Blood Clots

Overview

Blood flows to the veins and arteries (blood vessels), and it is always on the move as the heart performs its blood pumping duties through arteries in various parts of the body, such as in the cells, glands, organs, and more. After that, the blood goes back to the heart through the veins. The movement of the body allows the blood to return to the heart. It is the muscles that squeeze the blood towards the veins and back to the heart. With the absence of movement, blood can potentially end up stagnate through gravity, and this stagnant blood can result in a clot.

The medical term that refers to a blood clot is thrombus or thrombi for the plural form. Blood clotting is a vital mechanism to assist the human body in repairing and healing injured blood vessels. When a blood clot is created as part of the regular healing procedure of the body, a minimal consequence may be experienced. However, when blood clot builds up in an unusual way or during times when it is not necessarily needed, it can lead to severe consequences.

Causes of Blood Clots

Blood clots are usually caused by a damage in the blood vessel lining; it can either be in the vein or artery. The damage is due to obvious reasons, like lacerations, cuts, or something impossible to see using the naked eye. Blood clots are also caused by immobile and stagnant blood or diseases that encourage the blood to abnormally clot.

Blood clots that form in the vein or commonly known as venous thrombosis, take place when an individual starts to become immobilized, and his/her muscles are no longer contracting for the blood to be pushed back to the heart. The stagnant blood then creates tiny clots on the walls of the vein. The problem is, this first clot can slowly develop to wholly or partially occlude or block the vein. When this happens, the blood will have no means of going back to the heart.

Besides, blood clots that build up in the artery or popularly termed as arterial thrombi happen by a whole new different mechanism. For instance, those with atherosclerotic disease, plaque accumulation form in the lining of the artery, and from there, it starts to develop, resulting in narrow vessels. This disease procedure can cause the following: peripheral artery disease or PAD, stroke, and heart attack. 

In worse cases, a plaque may rupture and can lead to clot formation at the exact location that the rupture takes place. The newly formed blood clot can partially or entirely prevent the normal blood flow.

Other cases of blood clots include:

  • Blood leaking from the blood vessel – blood clot formation is caused by blood leaking from the blood vessel. However, this particular procedure is helpful since the clot prevents severe bleeding at the location of the injury. Some examples of bleeding that can benefit from blood clot formation are broken bones, scrapes or cuts, nosebleed, and strains or sprains. 
  • Blood clots in the heart – when a person is diagnosed with arterial fibrillation, the atrium or upper chamber of the heart loses its ability to beat in a typical fashion. Instead of beating in an organized way, it jiggles, and this caused the blood to remain stagnant in the walls of the atrium. After a long time, this could potentially lead to tiny blood clot formation. Moreover, clots can also accumulate in the ventricle right after the person suffers from a heart attack because some part of the heart muscle is wounded and loses its ability to contract properly. Since the injured area has no means to contract with the rest of the heart area normally, the blood will begin to stagnate or pool, resulting in a case of clot formation. 

Diagnosis and Treatment

The initial process in coming up with the diagnosis for a blood clot is seeing the patient and family let them understand the whole situation. Generally, the site of the blood clot and its impact on the blood flow are the main factors that determine the signs and symptoms that the patient will experience and can avoid. Apart from determining the location of the blood clot, physical tests also help with the diagnosis.

  • Vital signs help in judging the stability of the patient. These include respiratory rate, pulse rate, oxygen saturation, and body temperature.
  • EKG and heart monitoring are recommended to evaluate the heart rhythm and rate.
  • If the problem is associated with a pulmonary embolus, the healthcare professional might assess the lungs to listen to any odd noises caused by a site with inflamed lung tissue

Other tests and procedures carried out to diagnose blood clots include the following:

  • Venography
  • Ultrasound
  • D-dimer
  • Ventilation-perfusion scan
  • CT scan 
  • chest X-ray

Depending on the location, blood clots might be invasively cured or treated with symptomatic care. 

  • Blood clots in the superficial system – treated using warm compress and ibuprofen or acetaminophen because there’s no risk for clots in the superficial veins that can affect the lungs.
  • Deep venous thrombosis – treated with anticoagulation to stop the clot from developing and causing a pulmonary embolus. Blood thinners are popular medications to treat blood clots.
  • Blood clots below the knee – since there is a lowered risk for embolization to the lung in this area, serial ultrasound tests are performed to track the clot and determine whether it is progressing or stable.
  • Arterial blood clots – usually treated more invasively. Surgery might be performed to eliminate the blood clots, or drugs might be prescribed straight to the clot to dissolve it. Some of the most common clot-busting medications used are alteplase or tenecteplase. 
  • Pulmonary emboli - treated with a similar treatment used in deep venous thrombosis. In rare cases, vast amounts of the clot are accumulated in the pulmonary arteries, the lung and heart function needs to be strained, and thrombolytic therapy using tissue plasminogen activator or tPA drugs (clot-busting drugs) might be prescribed.

What are the normal conditions?

Blood clots happen due to stagnating blood, and it can be dangerous. Blood clots that accumulate in the veins of the legs, groin, and arms can grow and damage other parts of the body, such as the lungs. You can help support healthy blood flow in your body by:

  • wearing loose-fitting stockings, socks, and clothes
  • wearing specialized stockings known as compression stockings in case your healthcare provider suggests them
  • eating less salt
  • doing regular exercise
  • raising your legs about 6 inches above your heart for a few times each day
  • change your position from time to time, especially during long travels
  • don’t put pillows or cushions under your knees
  • don’t hurt or bump your legs
  • don’t sit or stand for over an hour
  • raise the bottom of your bed for about 4-6 inches using books or blocks

Risk of Having Blood Clots

There are several risk factors when talking about blood clots, and most of them are prevalent to all disorders that result in cholesterol plaque formation, narrowing of blood vessels, and rupture of the plaque. These include:

  • Diabetes
  • High blood pressure
  • Smoking
  • High cholesterol levels
  • Cancer
  • Family history of early stroke or heart attack

Blood clots that form in the veins are due to either of these two reasons: genetic problems in the clotting mechanism or immobility. There are also linked risk factors, such as taking birth control pills and smoking.

Genetic problems in the clotting mechanism are one of the risk factors of blood clot formation. Due to some genetic issues in the clotting mechanism, a person might become hypercoagulable (hyper means more and coagulation means clotting) and at higher risk for abnormal clot formation.

Immobility usually happens when the human body is no longer capable of moving, which puts the person at a higher risk of forming blood clots since the muscle movement is vital to keep the blood from moving towards the heart. Basically, a pool of blood in the vein is at risk of a clot. 

Some examples of how blood clots form due to immobility include:

  • Going through hip or knee replacement surgery
  • Immobility due to paralysis from spinal cord injury or stroke
  • Being bedridden or hospitalized after surgery or disease
  • Orthopedic injuries wherein the patient are required to place casts all over his/her broken limbs or bones.
  • Traveling for long hours, like in a plane, train, or car, when you don’t get to move or stand up more often. The stagnated blood in the leg veins can clot.
  • Pregnancy is a considerable risk factor for the formation of blood clots in the pelvis and legs since it results in an insufficient flow of blood to the heart.

When to seek medical attention

A blood clot that occurs in the brain can lead to a feeling of weakness in your arms, face or legs, difficulty in vision and speech, dizziness, and headache. Most of these symptoms are linked with other severe medical disorders like stroke or heart attacks. If you suspect or experience symptoms of a blood clot, don’t hesitate to contact your doctor right away or seek emergency medical attention. 

Table of Medications

  • Xarelto
  • enoxaparin
  • Eliquis
  • Lovenox
  • rivaroxaban
  • heparin
  • apixaban
  • Pradaxa
  • Heparin Sodium
  • Arixtra


Tilly Whittaker

Our Senior Editorial Pharmacist brings positivity and light banter during meetings. She is a walking encyclopedia of knowledge and explanations. You will rarely need to open a book when she's around. Her almost eidetic memory makes her an invaluable member of the group.

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