On the alert for deep-vein blood clots
Blood clots are lifesavers when they seal a cut. They can be dangerous, even deadly, when they form inside an artery or vein. A blood clot inside a coronary artery can trigger a heart attack; one inside an artery feeding the brain can set off a stroke. Inside a leg vein, a blood clot can cause deep-vein thrombosis.
Deep-vein thrombosis (DVT) is a clot that forms in a vein that runs deep inside a leg or arm. Pulmonary embolism (PE) is its most serious — and often deadly — complication. One or both strike upwards of 600,000 Americans a year, killing at least 100,000. And one-third of the survivors are left with long-term health problems.
Recognizing the signs
One of the big problems with detecting the presence of a deep-vein thrombosis or pulmonary embolism is that their signs and symptoms mimic those of a host of other conditions. Here are the most common warning signs:
Deep-vein thrombosis: pain or tenderness in a leg (especially in the calf, where it might feel like a charley horse that doesn't go away) or arm that gets worse with time, not better; swelling in one leg or arm; the skin of one leg or arm takes on a reddish or bluish color; one limb feels warm to the touch.
Pulmonary embolism: difficulty breathing; chest pain or discomfort that worsens with a deep breath or cough; coughing up blood; fast heart rate; sudden lightheadedness or fainting.
The main goal for treating deep-vein thrombosis is preventing pulmonary embolism. After that come easing symptoms and improving blood flow in the affected limb. Bed rest with the feet elevated, either at home or in the hospital, along with moist heat can help reduce pain and swelling.
Medications are also important. Heparin or other injectable blood thinners keeps the clot from getting larger and prevents new ones from forming. It is usually taken for five to seven days, and is then gradually replaced by warfarin (Coumadin, Jantoven, generic) for six months or longer. The use of compression stockings that squeeze the legs is also recommended.
The body's natural clot-busters gradually chip away at the clot. Sometimes it's important to speed the process along. This can be done by removing the clot with a procedure called venous thrombectomy or by injecting it with a clot-dissolving drug.
Treating pulmonary embolism is a far more urgent matter. Heparin and warfarin are used to stabilize the clot and to keep new ones from forming. Depending on the size and severity of the clot, additional treatments range from clot-dissolving drugs to physically removing the clot or placing a filter in the inferior vena cava, the large vein that carries blood from the lower half of the body to the heart, to prevent further pulmonary embolisms.
For some people, a deep-vein thrombosis or pulmonary embolism is a one-time event caused by an injury or a temporary change in the blood's capacity for clotting. For others, it becomes a long-term health problem. Having one deep-vein thrombosis or pulmonary embolism means you are at increased risk for another.
Prevention, early detection are essential
You can take simple steps, literally, to prevent deep-vein thrombosis and pulmonary embolism. Moving your legs is the best medicine. If you have to sit for several hours at a time — on a plane, in a train or car, at work, or even at home — try to get up and move around as often as you can. While sitting, help your muscles push blood back to the heart by raising and lowering your heels while keeping your toes on the floor, raising and lowering your toes while keeping your heels on the floor, and tightening and releasing your leg muscles. Avoid wearing stockings that bind your calf muscle. And drink plenty of water.
If you've had a deep-vein thrombosis or pulmonary embolism, talk with your doctor about whether taking a blood-thinning medication like warfarin is right for you. Wearing compression stockings that gently massage the legs when traveling or sitting for long periods might also be a good idea. And try to keep up with the exercises listed above.
If you are confined to bed with an injury, after surgery, or during an illness, ask your doctor if you need medication or other strategies to prevent the formation of blood clots.
June 2009 update