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Complications from a blood clot

Some people recover from a blood clot with few complications within a short number of weeks- others have a longer recovery. Sometimes blood clots can cause problems that affect you for life. You may have:

  • Long-term problems with breathing1
  • A higher chance of getting another clot2
  • Swelling that will not go away3
  • Sores or wounds that will not heal3

Here you can read more about two possible long term conditions from a blood clot named Post Thrombotic Syndrome and Chronic Thromboembolic Pulmonary Hypertension.

Be aware of PTS (Post thrombotic syndrome) if you have had a blood clot

Post thrombotic syndrome is a condition developed after (post) a blood clot (thrombotic).

PTS is a consequence of permanent injury to your veins and / or the valves inside the veins. Symptoms from PTS usually occur within the first 6 months but can occur several years after the blood clot3

Chronic symptoms of PTS can include:

  • Swelling3
  • Pain and discoloration of the skin of the affected leg or arm3  
  • In severe cases, the skin can break and create open sores (ulcers). These ulcers have difficulty healing and it can require a substantial amount of care to treat the wounds and prevent infection3
Little is known about what predicts who will develop chronic symptoms but PTS is more frequent in patients who have had a blood clot in the deep veins (deep vein thrombosis, DVT) of a leg compared to an arm3.

If you have been diagnosed with a DVT, talk to your healthcare professional about possible risk factors for developing PTS as well as signs, symptoms and preventive measures for PTS.

If you have developed PTS your doctor can help with pain management tailored to your needs, referral to a vein or wound care specialist as well as psychological support.

The connection between blood clots and CTEPH (Chronic thromboembolic pulmonary hypertension)

Blood clots in the lung (pulmonary embolism, PE) often completely dissolve within weeks or months and the symptoms of shortness of breath and chest pain disappear. Many people return to their normal self, others adjust to residual symptoms as shortness of breath and others experience chronic damage. If the damage is severe, it is referred to as chronic thromboembolic pulmonary hypertension (CTEPH).

When blood clots do not fully dissolve they develop into scar tissue. This obstructs the normal blood flow in the lung. The right side of the heart, which pumps blood into the vessels of the lung has to pump against this resistance. This puts a strain on the heart and over time results in right heart failure. 

CTEPH

CTEPH typically occurs within the first couple of years after a PE and occurs in a minor part of patients with PE4. The symptoms are usually5,6:

  •  Shortness of breath which typically worsens with exercise (or never resolved after the PE incident). 

Additional symptoms that can be experienced, such as:

  • Fatigue
  • Chest pain
  • Light headedness or fainting 

Symptoms of right heart failure such as the following, may develop over time:

  • Swelling of both ankles or
  • Swelling of an entire leg

“If your symptoms cease to improve after your PE or you reach an impaired functional level, talk to your healthcare professional”.

If you have developed CTEPH your physician may recommend a surgical procedure to remove the blockage7. This type of surgery is highly specialized and should only be performed by an experienced team.  

If you are not deemed a candidate for the above mentioned surgery, you may be prescribed different classes of drugs used for other types of increased blood pressure in the lungs.  

Having persistent symptoms, experiencing pain or coping with the emotional distress can be difficult to handle. It can be difficult to resume your normal life after a blood clot but you are not alone. There are a number of resources and organisations out there which can be of help to you. Some of these are mentioned here below:

www.clotconnect.org

www.stoptheclot.org

References

1. Sista A.K et al “Persistent right ventricular dysfunction, functional capacity limitation, exercise intolerance, and quality of life impairment following pulmonary embolism: Systematic review with meta-analysis” (2016) Vasc Med
2. Huang W et al “Occurrence and predictors of recurrence after a first episode of acute venous thromboembolism: population-based Worcester Venous Thromboembolism Study” J Thromb Thrombolysis (2016) 41: 525-538
3. Kahn S. et al “ Guidance for the prevention and treatment of the post-thrombotic syndrome” J Thromb Thrombolysis (2016) 41:144–153
4. McNeil K et al “Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Heart (2007) 93:1152–1158
5. http://www.cteph.co/en/patients/home/  Patient website on CTEPH 
6. Jenkins D. et al “State-of-the-art chronic thromboembolic pulmonary hypertension diagnosis and management” Eur Respir Rev (2012); 21: 123, 32–39
7. Muller D et al “Percutaneous treatment of chronic thromboembolic pulmonary hypertension” (2016) 12: 8 pages

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