Written by:
Daniel Haight, MD
Vice President of Community Health and Medical Director, LRHS Physicians Group
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By: Daniel Haight, MD
Wednesday, January 2 2013
The Truth about Blood Clots
Lakeland Regional Medical Center
Here are two words that typically never sound good together, or alone: “blood” and “clots.”
Why is this? After all, we need blood, and donating it is a noble action. And tiny clots are always forming and disappearing, but they are instrumental in assisting us the most when we need to stop bleeding after injury.
Blood clots have been in the news lately after U.S. Secretary of State Hillary Clinton developed dehydration after a stomach virus, fell, and suffered a concussion. During a follow-up exam, a clot was discovered in a type of blood vessel called a “vein” between her brain and the inside of her skull.
Whenever we hear of someone with a serious medical condition, we sympathize for the ill person and wish them well. But many of us often wonder if this could happen to me. Especially if we share something in common with him or her, such as age, a recent fall, or some other similar condition.
Like many topics in medicine, a medical condition can mean many different things depending on severity, location in the body and what caused the problem. The same is true for blood clots.
Small clots in the body form and dissolve all the time without problem. But if the clot blocks the flow of blood, a person may feel the result. These feelings, or symptoms, depend on where the clot is located. The seriousness of the clot also depends on the location and the size of the clot.
For example, veins are low-pressure blood vessels that bring blood back to the heart. Because the flow of blood is slower than the high pressure arteries, blood clots can form. If this occurs in the leg of a person who has been sitting for hours on a plane or in a car, this clot may cause swelling and pain in the leg. If part of the blood clot in the leg breaks off, it will float up to the heart and then get stuck in the small blood vessels of the lung. Now the person could feel short of breath, cough up blood, develop chest pain and faint from low blood pressure. This condition of a blood clot in the lung can be life threatening. It is called a pulmonary embolism.
Other blood clots may not cause serious conditions or may be discovered while doing a test for another unrelated condition. These clots might have disappeared without the patient ever knowing. But if a clot causes a person to feel a problem like swelling, pain, or shortness of breath, their doctor can prescribe medicine that help the body dissolve the clot. These medicines are often called “blood thinners.”
Remember, not all blood clots are the same. If a blood vessel leaks, for example, after a fall or a hit on the head, a blood clot can form outside the blood vessel. This may cause similar swelling or more serious conditions if it is inside the skull, like: headaches, seizures and vomiting. In these situations, blood thinning medications would not be used and a doctor might recommend surgery to remove the clot or further tests.
If you have any further questions about blood clots, or how they are treated, leave a comment on this blog….
Jan 3, 12:13 AM
LRMC saved my life 7 years ago when a ER doctor found that I had bilateral pulmonary conboli. I am thankful for Dr. Escois (not spelled correctly) and would like to express my gratitude! I am still on coumadin as a precaution but doing well. If it wasn’t for advanced care and amaxing doctors at your facility I would not be here. Thank you!
Jan 3, 2:08 PM
Yours is a great example how rapid treatment for a pulmonary embolus can save lives.
I’m glad you mentioned the key issue of prevention. For some patients it means taking a blood thinner like Coumadin (a.k.a. warfarin). How much it “thins” the blood is monitored closely to make sure the dose is most effective since that might change over time. Have a wonderful New Year.
Jan 3, 10:45 PM
How does a blood clot differ from a hematoma?
Jan 4, 10:03 AM
A hematoma is a collection of blood outside of a blood vessel. The more common name for a hematoma is a bruise. It is made up of clotted blood. This is often caused by an injury. A blood clot that forms inside a blood vessel or the heart is never called a hematoma. This is called a thrombus.
Here is how these terms are often used:
A blood clot stuck to the inside wall of the heart is called a mural thrombus.
If a person injures their head and causes bleeding outside of the blood vessel between the brain and the covering around the brain (called the “dura”), this is called a subdural hematoma. This would never be treated with blood thinners since that type of medicine might cause further bleeding.
A boxer after a fight who suffered a black eye would thus have a peri-orbital hematoma. Peri-orbital is another word for “around the eye”.
Jan 4, 2:49 PM
To bring one of these example full circle:
A blood clot stuck on the inside wall in the heart, called a mural thombus, could break off and float down stream inside a blood vessel. This is called an thrombotic embolus. The problem is that this inside of a blood vessel normally become smaller and smaller to the point where an embolus gets stuck and blocks the flow of blood.
If this happens in the brain, it will cause a stroke.
If it happens in the small blood vessels of the lung, a person cannot get oxygen into the blood.
If it happens in the small blood vessels in the foot, a toe might turn blue.
If it happens in many places, or if a large embolus gets stuck in a large blood vessel, too much blood flow will stop and the blood pressure will fall to dangerously low levels.
Each of these problems would normally alert the person, or a family member, of something seriously wrong and the need to go to an emergency room
To review:
- Hematoma is a bruise and is made out of clotted blood
- Embolus is something solid floating in the blood stream (could be a clot, foreign object, a clump of germs, or a clump of cholesterol)
- Thrombus is clotted blood inside a blood vessel
- Mural means wall
- A blood thinning medication helps clots dissolve but can cause bleeding in certain circumstances
Jan 9, 4:21 PM
I was hospitalize in July of 2011 for P.E. and no one knows how it formed. Only thing the doctors can tell me was it probably came from birth control. I’m scared to the day because I really don’t know how it formed. I have an IVC filter in my right leg, will that prevent clots from forming?
Jan 10, 3:01 PM
That is a common question and as you point out, it can be frustrating not to know the exact reason.
Many times, a disease cannot be blamed on an exact cause and a satisfying answer can never be given. But the next best approach is to learn about what would increase the risk for a disease or condition to appear.
First, a pulmonary embolism can occur for no reason in an otherwise perfectly normal and healthy person. You mentioned one risk factor, birth control pills, that may increase the risk of blood clots but the risk is still small. In fact, some birth control pills are designed so as to lower the risk further.
Other risk factors include:
It is understandable to be concerned, but it is good that you have discussed steps to help reduce the risk of future pulmonary emboli such as the filter. To learn more about your personal treatment options and risks, please ask your personal physician since it is hard to answer some questions without an in depth discussion, examination, and review of all medical records.
A person who has never had this problem does not know what it feels like, but your experience helps you understand the problem you had in 2011 and knowing to seek medical attention if a concern arises.
Jan 14, 8:55 AM
How is heparin different than
Ccoumadin and what therapies indicate its use over Coumadin?
Jan 18, 11:06 AM
Since everyone’s medical care is unique, sometimes an answer to a question may be incomplete if not answered by the doctor who meets the patient face-to-face for a discussion, examination, and review of all test results.
But in general, heparin is quick acting and is used first when a blood clot is discovered. Its blood thinning effect can be controlled and monitored easily in a hospital by using a special blood test. It is either given through the vein by dripping it in continuously or injected just under the skin. Its thinning effects on the blood can be reversed by slowing it, stopping it, or giving the patient a medicine that reverses its effect.
Coumadin (warfarin) has the advantage of being a pill, but it works too slow to be used when a blood clot is putting the patient in danger. Vitamin K reverses the blood thinning effect but it is not easy to fine-tune the effect quickly like heparin. It cannot be used in pregnancy, so a woman who needs her blood thinned at home would need to inject heparin (or a similar medicine) each day.
So it is understandable that if a person develops a blood clot in a blood vessel, the first step would be to start heparin and then begin coumadin. When blood tests show that the coumadin is fully working, the heparin can be stopped and the person can go home on coumadin. This person would need frequent blood tests to make sure the coumadin dose is right for them because many things affect how coumadin works such as a person’s diet.
It is also common to use a low dose of a medicine similar to heparin for patients who cannot get out of bed in the hospital (to prevent blood clots).
There are other blood thinning medications available for various uses, but that would be better to discuss later as it is a lengthy subject.
If the blood is too “thin”, bleeding can occur. If too “thick”, blood clots can form. “Thick” and “thin” are not scientifically accurate terms, but do get across the message that the action of blood clotting (or not) is a delicate chemical balance that our bodies do daily. Truly Amazing!
Jan 25, 2:26 PM
Thanks for the information. I have had pain (feels like a headache in the leg) in the back of my right calf just below the knee on and off for a little over two years now… no swelling or anything else.
One year ago, after a little more than a year of having the pain, I went to the ER and the physician took one look at my leg, listened to my symptoms (pain) and told me there was no way I had a blood clot… and that even if I did at one point, it would have attached by that time.
That made me feel better, but here it is a year later and I still have this pain.
I know you can’t and wouldn’t want to diagnose over the internet… and I understand. But my question is, could a person have a blood clot for over two years with no other symptoms other than pain and would it still be in danger of breaking off and traveling?
I appreciate your information… thank you.
Jan 25, 4:12 PM
Those are good concerns and when there are unexplained symptoms, such as pain, further visits are helpful. But in this situation, it would not to go to an ER if there are no new problems.
Yes, a person can have chronic blood clots but the most serious clots will produce more than just pain (such as swelling and skin discoloration). Not having those other problems does not bring the chance down to zero. Very little in medicine can be described with the words “always” or “never” – - so there is a possibility and it is good to have this rechecked for reassurance if the pain remains.
You may already have one, but the best place would be a primary care doctor that knows you well (or can get to know you). They may see minor changes in your leg examination that will help them find the cause.
Sometimes, by talking with a person, you learn that they may have worked in a job where they knelt on their knees a lot. That causes a “baker’s cyst” to form in the upper calf. It is a small sack of fluid that the doctor might feel when touching your leg.
There are other problems like arthritis;
There is also something called “referred pain” where you feel it in the calf, but the source of the pain really is the knee or the tendons around the knee or from the ankle or back.
It is often good to ask the doctor for a list of what could be causing the pain. Then, for each possible cause, ask what are the chances and why a test may or may not be needed.
Jan 25, 6:47 PM
Thank you for your reply. You have a great way of explaining things and you share some really valuable information here.
I will follow up with a primary care doctor and see what this is about.
Again, thank you so much.