Published Jul 7, 2014
Blood clots can be serious complications of orthopedic surgeries like joint replacement or surgery to repair knee, hip, or other joints. Heres how to recognize and minimize your risk of blood clots.
Up to 600,000 people in the United States are affected by venous thromboembolism each year, a disease that includes deep vein thrombosis (DVT) and pulmonary embolism (PE).
With DVT, a blood clot forms in a deep vein often in the leg and can result in serious illness, disability, and even death. A pulmonary embolism is a serious complication of DVT that occurs when part of the clot breaks up and travels through the bloodstream to the lung.
While there is always some risk of blood clots developing after knee or hip replacement surgery and other joint surgeries mentioned above, these dangerous conditions can mostly be prevented. Your best strategy is to work together with your medical care team before the procedure. Heres what you should ask your doctors.
What Puts You at Risk for a Blood Clot After Surgery?
We look at four main risk factors when trying to determine whether a patient faces a higher risk for a post-operative blood clot. These include:
- Having a body mass index, or BMI, over 40 (which is very obese)
- A previous history of blood clots
- Being an active tobacco smoker
- Currently undergoing treatment for cancer
We may monitor patients with these risk factors more closely or prescribe blood thinners following their surgeries to prevent clots.
There are other potential risk factors where the medical literature is less clear. You should tell your doctor if:
- You are taking hormonal pills like birth control
- You have a family history of clots but may not have experienced one yourself
Many factors contribute to surgical risk. Anything might impact the outcome of your surgery, so it is critical to be completely honest about all medicines you take and about your medical conditions.
Can I Do Something After Surgery to Curb My Clot Risk?
You can do three things to stave off DVT two of them before surgery starts:
- Stop smoking. Smoking has been shown to increase the risk for blood clot three to five times. Ask your doctor for referral to a stop-smoking program.
- Control your weight. If you are obese, losing weight is a way to reduce your risk for many complications after surgery. Ask your surgeon to refer you to a nutritionist or physician to help you with this.
- Get moving and keep moving right after surgery. Blood clots form when blood stays in one place. When you move your muscles, your blood does not sit still long enough to clot.
In fact, your care team will often begin physical therapy in the recovery room, immediately after orthopedic surgery. At NYU Langones Hospital for Joint Diseases, most joint replacement patients are on their feet the day of surgery. But even if you cant stand up, you can still tense and release your muscles to simulate movement.
Do Certain Medications Put Me at Risk for Blood Clots?
Rarely do medicines you take thicken the blood and create clot risk, and in very few cases, youll be told to stop taking a medication before orthopedic surgery.
However, after surgery, you may be prescribed a blood thinner. Unfortunately there is no perfect blood-thinning medication, and youll need to monitor your bleeding risk. For example the gold standard, warfarin, is effective at preventing clots but requires frequent blood tests to monitor levels in the body. When the blood is too thin from warfarin, your physician can reverse it with other medications.
Another blood thinner, low molecular weight Heparin (LMWH), is also effective, but requires daily injections. These too can be reversed if the blood becomes too thin.
Rivaroxaban (Xarelto) is a blood thinner taken as a pill. This medication does not require testing or injections. It works well but cant be reversed if the blood becomes too thin, which can be dangerous right after surgery.
Recently, research has shown that a combination of aspirin and leg massaging pumps can effectively prevent blood clots in low-risk patients. Together, these treatments slightly thin the blood and move it around, though the pump needs to be worn up to 18 hours a day.
If I Get a Clot, How Would I Know?
Despite all of your preventive efforts, you may still develop DVT. Telltale signs are fever and major swelling. Some swelling is expected and normal after orthopedic surgery, but if you notice a sudden increase in swelling or tenderness, or if the limb becomes too painful to move, these are signs you might have a clot. The good news is this is very treatable if discovered early.
Making DVT Prevention a Top Priority
At NYU Langone, in New York City, our leadership looks at DVT prevention as a top priority to ensure that our patients have the best possible outcomes after surgery. Weve developed quality and safety procedures to help minimize the risks of surgery in our patients. In fact, as part of a pioneering new effort to identify and treat VTE, a first-of-its-kind center for prevention, diagnosis, and treatment of VTE, the Venous Thromboembolic Disease Center (VTEC) will open soon at NYU Langone Medical Center.
Claudette Lajam, MD, is an assistant professor in the Department of Orthopaedic Surgery at NYU Langone Medical Center in New York City, and Chief Safety Officer at NYUs Hospital for Joint Diseases.
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