Blood Clots: 10 Things to Know

Thousands of Americans experience blood clots every year. Knowing if you’re at risk and what symptoms to look out for are important to ensure you get prompt treatment.

As a nurse practitioner at the Michigan Medicine Frankel Cardiovascular Center, my heart patients often come to me with questions about blood clots, also known as deep vein thrombosis. Here are answers to some of the most common questions I’m asked.

1. What is a blood clot?

A blood clot is a collection of blood in the body that has changed from liquid to a semi-solid mass. The body does this to stop bleeding when injured, but sometimes a clot forms inside a blood vessel and does not dissolve on its own.

Platelets — cells that float in the blood — become sticky in response to injury and begin to attach to one another as well as to a blood vessel wall. Next, web-like strands in the blood, called fibrin, attach to the platelets and form a net that traps red blood cells. This reaction usually stops when the injury is repaired, and the body breaks down the clot. Sometimes, the action continues and becomes a blood clot that prevents blood from flowing through that vessel.

The most common type of blood clot is called deep vein thrombosis or DVT. This is a clot in one of the deep veins of the body, usually in the leg. When the clot is new, a piece of it can break off and travel to the lungs. This is known as a pulmonary embolism.

2. What are the symptoms of a blood clot?

Symptoms of a DVT include swelling of the affected leg, pain, redness, warmth and new visible veins in the area. Symptoms of a pulmonary embolism include shortness of breath, chest pain, cough or coughing up blood and fast breathing.

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Although these symptoms can be associated with many different health problems, if you suspect you have a clot, call your health care provider right away or go to the nearest emergency room.

3. How is a blood clot diagnosed?

Your provider will ask you a series of questions. If a blood clot is suspected, you will likely undergo one of these tests:

• A blood test called a d-dimer. This is a compound released from blood clots. It is high when you have a new clot.

• An ultrasound of the leg. This uses sound waves to watch blood flow in the veins.

• A CT scan of the chest if a pulmonary embolism is suspected.

4. What causes a blood clot?

Many risk factors and illnesses increase your risk of getting a blood clot. Risk factors include:

• Inactivity related to an injury or a long car or plane trip

• Having surgery or being in the hospital for an extended period

• Damage to your blood vessel from an injury

• Taking some medications such as birth control pills

• Inherited blood clotting tendencies

• Cancer

• Pregnancy

• Being over 60 years’ old

• Obesity

5.

Why do those factors increase the risk of a blood clot?

Much of the risk is due to blood flow slowing down when you’re not able to move around. Blood that is stagnant or still tends to clot. Injury also causes a reaction in your blood that increases the risk of clotting. The genetic makeup of your blood, as well as illness, can also make clotting more likely.

6. How can I prevent blood clots?

The best way to prevent blood clots is to stay active and avoid sitting for long periods of time. Other things to keep in mind:

• When traveling by car or plane, take frequent breaks and move around.

• Maintain a good body weight and stay hydrated.

• Don’t smoke.

• Talk to your doctor about preventing clots after surgery.

• Know your family history of blood clotting.

7. How is a blood clot treated?

If you’re diagnosed with a blood clot, you may have to take a blood thinning medication, also called an anticoagulant. This type of medication stops the clot from growing and allows your body to break it down naturally, before it can travel to other areas of your body.

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If the clot is very large or life threatening, you may need to be hospitalized to receive clot-dissolving medication or to get a clot removal. Blood thinners are usually prescribed for three months, or until the health issue that caused the clot is gone. The decision of when to stop taking your blood thinning medication should be made with your doctor.

8. Once I have a blood clot, am I more likely to have another one?

A blood clot sometimes leaves a scar in the vein where it occurred. This makes the vein “abnormal” or different and more likely to clot again. Being aware of this risk and taking the necessary precautions helps to prevent another clot.

9. How are COVID-19 patients treated to prevent blood clots?

Patients who are hospitalized with COVID infection are at high risk for blood clots. They may be treated with blood thinners while they are in the hospital, and some for a short time after. The risk of blood clots is assessed in everyone who is admitted to the hospital. If your risk is high, you will receive low doses of blood thinners while in the hospital.

10. I have COVID-19 – am I at risk for blood clots?

Patients with COVID infection who are not hospitalized do not seem to have a high risk of blood clots. Talk to your doctor about your concerns and keep an eye on the symptoms listed above, getting care immediately if you’re concerned.

More Articles About:

Heart Health

Deep Vein Thrombosis (DVT)

Cardiovascular: Diseases & Conditions

Can a Blood Clot in Your Leg Dissolve on Its Own?

Many patients are curious to know whether a blood clot that has developed in the leg can dissolve on its own or does it require them to undergo a minimally invasive vein treatment procedure. After all, it formed naturally maybe the body can heal itself naturally. Unfortunately, answering this question is more difficult than providing a “yes” or “no” answer.

The Brief and Simple Answer

The brief and simple answer to whether or not blood clots in the legs can dissolve on their own is “yes”. However, even though the blood clot can dissolve naturally, you will want to make sure you have a doctor monitoring the situation.

Monitoring of the Blood Clot is Necessary to Avoid Serious Health Problems

Once a blood clot has formed in the veins of the leg, the body instantly starts to work to dissolve the clot so blood flow isn’t restricted or blocked. While this sounds like a good thing, it could lead to potentially serious, even fatal problems.

A serious problem, known as pulmonary embolism, can occur if a blood clot that has started to dissolve on its own doesn’t dissolve completely and instead breaks off from the walls of the veins and travels to the lungs. If this happens it can damage the lungs and cause serious complications.

In an effort to avoid the development of serious complications, a doctor may allow a blood clot, depending on its size, to dissolve on its own. However, your doctor will monitor your symptoms and watch for the possible development of pulmonary embolism.

How are Blood Clots in the Leg Treated?

If your doctor believes that you aren’t at risk for a pulmonary embolism, he or she may recommend that you let your body naturally dissolve the blood clot. However, if your doctor believes your health is at risk or you may develop a pulmonary embolism, he or she may recommend a procedure known as a catheter-directed thrombolysis.

Catheter-directed thrombolysis is designed to quickly break up the blood clot. Quickly breaking up the blood clot and dissolving it allows the body to restore blood flow to the veins and prevents any serious problems from developing.

Due to the risks involved with catheter-directed thrombolysis doctors will only use it when it is a medical emergency. If you are not in immediate danger, your doctor may recommend other treatment options or other less minimally invasive procedures.

Prevention is Important for Blood Clots

After you experience a blood clot in the leg, your chances of experiencing another blood clot increases. To avoid future problems that can develop from deep vein thrombosis or a pulmonary embolism, your doctor may work closely with you to make sure blood clots don’t form in the future.

The most common way to prevent blood clots from forming is with blood thinners. The thinner the blood is, the less likely it is to clot. Other treatment recommendations could include exercising more, making changes to your lifestyle, and avoiding prolonged periods of sitting.

If you suspect you may have a blood clot, don’t wait to see if something serious will happen. Call Vein911 in Tampa, Florida to schedule an appointment with Dr. Chris Pittman. Dr. Pittman can help treat your blood clot and provide you with recommendations on how to prevent future blood clots from forming. Call our office today to schedule an appointment to discuss blot clots or other vein problems such as varicose veins or spider veins.

Question to the doctor: how to avoid thrombosis

What can be done to reduce the risk of thrombosis? What role does heredity play in the occurrence of thrombosis? What examination do you need to undergo to check the condition of your blood vessels? What research methods are used today? Does everyone need anticoagulants at a certain age?
These and other questions of patients are answered by the cardiovascular surgeon of the N.N. A.V. Vishnevsky, Candidate of Medical Sciences, Associate Professor Zaurbek Akhsarbekovich Adyrkhaev.

– What role does heredity play in the occurrence of thrombosis?

– In terms of heredity, there are several factors that may predetermine an increased risk of thrombosis. The first of them is genetic mutations, of which there are at least 12. With arterial thrombosis, this is also congenital hypercholesterolemia and hyperhomocysteinemia. These and other hereditary factors that are capable of predetermining an increased predisposition to thrombosis, both venous and arterial, at the level of blood rheology, can be detected using laboratory diagnostics.

– Are arterial thromboses and atherosclerotic plaques the same phenomena?

– Plaques can increase the risk of arterial thrombosis by narrowing the lumen of the vessel and thereby contribute to a change in the spectrum of blood flow in this area. Or they are fragmented – and then their pieces can come off, closing the lumen of the vessel or impeding local blood flow in it, which leads to a decrease in blood flow and the formation of blood clots in this area.

– What is the difference between a thrombus and a plaque? Do they have different structures?

– A plaque is a denser formation, while a thrombus is a blood clot. A fresh blood clot is purple-red, soft, somewhat reminiscent of a slug in structure.

– Why does it form in some and not in others? What is the mechanism of such thickening of the blood?

– All vascular doctors know the rules of the “Virchow triad” (Rudolf Virchow – German pathologist, pioneer in the pathophysiology of thrombosis). In order for the process of thrombus formation to be started, three factors must necessarily take place: slowing of blood flow, damage to the endothelium (the inner lining of the vessel) and coagulopathy (increased blood clotting). Only in the presence of these three factors is it possible to form a blood clot. One factor is not enough, but if it is present, as a rule, others join it and sooner or later begin to manifest themselves. Simply put, if a patient has hereditary coagulopathy, he is already at risk. He can go on a long 8-hour flight, fall asleep on an airplane and not wake up, because a factor such as a decrease in blood flow will join his coagulopathy.

– When does it decrease?

– With prolonged static loads – if a person stands for a long time, or sits, or rides in a car, flies in an airplane … In a word, being in a stationary state contributes to the formation of venous thrombosis. At risk are also patients who have some kind of concomitant pathology – oncological diseases, gynecological diseases that require the use of hormonal drugs. By the way, oral contraceptives also increase these risks.

Arterial thrombosis very rarely occurs without the presence of systemic atherosclerosis. Another risk factor for their occurrence, of course, is a violation of the heart rhythm. If a patient even with unexpressed atherosclerosis has atrial fibrillation, then against its background, blood clots form in the heart, which can migrate and close the vessels, including the main ones – up to the aorta and iliac arteries, causing acute ischemia of the vessels of the legs.

– In what parts of the body do blood clots usually form?

– In case of venous thrombosis, the most common localization is the deep veins of the legs. The danger lies in the fact that the thrombus quickly rises from the lower extremities into the femoral iliac veins. This carries with it enormous risks of pulmonary embolism – what is often called by the people “a blood clot has come off.” This is the most formidable complication of venous thrombosis, and, of course, if it is not diagnosed in time, it carries a real threat to the patient’s life.

With arterial thrombosis, the most common complication is embolism in the aortic bifurcation, when the iliac arteries close, as well as embolism in the leg artery. The most commonly affected arteries are the tibia and the superficial femoral arteries, although others may also be affected. Here we are already talking about saving the limb, because, as a rule, such patients experience acute ischemia, which requires emergency surgery to restore blood flow in the leg. And if this is not done within the next few hours, the patient may lose his leg.

– And if there is a thrombosis, but it is asymptomatic, what should prompt the person to go to the doctor?

– Here we also have to separate venous and arterial thromboses. In the first case, this is, as a rule, a feeling of tension in the lower limb, sometimes already visually assessed by its swelling, pain and redness along the veins that are visible on the leg. These moments should, of course, alert, especially if this happens after the episodes that we talked about – taking hormonal drugs, pregnancy in women in the 3rd trimester, long journeys, sedentary work . .. If a person feels tension, swelling and pain in the limbs, as well as redness and hyperemia along the vein, of course, he should see a doctor.

If the thrombosis is localized only in the veins of the leg, it can often even go unnoticed for the patient, and we will find out about it later – when he is examined for some other reason. When doing an ultrasound, we see that the veins are changed, and even if there are no blood clots, there are signs that the patient has suffered thrombosis.

As for arterial thrombosis, it is hard not to notice it. If the blood flow in any segment of the limb stops suddenly, the patient will somehow feel it. Of course, this is acute pain, coldness of the limb. The longer ischemia lasts, the more neurological complications join – in the form of leg numbness, limitation of movement in the ankle, in the knee joint. In the later stages, of course, there is swelling.

The most difficult stage is the formation of the so-called contracture in the knee and ankle joints, when the patient can no longer move his leg independently due to severe pain as a result of muscle spasm. The color of the leg changes, it becomes pale at first, then a marble color appears. Severe episodes of acute ischemia are accompanied by such dangerous complications as foot phlegmon, etc.

If this process develops rapidly, it can lead to wet gangrene, when the patient can no longer be helped. Therefore, it is so important not to miss the first symptoms – a sharp pain that becomes permanent, cold feet, discoloration of the skin. And, of course, you should not try to be treated with home remedies, you need to urgently consult a doctor.

– What is the difference between dopplerography of the vessels of the legs and ultrasound, and in what cases is this study done?

– Dopplerography shows mainly the speed characteristics of blood flow, it is not aimed at determining the state of the internal lining of the vessel, visualizing plaques or blood clots that nest there. This is no longer informative today, and in our routine practice we are switching to color duplex scanning. It allows you to get complete data on both the speed characteristics of blood flow and the state of the vessel as a whole: the thickness of its wall, the degree of inflammation, if any, the presence or absence of atherosclerotic plaques, how much they narrow the lumen of the vessel, whether there are blood clots in it or not, how much they spread, how many centimeters of the vessel they occupy, how tightly they are fixed to the wall (which is also very important).

– We are talking about the legs, but there are blood clots in the vessels of the head. Or is that a different story?

– Such thrombosis leads to a formidable complication – a stroke. Today in Moscow, and indeed throughout Russia, a huge number of vascular centers have been opened, which are designed to deal with acute coronary syndromes and acute strokes. Thrombosis results in the so-called stroke on the go, that is, the patient has the entire stroke clinic (a part of the body, arm or leg goes numb, speech is disturbed, etc. ). If an ambulance arrives on time for such a patient, it will deliver him to one of the vascular centers, where an attempt will be made either systemic or local thrombolysis (dissolution of blood clots), or mechanical thromboextraction, when this thrombus is removed from the artery using special devices.
Now there are all the possibilities for this, and they cope with these states quite successfully. The main thing is to do everything on time, to get into the so-called therapeutic window (from 6 to 12 hours).

– There is an opinion that after a certain age everyone needs to take blood-thinning drugs, and everything will be fine.

– Let’s start with what a person can do on his own in order to protect himself as much as possible. First and foremost is an active lifestyle. Need aerobic exercise. I tell my patients: you should walk 30-60 minutes a day, and not walking, but accelerating up to 3-4 km per hour. Do Nordic walking, swim, do whatever you like, but be sure to keep moving! And in the air you should spend at least half an hour or an hour a day, and spend it actively. Of course, it is necessary to give up smoking – this is a proven fact of the risk of atherosclerosis and any complications of atherothrombosis.

Third, of course, food. Now the most popular diet, which sounds in all the recommendations, is the Mediterranean. It’s affordable and easy to stick to. The principles are very simple: limiting the consumption of animal fats and red meat (up to 1-2 times a week), the predominance of vegetable fats and fish, the basis of the diet is plant foods and vegetable proteins.

And another important point. In order to reduce the risk of thrombosis, it is necessary to observe an adequate regimen of hydration of the body. A person must consume the required amount of fluid per day, and this is no less than a liter and a half (with soup, jelly, water, tea – it is not necessary to drink only pure water). By consuming liquid, you achieve blood thinning in a physiological way. If a person does not regularly get fluid and there is not enough of it in his bloodstream, naturally, the blood will thicken, and the concentration of red blood cells per 1 ml of blood will increase. In this situation, he can, for example, go to the bathhouse and return from there with venous or arterial thrombosis. Sweating, a person loses up to several liters of fluid, which means that the same amount must be replenished.

Now about drugs. I believe that no one should take anything without a doctor’s recommendation. Outpatient therapists are now very educated in the field of prevention and possible complications of cardiovascular diseases, therefore, each person should be observed in the clinic, undergo a medical examination, which is being revived in our country, and if there are problems, be registered with a cardiologist or therapist, who, in accordance with with indications will prescribe therapy. And you can’t drink a drug that is heard or prescribed to a neighbor.

Previously, everyone was prescribed aspirin to reduce the risk of heart attacks and strokes – and now studies have begun to appear that speak of the dubious benefits of uncontrolled and general prescription of aspirin. 40 percent of people are generally tolerant to this drug, that is, when taking aspirin, they do not get the effect for which they drink it. And no one who prescribes this aspirin is tracking the expected effect. But everyone has a negative effect on the stomach and has long been proven.

– But there are new generations of antiplatelet agents.

– They are also not shown to everyone, because they thin the blood so much that they entail a risk of bleeding. Yes, someone needs them, especially after 50 years, but they should be prescribed by doctors according to indications. Everyone must do their job. The doctor – to treat, and the patient – being responsible for his health – try to lead a healthy lifestyle to the maximum and contact doctors in a timely and periodic manner.

– You talked about a healthy lifestyle. And if, say, a blood clot already exists or is forming, can’t fitness provoke its movement?

– If at the age of 50 you decide to go in for fitness for the first time in your life, of course, you should be examined first. Before starting classes, you must pass elementary fitness testing. This is not at all when they tell you how and which simulator works, you should be consulted by a doctor who will determine your tolerance for physical activity, make tests under the control of an ECG and other devices.

– Let’s simulate such a situation. The person knows that in his family there were strokes and cases of blood clots. And he wants to protect himself as much as possible. What examinations should he do to check the condition of the vessels?

– Firstly, a general and biochemical blood test, for a lipid profile – to find out the atherogenic index (the ratio of high and low density lipoproteins).

It is necessary to pass a coagulogram – look at the blood coagulation parameters, do an ECG, measure the ankle-brachial index, which reflects the state of blood circulation in the lower extremities. If this index is lowered, we can talk about systemic atherosclerosis. It is necessary to determine the level of homocysteine ​​in the blood (an increased level can also indicate atherosclerotic complications), as well as an ultrasound of the carotid arteries.

I would not lose sight of the ultrasound of the abdomen, which can look for an aortic aneurysm, which is often the first manifestation of the disease in a patient with atherosclerosis. And, of course, if a more in-depth examination is carried out, an echocardiogram will be required to see if the heart muscle is functioning normally.

The brain, heart and lower extremities are the risk points for atherosclerosis and blood clots for a person who knows his hereditary predisposition to these diseases. And the listed studies are the minimum that will allow him to draw up a primary picture.

– And then live in peace?

– Not really. The person who did all these studies should then come to the doctor. Even if the indicators are within the normal range, this may be the upper limit of the norm, which already indicates some kind of change. Only a doctor can determine the risks. And if changes in the vessels are detected, once a year it is necessary to repeat the examination.

Moreover, I recommend everyone to monitor blood sugar, because diabetes is also one of the risk factors and worsens the prognosis in patients with atherosclerosis. As for venous thrombosis, here you should pay attention to whether your legs swell by the end of the working day, whether you feel discomfort after long journeys and flights, whether it is difficult to put on boots or shoes. In this case, you need to do an ultrasound of the veins and again consult a doctor.

The main thing is not to self-medicate, it will never be effective. Take care of your vessels and health in general!

The full version of the interview was published in No. 5/20 of the Bud Zdorov magazine.

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