​

Intro: Expert Insights is an ongoing medical education podcast. The Carle Division of Continuing Education designates that each episode of this enduring material is worth a maximum of 0.25 AMA PRA Category 1 credit. To collect credit, please click on the link and complete the episode's post-test. This podcast forum is brought to you to share expertise and insights within our integrated delivery system to help us improve the health of the people we serve and achieve world-class accessible care. This is Expert Insights.

Scott Webb (Host): I'm Scott Webb. And with May being Blood Clot Awareness Month, it's a great time to have family practice physician Francesca Bryan on to discuss blood clot awareness and prevention

 Dr. Bryan, nice to have you here today. We're talking about blood clots and blood clot awareness. And of course, May is Blood Clot Awareness Month. So, great time to have you on. Let's just start there, maybe the most obvious one. What are the most common causes of blood clots?

Dr. Francesca Bryan: Scott, that's a really great question. Some of the most common causes of blood clots, it just comes down to abnormal blood flow and clotting. In medical school, we learned something called Virchow's triad. So, anytime there's a perfect storm of stasis, something called endothelial injury, whether it's just damage to a blood vessel and hypercoagulability, it puts you at risk.

Host: Sure. Yeah. And I imagine there's a lot of folks out there who either know that they're-- they suffer from blood clots or suspect that they might. Maybe you can take us through, like, what are the risk factors? Is it family history, genetics, behavior, lifestyle, you know, all the above kind of thing?

Dr. Francesca Bryan: Definitely. It's all of the above. Several risk factors for what we call a deep vein thrombosis would be that prolonged immobility. So whenever you have patients who are coming in from a long flight, long travel, even recent hospitalization, that puts them at risk; recent surgery, especially orthopedic surgery, pregnancy, that postpartum period. We also notice this when we have patients on hormonal medication, obesity, and that family history. If someone has a clot in your family, that definitely puts you at risk.

Host: Sure. Yeah. And as you say, it could be long flights, sort of behavior, lifestyle choices we make. So, there are some things that we can do maybe to help ourselves?

Dr. Francesca Bryan: Oh, definitely. If you find yourself on a long flight, I would recommend getting up every so often, not just to use the bathroom, but to stretch your legs, get that calf movement going.

Host: Yeah, I see folks doing that. I try to remind myself, you know, I should probably get up and move around. As you say, sometimes it is to use the restroom, of course. But that's just a good practice, right? And just how about sort of daily living? Is it just, you know, being as active as we can and getting up and moving around and going for walks after dinner, you know, that kind of thing?

Dr. Francesca Bryan: Definitely that kind of thing. But also, one of the major risk factors for those patients who do smoke, you want to make sure that you stop smoking. That's a major risk factor for a blood clot. Outside of just moving your body, making sure that you are not at risk for obesity. Being obese also makes you at increased risk for a blood clot.

Host: For sure. Right. So as you say, there's some family history, genetics, things we can do to help ourselves. How do we know if we have a blood clot? Like, first of all, is that a thing? Would we know if we have a blood clot? And if so, then what are some of the signs and symptoms or tip-offs?

Dr. Francesca Bryan: Believe it or not, yes, a lot of people do come in, and they know or have a high suspicion that they have a blood clot. It all depends on that location. So meaning if someone's worried that they have a blood clot in their leg, they may notice pain with walking, new tenderness, swelling. But then, if we're talking about a clot in the lungs, there's that sudden shortness of breath or chest pain with inspiration. They might feel lightheaded.

Host: And sort of on the flip side of that, Doctor, is it possible to have blood clots and simply not know and maybe sort of end up being sort of diagnosed accidentally, you know, be in for something else and, you know, the provider might be like, "Hey, by the way, you have a blood clot." Like, is that possible?

Dr. Francesca Bryan: Oh, absolutely. That is definitely possible. There's many patients who are in the hospital, and you might notice changes with their vitals, changes maybe even with their mentation, their behavior, depending on if they're having mental status changes, their age. But definitely, we start to do a workup, and sometimes all roads will lead back to a clot. So yeah, it can be something that we just find as well.

Host: Sure. You Just sort of find, yeah. And you mentioned DVT there, and I wanted to sort of drill down a little bit into that. Like, what is DVT? I mean, I can say a deep vein thrombosis, but what does that mean exactly? How do folks develop DVT? How do you treat it? What's the recovery time? All that good stuff.

Dr. Francesca Bryan: Lots of great questions. So, DVT, as you'd mentioned, deep vein thrombosis, there has to be some kind of damage to the blood vessel, the blood vessel walls. So, we call this an endothelial injury, this can happen in some kind of trauma or in surgery. So, we normally would diagnose it using Doppler or ultrasound. So if we're concerned about a clot in someone's leg, I would give them a blood-thinning medication as long as they had no contraindications to it. And we would get that ultrasound duplex of the lower legs. And thankfully, we have great techs. They would check the veins, they would check the deep veins. And if there was a clot that was seen, then we would typically get them on an oral medication. Sometimes we might even get them on different various types of medications, whether it's heparin or warfarin, but getting them on something that helps reduce new clot formation is most important.

And that treatment time, it depends. It depends on what their long-term complications are that some people may develop. It also depends on where the clot's at. Is it a chronic clot? So, treatment, typically three to six months, but you definitely notice improvement within days to weeks after starting treatment.

Host: Okay. Yeah. So, maybe not one-size-fits-all, but definitely treatable, of course. We have to be seen by medical providers, be diagnosed and all of that. I'm sure, doctor, like there's been so many advances, and I don't need to tell you, but medicine, science, technology, all of that. So when we think about the treatment of blood clots, maybe from where we used to be with them, like how are you treating them today? What type of meds are used? You know, just that sort of thing. For me and others as potential patients, like, how do we deal with blood clots?

Dr. Francesca Bryan: So again, it depends on someone's medical history and what medications can and can't be used in certain situations.

But one of the most common first-line treatments is usually heparin. It's often used initially. There's other blood-thinning medication or anticoagulants such as warfarin. And then, I mentioned some oral medications that we can give. These are normally called our direct oral anticoagulants. So, that Eliquis is one that I personally give in my department. But like I said, it's all about trying to prevent them from growing and also reducing that new clot formation.

But then, we also have another branch of medications, which we call it blus-busters. And these are our thrombolytics. So, these are usually used in more severe cases. So, let's say someone has a very large pulmonary embolism, we might be reaching for these more often.

Host: Okay. Yeah. And you mentioned prevention there, and that's kind of where I wanted to finish up. I feel like there's a lot of folks out there, Doc, who maybe are sort of self-medicating. I don't know if they put themselves on an aspirin regimen. And if they do, why they do that. Is it clots? Is it their hearts? You know, I don't know what folks do necessarily. This is all terribly anecdotal. But just in general, when we think about preventing blood clots, if that's a thing we can do, how best to do that?

Dr. Francesca Bryan: Absolutely. We love prevention in family medicine. So yes, there's always a way to prevent. Maintaining a healthy weight, like I've already mentioned. If you smoke, quit smoking. It just makes your risk even higher. If you are prescribed anticoagulant, I recommend taking your anticoagulant as prescribed. If you're someone who can't quite remember when to take medication, set a timer.

Some other things, no one really likes these, but wearing compression stockings, not the most comfortable or fashion-forward statement piece, but they do help with preventing blood clots. And then, you know, having those tough questions with your provider. If you're someone who's looking into getting on certain medications, whether it's hormonal therapy, talking about your risk of clot formation. Just being well-educated.

Host: Right. Education, knowing your risk factors, doing your part, whether it's, you know, trying to cut down or quit smoking, whatever it might be. I really appreciate your time and your expertise today. I'm glad there, there's a month dedicated to blood clot awareness, because I think we all need to be aware of that, especially folks like myself in my late 50s. It might be something to think about. Maybe some compression socks, you know, whatever it might be.

Dr. Francesca Bryan: All the things.

Host: Yeah. Thank you so much.

Dr. Francesca Bryan: Thank you for having me.

Host: For more information and to get connected with one of our providers, please visit carle.org. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Scott Webb. Stay well.