Health & Exercise Forum

Guest Columnist: Janet Caputo, PT, OCS

The ability of the blood to clot to close and heal a wound is something most of us take for granted. However, when this system is not working properly, serious health problems occur. Fortunately, it is treatable and preventable in most cases. This week will be dedicated to the definition and cause of blood clots. Next week, the column will discuss symptoms and prevention. There is good news for those with an active lifestyle. A recent study published in Journal of Thrombosis and Haemostasis found that regular participation in sports and exercise significantly reduces the risk of blood clots in ages 18 to 70.

Blood clotting is an important mechanism to help the body repair injured blood vessels. A clot that forms as part of the normal repair process offers little consequence but, one that forms when not needed, can result in potentially significant consequences.

A blood clot can form in one or more of the deep veins in your body, usually in your legs. This condition, known as deep venous thrombosis (DVT), is serious. While clots can also form in the superficial veins, they are typically less serious. Even though many clots resolve without treatment, a DVT can break loose and travel to your lungs. When this occurs, the condition, known as pulmonary embolism, is life-threatening for which prompt emergency medical attention is necessary.

Occasionally, DVT develops without any noticeable symptoms but the warning signs may include:

• Swelling in the affected leg, ankle and foot
• Pain in the leg, ankle or foot
• Pain often starts in the calf and feels like cramping or a “charley horse”
• Redness and warmth over the affected area
• If the clot forms in the arm or neck, swelling may occur in these areas

If you experience any one of these symptoms, notify your doctor immediately.

Blood clots form when there is damage to the lining of the vein. Blood clots can also be caused by blood that does not circulate normally or clot properly. Many factors can increase your risk of developing DVT and they include: (1) sitting for long periods, such as driving or flying, (2) prolonged bed rest during a hospital stay or paralysis, (3) inheriting a blood clotting disorder, (4) injury or surgery, (5) pregnancy, (6) cancer and its treatments, (7) heart failure, (8) birth control pills, (9) hormone replacement therapy, (10) a pacemaker, (11) a thin, flexible tube (catheter) in a vein, (12) personal or family history of DVT or pulmonary embolism, (13) being overweight or obese, and (14) smoking.

Blood clots can also form in your arteries. With atherosclerotic disease, hardening of the arteries, plaque deposits form along the lining of the artery and cause narrowing of the vessel. This disease may cause heart attack, stroke, and peripheral artery disease (i.e. poor circulation). If a plaque ruptures, a blood clot can form which can completely or partially occlude the blood flow at that point.

Your heart can form blood clots! Atrial fibrillation, an irregular heartbeat, prevents your heart from beating in an organized manner. The blood becomes stagnant and this may cause clots to form. Clots can also form after a heart attack when the ventricle is damaged and cannot work properly. Since the damaged ventricle does not contract in sequence with the rest of your heart, blood can pool and lead to clot formation.

Since clots that form in your arteries prevent oxygenated blood from reaching specific areas, several predictable symptoms can develop:

• Pain is the initial symptom of this oxygen deprivation due to loss of blood supply
• Other symptoms depend on the location of the clot and often the effect will be a loss of function. Heart attack and stroke are self explanatory
• In an arm or leg, in addition to pain, the limb may appear white, and weakness, loss of sensation, or paralysis may occur.
• If the blood supply is lost to an area of the bowel, in addition to intense, there may be bloody diarrhea.

Blood clots in arteries are life- or limb-threatening events and require immediate attention.  If you believe that you may be experiencing a symptom of a blood clot in an artery, seek medical attention immediately.

The risk factors for and the conditions that cause clots to from in arteries must be controlled! Since blood clots can cause permanent damage to blood vessels and organs, prevention is critical for maintaining health. Minimize your risk of cardiovascular disease and hardening of your arteries with blood pressure and cholesterol control, diabetes management, and refraining from smoking. Because family history is such an important risk factor, be more vigilant about risk factors if there is a family history. Even if you manage all controllable risk factors, you may still develop a blood clot.

Join us in the next two weeks for Part 2, to discuss the possible complications from blood clots and prevention of blood clots, and Part 3, about the connection between blood clots and flying.

CONTRIBUTING AUTHOR: Janet Caputo, PT, OCS is clinical director of physical therapy at Mackarey & Mackarey Physical Therapy Consultants, LLC in downtown Scranton where she practices orthopedic and sports physical therapy. She is currently a Doctor of Physical Therapy student at the University of Scranton.

MEDICAL REVIEWER: Anthony J. Yanni, MD, Chief Medical Officer, Mercy Health Partners, Scranton, PA.