APS 101 takes you through the ins and outs of APS, providing facts and key information to help you better understand the disease.
APS 101 is written by Jacqueline Madison, MD, Assistant Professor in the Division of Rheumatology and member of the Jason Knight Lab. In this month’s edition, Dr. Madison discusses prevention and early identification of blood clots.
The prevention and early identification of blood clots is one of the most important topics to learn about for patients with APS. Many patients diagnosed with APS have already had at least one blood clot, but there are different types and locations of blood clots in the body. It is important to make sure you know how to reduce your risk while also getting help right away if you are showing signs of a blood clot.
Identify Blood Clots Early and Seek Help
Blood clots can happen in any vein or artery in the body. Arteries take blood from the heart to the organs, and veins take that blood from the organs back to the heart so it can receive fresh oxygen from the lungs.
- A DVT is a Deep Vein Thrombosis, which is a blood clot that occurs in large veins, usually in the legs or sometimes the arms. Signs of a DVT include new onset of pain, warmth, and swelling in the arms or legs. Typically, only one leg or one arm is affected. Some patients might feel pain in their calf with moving their foot up and down. There may be color changes in the skin. DVTs are diagnosed with an ultrasound machine that is readily available in any emergency room.
- A PE or Pulmonary Embolism is a blood clot that affects the blood vessels in the lungs. Sometimes a DVT breaks off and becomes a PE, which is why diagnosing a DVT early is critical. Signs of a PE include new chest pain, shortness of breath, and sometimes coughing up blood-streaked secretions. Oxygen saturation levels go down, heart rate can go up, and breathing rate can also go up. A PE is usually diagnosed with a CT scan. This is a medical emergency and can be life threatening.
- A heart attack can also be caused by blood clots in a patient with APS. Symptoms include sudden-onset chest pain that lasts more than a few minutes, shortness of breath, and pain that radiates into the jaw, neck, shoulder, arm, or stomach. Some patients will have other symptoms including nausea, vomiting, lightheadedness, fainting, or intense sweating. Heart attacks are diagnosed with blood tests, EKG (electrocardiogram), and other ways of visualizing blood flow in the vessels of the heart. A heart attack is another medical emergency that can lead to death if not identified and treated right away.
- A stroke can be caused by a blood clot in the arteries of the brain. Depending on where it is in the brain, it can cause some different symptoms. Symptoms usually come on suddenly and could include numbness, weakness of the face or limbs, slurred speech, or loss of vision. Some patients also have trouble speaking, confusion, trouble walking, or a sudden and severe “out of the blue” headache. A stroke is another medical emergency that can lead to death if not identified and treated immediately.
- If you think you could be having one of these serious blood clots, call 911 (emergency medical services) or seek help at the closest emergency room right away. Do not delay when you need to be evaluated for one of these types of blood clots.
There are also blood clots that may not have these clear symptoms because they are smaller or affect unusual parts of the body. In such cases, you will need to trust your instincts and seek care when something simply does not seem right or you feel significantly worse than usual, especially if symptoms started suddenly.
Risk Factors for Blood Clots
Having a diagnosis of APS and/or having had a previous blood clot increases the risk for new blood clots. If you do not yet have a definite diagnosis, but have strongly positive antiphospholipid antibodies, you may also be at risk; ask your doctor if you are not sure. There are certain treatments, such as blood thinners, that can decrease the risk, but there are risks and benefits of these medications that you and your doctor must weigh. Other autoimmune diseases, such as lupus, can increase the risk of blood clots, especially if you also have antiphospholipid antibodies.
You may not be able to avoid some of the risk factors, but there is still a lot that you can do to protect yourself from blood clots:
DO:
- Take your medication regularly as prescribed.
- Stay well hydrated. Dehydration increases risk for blood clots.
- Stay physically active with regular exercise. Even simple exercise like going for a walk is great for cardiovascular (and mental!) health.
- Work with your doctor to treat other risk factors for blood clots: hypertension, diabetes, high cholesterol, and obesity.
- Maintain a healthy weight.
- If you have a surgery planned with prolonged immobility, such as a joint replacement, work with your doctor ahead of time to take steps to prevent blood clots.
- During periods of long travel (4-5 hours or more by plane, train, or car), consider wearing compression stockings. Also, take breaks to walk every hour, continue to move feet and toes while sitting, and increase your water intake.
DON’T:
- Do not smoke. Smoking increases the risk of blood clots. Smoking also makes it harder to treat autoimmune diseases. Ask about smoking cessation programs if you need help quitting.
- Avoid estrogen-containing birth control pills (also called combined oral contraceptive pills). There are other forms of contraception that are of lower risk, so discuss options with your doctor. Similarly, you may need to avoid estrogen in hormone replacement therapy.
- Do not drink excessive alcohol. This can make you dehydrated, which can increase the risk for blood clots.
- Avoid sitting for a prolonged time.If you must, make sure to take breaks and move your feet and toes.
There are steps you can take to reduce your risks, and it is important to discuss methods of reducing risk of blood clots with your doctor. Again, if you are worried that you could have a blood clot, seek help right away!
Contributed by Jacqueline Madison, MD
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