When she was 42, Tina Theobald suddenly developed a charley horse that wouldn’t ease. She had recently started jogging and thought nothing of the sore calf muscle. She iced it and hobbled through a short trip to Mexico as her leg swelled. Theobald happened to be scheduled to see her doctor for a sprained thumb upon her return, and she was diagnosed with—and immediately hospitalized for—a large blood clot in her leg. Two days later, Theobald struggled to breathe and was hit with chest pain so excruciating, she needed morphine. A portion of the clot had broken off and was blocking the blood supply to part of her lung, a life-threatening condition called pulmonary embolism.
Theobald always thought blood clots affected older people—and it’s true that their risk is far higher—but she quickly discovered that young and middle-aged people are vulnerable too. A number of risk factors play a role, including certain medications, pregnancy, immobility that allows blood to pool (prolonged sitting, say, during a long flight), surgery or trauma (such as a car accident) that can injure veins, and conditions that increase blood clotting (such as cancer and autoimmune disorders).
By conservative estimates, each year as many as 600,000 people in the United States develop deep vein thrombosis (DVT)—clots most common in leg veins, where they can cause pain, swelling, and redness. More than one in four adults struck by a first DVT or pulmonary embolism are under 50, according to a population study of Minnesota adults. One third of DVTs are followed by pulmonary embolism, which kills as many as 100,000 people each year, often suddenly, says the CDC. A 2013 report from Australia indicates that deaths from pulmonary embolism are on the rise in women 25 to 44.
“Symptoms can be vague, such as pain or feeling like you just can’t get enough air. As a doctor, if you’re not suspicious, you can miss a lot of cases,” says Bengt Zöller, MD, an associate professor of internal medicine at Lund University in Sweden.
A 2010 Danish study found that most younger adults with fatal pulmonary embolisms had told doctors about symptoms days or weeks before their deaths, only to have their complaints misinterpreted.
“Because DVTs and pulmonary embolisms can be difficult to recognize, we need to emphasize prevention,” says Nigel Key, MD, a professor of medicine at the University of North Carolina at Chapel Hill. These measures can help you avoid life-threatening clotting.
1. Review Your Meds
A few months prior to her DVT, Theobald had been prescribed birth control pills to regulate her period. All estrogen-containing medication (as well as the vaginal device NuvaRing and newer birth control pills containing drospirenone) may increase clot risk (as does pregnancy, with risk returning to normal about 12 weeks after delivery). Newer-generation birth control pills are one suspected reason for the rising pulmonary embolism deaths in young Australian women. If your doctor is worried about your clotting risk, she may recommend nonhormonal contraception such as a barrier method or a copper IUD.
The American College of Obstetricians and Gynecologists urges physicians to consider prescribing a patch rather than a pill for postmenopausal women on hormone replacement therapy. Taking pills raises DVT risk up to fivefold compared with not taking hormones, but delivering hormones through the skin doesn’t seem to affect clotting risk.
In June 2014, the FDA announced that prescription testosterone products must carry a warning that they raise DVT risk. Prednisone and other steroids, especially at high doses, also increase DVT risk in both men and women.
2. Know Your Family History
As the number of your close relatives who’ve had a clot rises, so does your own DVT risk, found Swedish research. Having two or more siblings with DVT raises your risk 50-fold compared with someone who has no affected siblings. “If you have a strong family history, your doctor may think twice about prescribing hormones or may give a longer course of anticlotting drugs after surgery,” says Dr. Zöller.
3. Lose Weight
Obesity can more than double DVT risk, especially in women over five foot six and men six feet or taller. “Tall people have to pump blood farther against the force of gravity, which may reduce flow in the legs and raise the risk of clotting,” explains Sigrid Brækkan, PhD, a researcher at the University of Tromsø in Norway. Theobald, who is five foot seven, weighed near her heaviest, at 190 pounds, when her clot occurred.
4. Get Moving
Walking, or raising and lowering your heels while sitting, engages your calf muscles, squeezing veins and propelling blood upward, which helps prevent DVT. Immobility is why long flights are a risk. The American College of Chest Physicians recommends you get up once every hour or so and raise and lower your heels or rotate your ankles when seated. If you’re at high risk, ask your doctor about wearing compression stockings or taking preventive blood-thinning medication for flights or car trips of more than four hours.
5. Eat Fish
In a large Swedish study from 2014, people who took fish oil capsules and ate fish three or more times a week had a 48 percent lower chance of developing DVT than those who ate fish less often and didn’t supplement with fish oil.
6. Be Vigilant at the Hospital
Sixty percent of DVTs occur in people who have recently been hospitalized, whether for surgery (general anesthesia temporarily widens veins, which can allow blood to pool and clot), trauma (anything that damages veins can slow blood flow, increasing risk), or illness (which can lead to prolonged bed rest).
Make sure doctors know about your medications and any DVT risks, such as a significant family history. You should be encouraged to move around, and you may need compression stockings or anticlotting drugs. Last June, Boston Medical Center reported that it had reduced postsurgery DVTs by 84 percent (from an admittedly lousy record) by tailoring preventive treatment to patients’ risks and by getting patients walking soon after operations. Also, follow medical advice before and after your discharge. Missed doses of preventive drugs are to blame for many clots.
Theobald, for one, is diligent about taking anticlotting meds because she knows that DVTs can return with a vengeance. Five months after her initial 13-day hospital stay, doctors weaned her off the blood thinner warfarin, but a new clot formed months later, enlarging her leg to almost the size of her waist. The resulting ten-day hospital stint brought new tortures, including shots of clot-busting drugs into the affected thigh that Theobald’s doctor likened to Roto-Rootering her veins.
Now she is committed to taking warfarin—or whatever easier treatment comes along—for the rest of her life. She wears compression stockings when sitting at her desk at a software company in Melbourne, Florida. In her free time, she keeps moving—she’s proud to have just completed her fifth triathlon.
Act Fast On These Symptoms
A blood clot is a medical emergency because of the possibility of a pulmonary embolism. If you experience any of the symptoms below, seek medical aid right away, especially if you might be at increased risk because of recent immobility, pregnancy, surgery, or cancer.
Signs of DVT in a Leg:
- Pain (like a pulled muscle or a charley horse)
- Discoloration (red or blue)
- Warm to touch
Signs of Pulmonary Embolism:
- Shortness of breath
- Chest pain
- Unexplained cough (may cough up blood)
- Rapid heartbeat