5 ways you can increase awareness about blood clots and how to prevent them

About half of all blood clots occur during or within three months of a hospital stay or surgery. At greatest risk are those with a traumatic injury, especially when there's an injury to a vein, such as with a broken bone. In addition, patients undergoing major surgical procedures involving the pelvis, abdomen, hip, or knee are at higher risk. In addition, being immobilized in a hospital bed or wheelchair increases the potential for developing a clot.

Cancer surgery (as well as chemotherapy) also increases the risk for blood clots. Certain cancers are especially dangerous, including cancers involving the pancreas, stomach, brain, lungs, uterus, ovaries, and kidneys — as well as blood cancers, such as lymphoma and myeloma.

Another type of patient often arriving in a hospital setting are pregnant women. During pregnancy and for three months after giving birth, women are at increased risk for dangerous blood clots, particularly when prescribed bed rest. Patients in this population should exercise according to their doctor's recommendation, drink plenty of liquids, and communicate swiftly with their doctor about any symptoms they might be experiencing.

When a blood clot forms, its origin can seem mysterious to the patient. Telling patients about known risk factors for the formation of blood clots can inspire them to be on the alert and seek help when signs emerge.

Blood clot risk factors include:

• Sitting or being immobile for long periods, such as during prolonged travel.
• Previous blood clots, a genetic clotting disorder (such as factor V Leiden), or a family history of blood clots.
• Smoking.
• Being overweight.
• Hormone treatment, including for birth control or menopausal symptoms.

While these factors increase the risk of DVT, it's important to communicate with patients that blood clots can affect people of all ages, races, and genders. Even those who are young and physically fit can experience a blood clot. This is why increasing awareness of the symptoms is critical.

Some (not all) who experience thrombosis will have symptoms. These will vary depending on where the clot is located.

In the arm or leg, symptoms can include:

• Swelling of arm or leg.
• Pain or tenderness in arm or leg not caused by an injury (can be in the hip).
• Skin on the arm or leg that is warm to the touch, often with swelling or pain.
• Skin on the arm or leg that is reddish or bluish, often with swelling or pain.

If the clot has traveled to the lungs (in the case of PE), symptoms include:

• Sudden difficulty breathing.
• Chest pain (sharp and stabbing) that worsens with a deep breath.
• Unexplained coughing, often with bloody mucus.
• Faster than normal or irregular heart rate.

Other conditions, such as muscle injury or pneumonia, can mimic the signs of blood clots. This is why it is important for patients to be examined by a medical professional and receive the appropriate tests. Tests that can determine whether or not patients have a blood clot include MRIs, X-rays with contrast dye, and D-dimer blood tests.

Encourage patients to take steps to prevent the formation of blood clots:

• Before a hospital stay, discuss personal and family risks for blood clots with a doctor and ask if you will need preventive measures during your stay.
• Try to reach and maintain a healthy weight.
• Stay active and exercise, which can be a simple as regularly going for a walk.
• When traveling, get up and move around (or stop the car and get out) at least every two hours. If unable to move around, do heel-toe exercises or circle the feet. On trips, also avoid crossing legs for too long, drink plenty of liquids, and wear loose clothing.
• During pregnancy, take medications and use compression devices as prescribed.

Rates of DVT vary across hospitals, and healthcare providers can work to lower rates at their facility through various efforts:

• Identify gaps in how your facility compares to others in rates of DVT and how hospital areas within your facility compare with one another.
• Ensure all patients being admitted to the hospital undergo a risk assessment and are placed into the appropriate prophylaxis group.
• Consider electronic alert systems, for surgeons and doctors, that prompt risk scoring and application of prevention techniques.
• Track your results and follow up with improvement measures.

As protocols and processes are strengthened, and compliance becomes widespread, your facility should see a decrease in rates of DVT.

Sources

1. Centers for Disease Control, National Blood Clot Alliance, "Stop the Clot, Spread the Word" Infographic.
2. Wolberg and Mackman, "Venous Thromboembolism Risk Factors, Biomarkers, and Treatment,"Arteriosclerosis, Thrombosis, and Vascular Biology
3. Centers for Disease Control, Hospitalization and Blood Clots Infographic
4. Stone et al., "Deep Vein Thrombosis: Pathogenesis, Diagnosis, and Medical Management," Cardiovascular Diagnosis and Therapy.
5. Centers for Disease Control, Cancer and Blood Clots Infographic.
6. Stop the Clot, Spread the Word, Pregnancy page.
7. Stop the Clot, Spread the Word, Checklist for Blood Clot Risk Factors.
8. Mayo Clinic, Factor V Leiden page.
9. Stop the Clot, Spread the Word, home page.
10. Stop the Clot, Prevention of Deep Vein Thrombosis page.
11. Centers for Disease Control, Diagnosis and Treatment of Venous Thromboembolism.
12. Centers for Disease Control, Learn About Hospital-Associated Venous Thromboembolism.
13. Cardinal Health, Do You Know How Your VTE Rates Compare to Your Peers?
14. Cardinal Health, See Blood Clot Prevention Tools like the Caprini Downloadable Tool.