COVID-19 may cause fatal blood clots! Doctors raise concern over harm caused from brain to toes

Coronavirus may cause fatal blood clots, thereby harming organs from brain to toes, a Bloomberg report indicates. Doctors have raised concerns about recent blood clotting disorders, which are now one of the ‘most important things’ to have recently emerged in the world’s fight against COVID-19. 

At times, these clots are not always life-threatening and can also exist as one of the clinical conditions of the Covid-19. Clots affect infected people in range from the formation of clots in one’s toes to blockages of blood vessels and subsequent strokes and infarctions. Notably, increasing the risk of blood clotting is not uncommon for infections. The Spanish flu pandemic of 1918, caused by a novel strain of influenza that killed about 50 million people worldwide, was also related to downstream clot destruction that could drastically end lives.

Viruses like HIV, dengue, and Ebola are all known to cause clumping-prone blood cells. In patients with coronavirus the pro-clotting effect can be even more pronounced. The clots which block blood flow in the lungs are more dangerous, causing difficulty breathing.

Researchers in China reported coagulation disorders in Covid-19 patients in February but their frequency has since become clearer. Doctors are looking at blood clots or coagulation as one of the possible reasons for lung damage. However, they still attribute majority of damage to viral pneumonia.

Dr. Anthony Fauci who heads the US’ National Institutes of Allergy and Infectious Diseases and also at a key position in president Donald Trump’s Covid-19 response team has said that autopsies of patients who have died recently are revealing some unexpected information. In an interview with CNN last week, he said that presence of thrombi or clumps of blood as a possible reason behind the rapid and dramatic deterioration of the patients.

Separate studies from France and the Netherlands found that as many as 30 per cent of seriously ill Covid-19 patients had a so-called pulmonary embolism — a potentially deadly blockage in one of the lung arteries. Sometimes these arise as pieces of blood clots in veins deep in the legs and migrating to the lungs.

Doctors are having a tough time treating the patients with the highly infectious Coronavirus that has infected more than 2 million people across the world.

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Blood clots don't have to be deadly: how to recognize signs and symptoms

One in four deaths in Canada is because of conditions caused by blood clots, and a new campaign offers an easy way to remember the symptoms of a clot in your leg or lung.

A Dr.  of medicine says clots can be prevented and treated and awareness of the signs and symptoms is crucial.

“What has become clear since we started our campaign is that definitely a significant portion of the population do not know about blood clots,” she explains. “We know from research that if we can identify individuals who are at high risk and if we can institute prevention methods we can actually stop clots.”

An awareness campaign was launched in the lead up to World Thrombosis Day, which is October 13th.

“Thrombosis is the most common vascular condition after heart attack and stroke. There are two types: deep vein thrombosis (or DVT, a clot in the upper or lower extremities) and pulmonary embolism (it happens when a piece of the blood clot breaks off and travels by the veins to the lung),” according to the doctors.

One tool they offer is a simple way to identify and remember the signs and symptoms of a clot.

The Dr. says these symptoms can come on suddenly or gradually, but a key sign that something might be wrong is when the symptoms persist.


“If the body is trying to speak to us it tries to get it’s message across. So pains that are worrisome don’t go away over a few minutes or a few hours. They tend to come back, they tend to get worse.”

People who are at a higher risk for developing blood clots include pregnant women, people who have been diagnosed with cancer, and people who have recently undergone surgery.

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Medications to Treat Cancer That Has Spread to Bones

Cancer that has spread to bones ( bone metastasis) is very common and can cause a great deal of pain and disability related to fractures and other complications. In recent years medications called bone-modifying agents have been recommended for many cancers to treat bone metastases as soon as they are diagnosed. In this setting, these drugs not only reduce the risk of fractures but may, in some cases, improve survival.

As a secondary benefit, both categories of bone-modifying drugs have anti-cancer properties. What do you need to know about drugs such as Zometa and denosumab if you're living with metastatic cancer?

Bone Metastases vs. Bone Cancer

When people hear about cancer in the bones, it can be very confusing. Most of the time when people talk about "bone cancer" they are referring to bone metastases; cancers that began in another region of the body and spread to the bones. While these people may use the term "bone cancer," cancers which spread to bones are not considered bone cancer. For example, a breast cancer which has spread to bones is not called bone cancer but rather "breast cancer metastatic to bones'" or breast cancer with bone metastases. Primary bone cancer is much less common than bone metastases. Under the microscope, bone cancer would show cancerous bone cells. In contrast, with bone metastases the cancer cells in the bone are the same tissue as the original cancer; cancerous breast cells in the case of breast cancer, cancerous lung cells in the bone (with lung cancer) and so on.

With primary bone cancer, there is usually a single tumor in one bone. With bone metastases, there is often evidence of cancer in different areas of a bone or in several different bones.

Cancers Which May Spread to Bone 

There are many cancers which can spread to bone the most common being breast cancer, lung cancer, prostate cancer, and multiple myeloma. Other cancers which may spread to bone include kidney cancer, stomach cancer, bladder cancer, uterine cancer, thyroid cancer, and colorectal cancers.

Bone metastases occur in roughly 70 percent of women with metastatic breast cancer (bones are the most common site of metastases), and bone metastases from breast cancer are a significant cause of pain and disability for these women (and men). For many of these people, bone metastases are the first sign that the cancer has recurred after years or even decades of remission. Some of the hormonal treatments used for breast cancer (such as aromatase inhibitors) can lead to bone loss, further compounding the problem. The most common bones to which breast cancer spreads are the spine, the ribs, the pelvis, and the bones of the upper legs and arms.

Bone metastases from lung cancer are also common, affecting roughly 30 to 40 percent of people with advanced lung cancer. The bones most commonly affected are the spine, pelvis, and upper leg and arm bones. Lung cancer is fairly unique in that metastases may occur to the bones in the hands and feet. Among people with bone metastases from lung cancer, 22 to 59 percent will experience a "skeletal-related event" such as a fracture.

Bone metastases are also common in advanced prostate cancer. As with women with breast cancer, hormonal treatments with androgen deprivation therapy can also weaken bones. Four out of five men with metastatic prostate cancer will have metastases to bone. Common site of metastases are the hips, spine, and pelvic bones.

Bone metastases from multiple myeloma are also common. On an x-ray, the bones take on a moth-eaten appearance. When multiple myeloma invades bones the cancer cells both inhibit the bone making cells (osteoblasts) and stimulate the bone cells which break down bone (osteoclasts). Multiple myeloma is usually found in larger bones such as the spine, the skull, the pelvis, the ribs, and the larger bones of the legs.

Types of Bone Metastases

There are two primary types of bone metastases: osteolytic and osteoblastic. With osteolytic metastases, the tumor causes the breakdown (lysis) of bone. Osteolytic metastases are seen with multiple myeloma as well as solid tumors such as breast cancer. Osteoblastic metastases result in increased bone production and are most commonly seen with prostate cancer. Most cancers have both types of bone metastases although 80 to 85 percent of metastases with breast cancer are osteolytic. Fractures are more likely to occur in bones with osteolytic metastases than osteoblastic metastases. 

Complications From Bone Metastases

Bone metastases can greatly reduce your quality of life with cancer, yet newer treatments are making a difference for many people. Not only do bone metastases mean a cancer has spread and is no longer curable, but can lead to several complications.

Pain from bone metastases can be very severe and often requires treatment with narcotic pain relievers along with anti-inflammatory medications.

Bone metastases also increase the chance of a fracture in the areas of bone which are weakened by a tumor. When a fracture occurs in bones with metastatic cancer they are referred to as a pathologic fracture. Pathologic fractures may occur with very mild injuries. In addition to predisposing to fractures, bone metastases can make it difficult for fractured bones to heal.

When metastases occur to the lower spine, an emergency condition called spinal cord compression  may occur. Cancer in the vertebrae can cause them to collapse and compress the nerves traveling from the spinal cord to the lower half of the body. Symptoms include back pain that radiates down the leg, weakness, and numbness of the legs, and loss of bowel and/or bladder control. Emergent treatment with radiation or surgery can stabilize the spine to avoid permanent disability.

Hypercalcemia of malignancy or a high calcium level in the blood may occur due to the release of calcium from destroyed sections of bone into the bloodstream. It's thought that 10 to 15 percent of people with advanced cancer will suffer from this condition (which has other causes as well in addition to bone metastases). 

Loss of mobility due to fractures not only reduces quality of life but can put you at risk of other problems. The risk of blood clots in people with cancer is already increased, and immobility raises the risk of developing deep vein thromboses or pulmonary embolism.

Treatments for Bone Metastases

There are currently many different options available for treating bone metastases. Some of the general treatments used for metastatic cancer may also reduce bone metastases. These treatments may include chemotherapy, targeted therapies, monoclonal antibodies, and immunotherapy drugs. There are also treatments which address bone metastases specifically. These include:

• Radiation therapy: Radiation therapy is a local therapy and can significantly reduce both pain and the likelihood of a fracture occurring. 
• Radiopharmaceuticals: Radiopharmaceutics are drugs in which a particle of radiation is attached to another chemical which can then be injected into the bloodstream. Examples include Strontium-89 and Radium-223. Since these particles of radiation are carried through the bloodstream to all of the bones in the body, they may be particularly effective for people with many or widespread metastases.
• Surgery: Surgery may be needed to stabilize a fracture or stabilize damaged bones to prevent a fracture.
• Stereotactic body radiotherapy  (SBRT) and proton beam therapy: For a single or only a few metastases (oligometastatic disease), eradication of the metastases with treatments such as stereotactic body radiotherapy or proton therapy may be done with a curative attempt, but this is very uncommon.
• Bone-modifying agents: These will be discussed below.

Medications for Bone Metastases (Bone-Modifying Agents)

There are two primary classes of drugs used to treat bone metastases. These include bisphosphates (such as Zometa) and denosumab. Bone-modifying agents are recommended for anyone with breast cancer metastatic to bone, and is frequently used with other solid tumors (such as lung cancer) as well. Other treatments (such as radiation therapy) are usually needed along with medications to control pain.

Bone-modifying agents can help people with cancer in several ways.

• They can strengthen bones affected by metastases to reduce both pain and the risk of fractures 
• Many of the treatments used for breast cancer and prostate cancer, can increase the risk of osteoporosis, and along with bone metastases predispose people to fractures. This is especially important as people are now living longer with cancer.
• Due to their effects on the microenvironment of bones, bone-modifying agents may reduce the risk of bone metastases occurring in the first place (with breast cancer and possibly prostate cancer thus far). The risk of bone metastases was lowered by up to one third, while the mortlity rate dropped by one-sixth.
• In recent studies looking at bone-modifying agents with lung cancer, it appears that these drugs may improve both progression-free and overall survival.

Bisphosphonates (Zometa)

Bisphosphonates are medications which were first used to treat osteoporosis and later noted to help with bone metastases. When used for cancers which have spread to bones they can do double duty. Not only can they reduce bone loss but they have anti-cancer effects as well. They work by suppressing the breakdown of bone to improve bone density.

Bisphosphonates most commonly used for bone metastases include:

• Zometa (zoledronic acid): Zometa is an intravenous medication used for bone metastases from many different cancers.
• Aredia (pamidronate): Aredia is an intravenous bisphosphonate. It is approved for breast cancer and multiple myeloma.

The most common side effects of Zometa and Aredia are a mild flu-like syndrome for the first few days after the infusion. Other less common side effects of bisphosphonates given intravenously may include kidney damage, low calcium levels, muscle, joint, and/or bone pain (which can arise any time after treatment), unusual fractures of the femur, and atrial fibrillation. Bisphosphonates may not be recommended for people with kidney disease.

An uncommon but serious adverse event associated with Zometa use (and other bisphosphonates) is osteonecrosis of the jaw . This condition is characterized by the progressive breakdown in an area of bone in either the mandible or maxilla and can be challenging to It's not known exactly how often the condition occurs, but a risk of roughly 2 percent was found in women who were treated with Zometa as adjuvant therapy for early-stage breast cancer. Osteonecrosis may occur with any drugs in the category of bisphosphonates but 94 percent of cases are found with intravenous bisphosphonate drugs and it is very uncommon with oral drugs.

Osteonecrosis of the jaw is more likely if people suffer from gum disease, have poor dental hygiene, or undergo dental procedures such as tooth extraction. There is some evidence that scheduling dental examination every three months and using preventive antibiotics for procedures such as tooth extraction may reduce risk. Treatment options include a combination of surgery, rinses, antibiotics, and hyperbaric oxygen treatments.

Bisphosphonates are also approved for postmenopausal women with early-stage breast cancer. In clinical trials, Zometa was found to reduce the risk of developing bone metastases by one-third and the risk of death by one-sixth.

Denosumab (Xgeva and Prolia)

Xgeva and Prolia (denosumab) is a monoclonal antibody (man-made antibody) which can reduce complications (such as fractures) associated with bone metastases. There are two formulations of this drug which have somewhat different indications with cancer. They are given by injection every four weeks.

Denosumab works by binding with and inactivating a receptor on a protein (RANKL) that regulates bone remodeling. There are two main types of cells in the bones: osteoblasts which cause bone growth, and osteoclasts which break down bone. Denosumab inhibits osteoclasts and increases bone density.

In a 2016 review of studies, denosumab was evaluated in three separate clinical trials looking at its role in breast cancer, prostate cancer, and a third study with people who had multiple myeloma or solid tumors other than breast or prostate cancer. With breast cancer and prostate cancer, denosumab was superior to Zometa in reducing the risk of fractures related to bone metastases. With multiple myeloma and other solid tumors (such denosumab was roughly equivalent in effectiveness to Zometa.

With lung cancer, a 2015 study found that compared with Zometa, denosumab reduced the risk of a fracture occurring by 17 percent. It also appears to delay the development of bone metastases, reduce skeletal tumor growth, and improved survival time by a little over a month.

Denosumab was also found to reduce the risk of treatment-related osteoporosis in breast cancer and prostate cancer (related to the use of aromatase inhibitors in breast cancer and androgen deprivation therapy in prostate cancer).

Side effects of denosumab are similar to bisphosphonates but these drugs are more likely to result in a low calcium level with long-term use. For this reason, taking a supplement of calcium and vitamin D is often recommended. Unlike bisphosphonates, denosumab may be used in people with impaired kidney function. As with bisphosphonates, there is a small risk of osteonecrosis of the jaw with these drugs.

Guidelines for Bone-Modifying Agents With Bone Metastases

Studies on bone-modifying agents have led to guidelines being in place for some cancers.

For metastatic breast cancer, with bone metastases, the American Society of Clinical Oncology guideline from 2017 recommend women be treated with one of the following drugs as soon as bone metastases are detected:

• Xgeva or Prolia 120 mg subcutaneously every 4 weeks
• Aredia 90 mg IV every 3 to 4 weeks
• Zometa 4 mg IV every 12 weeks or every 3 to 4 weeks

For prostate cancer,  2017 clinical practice guidelines also recommended that bone-modifying agents be started at the time of diagnosis of bone metastases. Options include either:

• Xgeva/Prolia (denosumab) 120 mg subcutaneously every 4 weeks
• Zometa 4 mg IV every 12 weeks or every 3 to 4 weeks

All other solid tumors with bone metastases may be treated with one of the following:

• Zometa 4 mg IV every 3 to 4 weeks
• Denosumab 120 mg subcutaneously every 4 weeks

Before Beginning Treatment

Before beginning treatment with either denosumab or bisphosphonates, it's recommended that people have a thorough dental exam looking for evidence of gum disease and that any dental work that is required should be done prior to starting these drugs.

Bottom Line on Bone-Modifying Medications for Bone Metastases From Solid Tumors

Bone metastases are challenging for many people with metastatic cancer and can reduce quality of life and survival. Bone-modifying agents are a relatively new approach and are now recommended early on after a diagnosis of bone metastases for many cancers. 

Bisphosphonates such as Aredia and Zometa can reduce the risk of fractures, and subsequently a cause of pain and immobility. Denusomab is effective in reducing fractures as well and may be somewhat superior to bisphosphonates for breast and prostate cancers. Both classes of medications carry an uncommon risk of osteonecrosis of the jaw, and a careful dental exam looking for signs of gum disease is recommended before starting these drugs.

In addition to reducing fracture risk, these medications can help correct bone loss due to hormonal therapies used for breast and prostate cancers. Both IV bisphosphonates and denosumab appear to have significant anti-cancer activity, increasing the benefits for people who choose to use these drugs. In fact, in addition to people with metastatic breast cancer, Zometa is now recommended for early stage breast cancer as an adjuvant therapy to reduce the chance that breast cancer will spread to bones in the first place.

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Signs and Symptoms of Blood Clots

Signs and Symptoms of Blood Clots: Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)

Deep Vein Thrombosis:

Signs and Symptoms

Deep vein thrombosis (DVT) occurs when a blood clot forms in one of the deep veins of your body, usually in your legs, but sometimes in your arm. The signs and symptoms of a DVT include:

• Swelling, usually in one leg (or arm)
• Leg pain or tenderness often described as a cramp or Charley horse
• Reddish or bluish skin discoloration
• Leg (or arm) warm to touch

These symptoms of a blood clot may feel similar to a pulled muscle or a “Charley horse,” but may differ in that the leg (or arm) may be swollen, slightly discolored, and warm.
Contact your doctor as soon as you can if you have any of these symptoms, because you may need treatment right away.

Pulmonary Embolism:

Signs and Symptoms

Clots can break off from a DVT and travel to the lung, causing a pulmonary embolism (PE), which can be fatal. The signs and symptoms of a PE include:

• Sudden shortness of breath
• Chest pain-sharp, stabbing; may get worse with deep breath
• Rapid heart rate
• Unexplained cough, sometimes with bloody mucus

Call an ambulance or 911 immediately for treatment in the ER if you experience these PE symptoms.

Learn More

The most important thing you can do to prevent blood clots is to learn if you are at risk. Learn more about blood clot risks here: 
Blood clots are serious, but they can also be prevented. Find out how you can prevent blood clots here:

PE - Pulmonary embolism

Understanding PE Diagnosis.

A number of different things may alert a physician that a person may be experiencing a pulmonary embolism, or blood clot in their lung.  When this is suspected, a number of crucial tests may be performed, including:

Pulse Oximetry

Often, the first test performed when PE is suspected is a blood oxygen level. The simplest way to measure the blood oxygen level is with a pulse oximeter. Pulse oximetry is a noninvasive way (does not involve a blood draw or needle stick) to monitor the percentage of hemoglobin that is saturated with oxygen. Hemoglobin is the unique molecule in red blood cells that has the ability to carry oxygen.
The pulse oximeter consists of a probe or sensor plus a computer. The probe, which looks like a padded clothespin, is placed on a relatively thin part of a person’s body, such as a finger or earlobe. Both red and infrared light are then transmitted through the tissue by the probe. Based on the absorption of the red and infrared light caused by the difference in color between hemoglobin that is saturated with oxygen (red) and unsaturated hemoglobin (blue), the computer can estimate the proportion of hemoglobin that is oxygenated. The pulse oximeter then displays this result as a percentage. A blood oxygen saturation level less than 95 percent is abnormal. It may be explained by a lung or heart problem already present, such as emphysema or pneumonia, or by PE (or both).

Arterial Blood Gas

A more precise measurement of blood oxygen level is obtained from a sample taken directly from an artery with a needle or a thin tube (catheter). An arterial blood gas (ABG) measures the levels of both oxygen and carbon dioxide in the blood to determine how well the lungs are working. While most blood tests are performed on samples taken from a vein, an ABG is performed on a sample taken from an artery. In most cases, the artery in the wrist is used for this purpose, but other arteries may be used. The levels of blood gases are measured as partial pressures in units of millimeters of mercury (mm Hg). A partial pressure of oxygen less than 80 mm Hg is abnormal.

Chest X-Ray

A chest x-ray cannot prove that PE is present or absent because clots do not show up on x-ray. Nevertheless, a chest x-ray is a useful test in the evaluation for PE because it can find other diseases, such as pneumonia or fluid in the lungs, that may explain a person’s symptoms. Occasionally, when pulmonary infarction occurs, the x-ray may suggest this diagnosis, although more testing is necessary to prove it with certainty. A normal or negative chest x-ray with a low, otherwise unexplained blood oxygen level, however, raises the suspicion for PE.

Ventilation-Perfusion Scan (VQ Scan)

A VQ lung scan may be a useful test to determine whether a person has experienced PE. This test evaluates both air flow (V = ventilation) and blood flow (Q = perfusion) in the lungs. About one hour before the test, a slightly radioactive version of the mineral technetium mixed with liquid protein is administered through a vein to identify areas of the lung that may have reduced blood flow. Multiple images are taken from different angles, using a special camera that detects radioactivity. For half of the images, the person breathes from a tube that contains a mixture of air, oxygen, and a slightly radioactive version of the gas xenon, which reveals air flow in different parts of the lung. For the other half of the images, the camera tracks the technetium, which reveals blood flow in different parts of the lung. PE is suspected in areas of the lung that have significant “mismatches”—that is, good air flow but poor blood flow.
Except for the minor discomfort from having an intravenous catheter placed, a VQ lung scan is painless and usually takes less than an hour. The exposure to radioactivity from the test is very minor and results in no side effects or complications.
A radiologist interprets the images from the VQ lung scan and decides whether the probability of a PE is high, low, or intermediate. If the probability is high, the diagnosis is made. If the probability is low or intermediate (that is, nondiagnostic), or if the VQ scan cannot be interpreted clearly, other testing must be considered. Even when PE is ultimately proven to be present, the VQ scan may be nondiagnostic. If clinical suspicion is low and the VQ scan reveals a low probability of PE, generally no further testing is needed. A normal VQ scan means PE is not present.

Spiral Computed Tomography of the Chest

An alternative to the VQ scan is a spiral computed tomography (CT) of the chest. A spiral CT of the chest uses special equipment to obtain multiple cross-sectional x-ray images of the organs and tissues of the chest. CT produces images that are far more detailed than those available with a conventional x-ray. Many different types of tissues—including the lungs, heart, bones, soft tissues, muscles, and blood vessels—can be seen.
When PE is suspected, contrast dye (usually iodine dye) is administered through a vein to make the blood vessels stand out.
During the spiral CT, radiation is emitted from a rotating tube. Different tissues absorb this radiation differently. During each rotation, approximately 1,000 images are recorded, which a computer then reassembles to produce a detailed image of the interior of the chest. The x-ray rotates as the patient passes through the CT scanner in a spiral path—hence the term “spiral” CT. The amount of radiation exposure is relatively low, and the procedure is not invasive.

Pulmonary Angiogram

If the VQ scan interpretation is low, intermediate, or uncertain probability of PE, or if the spiral CT is normal yet the symptoms are still suspicious, then the definitive test is a pulmonary angiogram.  An angiogram is an invasive test that uses x-rays to reveal blockages or other abnormalities within the veins or arteries. Contrast dye (usually iodine dye) helps blood vessels show up clearly on x-rays. During an angiogram, contrast dye is injected into a blood vessel, and its path is tracked by a series of x-rays.
A pulmonary angiogram examines the arteries that carry blood from the heart to the lungs and is performed to see if PE is present. Using x-rays in real-time (fluoroscopy), the radiologist inserts a catheter into a vein and advances it until it reaches the vena cava (the very large vein that carries blood to the heart). Next, the radiologist advances the catheter still farther into the right side of the heart and finally into the pulmonary artery, the large artery that carries blood to the lungs. The radiologist directs the tip of the catheter into the different branches of the right and left pulmonary arteries and injects the contrast dye, which illuminates the arteries on x-ray. If PE is present, it will show up as a blockage.

Risks associated with a pulmonary angiogram include the possibility of damage caused by the catheter, bleeding, and an allergic reaction to the contrast dye. The amount of radiation from the x-rays is too small to cause any harm.

Echocardiogram

An echocardiogram is an ultrasound of the heart. Doppler ultrasound, B-mode ultrasound, and M-mode ultrasound (a rapid sequence of B-mode images that allows motion to be visualized) are combined to give information about the size of the heart, the function of the valves, and the strength of the heart muscle. (Duplex ultrasound is discussed in detail in Question 9.) The echocardiogram can spot areas of the heart that are not working well. When patients with a PE have an echocardiogram, approximately 40 percent will be found to have abnormalities of the right side of the heart, particularly the right ventricle. While an echocardiogram is not actually used to diagnose a PE, it can identify strain on the right side of the heart caused by a large PE as well as certain heart problems that may imitate a PE.

Know Your Risk Blood clots

Know your risk for blood clots. The first and most important thing you can do to protect yourself from a life-threatening blood clot is to learn if you are at risk.

Below is a list of some of the most common risk factors for blood clots. Know your risk:

• Hospitalization for illness or surgery
• Major surgery, particularly of the pelvis, abdomen, hip, knee
• Severe trauma, such as a car accident
• Injury to a vein that may have been caused by a broken bone or severe muscle injury
• Hip or knee replacement surgery
• Cancer and cancer treatments
• Use of birth control methods that contain estrogen, such as the pill, patch, or ring
• Pregnancy, which includes up to three months after the baby is born
• The use of hormone therapy that contains estrogen
• A family history of blood clots
• Obesity
• Confinement to bed
• Sitting too long, especially with legs crossed

Talk to your doctor or healthcare provider if any of these risk factors apply to you and know your risk for blood clots.

Prevent Blood Clots

Blood clots can often be prevented and the best ways to prevent blood clots include:

• Know your risk for blood clots.
• Recognize the signs and symptoms of blood clots.
• Tell your doctor if you have risk factors for blood clots.
• Before any surgery, talk with your doctor about blood clots.
• See your doctor as soon as possible if you do have any symptoms of a blood clot. Blood clots can be safely treated.

Other steps you can take to reduce prevent blood clots:

• It’s important to know your family history. Tell your doctor and other family members if you learn that there is a history of blood clots among your relatives.
• If you have to be confined to a bed in a hospital or at home following surgery or due to illness or paralysis, ask your doctor what options exist to prevent blood clots.
• Get up and move if you’ve been sitting for a long time or travelling for a long time by plane, train, or car. Stand up, walk around, and stretch your legs every two to three hours.
• Maintain a healthy weight.
• Don’t smoke or take steps to quit smoking.                          
  
   
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