What are the symptoms of blood clots in legs. How does cancer increase the risk of developing blood clots. Can certain cancer treatments contribute to blood clot formation. Why is reduced mobility a risk factor for blood clots in cancer patients.

The Basics of Blood Clots: What You Need to Know

Blood clots are collections of blood that form inside blood vessels, potentially obstructing normal blood flow. Medically termed thrombus, these clots can develop in various parts of the body. When a clot forms in the deep veins of the leg, it’s called deep vein thrombosis (DVT).

DVTs can be particularly dangerous if they break off and travel through the body. If a clot reaches the lungs and blocks blood supply, it results in a pulmonary embolism (PE). Together, DVTs and PEs are referred to as venous thromboembolism (VTE).

Recognizing the Symptoms of Blood Clots

Identifying blood clot symptoms early is crucial for timely treatment. Common signs include:

• Unexplained pain in the leg or arm
• Redness and swelling in the leg (may be localized to the calf or affect the entire leg)

If a blood clot has traveled to the lungs, symptoms may include:

• Sudden or progressively worsening breathlessness
• Chest or upper back pain that intensifies when breathing
• Coughing up blood
• Feeling lightheaded

Is immediate medical attention necessary for suspected blood clots? Absolutely. If you experience symptoms of a blood clot in your lungs, it’s crucial to call emergency services or go to the nearest emergency department immediately.

The Connection Between Cancer and Blood Clots

Cancer patients face a higher risk of developing blood clots, with research suggesting that up to 20% of cancer patients may experience a blood clot at some point. Several factors contribute to this increased risk:

The Cancer Itself

Cancer can cause the blood to become stickier. This occurs because cancer cells may produce chemicals that stimulate the body to produce more clotting factors – proteins naturally made by the liver that combine with platelets to form blood clots.

Cancer Type

Certain types of cancer are associated with a higher risk of blood clots, including:

• Pancreatic cancer
• Uterine cancer
• Lung cancer
• Stomach cancer
• Kidney cancer
• Brain cancer
• Bladder cancer

The risk is also elevated in cancers that have metastasized to nearby lymph nodes or other parts of the body.

Cancer Treatments and Their Impact on Blood Clot Formation

Some cancer treatments can increase the likelihood of blood clots. These include:

• Cisplatin (a chemotherapy drug)
• Tamoxifen (a hormone treatment for breast cancer)
• L-asparaginase
• Thalidomide
• Lenalidomide

Medical professionals carefully weigh the benefits of these treatments against the potential risks. Additionally, long-term medical devices such as central lines and PICC lines, which remain in veins for extended periods, can also contribute to clot formation.

Reduced Mobility: A Hidden Risk Factor for Blood Clots in Cancer Patients

Cancer and its treatments often lead to fatigue and weakness, reducing a patient’s mobility. This decreased activity can significantly impact blood flow, especially in the leg veins.

How does movement affect blood flow in the legs? The blood flow in leg veins relies on the squeezing action of leg muscles during walking. When immobility reduces this blood flow, blood can stagnate in the legs and become sticky, increasing the risk of clot formation.

To mitigate this risk, patients are encouraged to move around as much as possible and perform simple exercises, such as moving the foot up and down to engage the calf muscles. After cancer surgery, when mobility may be limited, medical professionals often provide elastic stockings to help prevent blood clots. These stockings should be worn until the patient regains full mobility, which may take several weeks post-operation.

Other Risk Factors for Blood Clots in Cancer Patients

Beyond cancer-specific factors, other elements can contribute to an increased risk of blood clots:

• Long journeys: Extended periods of immobility during long-haul flights, bus, or car journeys can heighten the risk of clot formation.
• Age: Older individuals are generally at higher risk of blood clots.
• Obesity: Excess body weight can put additional pressure on veins, potentially impeding blood flow.
• Smoking: Tobacco use can damage blood vessels and affect blood clotting.
• Previous history of blood clots: Individuals who have experienced blood clots before are at higher risk of recurrence.

Preventive Measures and Management of Blood Clots in Cancer Patients

Given the increased risk of blood clots in cancer patients, preventive measures and proper management are crucial. These may include:

1. Regular physical activity: Encouraging movement and exercise as tolerated by the patient’s condition.
2. Compression stockings: Using these to improve blood flow, especially during periods of reduced mobility.
3. Anticoagulant medications: Prescribing blood thinners to reduce the risk of clot formation.
4. Hydration: Maintaining adequate fluid intake to prevent blood from becoming too thick.
5. Regular monitoring: Conducting routine check-ups to assess the risk of blood clots and adjust preventive measures as needed.

How often should cancer patients be evaluated for blood clot risk? This varies depending on individual circumstances, but generally, it should be part of regular oncology check-ups and before starting new treatments.

The Importance of Early Detection and Treatment of Blood Clots

Early detection and prompt treatment of blood clots are vital for preventing potentially life-threatening complications. When diagnosed early, most blood clots can be successfully treated.

What are the common treatment options for blood clots in cancer patients? Treatment typically involves anticoagulant medications, also known as blood thinners. These drugs work by preventing the blood from clotting too easily. In some cases, more aggressive treatments such as thrombolytic therapy (clot-busting drugs) or surgical interventions may be necessary.

It’s crucial for cancer patients and their caregivers to be aware of the symptoms of blood clots and to report any concerns to their healthcare team immediately. Regular communication with healthcare providers about any changes in symptoms or mobility can play a significant role in early detection and management of blood clots.

Ongoing Research and Future Directions in Cancer-Associated Thrombosis

The field of cancer-associated thrombosis is an area of active research, with ongoing studies aimed at improving prevention, detection, and treatment strategies. Some current areas of focus include:

• Developing more accurate risk assessment models for blood clots in cancer patients
• Investigating novel anticoagulant medications with fewer side effects
• Exploring the potential of personalized medicine approaches to thrombosis prevention and treatment
• Studying the underlying biological mechanisms linking cancer and blood clot formation

How might these research efforts impact future care for cancer patients at risk of blood clots? As our understanding of cancer-associated thrombosis grows, we can expect more targeted preventive strategies, improved diagnostic tools, and more effective treatments tailored to individual patient needs.

In conclusion, while blood clots pose a significant risk for cancer patients, awareness, early detection, and proper management can greatly reduce their impact. By understanding the symptoms, risk factors, and preventive measures, patients and healthcare providers can work together to minimize the risk of this potentially serious complication.

Cancer and the risk of blood clots

Cancer can increase the risk of developing blood clots. Doctors often give blood clots different names depending on where they start. You may hear them say:

• deep vein thrombosis (DVT)
• pulmonary embolism (PE)
• venous thromboembolism (VTE)

Blood clots can be very serious. Contact your doctor or get advice from 111 if you think you have a blood clot.

What is a blood clot?

A blood clot is a collection of blood that can form inside a blood vessel (a vein or an artery). It can block the normal flow of blood. The medical name for a blood clot is thrombus.

Blood clots can develop in different parts of the body. When a blood clot forms in the deep veins of the leg it is called a deep vein thrombosis (DVT).

Part or all of a DVT can break off and travel around the body. It may travel through your heart to block part or all of the blood supply to the lungs. If this happens, it’s called a pulmonary embolism (PE). DVTs and PEs together are sometimes called venous thromboembolism (VTE).

Doctors can successfully treat most blood clots when diagnosed. So it’s important to know about the symptoms of blood clots and report them to your doctor or nurse immediately.

Symptoms

Common symptoms of blood clots include:

• unexplained pain in your leg or arm
• redness and swelling in your leg – this may be just in the calf or include the whole of your leg

If a blood clot has moved to your lungs (a pulmonary embolism), the symptoms include: 

• feeling breathless – this might start suddenly or increase over time
• pain in your chest or upper back which gets worse when you breathe in
• coughing up blood
• feeling light headed

Call 999 or go to A&E if you have symptoms of a blood clot in your lungs.

Who is at risk of blood clots?

People with cancer have a higher risk of developing blood clots. Researchers think that up to 20 out of every 100 people with cancer (up to 20%) develop a blood clot at some point.

There are a number of reasons for this: 

The cancer itself

People with cancer often have sticky blood. This may be because cancer cells make chemicals that stimulate the body to produce clotting factors.

Clotting factors are proteins made naturally by the liver. They combine with platelets to form blood clots and help us stop bleeding.

The type of cancer you have

You are at a higher risk of developing blood clots if you have one of the following types of cancer:

• pancreas
• womb
• lung
• stomach
• kidney
• brain
• bladder

Also, the risk is higher in cancers that have spread to nearby lymph nodes or other parts of the body.

Cancer treatments

Certain cancer treatments can increase the risk of developing blood clots. These include:

• the chemotherapy drug cisplatin
• tamoxifen which is a type of hormone treatment for breast cancer
• L-asparaginase
• thalidomide
• lenalidomide

Your doctor will explain if the treatments you are having increase the risk of blood clots. They make sure the benefits of these treatments outweigh the risks.  

Blood clots can also form in long lines such as central lines and PICC lines. These lines usually stay in your veins for many months. So you don’t need to have needles into your hand or arm each time you have cancer drug treatment. 

Being less active

Cancer and its treatment can make you feel very ill. You can feel too tired and weak to move around as much. The blood flow in your leg veins depends on the squeezing of the veins by leg muscles when you walk. Immobility reduces the blood flow in the legs and blood can stagnate in the legs and become sticky.

So moving around helps reduce the risk of clots. As does doing exercises with the calf muscles such as moving your foot up and down.

After cancer surgery, you may not be able to move around much. Your nurses will give you a pair of elastic stockings to wear. These help to prevent blood clots. You need to wear these until you are moving around fully. This may be for a few weeks after your operation.

Long journeys, such as long haul flights, or long bus or car journeys can also increase the risk of clots.

Other factors

Other factors that increase the risk of developing a blood clot include:

• taking the oral contraceptive pill or hormone replacement therapy (HRT)
• certain medical conditions such as diabetes or heart disease
• smoking
• being overweight

Treating blood clots

Treatment for blood clots is usually drugs that thin your blood (anticoagulants). They don’t break up an existing clot but prevent it from growing bigger and others forming. This allows the body to gradually break the clot down and reabsorb it.

You usually take anticoagulants for 3 to 6 months.

The most common types of anticoagulants are:

Direct oral anticoagulants (DOACs)

These include:

• apixban
• dabigatran
• edoxaban
• rivaroxaban

These are new types of blood thinners that mean you don’t need to have regular blood tests. They are also used to prevent stroke and to treat blood clots in people who don’t have cancer.

Low molecular weight heparins

These include:

• dalteparin
• enoxaparin
• tinzaparin

You have low molecular weight heparins as an injection under the skin (subcutaneously). You may need regular blood tests.

Warfarin

Warfarin comes as a tablet. They are a type of anticoagulant called vitamin K antagonist (VKA). Doctors most often prescribe warfarin to people who have a heart condition called atrial fibrillation. This causes an irregular and fast heart rate.

It takes several days for warfarin to work so you may also have heparin first. You may take warfarin for a few weeks or months. You have regular blood tests to check that your blood is not getting too thin or too thick. 

Unfractionated heparin

This is a fast acting heparin. You usually have it directly into your bloodstream (intravenously). You might have it when you’re first diagnosed with a blood clot, especially if your kidneys are not working very well.

Reducing the risk of a blood clot while in hospital

The National Institute of Health and Care Excellence (NICE) has guidance about reducing the risk of blood clots for people in hospital.

When you are in hospital, your doctor or nurse will assess your risk of developing blood clots. They will suggest you have preventative treatment if you are at higher risk of developing blood clots. This might include:

• taking drugs that thin your blood (anticoagulants)
• wearing elastic stockings (anti embolism stockings)
• using compression devices (intermittent pneumatic compression)
• seeing a physiotherapist to help you get out of bed and move around as soon as possible
• stop taking certain drugs such as the combined oral contraceptive pill or hormone replacement tablets
• having fluids so that you don’t become dehydrated

Anti embolism stockings

You may be given anti embolism stockings to wear until you are moving around as usual. These are tight stockings that squeeze your feet and legs, helping the blood to circulate more quickly. Your nurse will measure your legs to make sure you have the right size. 

You cannot usually wear these stockings if you have:

• fragile skin, eczema or recently had a skin graft
• narrowing of the blood vessels leading to your legs (peripheral arterial disease)
• swollen legs
• recently had a stroke
• tingling or numbness in your fingers or toes (peripheral neuropathy)

Intermittent pneumatic compression

Your doctor may suggest you use an intermittent pneumatic compression device. You wear this around your legs and feet. It inflates regularly to keep the blood circulating well. You use this while you are in bed or in a chair.

Going home

Your doctor or nurse will tell you if you need to wear stockings or take blood thinners at home. They will advise you how long to take treatment for and who to contact if there are any problems.

If you’ve had major surgery to your tummy (abdomen) or pelvis, you have injections of heparin for 4 weeks after your operation. You have them every day as an injection under the skin (subcutaneous injection). Your nurse will show you how to do it before you go home.

The video below shows you how to give a subcutaneous injection. The video is 3 minutes long.

Transcript

Nurse: This is a short film showing you how to give an injection just under your skin. This is called a subcutaneous or sub cut injection. This does not replace what your doctors and nurses tell you, so always follow their advice.

Voiceover: Subcutaneous injections may be part of your cancer treatment. Or, you may need them to prevent side effects of treatment, such as blood clots after surgery. Or to help control cancer symptoms, such as pain or sickness.

Most injections come in prefilled syringes.

Nurse: So, today I am going to show you how to give a subcutaneous injection. I am going to start by giving it into a practice cushion and then you can have a go at giving one yourself. Before you start, you need to get your equipment together. What you are going to need is an alcohol wipe to clean your skin, some cotton wool, a prefilled syringe and a sharps bin. It is important that you wash your hands with soap and water and dry them thoroughly before you start. Check that you have got the correct drug and that it is in date.

You can give the injection into the back of your arm, your tummy, your thigh or the outer part of your bottom. It is important that you vary where you give the injection. So it may be that you give it one day in your tummy and the next in your thigh.

So you start by cleaning the skin with the alcohol wipe and allowing it to air dry. Then you take the cover off the needle and pinch the skin up and hold it a bit like a pen and in an upright position, in a quick dart like motion pop it straight down into the skin. Then you press the plunger right to the end, quickly pull the needle out, dab it with cotton wool, pop the needle into the sharps bin. And then you need to wash your hands again.

So here’s what you are going to need. If you start by checking the drug and the expiry date. And then with the alcohol wipe give your skin a clean. That’s it give it a few seconds for the air to dry it. Ok and then if you want to pick up the syringe and take the cover off the needle. Then pinch your skin up and at a ninety degree angle gently push the needle in…then press the plunger…and then quickly remove it… dab your skin with the cotton wool and put the syringe in the sharps bin.

Tips for preventing blood clots

Remember to:

• take short walks as often as possible
• keep active
• do simple leg exercises like bending and straightening your toes every hour if you can’t move around much
• drink plenty of water
• report any symptoms to your doctor or nurse straight away

Your feelings

The risk of developing a blood clot is higher in the first few months after being diagnosed with cancer. You might worry about how this complication will affect your cancer treatment.

It is important to understand that often blood clots are a normal part of the cancer journey. It’s normal to feel anxious about experiencing one.

Remember that doctors can successfully treat blood clots when diagnosed. This should not interfere with your cancer treatment. 

Who can help you?

For support and information, you can call the Cancer Research UK information nurses. They can give advice about who can help you and what kind of support is available.
Freephone: 0808 800 4040 – Monday to Friday, 9am to 5pm.

• Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism
  National Institute for Health and Care Excellence (NICE), 2019

• Venous thromboembolism in adults
  National Institute for Health and Care Excellence (NICE), 2021

• Management of venous thromboembolism (VTE) in cancer patients: ESMO Clinical Practice Guidelines
  M Mandala, A Falanga and F Roila
  Annals of Oncology, 2011. Vol 22, Supplement 6. Pages 85-92

• Incidence of venous thromboembolism and its effect on survival among patients with common cancers
  H Chew and others
  JAMA Network, 2006. Vol 166, Issue 4. Pages 458-464

• Cancer-associated thrombosis: an overview of mechanisms, risk factors and treatment
  N B A Razak and others
  Cancers (Basel), 2018. Vol 10, Issue 10. Page 380

• The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact [email protected] with details of the particular issue you are interested in if you need additional references for this information.

Last reviewed: 

10 Feb 2022

Next review due: 

10 Feb 2025

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When an Innocent Injury Turns Serious: Learn the Symptoms of Blood Clot in Leg

Bumping your leg against a table or stepping wrong and twisting your ankle typically results in a minor injury that quickly heals within a few days. However, there is a chance, a very small chance, that what you think is a minor injury could actually turn into something more serious – a blood clot.

Learning more about the symptoms of blood clot in the leg could help save your life. If left untreated, a blood clot could become life-threatening.

Table of Contents

Why Do Blood Clots Happen After a Minor Injury?

Blood clots can happen with any injury where you experience bleeding or bruising. When you injure yourself, the body actively works to stop the bleeding. To stop the bleeding, your blood coagulates and clots start to form.

Usually, the blood clot that forms after an injury isn’t of any concern. The blood coagulates, a clot forms, the bleeding stops and over time the clot will disappear. However, that doesn’t always happen with every injury.

Sometimes, an injury occurs deep below the surface of the skin or it causes damage to the blood vessels. With injuries like this, the blood will naturally start to coagulate and form a clot. Due to the location of the injury, the blood clot that forms could block much-needed oxygen and blood flow to an area of the body. When this happens, you could experience dangerous, life-threatening problems.

Damage to the blood vessels can be especially dangerous. If an injury occurs to the actual blood vessel or inside it, the clot that forms as a part of the natural healing process could travel away from the injured area and cause life-threatening problems.

For example, the blood clot could break off and travel to the brain or heart, which can cause a heart attack or stroke. Similarly, a blood clot could travel from the injured area and cause problems in the intestines, legs or lungs.

Know the Early-Stage Symptoms of Blood Clot in Leg

Blood clots can happen when you experience any injury that results in the formation of a bruise. Although rare, blood clots can also happen with injuries that bleed.

Some of the most common symptoms of a blood clot in the leg include:

• Bruises that never seem to go away – a bruise should disappear within two weeks. If a bruise is still present after two weeks, it could be a sign you have a blood clot.
• Formation of a small, noticeable lump – the lump will often feel like it is located directly under the skin and is near the injured area
• Sudden pain that doesn’t seem to go away with ice or other pain relieving methods
• Redness or discoloration of the skin
• Skin that feels warm to the touch, especially near the injured area
• Veins that seem to be bulging or protruding

It is important that if you experience any of the symptoms listed above, you seek medical treatment. Prompt medical treatment of blood clots is needed to prevent dangerous, life-threatening complications.

If you suspect you have a blood clot and experience shortness of breath, chest pain, coughing up blood, a dramatic increase in heart rate, or difficulty breathing, call 911 or visit the nearest emergency room. You could be experiencing a life-threatening condition that requires prompt medical attention.

A Vein Specialist can Help Treat Blood Clots

A vein specialist, like the professionals at Vein & Vascular Institute, have the necessary tools to help not only diagnose, but treat blood clots. The vein specialists at our clinic can run ultrasounds, MRIs and other imagining to determine if you may have a blood clot. Should a blood clot be found, our vein specialists can promptly treat it.

CONTACT US AT VEIN & VASCULAR

If you’re ready to schedule a consult at the Vein & Vascular Institute, just call 856-309-8346. During your call, we’ll help you find a great time to come by and get care for deep vein thrombosis, varicose veins, or any other venous disorders affecting your life. We look forward to helping you remain in great health through the years, so please feel free to call today.

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NEWS

Thrombosis of the veins of the lower extremities is an acute disease associated with the formation of a blood clot in the lumen of a vein, as a result of which the blood flow in it is disturbed or completely stops. Speaking of phlebothrombosis, doctors usually mean deep vein thrombosis. The formation of a thrombus in the lumen of a vein is associated with several pathological processes at once: disturbances in the structure of the vascular wall, slowing down of blood flow and increased blood clotting (Virchow’s triad).

Causes of phlebothrombosis

• stagnation of blood in the venous system of the lower extremities in case of varicose veins or in the presence of obstructions to normal blood flow, for example, vessel compression, as well as prolonged bed rest;

• inflammatory processes resulting from injuries, injections, as well as infectious and immunoallergic nature;

• violation in the blood coagulation system as a result of oncological diseases, metabolic disorders, liver pathology, etc.

Symptoms of thrombosis of the veins of the lower extremities

In the vast majority of cases, the symptoms of the disease occur suddenly, but they are mild. There is pain in the lower limb, which is aggravated by physical exertion (walking on level ground or stairs, standing for a long time). There are a number of symptoms that can help the doctor suspect deep phlebothrombosis. When the foot is dorsiflexed, pain appears, and patients are also disturbed by pulling pains along the inner surface of the thigh and foot. When applying the cuff of the tonometer to the lower leg and pressurizing it, patients complain of pain in the affected limb already at a pressure level of 80–100 mm Hg. st, while on a healthy limb pressure is injected up to 150–170 mm Hg. Art. does not cause discomfort.

A little later, swelling of the affected limb occurs, patients complain of fullness, a feeling of heaviness in the leg. Attention is drawn to the blanching of the skin below the site of thrombosis, often the skin acquires a bluish tint and becomes glossy, to the touch the affected limb may be colder than healthy. 1–2 days after thrombosis, dilated superficial veins are clearly visible under the skin.

Deep vein thrombosis of the lower extremities only in 50% of cases has classical manifestations or at least a few symptoms characteristic of this disease. Unfortunately, in many patients, the first manifestation of the disease is pulmonary embolism (PE).

Diagnosis and treatment of phlebothrombosis

The “gold standard” in the diagnosis of this disease is duplex ultrasound angioscanning with color Doppler mapping. This method allows you to quickly and fairly accurately determine the location and type of thrombus that clogged the vessel below the level of the inguinal ligament.
Treatment of phlebothrombosis of the deep veins of the lower extremities can be carried out on an outpatient basis in the event that a violation of blood flow has occurred below the level of the popliteal veins (phlebothrombosis of the lower leg). In all other cases, patients need treatment in the surgical department of the hospital.

If, according to the results of the examination, it is revealed that there is no threat of pulmonary embolism and the thrombus is fixed, then bed rest is prescribed for 3-5 days. If it is not possible to conduct a full examination and exclude the risk of developing serious complications, patients are shown strict bed rest for 7-10 days (the timing is determined by the doctor), the position of the affected limb is sublime. Any thermal procedures are strictly contraindicated. With the permission of the doctor, the regimen is gradually expanded and the usual physical activity is restored.

Drug treatment should be comprehensive, aimed at fixing a thrombus, further ensuring blood flow, normalizing blood clotting properties and preventing complications.

Thrombolytic drugs are effective only at an early stage of the disease, which, unfortunately, is rarely recognized; at later stages, the use of drugs that dissolve blood clots can lead to their fragmentation and PE.
If floating (mobile) thrombi are detected in the lumen of the veins of the lower extremities, patients need surgical treatment aimed at preventing thromboembolic complications. In addition, the patient may need surgery to eliminate the cause of this disease (when the vein is compressed by a tumor or lymph node).

Self-treatment and treatment of phlebothrombosis of the veins of the lower extremities with folk remedies is unacceptable, such treatment can lead to disability of the patient and even death.

Which doctor to contact
Vein diseases are treated by a phlebologist. An important role in the diagnosis of these lesions is played by the doctor of ultrasound diagnostics. If surgical treatment is prescribed, it is performed by a vascular surgeon.

Nurse (healthy lifestyle) Zaborskaya V.I.



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