood Clots

By Claudette Lajam, MD, Special to Everyday Health

Blood clots can be serious complications of orthopedic surgeries like joint replacement or surgery to repair knee, hip, or other joints. Here’s how to recognize and minimize your risk of blood clots.

Up to 600,000 people in the United States are affected by venous thromboembolism each year, a disease that includes deep vein thrombosis (DVT) and pulmonary embolism (PE).

With DVT, a blood clot forms in a deep vein – often in the leg – and can result in serious illness, disability, and even death. A pulmonary embolism is a serious complication of DVT that occurs when part of the clot breaks up and travels through the bloodstream to the lung.

While there is always some risk of blood clots developing after knee or hip replacement surgery and other joint surgeries mentioned above, these dangerous conditions can mostly be prevented. Your best strategy is to work together with your medical care team before the procedure. Here’s what you should ask your doctors.

What Puts You at Risk for a Blood Clot After Surgery?

We look at four main risk factors when trying to determine whether a patient faces a higher risk for a post-operative blood clot. These include:

  • Having a body mass index, or BMI, over 40 (which is very obese)
  • A previous history of blood clots
  • Being an active tobacco smoker
  • Currently undergoing treatment for cancer

We may monitor patients with these risk factors more closely or prescribe blood thinners following their surgeries to prevent clots.

There are other potential risk factors where the medical literature is less clear. You should tell your doctor if:

  • You are taking hormonal pills like birth control
  • You have a family history of clots but may not have experienced one yourself

Many factors contribute to surgical risk. Anything might impact the outcome of your surgery, so it is critical to be completely honest about all medicines you take and about your medical conditions.

Can I Do Something After Surgery to Curb My Clot Risk?

You can do three things to stave off DVT — two of them before surgery starts:

  1. Stop smoking. Smoking has been shown to increase the risk for blood clot three to five times. Ask your doctor for referral to a stop-smoking program.
  2. Control your weight. If you are obese, losing weight is a way to reduce your risk for many complications after surgery. Ask your surgeon to refer you to a nutritionist or physician to help you with this.
  3. Get moving and keep moving right after surgery. Blood clots form when blood stays in one place. When you move your muscles, your blood does not sit still long enough to clot.

In fact, your care team will often begin physical therapy in the recovery room, immediately after orthopedic surgery. At NYU Langone’s Hospital for Joint Diseases, most joint replacement patients are on their feet the day of surgery. But even if you can’t stand up, you can still tense and release your muscles to simulate movement.

Do Certain Medications Put Me at Risk for Blood Clots?

Rarely do medicines you take thicken the blood and create clot risk, and in very few cases, you’ll be told to stop taking a medication before orthopedic surgery.

However, after surgery, you may be prescribed a blood thinner. Unfortunately there is no perfect blood-thinning medication, and you’ll need to monitor your bleeding risk. For example the gold standard, warfarin, is effective at preventing clots but requires frequent blood tests to monitor levels in the body. When the blood is too thin from warfarin, your physician can reverse it with other medications.

Another blood thinner, low molecular weight Heparin (LMWH), is also effective, but requires daily injections. These too can be reversed if the blood becomes too thin.

Rivaroxaban (Xarelto) is a blood thinner taken as a pill. This medication does not require testing or injections. It works well but can’t be reversed if the blood becomes too thin, which can be dangerous right after surgery.

Recently, research has shown that a combination of aspirin and leg massaging pumps can effectively prevent blood clots in low-risk patients. Together, these treatments slightly thin the blood and move it around, though the pump needs to be worn up to 18 hours a day.

If I Get a Clot, How Would I Know?

Despite all of your preventive efforts, you may still develop DVT. Telltale signs are fever and major swelling. Some swelling is expected and normal after orthopedic surgery, but if you notice a sudden increase in swelling or tenderness, or if the limb becomes too painful to move, these are signs you might have a clot. The good news is this is very treatable if discovered early.

Making DVT Prevention a Top Priority

At NYU Langone, in New York City, our leadership looks at DVT prevention as a top priority to ensure that our patients have the best possible outcomes after surgery. We’ve developed quality and safety procedures to help minimize the risks of surgery in our patients. In fact, as part of a pioneering new effort to identify and treat VTE, a first-of-its-kind center for prevention, diagnosis, and treatment of VTE, the Venous Thromboembolic Disease Center (VTEC) will open soon at NYU Langone Medical Center.

Claudette Lajam, MD, is an assistant professor in the Department of Orthopaedic Surgery at NYU Langone Medical Center in New York City, and Chief Safety Officer at NYU’s Hospital for Joint Diseases.

Reducing Blood Clots After Knee And Hip Replacement, Recommendations Outlined In New Guideline

Each year more than 800,000 Americans undergo hip or knee replacement surgery. Last week the American Academy of Orthopedic Surgeons (AAOS) Board of Directs released an updated clinical practice guideline with recommendation strategies for the reduction of potential blood clot formation following hip or knee replacement surgery. Suggestions include using preventive treatments and advice against routinely screening patients after surgery using ultrasound imaging.
According to Joshua Jacobs, MD, Academy second vice president, an orthopedic surgeon at Rush University Medical Center in Chicago, who was chairman of the workgroup that developed the guideline:

“Hip and knee arthroplasty (joint replacement surgery) is among the most successful of procedures in terms of restoring function and minimizing pain. However, one possible complication that orthopedic surgeons are concerned about is venous thromboembolic disease.”
Thromboembolic disease incorporates two conditions. The first is deep vein thrombosis (DVT), a formation of a blood clot (thrombus) in a deep vein, for example in the thigh or calf. The second being a pulmonary embolism (PE), a fairly common event in which particles of a thrombus break lose and progress into the lung via the bloodstream where they obstruct the bloodstream blocking the lungs main artery or one of its branches. In very rare cases, PE can be fatal.
There are generally no warning signs for a PE, although possible symptoms include shortness of breath, chest pain, light-headedness or chest congestion. Likewise, many DVT patients also show no symptoms, however, in some patients swollen legs and pain necessitate further treatment or rehospitalization. The goal of the orthopedic surgeon is to prevent the occurrence of PE and DVT as best as possible following total hip and knee replacement.
The guidelines state that image detection revealed that approximately 37% of patients develop DVT if not administered with a prophylaxis.
Most of those patients will remain asymptomatic and will require no further treatment. According to recent studies in Denmark only 0.7 % of hip replacement patients and 0.9% of knee replacement patients needed to be hospitalized due to DVT in the first three months following their surgery.
Jacobs commented:
“After looking at all available scientific research evidence, in a rigorous fashion to minimize bias, we made recommendations that can help guide practitioners in the safest and most effective ways to prevent this potentially serious complication.”
For the prevention of DVT, experts assessed the safety and efficacy of mechanical compression devices and drug therapies designed to improve the leg’s blood flow after surgery. Drug therapy consists of anticoagulants (blood thinners) as well as aspirin, which prevent formation of blood clots by acting on platelets.
The work group also highlighted recommendations for future research on areas without sufficient supporting evidence that became apparent during their comprehensive and systematic review of the medical literature. Further research is considered as a vital necessity to optimize the safest and most efficient strategies for the prevention of venous thromboembolic disease.
After reviewing all evidence, the workgroup established the following recommendations for physicians treating patients prior to their hip or knee replacement:

  • Due to the increased risk of blood loss during surgery, antiplatelet (anticoagulant) drugs, such as, aspirin and clopidogrel (Plavix) should be discontinued prior to surgery. Advice on stopping any medication prior to surgery should be carried out under the guidance of the patient’s physician.
  • Patients with previous DVTs or PEs are at additional risk for thromboembolic disease and it is therefore vital that the surgeon is made aware of any previous events. There is no sufficient evidence to recommend for or against routinely assessing patients for other possible risk factors.
  • Patients may require or opt for surgery under local anesthesia, such as epidural or spinal instead of having a general anesthesia and even though evidence suggests that local anesthesia does not affect the occurrence of DVT or PE, it does limit blood loss.

The workgroup also established the following aftercare recommendations after hip or knee replacement surgery:

  • Joint-replacement patients should not have routine postoperative screening for thromboembolic disease with duplex ultrasonography, which shows the blood’s movement through arteries and veins. Ultrasound tests do not significantly reduce the rate of symptomatic DVT or PE or the rate of fatal PE.
  • Patients should receive anticoagulant therapy and/or mechanical compression devices after a hip or knee replacement surgery unless medical reasons, such as a bleeding disorder or active liver disease prevents them from using these drugs. There is no sufficient evidence to particularly recommend one preventive strategy or the duration of these treatments over the other. Duration and type of preventive treatment should be discussed with the patient’s physician.
  • Joint-replacement patients should get up and be mobile as soon as safely possible after surgery. Even though there is insufficient evidence that “early mobilization” reduces DVT rates, early mobilization is low cost, carries minimal risk and is consistent with current practice.

Written by Petra Rattue

Risk of clots ‘months’ after surgery

“Patients recovering from surgery are at a high risk of fatal blood clots for much longer than thought,” the Daily Mail reported. It said researchers had found that the risk continues for up to three months after surgery.

This report is based on a large study in 947,454 middle aged women, which examined the risks of developing blood clots after having different types of surgery. It found that there was an increased risk of blood clots up to 12 weeks after surgery.

This research has some uncertainties but due to its size these findings appear to be reliable. While it was already known that the risks were greatest in the few weeks following surgery, this study suggests that the risk may continue for a substantial time beyond this period. These findings may have implications for the use of blood clot treatments after surgery.

Where did the story come from?

The research was carried out by Dr Siân Sweetland and colleagues from The Cancer Epidemiology Unit at the University of Oxford. The study was funded by Cancer Research UK and the Medical Research Council. It was published in the peer-reviewed British Medical Journal.

Generally, the story was reported similarly well and accurately by The Daily Telegraph, The Daily Mail and BBC News.

What kind of research was this?

This was a large prospective cohort study involving 947,454 women who were followed for an average of 6.2 years. The research aimed to examine the risk of venous thromboembolism (blood clot) after different types of surgery. The researchers say that the risk of venous thromboembolism is highest during the first few weeks after surgery, but the exact pattern and magnitude of this over time is uncertain.

As the incidence of blood clots is relatively low in the general population, such a large study is necessary to give representative information.

What did the research involve?

The participants were part of the Million Women Study. This is a population-based prospective study that recruited 1.3 million women through the NHS breast screening programme between 1996 and 2001. The average age of the participants was 56 years and the majority were postmenopausal.

These women were followed up until 2005, for an average of 6.2 years. Their inpatient and day-case hospital admission records were analysed for this period. The researchers compared two groups of women:

  • Participants who had undergone day case or inpatient surgery during the follow-up period.
  • Participants who had not had any surgery over that period.

The researchers then checked hospital records for the incidence of blood clots. They grouped hospital admissions for two types of clots: deep vein thrombosis and pulmonary embolisms (clots affecting blood vessels in the lungs). They also looked at the incidence of blood clots with different types of surgery and the likelihood of having a blood clot with increasing time after surgery.

In their analysis, the researchers also took into account other factors that can affect the likelihood of having a blood clot, such as a high body mass index or being on hormone replacement therapy (HRT).

What were the basic results?

The women in the two groups were of similar age, weight, postmenopausal status and lifestyle, when they first enrolled in the study.

Both inpatient surgery and day-case surgery increased the risk of blood clots occurring within six weeks post operation, compared with people who had not had surgery. Women who had day-case surgery were 10 times more likely to have blood clots than women who had no surgery, (relative risk 9.6 ) The risk for women who had inpatient surgery was almost 70 times higher (relative risk 69.1 ).

In the inpatient group, the risk of blood clots peaked three weeks after surgery. The risk of clots in the day case group steadily decreased from immediately after the surgery. This risk reduced over time, but there was a slight increase in risk that was statistically significant 12 months after surgery.

At seven to 12 weeks after surgery, the risk of blood clots was six times higher for the day case surgery group compared to the no-surgery group, and 20 times higher for the inpatient surgery group.

Different types of surgery required a different length of stay in hospital afterwards. Patients who had knee or hip surgery, had an average stay of eight days in hospital and were more than 200 times more likely to have blood clots in the six weeks following surgery than a person who had not had surgery. When the researchers looked at the absolute incidence of blood clots in the 12 weeks after surgery they found:

  • One in 815 patients developed blood clots after day-case surgery,
  • One in 140 patients developed blood clots after inpatient surgery. This increased to 1 in 45 following knee or hip surgery.
  • For women who had not had any surgery, about one in 6,200 developed clots for the same period.

How did the researchers interpret the results?

The researchers conclude that in the year following an operation, the risk for hospital admission varies considerably. “Incidence rates for venous thromboembolism (blood clots) in the first six postoperative weeks were over 100 times the rates without surgery and, seven to 12 weeks after inpatient surgery rates, were still almost 20 times higher than without surgery. The relative risks after day-case surgery were lower than for inpatient surgery but still substantially increased.”

The researchers also say that the risks are greater and last longer than previously thought. They suggest that, following an operation, the time that patients are given the drugs to prevent blood clots should be extended to 12 weeks.

Conclusion

In this large and well-conducted study, the researchers determined that the risk for blood clots after surgery could last up to 12 weeks after the procedure. They also calculated the different risks for different types of surgery.

They warn that the incidence of blood clots after surgery may actually be higher than their figures indicate. This is because it’s likely that women were given treatments to prevent blood clots after surgery, and because the reported number based on hospital records may be an underestimation as some types of blood clot do not have symptoms.

It is worth noting that the researchers had no data on how many of the participants were taking preventive measures, such as wearing stockings or taking blood-thinning drugs around the time of their surgery. They say, quite reasonably, that if such data had been taken into account, the increased risk might have been even greater for people who had surgery and were not taking any preventive measures.

However, despite these uncertainties, and due to its size, these findings appear to be reliable. While it was already known that the risks were greatest in the few weeks following surgery, this study suggests that the risk may continue for a substantial time beyond this period. These findings may have implications for the use of blood clot treatments after surgery.

Analysis by Bazian
Edited by NHS Website

Links to the headlines

Risk of blood clots after surgery is higher than thought: research.

The Daily Telegraph, 4 December 2009

Clot risk after surgery warning.

BBC News, 4 December 2009

Risk of DVT after surgery could last for three months.

Daily Mail, 4 December 2009

Links to the science

Cohen TA.

Prevention of postoperative venous thromboembolism.

BMJ 2009; 339: b4477

Sweetland S, Green J, Liu B. et al.

Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study.

BMJ 2009; 339: b4583

Further reading

Amaragiri SV, Lees T.

Elastic compression stockings for prevention of deep vein thrombosis.

Cochrane Database of Systematic Reviews 2000, Issue 1

Handoll HHG, Farrar MJ, McBirnie J, Tytherleigh-Strong GM, Milne AA, Gillespie WJ.

Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures.

Cochrane Database of Systematic Reviews 2002, Issue 4

Kakkos SK, Caprini JA, Geroulakos G, Nicolaides AN, Stansby GP, Reddy DJ.

Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism in high-risk patients.

Cochrane Database of Systematic Reviews 2008, Issue 4

How to Spot and Prevent Deep Vein Thrombosis

When the Clot Thickens

Lots of things can cause pain and swelling in your leg. But if your symptoms stem from a blood clot deep in your leg, it can be dangerous. Blood clots can happen to anyone, anytime. But some people are at increased risk. Taking steps to reduce your chances of a blood clot forming in your veins can help you avoid potentially serious problems.

Blood clots can arise anywhere in your body. They develop when blood thickens and clumps together. When a clot forms in a vein deep in the body, it’s called deep vein thrombosis. Deep vein blood clots typically occur in the lower leg or thigh.

“Deep vein thrombosis has classic symptoms—for example swelling, pain, warmth, and redness on the leg,” says Dr. Andrei Kindzelski, an NIH blood disease expert. “But about 30–40% of cases go unnoticed, since they don’t have typical symptoms.” In fact, some people don’t realize they have a deep vein clot until it causes a more serious condition.

Deep vein clots—especially those in the thigh—can break off and travel through the bloodstream. If a clot lodges in an artery in the lungs, it can block blood flow and lead to a sometimes-deadly condition called pulmonary embolism. This disorder can damage the lungs and reduce blood oxygen levels, which can harm other organs as well.

Some people are more at risk for deep vein thrombosis than others. “Usually people who develop deep vein thrombosis have some level of thrombophilia, which means their blood clots more rapidly or easily,” Kindzelski says. Getting a blood clot is usually the first sign of this condition because it’s hard to notice otherwise. In these cases, lifestyle can contribute to a blood clot forming—if you don’t move enough, for example. Your risk is higher if you’ve recently had surgery or broken a bone, if you’re ill and in bed for a long time, or if you’re traveling for a long time (such as during long car or airplane rides).

Having other diseases or conditions can also raise your chances of a blood clot. These include a stroke, paralysis (an inability to move), chronic heart disease, high blood pressure, surgical procedure, or having been recently treated for cancer. Women who take hormone therapy pills or birth control pills, are pregnant, or within the first 6 weeks after giving birth are also at higher risk. So are those who smoke or who are older than 60. But deep vein thrombosis can happen at any age.

You can take simple steps to lower your chances for a blood clot. Exercise your lower leg muscles if you’re sitting for a long time while traveling. Get out of bed and move around as soon as you’re able after having surgery or being ill. The more active you are, the better your chance of avoiding a blood clot. Take any medicines your doctor prescribes to prevent clots after some types of surgery.

A prompt diagnosis and proper treatment can help prevent the complications of blood clots. See your doctor immediately if you have any signs or symptoms of deep vein thrombosis or pulmonary embolism (see the Wise Choices box). A physical exam and other tests can help doctors determine whether you’ve got a blood clot.

There are many ways to treat deep vein thrombosis. Therapies aim to stop the blood clot from getting bigger, prevent the clot from breaking off and moving to your lungs, or reduce your chance of having another blood clot. NIH scientists continue to research new medicines and better treatment options.

If you think you may be at risk for deep vein thrombosis, talk with your doctor.

Hospitalization and Blood Clots

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Title: Stop The Clot, Spread The Word

Prevent the Need for 911. Get the Facts on Blood Clots

Roughly 1 out of 10 hospital deaths are related to blood clots in the lungs.

Blood clots are a leading cause of preventable hospital dealth in the United States.

  • About half of all blood clots occur during or within 3 months of a hospital stay or surgery
  • Many of these blood clots can be safely prevented
  • Nearly half of all hospital patients do not receive proper prevention measures

Know Your Risk: The Link Between Hospitalization and Blood Clots

Hospitalization, particularly involving physical trauma, surgery, or prolonged immobility, increases the risk for blood clots.

  • Physical Trauma: Injury to a vein that may be caused by a broken bone, muscle injury, or other serious injury to the body.
  • Surgery: Major surgery, particularly of the pelvis, abdomen, hip, or knee.
  • Immobility: Confined to a bed or wheelchair for long periods of time due to a hospital stay, injury, or illness.

Understaning Blood Clots

A blood clot in one of the large veins, usually in a person’s leg or arm, is called a deep vein thrombosis or DVT. When a DVT forms, it can partially or completely block the flow of blood through the vein.

If a DVT is not treated, it can move or break off and travel to the lungs.

A blood clot in the lungs is called a pulmonary embolism or PE. This requires immediate medical attention since it can cause death.

Going to the Hospital? Get Better. Don’t Get a Blood Clot. Have a Prevention Plan.

Before You Enter the Hospital

  • Discuss your potential risk factors and family health history with your doctor.
  • Ask if you will need prevention measures for blood clots while in the hospital.
  • Make sure that all of your doctors know your blood clot risks and ask for a prevention plan.

Before your Leave the Hospital

  • Ask your doctor how to prevent blood clots when you are at home.
  • Discuss the signs and symptoms of blood clots.
  • Make sure you know what to do if you experience the signs or symptoms of a blood clot.

When You Return Home

  • Follow instructions and take medications as prescribed.
  • Move around, if confined to bed or a wheelchair, have someone help you move your arms and legs.
  • Notify your doctor if you experience signs or symptoms of blood clots.

If you experience any of the following signs or symptoms …

Blood Clots in Your Legs or Arms
Alert Your Doctor As Soon As Yo u Can

  • Swelling of your legs or arms
  • Pain or tenderness not caused by an injury
  • Skin that is warm to the touch
  • Redness or discoloration of the skin

Blood Clots in Your Lungs
Seek Medical Attention Immediately

  • Difficulty breathing
  • Chest pain that worsens with a deep breath
  • Coughing, or coughing up blood
  • Faster than normal or irregular heartbeat

To learn more about blood clots and to spread the word, visit stoptheclot.org/spreadthewordexternal icon

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