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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