Everything You Wanted to Know about Blood Clots

In layman’s terms, my mom died of a blood clot, but there’s much more to it than that — and you need to know about it.

First of all, the ability of our blood to clot is both natural and crucial. If our blood didn’t clot, we’d bleed to death from paper cuts. There are about 10 factors in our blood that contribute to the ability to clot, and a few factors that work against those 10; they combine to create a beautiful balance in which our blood flows easily to and from our hearts.

Usually, that is.

While the vast majority of blood clots form on our skin when we scrape our knees or elbows, clots can also form in places and at times we don’t want them to. There are different kinds of blood clots; arterial clots form, obviously, in the arteries. Venous clots, of course, form in the veins, and deep venous clots form in veins that are deeper in (and more vital to) the body. Therefore, deep vein thrombosis — the clinical term for clot — can be serious.

Typically, deep vein thromboses (DVT’s) form in the legs. Because of the way our bodies work and, well, gravity, the legs are where blood is most likely to coagulate or pool — especially for people who lead sedentary lives or are forced to spend long periods of time seated or reclined. (For this reason, if you take a long road trip or flight, please please please stand up once or twice an hour and take a stroll, or at least pump your calves a few times against the floor.)

You might know if you developed a clot in a deep vein; there could be warning signs around the area of a clot, such as swelling, tenderness, or redness. But you might not know; many times, clots are “silent” and show no signs at all.

When a clot forms, the same factors that make our blood able to clot in the first place are fighting to enlarge it, while the anti-clot forces are fighting to break it up. Of course, the same lifestyle habits that make clots more likely — sedentariness and obesity — also tend to make clots bigger once they form.

But if you find that you have a clot — even one in a deep vein — it can be treated. Compression socks can improve blood circulation in your legs. Blood-thinning medicine can be effective — Coumadin is the most common one — and for more serious clots, thrombolytics or “clot-busters” are drugs that are inserted through an IV or catheter directly into a clot.

Much more dangerous than the clot itself is when a clot becomes an embolism. An embolism develops when a clot breaks off from a vein (again, usually in the leg), travels through the body, and lodges in an artery. We don’t really know what causes a clot to be more or less likely to break off and move. In some people, only small particles of a clot break off and travel, resulting in minor episodes of breathlessness and chest pain. But because blood pumps through our bodies so fast, there’s usually just a heartbeat or two between the moment a clot breaks off and the moment it becomes an embolism.

When the artery a clot lodges into is in the lungs, it’s called a pulmonary embolism. If you have a pulmonary embolism (PE), and blood flow from your lungs to your heart or vice versa is restricted, you’ve got a big problem on your hands, and you’ll know it: You’re likely to have chest pain, a cough, and/or shortness of breath. But you can survive a PE (albeit with the potential for permanent lung damage), provided the clot only restricts blood flow and doesn’t completely prevent it.

My mom had an occlusive pulmonary embolism, which means the clot totally plugged her pulmonary arteries, right at the point where the right and left pulmonary arteries split.

An occlusive pulmonary embolism will induce immediate cardiac arrest and almost certainly death within seconds or minutes. My mom was probably gone long before the paramedics arrived, although often, even when they know it’s hopeless, paramedics perform CPR anyway, to give the family some peace of mind that they tried something. Even if they had arrived at the very instant the PE occurred, there’s not much they could’ve done. Unlike a heart attack, where the heart stops for electrical reasons, her heart could not have been restarted with a defibrillator.

In fact, even if she had been sitting in the best hospital in the world, with a dozen of the world’s best doctors surrounding her when this occlusive pulmonary embolism occurred, she probably wouldn’t have survived unless those doctors somehow knew exactly what to look for and where.

The good news, if you can call it that, is that she most likely passed without pain. She simply went to sleep sometime after 10:45 p.m. — the time of the last text she sent — and died probably sometime before 6:00 a.m., since her body was already cold and showing signs of rigor mortis when Grandma found her before 8:00.

Pulmonary embolisms kill approximately 100,000 Americans every year. (It’s true that after almost every death from any cause, blood will clot in the body. However, it’s easy for doctors to tell which clots form before death, and which ones form after.) That’s about one PE death every six minutes. Put another way, if you attend a sold-out show at The Pageant, there’s a strong chance that at least one of the people in that crowd will die from a PE within a year. Additionally, PE’s are a leading cause of death in women during pregnancy or just after having a baby.

One way that PE’s can be prevented is, of course, by reducing your risk for clots in the first place — by maintaining a healthy weight, by leading a generally active lifestyle, and by avoiding long periods of sitting or lying down. A much more complicated, and medically invasive, way to prevent PE’s is with an Inferior Vena Cava filter. The Inferior Vena Cava is a large vein that runs from the heart all the way down the legs, and an IVC filter can be installed in the abdomen and act like a gate: It lets blood through, but anything as big as a clot would get stopped before it reaches the lungs or heart and becomes fatal.

Other than being overweight and inactive, what can increase the risk of blood clots — and therefore the risk of a pulmonary embolism?

Women are at a greater risk than men for hormonal reasons, although men can and do develop blood clots and PE’s. Pregnant women are at greater risk still. Birth control pills, too, can increase the risk of blood clots — especially for women who have a history of thrombophilia (proclivity toward blood clots) in their families. This hereditary thrombophilia is present in approximately 20 percent of the general population. The most common reason is the Factor V Leiden genetic mutation in the blood, which resists our blood’s Protein C, a natural anticoagulant.

Therefore, when Grandma was diagnosed in April of 2012 with deep vein thrombosis, her doctor’s office should have sounded all kinds of alarms for the rest of the family. If they had, there’s a good chance my mom would still be with us because, again: There are steps we all can take to reduce our risk of developing clots in the first place — and they can usually be treated even after developing.

So, here’s what you need to do to reduce your blood clot risk:

• Get a blood test done, and ask specifically about the Factor V Leiden mutation.
• At least once an hour, get up to top off your coffee … or go to the bathroom … or get the mail … or just stand up and pat your head with one hand and rub your belly with the other — whatever it takes to get your blood flowing. They say “Sitting is the new smoking.” Even if that proves to be crazy-talk 50 years from now, there’s no harm in acting like it’s true.
• From time to time, elevate your feet at least six inches above your heart. It’ll improve circulation in your legs.
• Turmeric, ginger, cayenne pepper, garlic, and cinnamon are natural blood thinners that you can incorporate into your diet right now.
• Be more active — commit to at least one 30-minute walk per day. Two, ideally.
• Drink as much water per day as you possibly can. When the body isn’t properly hydrated, the blood can thicken.
• Acclimate yourself with ingredient labels and eat better. Start by eliminating or reducing these four categories of food from your diet: Bread/bread products like bagels, crackers, etc; Sugar; Alcohol; Vegetable oils (such as canola, peanut, soybean, grapeseed … basically, try to avoid any oil that’s not olive, coconut, or avocado.)
• If you’re overweight, lose some of it. There are two main ways to lose weight: Move more and eat better. If those two prove difficult for you, there’s a third option: Eat less. Try skipping a meal a week, then maybe skip two meals a week, and maybe work yourself up to skipping a meal a day. You’ll be hungry, but trust me: You’ll survive ‘till dinner.
• Finally, seek healthy ways to reduce stress (exercise is a great one; mediation another). “The blood froze in my veins” and “My blood curdled” have long been figures of speech in horror stories when characters confront suddenly stressful situations — but they might not be just figures of speech after all. Research shows that extended periods of stress, anxiety, and fear (such as my mom experienced from March-November; “My world is upside down,” she texted once, “new job, pandemic and house sale. I can’t do all this”) can constrict blood vessels, decrease blood flow, and make clots more likely.