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What Causes Blood Clots? - USA TODAY
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Blood Clots Are Silent Killers Hiding In Your Legs
Every year, millions of people develop dangerous blood clots in their legs without realizing the life-threatening risk growing within their bodies. These formations, medically known as deep vein thrombosis, represent one of the most underestimated health dangers of modern life. What makes them particularly insidious is their ability to develop silently, often without obvious symptoms, until they break free and travel to vital organs with potentially fatal consequences.
Deep vein thrombosis affects approximately 8 million Americans annually, yet many remain unaware of their elevated risk factors or the subtle warning signs that could save their lives. The condition occurs when blood clots form in the deep veins of the legs, typically in the calf or thigh muscles. While the human body naturally forms clots to stop bleeding from injuries, these internal clots serve no protective purpose and instead pose significant health threats.
The anatomy of a hidden dangerUnderstanding how blood clots form in leg veins requires examining the complex system of blood circulation throughout the lower extremities. The legs contain two main types of veins: superficial veins near the skin surface and deep veins embedded within muscle tissue. Deep veins carry the majority of blood back to the heart, working against gravity through a series of one-way valves that prevent backward flow.
When blood flow becomes sluggish or stops entirely, the risk of clot formation increases dramatically. This stagnation can occur for numerous reasons, including prolonged immobility, injury to blood vessel walls, or changes in blood chemistry that make clotting more likely. The clot typically begins as a small formation that gradually grows larger as additional blood cells and proteins accumulate around the initial blockage.
The location of deep vein thrombosis makes detection particularly challenging. Unlike superficial blood clots that may be visible as red, warm, or swollen areas on the skin surface, deep clots remain hidden beneath layers of muscle and tissue. This concealment allows them to grow substantially before producing noticeable symptoms, if any symptoms develop at all.
What makes these clots especially dangerous is their potential for embolization. When a piece of the clot breaks away from its original location, it becomes an embolus that travels through the bloodstream toward the heart and lungs. If this traveling clot reaches the pulmonary arteries in the lungs, it creates a pulmonary embolism, a medical emergency that can be fatal within minutes.
The silent development processMany people unknowingly possess multiple risk factors that significantly increase their likelihood of developing dangerous blood clots. Age represents one of the most significant factors, with risk doubling approximately every decade after age 40. However, younger individuals are not immune, particularly when other risk factors are present.
Extended periods of immobility create ideal conditions for clot formation. This includes not only obvious scenarios like long-distance travel or bed rest following surgery, but also less apparent situations such as working at a desk for many hours daily, binge-watching television shows, or spending extended time gaming. The modern sedentary lifestyle has dramatically increased the prevalence of circulation-related health issues.
Hormonal influences play a substantial role in clot formation risk. Pregnancy naturally increases clotting tendency to prevent excessive bleeding during childbirth, but this protective mechanism can sometimes work too well, creating dangerous clots. Birth control pills and hormone replacement therapy can have similar effects, particularly when combined with other risk factors like smoking or obesity.
Previous injury or surgery, especially involving the legs, pelvis, or abdomen, significantly elevates clot risk. The body's natural healing response includes increased clotting activity, which sometimes continues beyond what is necessary for proper wound healing. Cancer and certain autoimmune conditions also alter blood chemistry in ways that promote clot formation.
Genetic factors that many people never discover until experiencing a clotting event can dramatically increase risk. These inherited conditions affect various aspects of the clotting process, making some individuals much more susceptible to developing dangerous blood clots throughout their lives.
Recognizing the warning signsWhile many blood clots develop without obvious symptoms, certain warning signs should never be ignored. Understanding these indicators could mean the difference between early treatment and life-threatening complications.
Leg swelling that appears suddenly or affects only one leg warrants immediate attention. This swelling typically feels different from the temporary puffiness that might occur after standing for long periods or consuming excess salt. Clot-related swelling tends to be more persistent and may worsen throughout the day rather than improving with elevation.
Pain in the affected leg often starts as a dull ache or cramping sensation that gradually intensifies. The discomfort typically worsens with walking or standing and may be accompanied by tenderness when the area is touched. This pain differs from typical muscle soreness because it doesn't improve with rest or stretching.
Skin changes in the affected area can provide important clues about clot formation. The skin may appear reddish or have a bluish tint, feel warmer than surrounding areas, or develop a tight, stretched appearance. These changes occur because the blocked vein cannot properly drain blood from the surrounding tissues.
Visible vein enlargement sometimes occurs as blood seeks alternative pathways around the blocked vessel. These enlarged veins may appear as prominent, rope-like structures beneath the skin surface and can be accompanied by a heavy or dragging sensation in the affected leg.
The deadly journey to the lungsWhen blood clots break free from leg veins, they embark on a potentially fatal journey through the cardiovascular system. These traveling clots, called emboli, follow the path of venous blood flow directly toward the heart and then into the pulmonary circulation of the lungs.
The pulmonary arteries gradually branch into smaller and smaller vessels as they deliver blood to lung tissue for oxygen exchange. When a traveling clot reaches a vessel too narrow for passage, it becomes lodged and blocks blood flow to that section of lung tissue. This blockage, known as a pulmonary embolism, prevents proper oxygenation and can cause severe breathing difficulties.
Small pulmonary emboli might cause subtle symptoms like mild shortness of breath or chest discomfort that could be mistaken for other conditions. However, larger clots or multiple smaller ones can rapidly overwhelm the lungs' ability to function, leading to severe oxygen deprivation, heart strain, and potentially fatal cardiovascular collapse.
The speed at which pulmonary embolism can become life-threatening makes early recognition and treatment of leg blood clots crucial. Once a clot has traveled to the lungs, treatment becomes more complex and the risk of serious complications increases substantially.
Modern lifestyle dangersContemporary living patterns have created an environment particularly conducive to blood clot formation. The shift toward sedentary occupations means millions of people spend most of their waking hours in seated positions with minimal leg movement. This prolonged immobility allows blood to pool in leg veins, creating ideal conditions for clot development.
Air travel has become increasingly common, but many travelers remain unaware of the clotting risks associated with long flights. The combination of cramped seating, cabin pressure changes, and dehydration creates a perfect storm for blood clot formation. Even relatively short flights of three to four hours can pose risks for susceptible individuals.
The obesity epidemic has significantly increased blood clot risks across all age groups. Excess weight puts additional pressure on leg veins, impairs circulation, and often coincides with reduced physical activity levels. The combination of these factors dramatically increases the likelihood of developing dangerous blood clots.
Smoking continues to be a major risk factor due to its effects on blood vessel health and clotting mechanisms. The chemicals in tobacco smoke damage blood vessel walls and make blood more likely to clot inappropriately. When combined with other risk factors like birth control use or prolonged sitting, smoking can create extremely dangerous conditions.
Prevention strategies that save livesPreventing blood clot formation requires a multifaceted approach that addresses both modifiable risk factors and unavoidable circumstances. Regular movement represents the most effective prevention strategy for most people. Even simple actions like flexing ankles, pointing and flexing toes, or taking brief walking breaks can significantly improve circulation.
During extended periods of sitting, whether at work or during travel, implementing regular movement breaks becomes crucial. Standing and walking for just a few minutes every hour can help maintain proper blood flow and prevent the stagnation that leads to clot formation. When movement isn't possible, leg exercises performed while seated can provide some benefit.
Proper hydration plays an important role in maintaining healthy blood consistency. Dehydration makes blood thicker and more prone to clotting, while adequate fluid intake helps maintain optimal circulation. This becomes particularly important during air travel, illness, or hot weather when fluid losses increase.
Compression stockings provide mechanical assistance to leg circulation by applying graduated pressure that helps push blood back toward the heart. These specialized garments are particularly beneficial for people with known risk factors or those who must remain seated for extended periods.
When to seek immediate helpRecognizing when blood clot symptoms require emergency medical attention can be lifesaving. Any combination of leg swelling, pain, warmth, and skin color changes should prompt immediate medical evaluation, particularly if symptoms develop suddenly or worsen rapidly.
Breathing difficulties, chest pain, rapid heart rate, or coughing up blood could indicate that a leg clot has traveled to the lungs. These symptoms represent medical emergencies requiring immediate hospital treatment. Even mild breathing problems following leg symptoms should not be ignored.
The key to successful blood clot treatment lies in early detection and prompt medical intervention. Modern treatments can effectively dissolve existing clots and prevent new ones from forming, but their success depends heavily on timing. Waiting to see if symptoms improve on their own can have devastating consequences.
Understanding the hidden danger of leg blood clots empowers individuals to recognize their personal risk factors, implement preventive measures, and seek appropriate medical care when warning signs appear. This knowledge can literally mean the difference between life and death for the millions of people at risk for this silent but deadly condition.
The Risk Factors For A Blood Clot Are More Common Than You Think
The San Antonio Spurs center Victor Wembanyama will be out for the rest of the season following a diagnosis of deep vein thrombosis. Via Associated Press
When they happen on the outside, blood clotting can be a good thing to help prevent excessive bleeding after you've been injured. Platelets (a type of blood cell) and proteins in your plasma (the liquid part of the blood) band together and form a clot over the injury, which eventually dissolves once the injury has healed.
Blood clots that strike inside the body, however, can sometimes block a vein or an artery and have serious consequences. A clot that blocks a vein deep in the body is what's known as deep vein thrombosis (DVT). DVTs can form in any deep vein but it typically develops in the lower leg, thigh, pelvis or arm.
It's estimated that as many as 900,000 people across America can develop a DVT each year, according to the Centers for Disease Control and Prevention. And it's not only a disease of the elderly or extremely ill. Recently, Victor Wembanyama, a 21-year-old NBA player on the San Antonio Spurs, was diagnosed with DVT with a clot in his right shoulder. As a result, he is out for the remainder of the season.
"DVTs can occur in younger patients without obvious medical issues," Dr. Vincent Varghese, a board-certified interventional cardiologist at Deborah Heart and Lung Center in New Jersey, told HuffPost. "Awareness and education are critical in early recognition of DVT."
Why and how DVT blood clots typically manifestThe blood in our body exists in a highly regulated balance between promoting blood clots (thrombogenesis) and breaking them down (thrombolysis), Dr. K. Francis Lee, medical director of Advanced Vein Care Center in Springfield, Massachusetts, told HuffPost.
"This fine balance is tilted to one side or the other as the need arises," Lee explained.
But there are risk factors that can disrupt this homeostasis, which is categorized as either acquired or inherited. "Acquired risk factors include common 'trigger' events, such as trauma (major bone fractures), major surgery, immobilization (long-term sedentary or fixed body position, such as following surgery or during long trips), serious infections or cancer," Lee said.
The venous system is considered a passive flow system with low pressure — the muscles in the legs and arms actively pump blood through the vein system, back to the heart and lungs. "When a person is unable to move (say, after a major abdominal surgery), then those muscles in the legs and arms aren't actively moving to pump blood effectively," Varghese said. "This can lead to a slowing down of blood flow and possible blood clots."
Blood thickens around matter that doesn't belong in the veins — so things like tissue debris, collagen or fat that may be released into the blood system after a trauma or major surgery can cause blood to clot too. And if there's damage to the vein walls, this can release naturally-occurring substances that promote blood clotting, according to the American Academy of Orthopaedic Surgeons (AAOS).
"There's also an overall inflammatory response in these conditions, which can activate the clotting cascade and lead to blood clot development," Dr. David Nation, a board-certified vascular surgeon at VeinSolutions in Austin, Texas, told HuffPost.
Meanwhile, certain medications (birth control pills, hormone replacement therapy) and diseases (heart failure, kidney disease, cancer) can lead to a thickening of the blood due to various mechanisms, with the potential risk of DVT. There are also dozens of genetic conditions that can increase a person's risk of not only developing DVTs but early-age heart attacks and strokes.
"As a layperson, it's not practical to remember nor be concerned with every inherited genetic factor for developing blood clots," Lee said. "But any devastating occurrences (heart attack, stroke, blood clots, recurrent miscarriages) to a family member in their 20s to 40s in age should raise suspicion for an underlying inherited genetic condition that should be tested."
COVID-19 can also increase your risk of DVT blood clots. Experts have a few theories on the mechanisms behind why this happens.
"The virus creates an inflammatory state, which can lead to blood clotting too easily," Nation said. "It also causes direct endothelial injury to the lung tissue — damage to the cells that line the interior surface of blood vessels — that can release signals into the bloodstream that stimulate clot formation."
It's also been suggested the virus may directly activate the clotting cascade through interactions within the bloodstream. All of these effects are more prominent in patients with a severe COVID-19 infection and much less common in mild cases.
Then there's the immobilization factor — from spending days in bed to weeks in intensive care — that comes with any illness, especially if you end up in the hospital. That can lead to slower blood flow, and as a result, increased risk of blood clot formation.
"People with risk factors that place them at high risk for DVT should be covered with preventative anticoagulation upon discharge from the hospital," Lee said. "Although not routine, preventative anticoagulation upon discharge for a period of time appears to be beneficial for those high-risk people."
Lee added: "Certainly, those patients who developed DVT while in the hospital should stay on anticoagulation upon discharge for a period of months, as determined by their physician."
What about if you were infected with COVID or another illness but not sick enough to be hospitalized? You probably don't require routine preventative blood thinners, but if you have any of the risk factors for DVT — recent surgery, trauma, prolonged immobilization due to severe illness, family history — you should be preventatively anticoagulated.
The more you move around, the less chance you have of developing a DVT blood clot. Westend61 via Getty Images
The best ways to protect yourself from DVT blood clotsWhether you're in your usual state of health or recovering from physical trauma, surgery or infection, the best way to avoid DVT is to remove or minimize as many acquired and inherited risk factors as possible.
Know the signs.Symptoms of DVT include swelling, pain or tenderness in your leg, ankle, foot or arm. Other less common symptoms and signs include hip, thigh or back discomfort, unexplained palpitations, fever, dizziness, coughing with tinged blood or general fatigue and malaise.
"These symptoms may seem unrelated to blood clots in the legs, but they may portend early warnings of a serious DVT blood clot in the making," Lee said. The quicker you act, the better your outcomes.
Keep moving.Exercising regularly improves blood circulation and is one of the most important things a person can do to stave off DVT. "Take a break at work if you sit all day by walking around your work area," Dr. Sanjay Bhojraj, a board-certified cardiologist with Providence Mission Hospital in Orange County, California, told HuffPost. "Schedule longer walks, take standing breaks and make sure to periodically stretch."
Even something as simple as pumping your feet when sitting for extended periods — by lifting your toes in the air for three seconds with your feet flat on the floor — can give your circulation a boost during times when you're more sedentary. The more you move around, the less chance you have of developing a DVT blood clot.
Be mindful of medications.Certain medications, such as birth control pills and chemotherapy, can increase your risk of blood clots.
"When a treatment is unavoidable, be sure to consult with your doctor about prophylactic anticoagulation options," Lee said, and take your medications exactly as prescribed to maximize efficacy.
Wear compression socks.Compression socks may help circulation by preventing blood from pooling in the veins, not only improving blood flow but stimulating the body's own ability to prevent blood clots, according to the American Academy of Orthopaedic Surgeons.
This is a particularly helpful strategy to use when traveling, after surgery or during other bouts of inactivity, like when at your desk working.
Travel smart."If you're planning to travel on an airplane, wear loose-fitting comfortable clothes, drink plenty of water and stay active by walking around every hour or so," Bhojraj said. "You should also change your sitting position often and avoid crossing your legs throughout your flight."
Quit smoking."Smoking restricts blood flow and increases the risk of blood clots," Bhojraj said. "It's never too late to quit."
Follow a post-surgery protocol.If you have to undergo major surgery and can't be physically active, your doctor will probably implement low-dose blood thinners in either pill or injectable forms, or compression devices on your legs, to prevent blood clots, Varghese said. They may also promote early ambulation (walking or other movements) to lower your risk.
The length of time you're on the protocol will vary, depending on the type of surgery you've had and your other risk factors, but following the protocol — and staying in close contact with your doctor about how it's going — is a super-important part of having a DVT-free recovery.
Seek out your family history.Look into whether or not you have a family history of blood clot events, such as early-age heart attacks, strokes, DVTs or unexplained pregnancy complications.
"If such family history is present, then consult with your physician or a hematologist on whether genetic or hematologic testing may be indicated," Lee said. "If one family member tests positive for any abnormality, then test everyone among the appropriate family circle in consultation with the physician."
This knowledge can be lifesaving — not just for you, but possibly for your parents, siblings and children too.
What to do if you suspect a DVT blood clotIf you experience sudden and persistent swelling, pain or tenderness in your leg, ankle, foot or arm that feels like a charley horse (a sudden and painful muscle cramp) and these symptoms stick around for more than a day or two and get worse, make an appointment with your doctor right away — and if you have shortness of breath or experience sharp chest pains, call 911.
When you see your doctor or visit an emergency room, you'll receive a physical exam. A doctor will ask you questions about your health to help determine the likelihood of a DVT blood clot.
Make sure to let them know if you've had a recent surgery or serious injury (think: breaking a bone), cancer, stroke, heart failure, are taking hormones (such as birth control pills) or have traveled for an extended period, as these can all increase your risk.
A DVT blood clot is usually diagnosed by ultrasound of the extremity. Depending on the situation, advanced imaging — including a CT, MRI or venogram — may be needed.
Blood thinners are the go-to therapy, which helps to dissolve the clot, and are either given intravenously or in pill form.
"In the past, the only blood thinning pill was Warfarin, which required frequent bloodwork to monitor levels and efficacy," Varghese said. "We now have several blood thinning medication options that appear to be safer, better tolerated and don't require frequent blood work."
In more severe cases, your physician may recommend removing blood clots from your legs or lungs using minimally invasive procedures or surgery.
"Veins that are cleared of blood clots lead to much healthier outcomes than those that have residual blood clots or scarring remaining inside the vein," Lee said. "Early diagnosis and aggressive treatment can lead to satisfactory long-term clinical outcomes."
A previous version of this story appeared in August 2022.
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