What are the complications of thrombosis (blood clots) to watch out for?

From the Guidelines

Blood clots can lead to life-threatening complications, including pulmonary embolism, stroke, and deep vein thrombosis, which require immediate medical attention. According to the American Heart Association 1, venous thromboembolism is responsible for more than 300,000 hospital admissions per year in the United States and can cause death from pulmonary embolism, long-term consequences of the postthrombotic syndrome, and complications of anticoagulant therapy.

Complications to Watch Out For

• Pulmonary embolism: symptoms like sudden shortness of breath, chest pain, or coughing up blood
• Stroke: severe headache, vision changes, or seizures
• Deep vein thrombosis (DVT): increasing pain, swelling, redness, or warmth in a limb
• Other concerning symptoms: unexplained rapid heartbeat, dizziness, fainting, or confusion

Medication Complications

If you're on blood thinners like warfarin, apixaban, or rivaroxaban, watch for unusual bleeding such as nosebleeds, blood in urine or stool, or excessive bruising, as these can indicate medication complications 1. These medications work by interfering with clotting factors in your blood, preventing harmful clots but also increasing bleeding risk.

Importance of Prompt Medical Attention

Don't delay seeking emergency care if you experience any of these symptoms, as blood clot complications can be life-threatening if not treated promptly 1. The burden of illness produced by venous thromboembolism and arterial thrombosis is enormous, and prompt medical attention can help prevent long-term consequences and reduce the risk of mortality.

From the FDA Drug Label

ADVERSE REACTIONS Potential adverse reactions to warfarin sodium tablets may include: Fatal or nonfatal hemorrhage from any tissue or organ. Hemorrhagic complications may present as paralysis; paresthesia; headache, chest, abdomen, joint, muscle or other pain; dizziness; shortness of breath, difficult breathing or swallowing; unexplained swelling; weakness; hypotension; or unexplained shock Anticoagulants have no direct effect on an established thrombus, nor do they reverse ischemic tissue damage However, once a thrombus has occurred, the goal of anticoagulant treatment is to prevent further extension of the formed clot and prevent secondary thromboembolic complications which may result in serious and possibly fatal sequelae.

Complications for blood clots to watch out for include:

• Hemorrhage from any tissue or organ
• Hemorrhagic complications, such as:
  • Paralysis
  • Paresthesia
  • Headache
  • Chest, abdomen, joint, muscle or other pain
  • Dizziness
  • Shortness of breath, difficult breathing or swallowing
  • Unexplained swelling
  • Weakness
  • Hypotension
  • Unexplained shock
• Secondary thromboembolic complications, which may result in serious and possibly fatal sequelae 2

From the Research

Complications of Blood Clots

• Pulmonary embolism (PE) is a serious complication of blood clots, characterized by occlusion of blood flow in a pulmonary artery, typically due to a thrombus that travels from a vein in a lower limb 3
• The incidence of PE is approximately 60 to 120 per 100 000 people per year, and approximately 60 000 to 100 000 patients die from PE each year in the US 3
• Patients with PE may present with acute chest pain, shortness of breath, or syncope, and the diagnosis is determined by chest imaging 3
• In patients with a high probability of PE, chest imaging is necessary, and D-dimer testing is not necessary 3
• Treatment of PE includes anticoagulants such as warfarin, unfractionated heparin (UFH), and low-molecular-weight heparins, as well as direct oral anticoagulants such as apixaban, edoxaban, rivaroxaban, or dabigatran 4, 3
• Systemic thrombolysis is recommended for patients with PE and systolic blood pressure lower than 90 mm Hg, and is associated with an 1.6% absolute reduction of mortality 3

Risk Factors and Evaluation

• The clinical probability of PE can be assessed using a structured score or using clinical gestalt 3
• Patients with a probability of PE that is less than 15% and who have 8 clinical characteristics (age <50 years, heart rate <100/min, an oxygen saturation level of > 94%, no recent surgery or trauma, no prior venous thromboembolism event, no hemoptysis, no unilateral leg swelling, and no estrogen use) are at very low risk of PE and do not require further testing 3
• D-dimer testing can be used to exclude PE in patients with low or intermediate clinical probability, and a D-dimer level of less than 500 ng/mL is associated with a posttest probability of PE less than 1.85% 3