May 26, 2017

Blood Clots

What are the complications of blood clots?

  • Blood clots prevent proper circulation of blood.
  • Deep vein thrombosis of the leg or arm may cause permanent damage to the veins themselves and cause persistent swelling of the extremity (post-phlebitis syndrome). The life-threatening issue that may arise from deep vein clots in the arm or leg is that they may break off and embolize to the lungs (pulmonary embolus), causing problems with lung function and oxygenation of the blood.
  • Arterial thrombus often is a life- or limb threatening event, since organs and cells do not get enough oxygen when cut off from their oxygen supply.

How can blood clots be prevented?

Prevention is key in thrombosis or clot formation.

Arterial thrombosis

  • For arterial thrombosis, the most likely precipitating event is a plaque rupture with clot formation in the artery.
  • Minimizing the risk of vascular disease requires life-long attention to the risk factors that lead to plaque buildup and "hardening" of the arteries.
  • Blood pressure and cholesterol control, diabetes management, and refraining from smoking all minimize the risk of arterial disease.
  • Although family history is an important risk factor, one needs to be even more vigilant about the other risk factors if there is a family history of early heart attack or stroke.

Deep vein thrombosis

The main risk factor for deep vein thrombosis risks is immobilization. It is important to move around routinely so that blood can circulate in the venous system. On long trips, it is recommended to get out of the car every couple of hours and in an airplane routinely get up and stretch.

Physicians and nurses work hard at getting people moving after surgery or while in the hospital for medical conditions. The low molecular weight heparin known as enoxaparin (Lovenox) can also be used in low doses to prevent clot formation. Patients are often given tight stockings to promote blood return from the legs and prevent pooling of blood.

In patients who have had hip or knee replacement, anticoagulation with a NOAC may be appropriate.

In patients with atrial fibrillation, anticoagulation may be appropriate depending upon the patient's underlying condition, the clinical situation, and the risk factors for stroke. Using the CHA2DS2-VASc scoring system, the risk for stroke in atrial fibrillation may be calculated and discussed with the patient. This system takes various factors into account to determine the patient's risk:

  • Age in years
  • Sex
  • Congestive heart failure (CHF) history
  • Hypertension (high blood pressure) history
  • Stroke/TIA/ blood clot history
  • Vascular disease history
  • Diabetes

Anticoagulation with a NOAC or warfarin may be appropriate.

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Reviewed on 10/28/2016
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