Blood clots after surgery – call to action

Deep vein thrombosis (DVT) and pulmonary embolism (PE) – “blood clots” – kill about 100,000 Americans each year. Many blood clots occur after routine elective surgery – especially spine surgery and major surgery on the hip or knee.

An excellent consumer guide to the risks, prevention and treatment of blood clots can be found here.

The Office of the Surgeon General in the US recently called for action to address this major public health problem. The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism documents the problems DVT and PE pose, as well as strategies to reduce the risk of developing the conditions. Clearly we need to improve public knowledge about risk factors, triggering events, and symptoms of the disease, which is often silent.

Before any surgical procedure, particularly those requiring more than a day or so in hospital, you should be evaluated for any risk factors for a blood clot. People at risk need preventive measures, which can include anticoagulants, like heparin, special stockings, or the use of automated calf compression devices.

Rapid mobilisation – i.e. getting out of bed – is one of the best ways to avoid blood clots and is one of the reasons why patients having outpatient or day surgery very seldom need specific preventive treatments.

Blood Clots and Surgery

Any injury to the body, whether due to surgery or trauma, increases the risk of a blood clot, because the injury stimulates the body’s clotting processes. Most of these blood clots occur within 2 weeks of the event, but some happen within a few hours or even during the operation. DVT/PE also can occur up to several months after surgery or major trauma.

Certain types of surgery and certain types of trauma are especially likely to lead to blood clots, including:

  • Pelvic (gynecological and urological) surgery
  • Orthopedic surgery (including hip replacement or fracture repair)
  • Spinal cord paralysis
  • Multiple limb fractures
  • Pelvis/hip socket injury.

Signs and Symptoms of Blood Clots

Unfortunately the symptoms are sometimes mild, and easily confused with other conditions. If you have a blood clot in your leg (DVT) you may notice:

  • New swelling in your arm or leg.
  • Skin redness.
  • Soreness or pain in your arm or leg.
  • A warm spot on your leg.

If a blood clot travels to your lungs (PE) may have:

  • A hard time breathing.
  • Chest pain.
  • A fast heartbeat.
  • Fainting spells.
  • A mild fever.
  • A cough, with or without blood.

What You Can Do

  1. Get checked. All hospitalized patients should be evaluated upon admission to assess their risk for DVT/PE. Many different sets of guidelines have been published but every hospital is supposed to have one that they adhere to. Not everyone needs prophylaxis (preventive treatment) but make sure you have been assessed and a decision made by your doctor(s) on whether you need anticoagulants or other preventive measures.
  2. Get checked again. If you stay in hospital you should also be assessed regularly thereafter, both for the need for prevention, and for the development of blood clots.
  3. Familiarise yourself with the symptoms of blood clots and don’t hesitate to seek help if you are worried.

Reference

Your Guide to Preventing and Treating Blood Clots. AHRQ Publication No. 08-0058-A. Agency for Healthcare Research and Quality, Rockville, MD. August 2008. http://www.ahrq.gov/consumer/bloodclots.htm

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8 Responses to Blood clots after surgery – call to action

  1. pat coflin says:

    Concern re blood clot under incision following lumbar laminectomy 5 wks. ago the size of a very large egg.post-op first day draining not complete on discharge but removed causing clot. Neurosurgeon does not want to open there, fearing infection. Is there any other treatment to reduce size and discomfort? PC

  2. Marilyn says:

    Hello,

    My 49 year old son is battling three DVt’s in right thigh following shoulder surgery in Feb, 2009. He also has clots in both lungs. He was hospitalized for only two days…kicked out…signed off and his wife said “I am not taking him home” and was put in a swing bed in a small town for 10 days. Well, eight months later another clot developed in thigh and his leg is still swollen and nothing is being done except physical therapy. What SHOULD THE NEXT STEP BE? I had one in my thigh and they did surgery immediately. I am worried about him. Please help with suggestions. Thanks

    • surgiprep says:

      On this blog I don’t provide medical advice of the sort you are seeking. That wouldn’t be wise, would it, especially in the case of serious, acute conditions like blood clots in the legs or lungs. The usual treatment for this condition is the immediate administration of anticoagulants (blood thinners). Blood clots are particularly common after major orthopedic surgery. Prevention is better than cure. Please talk to your doctors.

  3. pat coflin says:

    See above for problem, still there after 2 months post surgery. Dr. did not answer question to give blood thinners (husband previously took baby aspirin daily until 2 wks before surgery. Does clot self absorb in time? Is there danger of it moving to lungs etc.? Please help.

  4. Avis Valdespino says:

    My 83-year-old step-mother just had inguinal hernia repair surgery a week ago. Because she developed a lump near/on the hernia site and has had a lot of pain, she is going to have an ultrasound to determine the cause of the lump. The surgeon suspects it may be a blood clot. How is it removed, will more surgery be required? Is she in serious danger? I’m trying to determine whether I should travel to visit her in another state or not. Thank you.

  5. Glesa says:

    my dad had a hernia re=moved from his lower abdomen…He’s was 78. well on Nov.2, he was doing physical theropy, and after his 9th rep, he rolled over and his body went totally still. He look like someon who had a sugar attack episode..He had been on coumdain for six months for a blood clot in his left leg.. and off of the medication three months before this surgery. I feel like we slipped by not placing him back on coumdian, and putting his compresion stocking on every morning..He fainted, and broke out in a sweat..unfortunely, I don’t know if this was signs of a blood clot, but he passed away couple hours after, this….Now I think the signs were there of the blood clot and we negleted my dad by not haveing him checked out to prevent this horrific episode, if the cause of death was a blood clot two weeks after this surgery.. I feel like it’s my fault

    • surgiprep says:

      A person who has had a blood clot in the past may be at increased risk of having another one after a surgical procedure, and would often be eligible for some form of prophylaxis, such as coumadin. However the extent of the risk, and therefore the type of preventive treatment will vary and will depend on the invasiveness of the surgery and other factors. Early mobilisation after surgery decreases the risk of a blood clot and so is not usually offered after outpatient surgery.

      These decisions require weighing up risks and benefits and are not always straightforward. When coumadin prophylaxis is advised after major surgery, guidelines state that it should be continued for 6 weeks or so, but in practice the duration of treatment is often shorter.

    • Avis Valdespino says:

      Glesa,

      I’m sorry about your father. My step-mother has been taking Coumadin regularly for years. I think she was taken off it a few days before surgery, possibly to prevent excessive bleeding during surgery. However, post op she was placed back on it, with the nurse coming every evening to give her an injection for a full week following surgery. Then, after the first week, she has restarted taking the Coumadin pills once again.

      Seems to me that in your father’s case, the doctor should have provided some type of follow-up care in regard to the blood clot. From personal experience, I can tell you that it’s easy and typical to blame oneself when a loved one dies, but without medical expertise it’s very difficult to understand and pick up on the signs of trouble. Also, since your father had just had hernia removal surgery, you (and him) were probably focusing on the hernia removal issue and not so much on the blood clot in his leg. A friend of mine who was 77 kept complaining that he had the flu and I accepted it as such. Turned out that he was having pre-stroke symptons and he ended up having one and died a couple of weeks later. I’ve been blaming myself too for not being more aware. But, as I said, without medical training how was I to know. Take care of yourself and be a better person with those that surround you in your dad’s memory.

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