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Treatment

If you have deep vein thrombosis, especially if blood clots have traveled to your lungs, your doctor will prescribe an anticoagulant drug to prevent clotting. The drugs are usually injected initially and then taken in pill form. Treatment is usually done on an outpatient basis. Because these drugs can cause bleeding if used incorrectly, you must take them exactly as prescribed, usually for about 6 months. Most clots are gradually reabsorbed into the bloodstream. In rare cases, surgery is necessary to remove blood clots.

If you are scheduled to have surgery, and your doctor thinks you may be at risk of developing deep vein thrombosis, he or she may give you injections of an anticoagulant drug such as heparin, either before or after surgery, to help prevent the formation of blood clots.

If you are confined to bed, your doctor will probably encourage you to flex your leg muscles, wiggle your toes, and bend your ankles to keep your blood circulating. If you are immobilized for a long period of time, your legs also may be mechanically elevated and placed in plastic sleeves called sequential compression devices (SCDs), which are alternately filled with air and deflated. The resulting pumping action keeps the blood flowing normally.

Preventing Blood Clots When You Fly

Deep vein thrombosis can develop during long-distance air travel because you are forced to sit for long periods. You are at increased risk of developing deep vein thrombosis from inactivity if you are overweight, a smoker, an athlete, or pregnant; have already had blood clots in a leg or have varicose veins; or have recently had pelvic surgery or a leg injury. To prevent yourself from developing deep vein thrombosis on a plane, exercise your leg muscles often during the flight.

Here are some other tips to minimize your risk of circulation problems during air travel:

• Wear loose, comfortable clothing. Don’t wear anything such as knee-length stockings or an elastic knee brace that could hinder the circulation of blood in your legs.

• To get more legroom, ask for a seat in an emergency-exit row, at the bulkhead (the area in front of the first row in a section of a plane), or on the aisle.

• Don’t sit with your legs crossed.

• Extend your legs straight out if you can, and flex your ankles up and down. If you can’t extend your legs, try curling your toes while you lift your heels off the floor. Slide your feet forward and back a few inches to exercise your thigh muscles.

• Massage your feet and legs to propel blood out of your legs and toward your heart.

• Get up and walk in the aisle as often as you can.

Some doctors recommend taking half an aspirin before a long flight to reduce the risk of clotting and to maximize blood circulation; ask your doctor if taking aspirin before flights would be helpful for you.

If you are a woman over 35 who smokes and you want to take oral contraceptives, ask your doctor for information about quitting smoking (see page 29).

Pulmonary Embolism

Pulmonary embolism usually occurs as a serious complication of deep vein thrombosis (see previous article). A blood clot detaches from the wall of a deep vein and moves into the bloodstream, through the heart, and through the pulmonary artery to the lungs. If the loose clot (called an embolus) is large, it can lodge in an artery inside the lungs and block blood flow to the lungs. If most of the pulmonary artery is obstructed, the right ventricle of the heart is forced to pump harder, which can lead to heart failure. The obstruction reduces the volume of freshly oxygenated blood returning to the left side of the heart. If the volume of blood is reduced significantly, shock (see page 579) can result. A pulmonary embolism can be fatal.

The condition affects women more frequently than men. People who are confined to bed, especially after pelvic surgery or surgery involving the hip or knee, are at increased risk.

Symptoms

Symptoms of pulmonary embolism depend on the