Blood Clots

Timothy Woods, MD
Bitterroot Orthopedics and Sports Medicine
1200 Westwood Drive
Hamilton, MT 59840


Blood Clots
For most surgical patients, the fact that their blood clots-and they stop bleeding is a good thing! However, there are a few circumstances where clotting of blood can be a problem. These are often called by their medical name-Deep Vein Thromboses (DVT).

A German physician, Rudolf Virchow, is credited with the description of 3 key components that often contribute to clot (DVT) formation. These are known as Virchow's Triad, and consist of: Hypercoagulability, Stasis, and Vessel injury. While inherent to many injuries, there are a few orthopedic conditions when blood clots are particularly common. They include Hip fractures, pelvis fractures, hip & knee replacement surgery, and many other fractures or injuries of the lower limb. These injuries often impair mobility of the patient, i.e. stasis, and can result in clot, or DVT, formation.

It is for this reason, and others that hospitalized patients are mobilized as soon as practical. We even use mechanical compression devices that simulate leg muscle contraction and minimize blood stasis.

Deep vein thrombosis (DVT), occurs when a blood clot forms in one of the deep veins of the body. This can happen if a vein becomes damaged or if the blood flow within a vein slows down or stops (stasis).

A DVT can have serious consequences. If a blood clot breaks free, it may travel through the bloodstream and block blood flow to the lungs. Although rare, this complication-called a pulmonary embolism-can be fatal. Even if a blood clot does not break free, it can cause permanent damage to the valves in the vein.

In many cases, DVT occurs without noticeable symptoms and is very difficult to detect. For this reason, doctors focus on preventing the development of DVT using several different types of therapy.

Deep vein thrombosis (DVT) occurs when a blood clot forms within one of the deep veins. While it can occur in any deep vein, it most commonly occurs in the veins of the pelvis, calf, or thigh.

Several factors can affect blood flow in the deep veins and increase the risk for developing blood clots.

These include:
  • Increasing age
  • Personal or family history of DVT (or pulmonary embolus)
  • Cancers
  • Varicose veins
  • Smoking
  • Birth control pills or other hormone therapies
  • Obesity
  • Having a blood clotting disorder
A broken hip or leg, or having major surgery on your hip, knee, or lower leg can affect normal blood flow and clotting pathways. Knowing these at risk conditions means extra care and steps should be taken to lower the chances of blood clot formation.

Symptoms of DVT occur in the leg affected by the blood clot and include:
  • Swelling
  • Pain or tenderness
  • Distended veins
  • Red or discolored skin
  • A firmness or thickening of the vein called a "cord"
Many patients, however, experience no symptoms at all.

In some cases, a pulmonary embolism may be the first sign of DVT. Symptoms of pulmonary embolism include:
  • Shortness of breath
  • Sudden onset of chest pain
  • Coughing
  • Spitting up or vomiting blood
If your doctor suspects DVT, he or she will order diagnostic tests, such as a Duplex ultrasound. This is the most common test for DVT. Sometimes an MRI or a CAT scan is preferred, especially if the clot is thought to have broken off and gone to the lungs.

Since DVT may occur after a major fracture or surgery, many patients are already hospitalized when the condition is diagnosed. The goals of treatment for DVT are to:
  • Stop the blood clot from getting bigger
  • Prevent the clot from breaking off and traveling to the lungs where it could lead to pulmonary embolism
  • Reduce the chance of developing another clot
  • Minimize the risk of developing other complications
Most often, treatment for DVT is nonsurgical and involves the use of anticoagulants such as Heparin, Warfarin, or Xa inhibitors.

If you are having orthopedic surgery, your risk for developing DVT is highest from 2 to 10 days after surgery and includes the time after you have been discharged from the hospital. You remain at risk for about 3 months.

The measures your doctor uses to help prevent DVT are called prophylaxis. He or she will use several preventive measures in combination. For example, if you are having total knee or total hip replacement, your doctor may prescribe early movement and exercise, compression stockings, and medications that thin the blood and reduce the body's ability to form blood clots.

In conclusion, blood clots are regrettably fairly common with orthopedic surgery and orthopedic injuries. Although no preventive strategy is 100% effective using some or all of the above strategies can lower your chances of developing a blood clot (DVT) and possibly of having that blood clot break off and become a pulmonary embolus. For more information about blood clots and other interesting orthopedic topics go to orthoinfo.aaos.org.

Questions and or comments regarding this week's health column please contact, Timothy Woods, MD at Bitterroot Orthopedics and Sports Medicine, a service of Marcus Daly Memorial Hospital, 1200 Westwood Drive, Hamilton, MT 59840. Working together to build a healthier community!
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