A blood clot in the leg is a serious medical issue. But, often I am asked if it is life threatening. As with many things, the answer is yes and no. A blood clot in the legs is also called a
Deep Vein Thrombosis. It is typically found in the deep veins of the legs. They can be found in the calf, behind the knee, and thigh. Clots have also been found in the arms.
The blood clot restricts that flow of blood through the portion of the vein after the clot. Clots are much more likely to be seen in veins. Some immediate symptoms will include pain, leg swelling, skin warmth, tightness of the area, leg cramps, and even some color changes to the skin.
Inflammation is a large reason that many of the symptoms occur. Inflammation happens because of the clot itself and the pressure on the tissue around the clot. Irritation of the skin is noted. This is called:
Thrombophlebitis.
Bruising in the leg is often not a symptom of a blood clot
Blood clots in the arm can be caused by IV drug use.
When does a Blood Clot become Life Threatening?
When that clot leaves or "breaks loose" from your legs and travels through the blood system it can end up in the
Lungs -
Pulmonary Embolism and/or the brain - Stroke.
This process of breaking off is called -
Embolism
When the clot then lodges itself in the lungs - it affects the pulmonary arteries. This can lead to shortness of breath, difficulty breathing and even death. This is a Pulmonary Embolism or PR. The degree of blockage (location and severity) will determine significance.
9000,000 people each year are affected by DVT/PE
When the clot lodges in the
Brain instead of the lungs -
Stroke is often seen. Stroke is about loss of oxygen to a portion of the brain. Where the clot is located can determine the symptoms. Common symptoms include: Vision changes, loss of the ability to speak or slurring of speech, body weakness (usually one sided), and others.
Risk Factors for DVT/PE
1.) Prolonged sitting
2.) Immobility
3.)
Pregnancy
4.)
Childbirth
5.) Recent Surgeries
6.) Family history of clotting disorders
7.) Recent trauma to lower extremities
8.)
Heart Attack
9.) Heart Failure
10.) Some birth controls - Estrogen
11.) Estrogen treatment/therapy
12.) Cancer
13.) High altitudes
14.) Advance Age
15.) Certain heart or respiratory conditions
16.) Other Genetic Conditions
17.) Other
How to Diagnosis a DVT or Pulmonary Embolism?
1.) The first step is physical exam. There are certain tests that can be done in clinic on exam that can increase or decrease the suspicion of DVT.
2.) A Doppler Ultrasound is essnetial to evaluate the vein of the leg. Other tests include venography, impedance plethysmography, and a CT exam.
3.) Physical exam is also important in Pulmonary Embolism. Other treatment include CT, Blood work (D-dimer), bronchoscopy, etc.
What is the Treatment of DVT or PE?
Initial treatment is based on symptoms and severity.
Blood thinners are essential to both help the clot (if possible) and prevent new clotting.
Surgery in the leg can be done for large clots if the patient is unable to take blood thinners.
Blood Thinners
- Warfarin (Coumadin)
- Enoxaparin (Lovenox)
- Dalteparin (Fragmin)
- Rivaroxaban (Xarelto)
- Apixaban (Eliquis)
- Dabigatran (Pradaxa)
- Aspirin
How can you prevent DVT and PE?
Prevention is key to many different things that providers and patients must do. Movement is the key. Move around after surgery, on long flights, during work, and while pregnant.
Weight loss is important because it will help you move around and will help blood flow from the legs back to the heart.
Elevation of legs - after surgery and when immobile. This will decrease the resistance and force required to get blood back to the heart.
Avoid high dose Estrogen pills.
Compression stalking or other compression devices. Some patients with complicated medical problems including edema may require compression stalkings. Some devices after surgery also can help the blood flow.
