Prevent Blood Clots in Your Legs to Avoid Potentially Serious Consequences
From Focus on Healthy Aging - January, 2008
These are treatable if diagnosed early; if you have leg pain or swelling and know you have risk factors, ask your doctor to consider an ultrasound.
You’re just had knee surgery and your doctor tells you to get up and walk around as soon as possible. Why?
To avoid a blood clot from forming in your leg.
Deep vein thrombosis (DVT) is a clot that forms in a vein deep in the body, usually in the leg. About five people per 10,000 in the general population experience their first DVT each year — a preventable condition that can be serious and potentially fatal if ignored. A blood clot in the leg has the potential to break free and move to an artery in the lungs, where it’s known as a pulmonary embolism (PE). This combination of DVT and PE is called venous thromboembolism (VTE).
“Your condition is serious the minute you have a blood clot,” says Jeffrey Olin, DO, director of Vascular Medicine and the Vascular diagnostic Laboratory at Mount Sinai Medical Centre’s Zena and Michael A. Wiener Cardiovascular Institute. “Without treatment, the clot will go to the lungs about 50 percent of the time.” However, people do not always experience symptoms from a blood clot in the lungs.
Prevention and risk factors. Travelers who embark on long plane or car rides can develop blood clots because they are sitting for many hours at a time. You’re advised to get up and walk around every hour or so, if possible, to keep your blood flow unimpeded. If you are unable to get up and move around, try flexing your feet and pointing your toes periodically. You should avoid wearing tight-fitting socks or stockings and crossing your legs for an extended period of time. Also, be sure to drink plenty of water as dehydration can increase the possibility of a clot forming.
Undergoing surgery is another big risk factor for developing DVT. Dr. Olin says that about 60 percent of patients undergoing total hip or knee replacement without receiving preventative treatment for DVT will develop a blood clot, although the majority of these are asymptomatic and cause no harm.
Minor surgeries can lead to clot formation as well. Certain surgeries can cause damage to the blood vessels and encourage the formation of clots. In addition, being confined to bed a after surgery can make your chances of developing DVT even greater.
There are numerous measures you can take to reduce your risk, such as wearing compression stockings if you are hospitalized or put on extended bed rest. Compression stockings reduce the swelling below the knee that can accompany a blood clot. They are tighter near the ankle and become slightly looser as they go up the leg, in order to cause gentle external pressure on the leg. In addition, if you’re going to be in bed for an extended period of time, you might want to consider elevating your feet to promote blood flow. Intermittent pneumatic compression devices can be used to help prevent clots in those at moderate risk by increasing blood flow in the deep veins of the leg; however, these should not be used by people who have been at bed rest or immobilized as they may dislodge a pre-existing clot.
Another way to reduce your chances of developing blood clots is to maintain a healthy weight, because obesity is a risk factor.
The American Heart Association (AHA) reports that VTE leads to hospitalization in about 250,000 people annually. However, Dr. Olin notes that many patients are treated entirely on an outpatient basis, so the AHA’s number may be an underestimation of the true prevalence of VTE.
Several genetic factors can increase a person’s risk of VTE. One example is the genetic mutation known a Factor V Leiden, which can be identified through a DNA test. It’s present in about five percent of the Caucasian population in the U.S. and about 1.2 percent of the African-American population. If you have a strong family history of blood clots or you had your first DVT before the age of 50, you should be screened.
Signs and symptoms. The two most obvious symptoms of blood clots are sudden swelling and/or pain in one leg. However, it’s important to note that leg pain can have many other causes as well, which don’t necessarily indicate DVT.
If you do have a clot, you might feel increased warmth or see redness around the area of your leg that is swollen or sore (usually the calf). You also may notice enlargement of the superficial veins in the affected leg.
Symptoms of pulmonary embolism can include sudden shortness of breath, chest or back pain, and sharp chest pain, often aggravated by coughing or movement. If you experience any of these symptoms you should seek prompt medical attention. Your doctor may choose to screen for a clot by performing an ultrasound, x-ray, or magnetic resonance imaging (MRI).
Medication options. Once diagnosed, treatment usually begins with an injection of heparin or low molecular weight heparin (anticoagulants). Your doctor may also prescribe the blood thinner warfarin (Coumadin). “It’s important to realize that these drugs don’t dissolve the clot,” Dr. Olin says. “They prevent more clot formation and prevent it from moving to the lungs.”
Excessive bleeding is a potential side effect of heparin and warfarin, and patients should tell their doctors about all medications and supplements they are taking to check if any interfere with their VTE treatment.
In serious cases, a “clot-busting” drug such as tissue plasminogen activator (r-PA) can be effective, though in older adults and those who have had strokes or bleeding problems, t-PA could lead to other serious complications.
Surgical treatment. Whether the blood clot is in a leg vein or a pulmonary artery, a minimally invasive procedure known as a catheter-directed thromboectomy can pulverize or suck out the clot. The procedure is usually performed only where there is severe blockage of the large veins in the leg or pelvis with severe leg swelling. This technique is often used in conjunction with t-PA.
“Once diagnosed and treated properly, deep vein thrombosis shouldn’t keep anyone from enjoying their regular activities,” Dr. Olin says.
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