Blood Clots

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Quick GuideDeep Vein Thrombosis (DVT): Symptoms, Treatment & Prevention

Deep Vein Thrombosis (DVT): Symptoms, Treatment & Prevention

What kind of doctors treat blood clots?

A variety of different specialists may be involved in the care of a patient with a blood clot, depending upon the exact type and location of the clot. These can include internists, family medicine specialists, interventional radiologists, surgeons, cardiologists, cardiothoracic surgeons, neurologists, or critical care specialists.

How are blood clots diagnosed?

The first step in making the diagnosis of a blood clot is talking to the patient and family to understand the situation. The blood clot itself does not cause a problem. It's the location of the blood clot and its effect on blood flow that causes symptoms and signs. If a blood clot or thrombus is a consideration, the history may expand to explore risk factors or situations that might put the patient at risk for forming a clot.

Venous blood clots often develop slowly with a gradual onset of swelling, pain, and discoloration. Symptoms of a venous thrombus will often progress over hours.

Arterial thrombi occur as an acute event. Tissues need oxygen immediately, and the loss of blood supply creates a situation in which symptoms begin immediately.

There may be symptoms that precede the acute artery blockage that may be warning signs of the potential future complete occlusion of the blood vessel.

  • Patients with an acute heart attack may experienceangina or chest discomfort (pressure, pain, indigestion, fatigue) in the days and weeks prior to the heart attack.
  • Patients with peripheral artery disease may have pain with walking (claudication)
  • ATIA (transient ischemia attack, mini-stroke) in which the symptoms resolve without treatment may precede a stroke.

Physical examination can assist in providing additional information that may increase the suspicion for a blood clot.

  • Vital signs may be helpful in deciding how stable the patient is doing. These include blood pressure, pulse rate, respiratory rate, body temperature and oxygen saturation (what percentage of red blood cells have oxygen attached).
  • Heart monitoring and an EKG may be ordered to assess heart rate and rhythm.
  • Venous thrombi may cause swelling of an extremity (arms, legs). It may be red, warm, and tender; sometimes the appearance is difficult to distinguish from cellulitis or an infection of the extremity. If there is concern about a pulmonary embolus, the doctor may examine the lungs to listen for abnormal sounds caused by an area of inflamed lung tissue.
  • Arterial thrombus symptoms are much more dramatic. If a leg or arm is involved, the tissue may be white because of the lack of blood supply. Also, it may be cool to touch and there may be loss of sensation and movement (paralysis). The patient may be writhing in pain.

Arterial thrombus is also the cause of heart attack and stroke (cerebrovascular accident) and their associated symptoms.

Reviewed on 4/27/2016
References
REFERENCES:

Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2_suppl):

Dzsheka MS, et al. Stroke and bleeding risk in atrial fibrillation. Clin Cardiol.2014, Oct, 37(10)

Medscape. Deep Vein Thrombosis and Thrombophlebitis.

Fauci, Anthony S., et al. Harrison's Principles of Internal Medicine. 17th ed. United States: McGraw-Hill Professional, 2011.

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