Preventing Hospital-Associated Blood Clots
What is a hospital-associated blood clot?
Blood clotting helps us to stop bleeding when we have an injury, blood clots usually dissolve after the injury heels. Blood clotting can cause problems when the blood becomes ‘sticky’ and doesn’t flow through the veins as well as normal, for example, when you are ill, immobile, or dehydrated after an illness or operation - all can be associated with being in hospital.
Blood clots can form a blockage in the veins, usually in the deep veins of the leg or pelvis. This is called a deep vein thrombosis also known as a DVT. Very occasionally, a piece of the clot can break off and flow to the lungs. This is known as a pulmonary embolism (PE). Venous thromboembolism (VTE) is the collective name for DVT and PE.
Although these risks are small, the consequences can be serious.
A DVT can lead to long-term medical problems and health conditions, such as permanent swelling in the leg, varicose veins, and leg ulcers which may impact your mobility. A PE can lead to a need for a high level of care, continued treatment, greater risk of re-occurrence, and might be fatal.
Patients that are in hospital are more at risk of developing blood clots either in hospital or up to three months afterwards, so it is important that you know:
- About your risk.
- What to do to prevent clots.
- The signs and symptoms of types of clots (DVT and PE) so you can access help quickly.
How do I know if I am at risk?
As there is an increased risk due to you being in hospital, your doctor or nurse will carry out a risk assessment. This will tell them whether you need additional measures to prevent clots, for example blood-thinning medicines, stockings or calf pumps.
There are factors which place you at a greater risk of clots.You can ask your doctor what your specific risk factors are. As an example, they include:
- Staying in one position for long periods of time, for example, after an operation or being confined to bed during an illness.
- A family or personal history of VTE.
- A medical condition, such as heart failure, diabetes, significant infection or cancer.
- Certain medications, such as the contraceptive pill or hormone replacement therapy.
- Increasing age, especially over 60 years.
What can be done to reduce my risk?
If you are at risk of clots, healthcare professionals may prescribe medicines, mechanical devices or stockings to help reduce your risk. You MUST use these as directed for the full duration of the course.
For example:
Blood thinners – a small dose of anticoagulant can be given as a single tablet or injection, or a course lasting a few weeks. It may cause bruising and there is a risk of bleeding, but this is less than the risk from clots.
Your prescriber will check it is safe for you to have blood thinners. Please let them know if you have a bleeding disorder, had a past stomach ulcer or adverse reaction to blood thinners, a recent brain bleed/surgery, or spinal/epidural anaesthesia.
If you experience prolonged bleeding or excessive bruising, please speak to your doctor/GP.
Most injectable types are derived from animals. Speak to your doctor or nurse if you would like them to consider an alternative, such as if you are vegan or for religious reasons.
If you are concerned about your need for medication, please discuss with your doctor.
Stockings – you may need these as well as, or instead of, blood thinners to prevent blood pooling in the legs. Your leg should be measured beforehand, and they must be worn correctly. You should remove them twice a day so that you can have a wash and check for any skin problems. Should your stockings cause skin marking, discolouration, or blistering particularly over the heels or bony prominences, please contact your GP immediately.
Calf pumps – these are special inflatable sleeves that automatically inflate while you are in a bed or chair. This improves flow through the leg veins, preventing clots.
What can I also do to prevent clots?
Keep as active as you can:
- if you are less mobile you can do gentle leg exercises such as moving your ankles around in a circular motion and moving your toes up and down.
- get up and walk around every 90 minutes.
- Check your sitting style, avoid crossing legs/ankles or being sat on one leg for prolonged periods.
- Stay well hydrated.
- Stop smoking.
- Let your doctor know if you are taking a hormone pill containing oestrogen, such as a contraceptive pill. This may need to be stopped for a short period of time and alternative contraception used.
- Keep a healthy weight.
- Understand what has been prescribed and follow as directed.
What are the signs of a clot?
Deep Vein Thrombosis (DVT)
- Pain or tenderness.
- Swelling.
- Discolouration or redness of the leg.
- Warm skin around the painful area.
If you experience any signs of a DVT, especially within three months of a hospital admission, immediately contact your GP or nearest Emergency Department.
Pulmonary Embolism (PE)
- Difficulty breathing.
- Coughing up blood/blood-stained sputum (phlegm).
- Chest pain.
- Palpitations (racing heartbeat).
- Collapse.
If you experience signs of a PE, visit your nearest Emergency Department immediately.
To help prevent clots remember to:
- Stay hydrated.
- Stay mobile.
- Take your medication as prescribed.
Where can I find out more about clots?
Visit https://www.nhs.uk/conditions/pulmonary-embolism/ for more information on pulmonary embolism.
Visit the Thrombosis UK website: www.thrombosisuk.org or download their free app ‘Let’s talk clots’.