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Health Matters

Blood clots can be due to many factors

Conway McLean, DPM, Journal columnist

A patient came into my office with pain in the back of their ankle, expressing concern this might be a blood clot. Another individual during a visit related a recent event where the back of their ankle was struck and was now painful. They believed it was due to a clot forming in their leg. This person was referring to the formation of a DVT, a deep venous thrombosis. This is a blood clot, a thrombus, which can form and then travel through the bloodstream. Depending on where this traveling clot lodges determines what complications develop. But many conditions can cause swelling or pain and neither of these individuals had a blood clot.

Our blood has a critically important task, that of flowing continuously, smoothly, throughout the body, providing nutrients and oxygen to all the living cells of the body. When an injury occurs, blood flow must be restricted to keep loss to a minimum. Blood clots are appropriate, even life-saving, but they can develop at times and places which are problematic, potentially leading to dangerous complications. And clots can form in any blood vessel in the body.

A blood clot is a mass of coagulated blood that has formed within a blood vessel. Again, it’s a necessary part of blood loss prevention in the face of injury. But problems will develop when this process is not regulated correctly, occurring with various conditions, or due to different substances. About two-thirds of those diagnosed with a blood clot have an underlying clotting disorder. Thrombophilia is the term referring to this condition, and is an inherited problem in about 8 percent of people.

When a blood clot occurs in an artery, symptoms develop immediately. This is a medical emergency since, without treatment, the tissues supplied by that vessel will henceforth be deprived of blood. This produces severe pain, untouchable by opioid pain medications. Consequences of an arterial clot may include gangrene, paralysis, a heart attack or stroke. A venous clot occurs in a vein and often takes place slowly, over time, but they can still be life-threatening.

When a clot forms inside one of your veins, it will frequently dissolve on its own. Blood clots can form and not move, causing minimal symptoms or consequences. But if one travels, it can be dangerous. One of the most serious complications is a deep vein thrombosis which travels to the lungs. This is called a pulmonary embolism. A clot that becomes lodged in a lung artery can cause lung damage, organ damage, or death.

Numerous other factors are at play in the incidence of thrombophilia. Various medications can increase your risk of abnormal clotting. Prolonged periods of immobilization, like a long flight or a hospital stay, are well recognized to stimulate the formation of blood clots. Certain diseases can also, or trauma, such as after a motor vehicle accident. Obesity is also a major risk factor, increasing the chances you will suffer some consequence of abnormal clotting such as a stroke.

But there are many techniques and practices that can go a long way toward reducing the chances of forming an abnormal clot. The use of tight, restrictive clothing increases risk so being mindful of your apparel is helpful. A lengthy period of immobilization or inactivity can increase your risk, so changing your positioning and moving your legs periodically can reduce it. The use of compression stockings is also recommended, as is regularly elevating your legs during the day.

High blood pressure seems to be associated with a higher risk of clotting problems, although we don’t understand the mechanism. Dietary factors can reduce your risk while poor choices increase it. Staying away from salty foods is recommended. Limiting unhealthy fat intake and avoiding sugary and processed foods should also be part of a nutritional plan to reduce the risk of blood clots.

Abnormal clotting is both preventable and treatable. Since diet plays a role in raising or lowering your risk, one simple step is changing your diet. Certain foods increase the risk for clotting while others decrease it. Although not a food, water naturally thins your blood and so it’s less likely to clump together. Olive oil reduces the activity of the cells in our blood that produce a clot (called platelets), thus lessening your risks of a clot forming in the leg. Olive oil is made up of healthy fats that contain substances that seem to make platelets less likely to clump.

Naturally, exercise has an extremely positive effect on both conditions, hypertension and an increased tendency for your blood to clot (termed hypercoagulability since coagulation is the process of forming a blood clot). Additionally, minor trauma such as bumping your legs or even the pressure of keeping your legs crossed can lead to abnormal coagulation.

Many believe that anti-coagulants are helpful when someone has developed narrowing of their blood vessels. But these medications are of no benefit when a person has this problem, PAD (peripheral arterial disease), failing to increase the blood reaching the tissues of the feet and legs. Blood clots are not associated with plaque build-up inside our arteries and, consequently, “blood thinners” are of no benefit in the face of narrowed arteries.

Many people take medicine to treat this tendency to clot, generally referred to as a blood thinner (technically called an anticoagulant). These affect everyone differently, so careful monitoring of drug levels and how it is affecting your clotting is essential. Complications from these meds may include anything from finding blood in your urine, severe bruising, bleeding gums, and others.

Blood clots are no laughing matter, but not every pain nor every area of swelling is due to a clot. But there are some serious complications which can result from abnormalities with this process. Know your risk factors. And if you have many, be knowledgeable of those conditions which promote excessive clotting. As you now know, there are effective methods of decreasing your risk and living a longer healthier life.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments at drcmclean@outlook.com.

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