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Keep Deadly Blood Clots at Bay

Medication, movement can prevent DVT, pulmonary embolism.  

Each year in the United States, pulmonary embolisms (PE) kill more people than AIDS, breast cancer and motor vehicle crashes combined. According to the American College of Foot and Ankle Surgeons, this little-known condition occurs when a blood clot in the leg travels to the lungs, blocking one or more arteries.

Most recently, news that tennis star Serena Williams suffered a PE after undergoing surgery is raising awareness about the condition, its risk factors and how to prevent the potentially deadly condition from occurring.

The blood clots that cause PE often originate in the deep veins of the leg, a condition called deep vein thrombosis or DVT.

Connecticut foot and ankle surgeon and assistant clinical professor at Yale School of Medicine Peter Blume, DPM, FACFAS, explains that women are at the highest risk for blood clots and pulmonary embolism as well as men and women who are overweight, smokers and those taking oral contraceptives. “Surgery is also one of the leading causes of blood clots in patients, which means those at highest risk need to be diligent in speaking to their surgeon about their elevated risks so preventive measures can be taken,” Dr. Blume said.

Patients facing surgery should take note, though, that blood clots in the leg are relatively rare after foot and ankle surgery, Dr. Blume said. In addition, the clots can be prevented with medication and exercise.

Depending on a patient’s risk factors, the surgeon may decide to prescribe an anticlotting medication to prevent DVT. The most common medications are low-molecular weight heparins, which patients inject into their arm, leg or stomach for about two to three weeks after surgery.

Patients with confirmed DVT, which is diagnosed with an ultrasound, may be put on warfarin (Coumadin) for six months to a year to prevent new clots from forming.

“If a patient had a confirmed DVT and we’re concerned about the clot moving based on ultrasound, sometimes we’ll put in an inferior vena cava (IVC) filter that leads from the leg to the heart to prevent the clot from traveling to the lungs,” Dr. Blume added.

Patients also would be advised to get up and move around after surgery—even if they are wearing a cast or using crutches.

“The biggest recommendation you see in the airline magazines when you’re flying is to move your legs to prevent DVT, because people who sit on a long flight have a high incidence of DVT,” Dr. Blume explained. “Similarly, if you’re sitting after surgery and the blood is not moving in the calf and you’re not exercising, you could end up with a clot in your calf. Surgeons have learned over the years that getting people moving after surgery will reduce the risk of a clot causing a pulmonary embolism.”

Symptoms of pulmonary embolisms vary and can mimic those of other conditions, such as a heart attack. The most common signs include sudden, unexplained shortness of breath, chest pain and a cough that produces blood-tinged mucus. “Other symptoms may include wheezing, leg swelling, excessive sweating, rapid heartbeat and fainting,” adds Dr. Blume. “Pulmonary embolisms can occur quickly, and prompt medical attention is vital for recovery, so patients need to seek care if they are suffering from any of the symptoms associated with the condition.”