Preventing blood clots for legs in plaster casts, splints, and boots
What is a blood clot?
Blood clotting helps us to stop bleeding when we have an injury, blood clots usually dissolve after the injury heals. Blood clotting can cause problems when the blood becomes ‘sticky’ and doesn’t flow through the veins as well as normal, for example, when you are ill, immobile, or dehydrated after an illness or operation.
Blood clots can form a blockage in the veins, usually in the deep veins of the leg or pelvis. This is called a deep vein thrombosis also known as a DVT. Very occasionally, a piece of the clot can break off and flow to the lungs. This is known as a pulmonary embolism (PE). Venous thromboembolism (VTE) is the collective name for DVT and PE.
Although the risks are small, the consequences can be serious.
A DVT can lead to long-term medical problems and health conditions, such as permanent swelling in the leg, varicose veins, and leg ulcers which may impact your mobility. A PE can lead to a need for a high level of care, continued treatment, greater risk of re-occurrence, and
might be fatal.
Why does lower limb immobilisation increase the risk of blood clots?
Following a fracture or injury you may have had your whole leg or some of your leg placed in a plaster cast, a splint, or a protective boot, meaning you will no longer be able to move the limb as freely as you were able to before the injury. Blood normally flows quickly through veins and does not clot. Blood flow in the leg veins is helped along by movement of the legs, because the muscle action squeezes the veins. While your leg is immobilised, blood flow becomes sluggish and can form clots.
Your doctor or nurse will ensure that you have been risk assessed before you leave the hospital and a decision will be made as to whether you will require medication to prevent you from developing a DVT.
What medication will I need?
Anticoagulants (blood thinning drugs that prevent clotting) may be used, in the form of a daily tablet or injection. If the doctor or nurse makes the decision to commence you on medications, they will advise you and share how to administer them and when to stop taking them.
It may cause bruising and there is a risk of bleeding. Your doctor or nurse will check it is safe for you to have blood thinners. Please let them know if you have a bleeding disorder, had a past stomach ulcer/adverse reaction to blood thinners, a recent brain bleed/surgery, or spinal/epidural anaesthesia.
If you experience prolonged bleeding or excessive bruising, please speak to your GP.
Most injectable types of anticoagulants are derived from animals. Speak to your doctor or nurse if you would like them to consider an alternative, such as if you are vegan or for religious reasons.
If you are concerned about your need for medication or if you need help with administering the medication at home, please discuss this with the nurse or doctor attending to you.
What happens if I don’t need medication?
If your doctor or nurse has decided that you don’t need any anticoagulation medication, this is because you are at low risk of developing a blood clot.
If your leg is immobilised in a cast, you may receive a follow up appointment to an outpatient fracture clinic within 7-14 days. Alternatively, if your injury is stable, your x-rays may be discussed in the virtual fracture clinic, and you may be discharged with advice instead.
What can I also do to prevent clots?
It is difficult to predict who will develop a blood clot, and there are steps you can take to try and reduce this risk:
- Drink plenty of fluids, to keep hydrated.
- Stop smoking (if you smoke) - this will also help your bone to heal.
- Keep as mobile as possible, talk to your doctor or nurse about what exercises you can do and how often.
- Take any medication prescribed for the full duration.
What are the signs of a clot?
Deep Vein Thrombosis (DVT)
- Pain or tenderness.
- Swelling.
- Discolouration or redness of the leg.
- Warm skin around the painful area.
These symptoms usually affect one leg, although clots can occur in both legs. If the clot is somewhere other than in your leg, there may be no physical signs of DVT.
If you experience any signs of a DVT, especially within 3 months of a hospital admission, immediately contact your GP or nearest Emergency Department.
Sometimes bits of the clot can break up and lodge in the lungs causing a pulmonary embolism (PE).
Pulmonary Embolism (PE)
- Difficulty breathing.
- Coughing up blood/blood-stained sputum (phlegm).
- Chest pain.
- Palpitations (racing heartbeat).
- Collapse.
If you experience signs of a PE, visit your nearest Emergency Department immediately.
Where can I find out more about clots?
Visit https://www.nhs.uk/conditions/deep-veinthrombosis-dvt/ for more information on DVT.
Visit https://www.nhs.uk/conditions/pulmonaryembolism/ for more information on pulmonary embolism.
Visit the Thrombosis UK website: www.thrombosisuk.org or download their free app ‘Let’s talk clots’.