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Blood Clots

Risks | Causes | Symptoms | Prevention | Diagnosis | Treatment | 

Every year many thousands of people in the USA develop blood clots in a vein.  It’s known as Venous Thrombosis.  This is a serious, potentially fatal medical condition.  Although serious, most clots can be completely avoided.  The key is to be aware if you’re at risk and take some simple preventative steps.  This article concentrates on blood clots in a vein.  If you want information on blood clots in an artery, which is a common cause of heart attack and stroke, you can read more about arterial thrombosis.

Who gets blood clots? – Although it can happen to anyone, you’re more at risk of developing blood clots if you can’t move around very much or if you’re ill.  You have probably heard of blood clots linked to long airplane journeys or the birth control pill, but you’re much more likely to get a blood clot after going into the hospital.  In fact, about 2/3 of all blood clots occur during or just after a stay in the hospital.  Blood clots can occur in the superficial veins, the communicating veins or the deep veins.  The superficial veins are just below the skin and the deep veins run between your muscles.  The communicating veins connect the deep to the superficial veins.

DVT (deep vein thrombosis) is a blood clot that can block flow in one of the deep veins. Usually, DVT occurs in your pelvis, thigh, or calf, but it can occur less commonly in your arm, chest or other locations. DVT can cause sudden swelling, pain or sensation of warmth. In this condition, a blood clot can break free from your deep veins and travel through your bloodstream through the inferior vena cava and lodge in your lungs blocking the blood flow in your lungs. This can strain your heart and lungs. A pulmonary embolism [link to Pulmonary Embolism below] is a medical emergency which can be fatal if the size of the blood clot is large. When diagnosed early, the condition can be treated effectively once your physician diagnoses it.

RISK FACTORS FOR BLOOD CLOTS

Anyone being admitted to the hospital can get a blood clot.  Your risk may be higher if you’re having a major operation, if you’re going to be confined to bed for long periods, or you’re very overweight.  Nowadays, all hospitals will place inflatable cuffs around your calves that inflate and deflate every couple of minutes to keep the blood flowing through your veins throughout your hospital stay. In addition, you may receive an injectable medication throughout your hospital stay and up to thirty days following hospital discharge.  You have a greater chance of developing DVT if:

  • You are obese
  • Have a history of heart attack
  • Have a history of stroke or congestive heart failure
  • Are pregnant, nursing or taking birth control pills
  • Have inflammatory bowel disease

Most cases affect your legs, but DVT in the upper body is becoming more commonly recognized.  Some factors that increase your risk of DVT in the upper body include:

  • Having a long, thin flexible tube called a catheter inserted in your arm vein which can irritate your vein and cause a clot to form.
  • Having a pacemaker or implantable defibrillator or pacemaker
  • Having cancer
  • Performing vigorous repetitive activities with your arms.  This type of DVT is rare and occurs mostly in athletes such as weight lifters, swimmers and baseball pitchers.  This disease is known as Paget-Schroetter syndrome, and can often be associated with other anatomic abnormalities.

CAUSES OF BLOOD CLOTS

When something goes wrong with your blood clotting system, DVT can occur.  Once a small blood clot forms in your vein, it can cause inflammation that may encourage more blood clots to form.  Often, poor blood flow, or stagnation of blood, in your leg veins increases the risk of DVT.  This poor flow can occur when you’re not able to move for long periods of time.  As a result, your blood pools in your veins and clots are more likely to form.  Some specific causes of DVT include:

  • Major surgery on your hip, knee, leg, calf, abdomen, or chest
  • A broken hip or leg
  • Prolonged travel in seating areas without enough room to move your legs. Although this is true, it rarely occurs. Most cases of DVT occur in sick, hospitalized patients.
  • Inherited blood clotting abnormalities
  • Cancer

SYMPTOMS OF BLOOD CLOTS

About half of all DVT cases do not cause symptoms.  The symptoms you feel can depend on the location and size of your blood clot.  They include swelling, tenderness, leg pain that may worsen when you walk or stand, a sensation of warmth, and skin that turns blue or red.

PREVENTION OF BLOOD CLOTS

  • Losing excess weight
  • Stop smoking
  • Talking to your doctor if you take Hormone Replacement Therapy (HRT)
  • When in the hospital, drink plenty of fluids to keep hydrated
  • Wear compression stockings day and night (except when you’re bathing)
  • Wear any other compression device when you’re in bed
  • Take any blood-thinning medication you have been prescribed
  • Get up and move around as soon as you’re advised to do so.

If you have left the hospital, and you develop any of the symptoms of a blood clot, or you suspect you have a blood clot, go to the nearest emergency room as soon as possible so you can be treated promptly.

DIAGNOSIS OF BLOOD CLOTS

First, your physician will take a history and perform a physical exam.  To confirm a diagnosis of a DVT, your physician may order a Duplex Ultrasound test or another test called a Venogram.  Duplex Ultrasound uses high frequency sound waves, allowing the measurement of the speed of blood flow, and to see the structure of your veins and sometimes the clots themselves.  A Venogram is an x-ray that allows the physician to see the anatomy of your veins and sometimes the clots within them.  During this test, your doctor injects a dye that makes your veins visible on an x-ray.  Other tests are also possible: a computed tomogram (CT) or a Magnetic Resonance Venogram (MRV) are excellent studies that provide useful information regarding the location and extent of the clots.

TREATMENT OF BLOOD CLOTS

Your physician or vascular specialist can usually treat DVT with medications or minimally invasive procedures.  Rarely, surgery may be required.  When DVT is confirmed, your physician may inject a drug called heparin.  Anticoagulants are also called blood thinners.  They don’t literally thin your blood, but they help prevent your blood from clotting too easily.  Heparin helps prevent clots from forming and keeps clots you already have from growing larger.  Alternatively, your physician may prescribe a medication known as low molecular weight heparin (LMWH).  This has many of the same effects as heparin, but is given through an injection in the abdomen, once or twice a day.

Usually, you will receive heparin or LMWH for 5-7 days and after that, you will take anticoagulant pill called warfarin (Coumadin), usually for 6 months.  During the time you’re taking Coumadin, your physician will order blood tests to make sure your anticoagulation level is adequate to prevent clots, but not too high so as to cause excessive bleeding.

If your physician wants to dissolve the clot, he / she may recommend Thrombolysis.  In this procedure, your vascular surgeon injects clot-dissolving drugs through a catheter directly into the clot.  Rarely, physicians recommend surgery to remove a deep vein clot.  The procedure is called venous thrombectomy.  Also, your physician may recommend a special metal filter inserted via a catheter in your vein and position it in your inferior vena cava to protect you from pulmonary embolism.  This device is called vena cava filter.

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