“You have a blood clot.”
Hearing these words from your healthcare provider can be shocking—and scary. Blood clots can break loose and go straight to your lungs, causing sudden death, right? Can’t they cause strokes or heart attacks?
Yes, but not always. In most cases, clots can be treated successfully without long-term problems. So before panic sets in, let’s learn about blood clots from UNC Health hematologist Stephan Moll, MD. A hematologist is a doctor who specializes in diagnosing, treating and preventing blood diseases.
“Blood clots are manageable in most people,” Dr. Moll says. “I would like everyone to be able to recognize the symptoms of a blood clot and the risk factors for a clot.”
After diagnosis, first find out whether your clot is in an artery (vessels that carry blood away from the heart) or a vein (vessels that carry blood back to the heart from legs, arms, abdominal organs and brain). Clots in arteries may lead to stroke, transient ischemic attack (TIA or mini stroke), heart attack and other conditions.
Clots in veins may lead to deep vein thrombosis (DVT) and pulmonary embolism (PE).
These conditions and their treatments are different, so we’ll focus on clots in veins, a fairly common medical condition. As many as 900,000 people in the United States develop DVT and PE each year.
Most commonly, DVT occurs in a leg, but it can occur anywhere in the body, including arms, abdomen and around the brain. A pulmonary embolism is a potentially life-threatening complication of DVT, and occurs when a blood clot breaks off, travels through the bloodstream and lodges in the lung.
Diagnosis of DVT or PE is a lot to deal with for a patient, not just physically, but also emotionally.
“Shock, anxiety and even fear are normal reactions to being diagnosed with a blood clot,” Dr. Moll says. “You may feel anxious or even depressed during the first few weeks of treatment. Fear of developing another clot might cause ongoing anxiety, as may fear of abnormal bleeding while on a blood thinner. Talk to your doctor if these feelings are overwhelming you.”
What causes a blood clot?
Anyone can develop a blood clot, including apparently healthy individuals. Clots are not uncommon in athletes in their prime, women who are pregnant or have recently given birth, and people with obesity.
Clots form when the flow of blood in a vein slows, a vein is damaged or blood clots more easily. Common risk factors for developing a clot include:
- Immobility (for example, hospitalization; paralysis; prolonged sitting, including long-distance travel)
- Surgery and trauma (major surgery; bone fracture or cast; catheter in a big vein)
- Increased estrogens (birth control pills, patches or rings; pregnancy, including up to six weeks after birth; estrogen hormone therapy)
- Medical conditions (cancer and chemotherapy; heart failure; inflammatory disorder; a kidney disorder called nephrotic syndrome)
Other risk factors include having had a previous blood clot, a clotting disorder, varicose veins or a family history of clots. Getting older and smoking cigarettes increase risk, too.
What are the symptoms of a blood clot?
“Symptoms can range from barely noticeable to severe,” Dr. Moll says.
Classic symptoms of DVT often involve the foot, ankle, calf, the entire leg or an arm. You may experience pain, swelling, discoloration (your skin may look bluish, purplish or reddish) and warmth. Because symptoms can be subtle, they may be confused with those of a sprained ankle, cramp or pulled muscle, which can delay a correct diagnosis.
A PE may cause shortness of breath, chest pain, unexplained cough (you may even cough up blood) and unexplained rapid heart rate. PE symptoms may be misinterpreted as new onset of asthma, a respiratory infection such as a mild pneumonia or inflammation in the breastbone or ribs.
How are blood clots diagnosed?
Typically, your provider will ask about your current symptoms, family medical history and risk factors for clots. They will examine your extremities (arms and legs) for swelling and look for tenderness and skin discoloration. If your provider suspects a clot, they may do certain blood tests or imaging tests.
How are blood clots treated?
Treatments are similar for both DVT and PE, Dr. Moll says.
“We want to prevent an existing clot from getting larger,” he says. “Also, we want to keep new clots from forming and, especially, prevent a DVT from breaking off and becoming a PE.”
Treatments include blood-thinning medications, or anticoagulants, given either as a tablet taken by mouth or an injection. Many patients do not need to be admitted to the hospital but can be treated as outpatients; however, patients with more severe symptoms typically get admitted, Dr. Moll says.
Occasionally, with more severe clots, IV clot buster drugs are used to break up the clot and removal of the clot with a catheter, called a thrombectomy, will be considered.
Blood thinners are very effective in preventing clots from getting bigger or breaking off. Patients on blood thinners will have an outpatient follow-up appointment to make sure the medicine is helping, any bleeding issues (such as increased menstrual bleeding in women) are recognized early enough, and the patient is improving appropriately.
A key point to discuss with your provider is how long you need to be on a blood thinner, Dr. Moll says. This depends on what triggered the blood clot and what your risk of another clot would be if you came off blood thinners. Some people are on blood thinners for as little as three months; for others, they are needed for years.
When will I recover?
Clots can be painful, and shortness of breath is frightening. People want to know when they will recover.
“Most patients with DVT or PE recover within a few days or weeks without significant complications or lasting effects,” Dr. Moll says.
The risk of a clot breaking off and forming a PE is present mostly during the first few days while the clot is fresh and fragile. In general, patients improve significantly over the first seven to 10 days after starting blood thinners. Additional, although slower, improvement often continues for the next several weeks.
When can I get back to my normal activities?
“I tell patients to use common sense and listen to their body,” Dr. Moll says. “It’s fine for a patient to be physically active right after the DVT or PE diagnosis, walking or doing light housework. But I also remind them that if they have a lot of leg pain or swelling, or shortness of breath from a PE, they should take it easy. A blood clot puts a lot of stress on a person’s body and mind—it takes time to heal and recover.”
Where can I get more information about blood clots?
UNC’s Hematology group provides Clot Connect, a web-based clearinghouse of information about blood clots. Among the resources is a helpful guide for newly diagnosed DVT and PE patients. The site also provides information about recovery and support groups. UNC Health has recently opened a DVT Walk-In Clinic as part of the UNC Benign Hematology Clinic in Chapel Hill. The clinic treats patients experiencing symptoms of a clot and then follows up with them to make sure they receive the appropriate treatment.
If you are experiencing symptoms of a blood clot, talk to your doctor. If you need a doctor, find one near you.