Deep Vein Thrombosis Risks After Surgery
Every surgery has risks, but the threat of developing blood clots of DVT is greater for some procedures.
By Diana Rodriguez
Medically Reviewed by Farrokh Sohrabi, MD
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Surgery always comes with risks. Developing blood clots of deep vein thrombosis (DVT) is at the top of the list, even for minor surgical procedures.
DVT is a blood clot that forms inside a vein, deep within the body very often in the thigh or lower leg. Any surgery that requires a long recovery period with extended bed rest can increase the risk for deep vein thrombosis. Being confined to bed can cause blood to pool, which makes clotting more likely. Blood clots can form a DVT. The danger increases because it's possible for the clots to break off and travel to another part of the body, such as the lungs. This is called a pulmonary embolism, or PE and it can be fatal.
The Riskiest Surgeries for Deep Vein Thrombosis
Three main factors influence an individual’s chances of developing deep vein thrombosis after surgery: hypercoagulability (an increase in the blood’s ability to clot), endothelial injury (damage to the lining of blood vessels), and venous stasis (slowing of the blood flow in the veins).
“These are the three pieces that act together that put people at risk for getting DVT and PE,” said Elliott Haut, MD, an associate professor of surgery, anesthesiology, and critical care medicine at the Johns Hopkins University School of Medicine and director of the trauma surgery fellowship program at Johns Hopkins Hospital.
Any procedure that requires general anesthesia and a recovery period can increase the risk for DVT. Surgery to the lower half of the body, especially hip and knee replacements, also increases DVT risk.
A Swiss study published in The Journal of the American Medical Association in 2012 examined data on nearly 45,000 patients who underwent either total or partial knee replacement surgery and total or partial hip replacement surgery to find the incidence of blood clots in the veins. The researchers found that one out of 100 knee replacement patients and one out of 200 hip replacement patients developed blood clots before being discharged from the hospital.
Orthopedic surgeries like these can also trigger the release of particles into the bloodstream that can lead to clots. Collagen, fats, and small bits of tissue may be disturbed during these surgeries and enter the bloodstream, increasing the risk for DVT.
RELATED: Knee Surgery Revealed Blood Clot Risk for Runner
Trauma surgeries are also more likely to result in DVT after the operation than are other types of surgery. “With trauma surgeries, it’s a combination of immobilization and potential blood vessel damage,” said Dr. Haut. The nature of these surgeries increases DVT risk because they are often lengthy procedures with long recovery times.
Major cancer surgeries also increase DVT risks. It’s not always the specifics of the surgery that increase DVT risk, Haut said, but the recovery period and what it entails. “Staying in the hospital, particularly in the ICU [intensive care unit], and potentially getting sick … these also increase your risk of getting DVT," he said. Any surgery or hospital stay that requires the use of a central line, which is an IV that's placed in a large blood vessel in the neck or the groin, also increases DVT risk because it irritates the blood vessel and can slow blood flow.
It all comes down to the cumulative effects of all these factors during and after surgery, according to Haut. “The more risk factors you have, the higher your risk becomes," he said.
Educating Yourself About Blood Clot Risks
Before surgery, it’s important to prepare yourself — sometimes mentally more than physically. Homework is the most important surgery prep you can do to reduce your risk of DVT from surgery. “It’s about patient education,” said Haut. “The most important thing people can do is realize it’s a really big deal. We try to remind people that more people die of pulmonary embolism than AIDS, breast cancer, and motor vehicle collisions combined."
Sometimes patients themselves get in the way of preventive treatment that's known to reduce DVT risk: medication. “We’ve found that [one reason] half the doses don’t get administered is because patients are refusing" to take medication, Haut said. He urged people to listen to their surgeons and work with them to minimize surgery risks and DVT. “It’s important for them to understand that we’re trying to do the best thing for them," he said.
Taking Precautions After Surgery
Even after surgery you can take steps to reduce DVT risk. “There’s a ton of things we can do to prevent DVT," said Haut, who described preventive actions as "excellent." They include effective medications, such as heparin, that can thin the blood and prevent clotting during recovery from major surgeries. Compression stockings or other compression devices, such as stockings or booties regularly squeeze the legs to promote blood flow and can help keep blood from pooling in the lower legs. This can ward off DVT. Ask your surgeon what precautions you can take.
Warning Signs of DVT and PE
Everyone scheduled for surgery should also make sure they know the warning signs of DVT. These include:
- Warmth in one leg
- Swelling in one leg, especially along a vein
- Pain in one leg, especially while standing or walking
- Redness or unusual coloring in one leg
Shortness of breath, chest pain when breathing, and coughing up blood are signs of a pulmonary embolism and require immediate medical attention.
"DVT is a big health problem, and we’re trying to fix it and prevent it,” noted Haut. But it's not all up to doctors. As a patient, you can be proactive in making sure that you take the proper precautions to reduce your DVT risk.
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