Blood Clot Pain Can Be Easily Misinterpreted

LAS VEGAS—Venous thromboembolism (VTE: deep vein thrombosis [DVT] and pulmonary embolism) is potentially deadly but its symptoms, which frequently include pain, are nonspecific and easily misinterpreted.

“Listen to the patient's pain,” urged Barbara L. Kornblau, JD, OTR/L, CPE, DASPE, Professor of Occupational Therapy at Florida A&M University in Tallahassee, Florida. “Detecting blood clots when the presentation is pain takes detective work, patience, a look at context, and collaboration with the patient.”

Risk factors are varied and nonspecific: hospitalizations, major surgeries, knee or hip replacements, major trauma, obesity, cancer chemotherapy (which increases the risk of VTE by up to 6.5-fold), and living in a nursing home, she explained. But VTE can also occur in young, healthy adults engaged in certain types of physical fitness regimens or sports.

DVT signs and symptoms can include pain or tenderness in your arm or leg, “often described as a cramp or Charley horse that does not go away,” Kornblau said. These symptoms are often accompanied by swelling, red or purple skin color, or skin warmth to the touch, she noted.

Pulmonary embolism, which can occur after a clot migrates to the lungs, is often accompanied by difficulty breathing or shortness of breath, chest pain upon inhalation, a rapid or racing heart-beat, bloody cough, or fainting or passing out.

Upper extremity DVTs are also seen, and can include so-called “effort thrombosis” or Paget-Schroetter Syndrome, which involves compression of blood vessels, and compartment syndrome, all of which can cause blood clots.

Risk factors for upper extremity clots can therefore include, surprisingly, physical fitness activities and sports like weight-lifting, swimming, or volleyball, among healthy young adults. “Axillary-subclavian vein thrombosis can actually be related to lifting,” Kornblau noted. “Upper extremity motions can cause small tears in the inner layer of the subclavian vein that predispose to a clot.”

Thrombophilias include acquired or inherited antithrombin deficiency, protein C or protein S deficiency, acquired antiphospholipid antibody syndrome, and heritable factor V Leiden mutation or prothrombin gene mutation, Kornblau said.

“Blood clots affect all ages,” she emphasized, although adults older than 65 years are at higher risk overall. Patients should be asked if they have ever previously experienced similar pain (“pain like this”), she advised--and whether they'd recently been hospitalized or undergone surgery. Patients should also be asked about recent road or airplane trips; family history of blood clots; birth control or any hormone therapy; recent catheterization or IV; and cancer and anticancer chemotherapy, hormones or tamoxifen.

Physical activities should be noted, particularly if upper extremity VTE is suspected.

Kornblau encouraged the audience to visit StoptheClot.org for more information.

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