Can Compression Stockings Cause a DVT to Break Off?
A doctor answers the question if compression socks or stockings can trigger dislodging of a DVT.
Compression socks or stockings are well-known to people who have a medical condition that causes fluid retention in their legs.
This may be liver disease, kidney disease, or much more commonly, chronic heart failure.
The compression socks help push the backed-up fluid upward. Plus, they can reduce the discomfort that’s caused by the edema.
A person who has a medical condition that would cause enough fluid back-flow in the legs to necessitate the need for compression stockings is also a person who has a DVT risk that’s higher than that of the average population.
Complicating the issue is that if both of the patient’s legs are quite swollen at any given time, the swelling that’s caused by a deep vein thrombosis will not be as obvious as it would be in a normal leg.
And not all deep vein thromboses turn a leg red, hot or cause a calf cramp.
“Contrary to what most people believe, movement in general does not trigger a DVT to dislodge,” says Paul Lucas, MD, surgeon with the Vascular Center and director of the Vascular Laboratory at Mercy Hospital in Baltimore.
“Dislodgment of a free-floating clot is more dangerous and prone to embolization at rest or with movement.”
Compression Garments
Dr. Lucas explains, “In the presence of DVT and unilateral leg swelling, mild compression garments can be worn to ease the swelling and offer support.
“They don’t squeeze the clot causing it to propagate or embolize.”
Lowering DVT Risk when You Have a Serious Medical Condition
One of the fastest ways to cut DVT risk is to quit smoking.
Another quick way is to take up exercise. If your legs hurt all the time due to your medical condition, then have a seat and do upper body strength training.
Drink six to eight cups of water a day and never sit for more than an hour nonstop.
If you’re obese, it’s time to start a safe weight loss plan.
Having a condition that warrants the use of compression socks does not give you a pass on taking measures to lower your risk of a DVT.
Dr. Lucas leads a team of vascular surgeons and technologists who specialize in the diagnosis and treatment of patients with diseased blood vessels.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Top image: Lentpjuve
Does Psoriatic Arthritis Increase DVT Risk?
Find out what a doctor says about rheumatic disease’s relation to a deep vein thrombosis.
Psoriatic arthritis is an autoimmune disease that has no cure — only treatments — and for some patients, the flare-ups are resistant to treatments.
One thing that they might worry about is if psoriatic arthritis raises the risk of developing a deep vein thrombosis.
“Rheumatic disease doesn’t cause DVT,” begins Paul Lucas, MD, surgeon with the Vascular Center and director of the Vascular Laboratory at Mercy Hospital in Baltimore.
He continues, “It does, however, pose a risk for the development of DVT. In fact, a three-fold increase researchers have found.”
Risk Factors for a DVT in no Particular Order
- Birth control pills
- Smoking, chewing tobacco
- Chronic dehydration
- Pregnancy — current
- Sedentary lifestyle, no regular exercise, excessive sitting
- Long airplane flights or vehicular travel with little movement in the legs
- Obesity or even moderate overweight
- Diet high in ultra-processed foods
- Recent joint replacement or abdominal surgery
- Fracture or major body trauma
- Genetic clotting disorder
- Crohn’s disease
- Ulcerative colitis
- Chronic heart failure
- Chronic kidney disease
- Varicose veins
- Chemotherapy, active cancer
- Psoriatic arthritis
Dr. Lucas explains, “The biologic etiology of the elevated risk is a bit tricky. There isn’t anything definitive noted in the literature I looked up.
“There is speculation that there are increases and decreases in various liver proteins and factors that may convey the increased risk.”
What does this mean if you have psoriatic (or rheumatoid) arthritis?
If you have any of the aforementioned risk factors, see which ones that you can modify as much as possible.
Some of them are quite easy to modify, such as standing up and walking around for several minutes, at least once an hour, on a long airline flight or while at your workplace desk.
If you smoke, quit. Yes, just quit already.
Start a plan to lose weight if you’re obese. If you smoke and are also obese, at least you can instantly eliminate one of these DVT risk factors.
If you don’t exercise, it’s time to start. Psoriatic arthritis does not contraindicate exercise.
Finally, drink at least six, eight-ounce glasses of water a day, as dehydration can elevate the risk of a DVT in vulnerable individuals.
Dr. Lucas leads a team of vascular surgeons and technologists who specialize in the diagnosis and treatment of patients with diseased blood vessels.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Solarisys
Swelling from DVT vs. Joint Replacement Fluid Retention
Is there a way to tell the difference, without imaging, between DVT swelling and post-surgical edema or fluid retention from a joint replacement surgery?
When a joint replacement patient views their affected limb for the first time free of any bandage or wrapping, the patient is bound to be in for a shock at how swollen the limb is.
If the patient knows some basic facts about deep vein thrombosis, they may start wondering if what they’re viewing is swelling from such a blood clot.
Joint replacement surgery is a major risk factor for a deep vein thrombosis.
But a knee or hip replacement will also cause par-for-the-course swelling.
“Swelling after joint replacement can be due to lymphedema, or reactive swelling due to the surgery itself,” says Paul Lucas, MD, surgeon with the Vascular Center and director of the Vascular Laboratory at Mercy Hospital in Baltimore.
“Lymphedema can be caused by over-hydration during surgery, or by disruption or scarring of lymphatic channels near and around the soft tissues in the area of the surgery,” explains Dr. Lucas.
“Swelling may or may not be associated with a DVT. You cannot discern between them; you have to get an ultrasound to be sure that a DVT isn’t being missed.”
Your orthopedic surgeon as well as any other kind of doctor such as a vascular specialist simply cannot tell whether your swelling is from a DVT or the surgery itself.
However, the presence of other symptoms can definitely arouse high suspicion for a blood clot.
Based on other symptoms, your doctor will order an ultrasound of the limb.
Symptoms Suspicious for a DVT
- Unusual redness of the leg
- Excessive warmth in a part of the leg
- Cramping or pain in the calf, even though this area was not operated on.
- Sudden difficulty breathing (can mean a DVT dislodged and traveled to the lung).
- Sudden chest pain (another symptom of a blood clot traveling to the lung).
If you’re scheduled for joint replacement surgery, expect to see a lot of swelling the first time you see your bare skin. The puffiness can last for several weeks.
Dr. Lucas leads a team of vascular surgeons and technologists who specialize in the diagnosis and treatment of patients with diseased blood vessels.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Dave Haygarth
Cause of DVT Weeks after Joint Replacement Surgery
Shutterstock/Naeblys
The “grace period” for DVT development after joint replacement surgery is 90 days, but why so far out if by then, the patient is walking?
Three months out from a knee or hip replacement surgery, a patient who has recovered well might be walking a few miles a day.
Despite that, the risk for a deep vein thrombosis is still present.
“Hard to say why one may get a DVT weeks after joint replacement surgery,” says Paul Lucas, MD, surgeon with the Vascular Center and director of the Vascular Laboratory at Mercy Hospital in Baltimore.
“Obviously, being sedentary is the main reason, but poor joint movement, lack of flexion ability….anything that may contribute to stasis [inertia] will be a risk….scar tissue, post-op inflammation/swelling within the knee space,” explains Dr. Lucas.
My father has had four joint replacement surgeries. For the fourth one, he was on Coumadin for only 10 days post-op.
Interestingly, the medical literature, in general, says that a patient is at increased risk for DVT up to 90 days after knee or hip replacement surgery.
DVT Risk Following Joint Replacement Varies from One Patient to the Next
Dr. Lucas says, “Some people have a hypercoagulable state [more prone to clotting] that they are not even aware of, and the insult of surgery triggers the DVT.
“Usually these people don’t get DVT unless another risk exposure presents, like surgery or a traumatic injury, etc.”
DVT Symptoms to Be on the Alert for
- Soreness, tenderness or cramp in the lower leg that is not relieved with rest.
- A cramp or other discomfort can also occur in the upper leg and pelvic area.
- The affected area appears suddenly bigger or swollen.
- The affected area may be reddisn/pinkish. It may also be pale or blanched.
- It may be exceptionally warm to the touch.
- In some cases, the affected vein can be felt by a finger, but this usually doesn’t happen.
- If you suspect you have a deep vein thrombosis, you need to get to the ER as soon as possible, even if the pain is only minor. A DVT can dislodge, travel to the lungs and become life threatening.
Dr. Lucas leads a team of vascular surgeons and technologists who specialize in the diagnosis and treatment of patients with diseased blood vessels.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Naeblys
How Long in Length Can a DVT Be?
A doctor explains how long a DVT can measure in length; no wonder a breakoff can cause a massive fatal pulmonary embolism.
Perhaps you’ve always thought that a DVT, a blood clot in a deep vein, is the size of a BB, just a little bit of sticky blood matter inside a vein, only a centimeter or so long.
Length of a DVT
“In terms of length or extent of a DVT, they can range from those that are very focal (a couple of mm only) to extensive clot throughout the length of the leg, and even into the iliac veins and inferior vena cava,” says Paul Lucas, MD, surgeon with the Vascular Center and director of the Vascular Laboratory at Mercy Hospital in Baltimore.
In other words, a deep vein thrombosis can extend the length from the foot all the way to the heart, all in one vessel, that extends this length, and merges into the inferior vena cava, a major vein that transports blood from the lower body to the heart where it’s reoxygenated and recirculated.
A DVT that’s almost the entire length of the body has the potential for huge bits of it to dislodge.
And in seconds it can plug up the pulmonary artery where it splits off into each lung, causing near-instant death from a massive or “saddle” pulmonary embolism.
Length of Most DVT’s
“Obviously, most clots aren’t that extensive, but it’s important to note that they certainly can be,” says Dr. Lucas. “They can cause a myriad of symptoms from pain only, to swelling, or a combination of them.”
There are other, more benign causes of pain and swelling in the leg, but Dr. Lucas warns that if you have these symptoms and there’s no simple explanation (e.g., no recent hard run up a hill), you should at least think about a blood clot as a possibility and get the leg examined.
Both pain and swelling, especially in the lower leg, are worrisome, says Dr. Lucas, but not diagnostic for a DVT.
“In fact, no physical examination finding is accurately diagnostic of a DVT, but suspicion should be rendered. About 2-5 percent of people experience a DVT within their lifespan.”
It’s not true that the longer in length a DVT, the more prominent the symptoms will be.
A person can have a DVT that extends from foot to hip and not have symptoms, since in about half the cases, these blood clots present with no symptoms.
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- Abdominal surgery — recent
- Age over 60
- Airline travel — prolonged
- Bedrest — extended
- Birth control pills
- Cancer (active malignancy)
- Chemotherapy
- Chronic heart failure
- Chronic kidney disease
- Chronic venous insufficiency
- Dehydration
- Factor V Leiden mutation
- Family or personal history of DVT
- Fracture, major trauma
- Heart attack
- Hormone replacement therapy
- Joint replacement surgery: recent
- Obesity or moderate overweight
- Paraplegia or quadriplegia
- Pregnancy — current
- Sedentary lifestyle
- Sitting excessively most days
- Smoking, chewing tobacco
- Ultra-processed food diet and lastly, varicose veins
Dr. Lucas leads a team of vascular surgeons and technologists who specialize in the diagnosis and treatment of patients with diseased blood vessels.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Naeblys
You Suspect DVT; Ultrasound Negative; What’s Next Step?
Find out what testing you should insist upon if you suspect a DVT but the ultrasound turns up negative.
One of my articles on DVT is about Staci Stringer, who was told she did not have a DVT even though her calve was swollen and so painful that it was “hard to walk,” she says.
This sounds unbelievable, but it happens: An ultrasound will be negative for a DVT, even though there is one, and the patient just knows that the procedure missed it.
If you ever suspect a deep vein thrombosis but the ultrasound technician says there’s “nothing,” and a doctor says “go home,” count to 3, then remember the following:
“As the director of our vascular lab, I make sure that my techs are very well-versed in venous ultrasound,” says Paul Lucas, MD, surgeon with the Vascular Center and director of the Vascular Laboratory at Mercy Hospital in Baltimore.
“A true vascular lab will examine the entire leg in question, both above and below the knee.
“Some ultrasound departments will only rule out a DVT to the level of the popliteal vein, i.e.. to the knee.”
The popliteal vein is in the back of the knee, and a blood clot in this vessel can cause pain behind the knee.
The reason that some ultrasound departments run the transponder only up to the knee, says Dr. Lucas, “is the low embolization risk for a DVT in the tibial veins.”
Tibial refers to the larger of the two bones in the lower leg.
“If you need an ultrasound done to rule out a DVT, a certified/accredited vascular lab is the place to go.
“Vascular technologists only do vascular studies, whereas an ultrasound tech in some places will do all types of tests. Experience means a lot here.
“If however, a DVT is ‘missed.’ a repeat ultrasound exam may be warranted. If you suspect the DVT may be at the pelvic level or higher, a CT scan may be useful.
“It is possible to have a negative test and within days a repeat could be positive–and it really might not have been there on the first go-around.”
Read more about Staci Stringer.
Dr. Lucas leads a team of vascular surgeons and technologists who specialize in the diagnosis and treatment of patients with diseased blood vessels.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Shaynepplstockphoto
Causes of DVT in Absence of Risk Factors & Clotting Disorder
Find out what can possibly cause a DVT when there’s no risk factors and no clotting disorders.
A DVT is a deep vein thrombosis: a blood clot in a vein deep in the body, usually in the leg, but sometimes also in the hip area.
In some cases of these blood clots, the patient seemingly did nothing to bring it on (such as being a smoker and sitting cramped in an airplane for several hours)
Additional DVT Risk Factors
Risk factors for a DVT are quite numerous and include prolonged immobility from any kind of traveling, joint replacement and abdominal surgery, birth control pills, hormone replacement surgery, obesity, lack of regular exercise, elderly age, pregnancy and dehydration.
And of course, blood clotting disorders raise the risk.
However, people have been known to get a DVT who have none of the risk factors and who test negative for clotting disorders, leaving the patient, who may even be a young lean gym rat who can’t sit still, baffled.
“In some cases the cause of a DVT is never found,” says Darren Klass, MD, clinical instructor of interventional radiology at the University of British Columbia and the Vancouver Coastal Health Association.
Dr. Klass explains, “In young healthy patients with no risk factors, mechanical compression of the left iliac vein by the right iliac artery in the pelvis may cause a spontaneous DVT. This entity is called May-Thurner syndrome.”
A person may never know they have May-Thurner syndrome until a deep vein thrombosis develops.
“A similar entity exists in the chest, where the subclavian vein (continuation of the vein from your arm) may become compressed by muscle or bone in the chest and cause a DVT,” says Dr. Klass. “This is called Paget-Schroetter syndrome.”
In this condition, repetitive and strenuous upper body activity (swimming, gymnastics, wrestling) is often linked to the deep vein thrombosis.
“Young patients with DVT with no risk factors will be investigated by their physician and these entities excluded,” continues Dr. Klass.
“Other more benign causes may simply be due to dehydration; patients who do not keep their fluid intake up may become dehydrated, which makes the blood more susceptible to clotting.
“In these cases often the dehydration is corrected long before the clot is discovered, and the cause is never found.
“These cases are very few and often a cause can be found after extensive investigation.”
Dr. Klass specializes in interventional oncology, aortic intervention, PVD, venous disease and venous access. He has been inducted into The Leading Physicians of the World, published by the International Association of HealthCare Professionals.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Top image: Shutterstock/metamorworks
Can a Blood Clot in the Leg Break off with Movement?
Learning you have a blood clot (DVT) in the leg is frightening.
And even more unsettling is the thought that movement can cause it to break off and travel to the lung and become a life-threatening pulmonary embolism.
If the broken-off portion of the clot is big enough, it can block both entryways for oxygen to the lungs, resulting in a quick death.
A person who’s been diagnosed with a DVT, or who believes they have one, may be afraid to be up and about walking.
Should movement be limited in someone diagnosed with a DVT?
If you’ve been diagnosed with a deep vein thrombosis, you might be thinking that you should remain as still as possible so that it doesn’t break off and travel to your lungs.
“No, most DVTs are fixed to the wall of the vein and it is highly unlikely to dislodge unless the vein is exposed to vigorous compression or unnatural force,” says Darren Klass, MD, clinical instructor of interventional radiology at the University of British Columbia and the Vancouver Coastal Health Association.
When these blood clots do dislodge, it’s usually something that happens spontaneously, with no apparent trigger.
This is why if you suspect a blood clot in a leg, you should immediately go to the nearest emergency room. Have someone drive you!
Treatment will begin immediately after diagnosis.
A DVT may cause redness, warmth, pain, cramping and/or swelling in a leg or behind the knee.
Immobility
Dr. Klass adds, “Conversely, not moving with a DVT may increase the risk of the clot getting larger due to the lack of blood flow from the legs.
“For this reason, pneumatic compression devices are often used during and/or after major surgery when a patient is not ambulant in order to stimulate venous flow in the legs.”
Dr. Klass specializes in interventional oncology, aortic intervention, PVD, venous disease and venous access. He has been inducted into The Leading Physicians of the World, published by the International Association of HealthCare Professionals. Vancouver Coastal Health
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Casa nayafana
Top 4 Causes of Swollen Legs after Surgery
There are four main conditions that can cause legs to swell after surgery.
“There are a number of reasons for swollen legs post-operatively,” says Darren Klass, MD, clinical instructor of interventional radiology at the University of British Columbia and the Vancouver Coastal Health Association.
“The majority of the causes for this is fluid leaking into the soft tissues due to low protein in the blood, poor heart function, deep vein thrombosis, lack of mobility.”
Surgery that causes swollen legs need not involve the lower part of the body.
Coronary bypass surgery can leave both legs quite bloated.
DVT not the Leading Cause in Bilateral Swelling
“Unless the swelling is only on one side, the chance of this being a deep vein thrombosis is less than other causes,” says Dr. Klass.
“A deep vein thrombosis may not cause swelling of the leg initially and patients may be completely asymptomatic. It is only when the return of blood to the heart from the legs becomes compromised, do we see swelling from DVT.”
The swelling in the one leg may not be noticeable at first. But if the patient believes that the lower leg is looking just a little bit bigger than the other, they should point this out to their nurse and doctor.
If a DVT is suspected, a bedside ultrasound will be taken of the leg. It will immediately show if there is a blood clot.
If the result is negative, this is no reason to let your guard down. Do keep monitoring your legs, since a DVT may still develop.
Other Symptoms of DVT
Some hospitals will make sure that no matter what kind of surgery, the patient will postoperatively have on pneumatic compression devices for their liower legs.
These deliver intermittent compressing motions that help keep the blood from pooling.
To further help prevent a blood clot, some hospitals will mandate that all patients receive a daily injection of the blood thinner heparin.
Other signs of a deep vein thrombosis are reddish or purple or pale discoloration of the leg, tenderness, cramping or pain.
The pain may even persist even if you’re at rest or sitting. Pain can also occur in the pelvic area.
If both legs are swollen soon after surgery but feel fine and are not discolored, the patient should always be DVT-conscious.
Dr. Klass specializes in interventional oncology, aortic intervention, PVD, venous disease and venous access. He has been inducted into The Leading Physicians of the World, published by the International Association of HealthCare Professionals.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Freepik.com/ pressfoto
Can a Pulmonary Embolism Be Diagnosed without Imaging?
A doctor may strongly suspect a pulmonary embolism based on a patient’s circumstances, such as suddenly struggling to breathe the day after hip replacement surgery, or sudden chest pain.
Even if the patient has other classic symptoms of a pulmonary embolus such as coughing up blood-tinged sputum, a doctor in good faith cannot just order administration of a clot busting drug unless the diagnosis is confirmed with imaging.
“The use of medication to bust up clots carries with it a risk of bleeding elsewhere in the body, as the medication stops blood from clotting,” says Darren Klass, MD, clinical instructor of interventional radiology at the University of British Columbia and the Vancouver Coastal Health Association.
“The physician responsible for administering the medication knows this and will ask specific questions to the patient to ensure it is safe.
“The patient must be closely monitored after this medication has been administered and therefore requires hospital admission.”
What leads to a pulmonary embolism?
Shutterstock/Designua
A pulmonary embolism is a blood clot in a lung (sometimes both; there can be multiple) that originally developed in a lower-extremity vein (lower leg to hip).
Such a blood clot is called a deep vein thrombosis (DVT) and are considered an emergency situation because it can dislodge at any time — and head straight for the lungs.
So to prevent a pulmonary embolus, one must take measures to lower their risk of a DVT.
Major Risk Factors for a DVT
- Obesity
- Smoking
- Birth control pills
- HRT therapy
- Excessive sitting throughout the day
- Sitting immobile in cramped quarters for hours without a break
- Long airplane rides
- Recent joint replacement or abdominal surgery
- Excessive bed rest
- Pregnancy
- Older age
A DVT is easily diagnosed with an ultrasound. A pulmonary embolism is diagnosed with a CT scan.
PE symptoms in combination with a positive result of a specific blood test will raise strong suspicion of this blood clot, but are not enough for an official diagnosis.
“Aside from this, PE can only be confidently diagnosed using medical imaging such as a CT scan,” says Dr. Klass.
“The clinical signs of pulmonary embolus are non-specific and cannot be confidently made without imaging.”
Dr. Klass specializes in interventional oncology, aortic intervention, PVD, venous disease and venous access. He has been inducted into The Leading Physicians of the World, published by the International Association of HealthCare Professionals.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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