How Do I Prevent Blood Clots?
Knee Surgery Revealed Blood Clot Risk for Runner
Joe Isaacs was surprised by cramping in his leg after knee surgery. Unlike many of those who experience deep vein thrombosis, he reacted in time.
By Madeline R. Vann, MPH
Medically Reviewed by Lindsey Marcellin, MD, MPH
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Health care industry executive Joseph Isaacs was a lifelong runner and in great shape. But soon after his second arthroscopic knee procedure in 2006, he noticed the telltale signs of a blood clot in his leg, also known as deep vein thrombosis (DVT).
“I started feeling cramping in my calf, and my leg was turning purple,” the now 63-year-old recalled. “That was the first I knew of any association between DVT and arthroscopic surgery.”
Isaacs was rushed from his doctor’s office to the ER, where they found the clot using ultrasound. He was given enoxaparin sodium (Lovenox) shots immediately to break up the clot. He was also put on warfarin, a daily blood thinning medication. Two years later, even with the blood thinner, he said he had another clot, though this one eventually went away on its own.
Testing revealed that Isaacs has a genetic predisposition toward clotting. But without a personal or family history of blood clots, he had no idea that he needed to talk to his doctor about any DVT risk before his procedures. He doesn’t recall anyone mentioning the possibility to him.
From Patient to Advocate
Isaacs became an advocate for blood clot awareness and CEO of the nonprofit group National Blood Clot Alliance. Since then, he has heard hundreds of stories of blood clots that have been fatal and those that were near misses, like his own.
“It doesn’t matter your age, gender, race, or how fit you are. It can happen to anyone,” he pointed out. And while he had classic symptoms of a blood clot, many people either don’t have symptoms or don’t realize that their symptoms require immediate action — if a blood clot travels from leg to lung, it can cause a fatal pulmonary embolism.
RELATED: 6 Simple Steps to Avoid Deep Vein Thrombosis
Facing Risk of Deep Vein Thrombosis After Surgery
Isaacs said that he is one of more than a million people annually who have knee and hip procedures ranging from arthroscopic surgery to total joint replacements. Even with current strategies to reduce DVT, blood clots remain one of the primary reasons patients are readmitted to the hospital after surgery, according to the American Academy of Orthopaedic Surgeons.
Up to half of all patients who have joint replacement would have a clot without preventive — also called prophylactic — measures, said Claudette Lajam, MD, assistant professor of orthopedic surgery at the NYU Langone Medical Center in New York and a spokesperson for the American Academy of Orthopaedic Surgeons.
While people facing such invasive knee and hip surgeries are screened for DVT risk and given preventive measures, arthroscopic surgery patients are not, because DVT is less common after these procedures.
“It’s really not cost-effective to prophylax everyone having arthroscopic knee surgery. Physicians should do a more individualized approach for assessing the risk,” said David Flanigan, MD, orthopedist, associate professor of clinical orthopedics at the Ohio State University Medical Center in Columbus, and co-author of a 2014 review of DVT risk and arthroscopic knee surgeries published in the journal Sports Medicine.
Steps to Prevent Deep Vein Thrombosis After Surgery
Clot preventing strategies depend on many factors: your risk level, which your doctor determines based on any personal history of blood clots, any family history of clots, age, your overall health, whether you're on any hormone therapy, and lifestyle factors such as smoking and obesity.
In order to reduce the risk of blood clots after knee or hip surgery, preventive strategies include:
- Taking medications.Options range from aspirin to prescription anti-clotting drugs such as warfarin, heparin, enoxaparin, apixaban, (Eliquis), and rivaroxaban (Xarelto). Medications to prevent clotting may be started before surgery and continued during recovery.
- Using pressure devices.Your doctor might prescribe a pressure stocking or device placed over your limb to keep blood moving.
- Getting out of bed.“Just getting people up and moving after surgery cuts down on deep vein thrombosis events and deaths,” said Lajam. You might be told to do leg exercises while in bed as well as sitting up and walking.
- Knowing the symptoms.Signs that you might be developing a clot include pain, swelling, and discoloration in your leg. Signs that a clot has moved to your lungs as a pulmonary embolism are shortness of breath, pain when you breathe, and bloody coughs. Respond immediately to these symptoms by calling 9-1-1 and going to the emergency room.
The most important first step you can take to reduce your risk for DVT after hip or knee surgery of any kind is to have a conversation with your doctor about your risk, said Lajam. That way you can decide together on the best strategy to prevent clots.
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