Stephan Moll, MD writes… Some patients may only have mild symptoms when diagnosed with a deep vein thrombosis (DVT) or pulmonary embolism (PE) and may feel normal again within a few days after initiation of blood thinners. Patients with more extensive clots and more pronounced symptoms may take several weeks to get back to normal. However, some patients never return to feeling normal and may have chronic symptoms: (a) Patients with DVT may be left with some degree of chronic leg swelling and pain (called post-thrombotic syndrome, or PTS – more extensive discussion here); and (b) patients with PE may be left with some degree of chronic shortness of breath with exercise, general fatigue, or chest pain. This may be referred to as CTEPH (chronic thrombo-embolic pulmonary hypertension – more extensive discussion here). Thus, there is a spectrum of how quickly and how completely patients recover. It is, therefore, difficult to make generalized comments on speed and degree of recovery, as this depends so much on the size and extent of the DVT and PE, a patient’s other medical conditions, the way a patient’s body responds to having a clot, and the body’s mechanism to dissolve and heal from the clots.
How quickly to expect improvement?
In general, patients often improve significantly over the first 7-10 days, once blood thinners are started. After that there may be further, yet slower additional improvement over the next several weeks. There may even be further improvement after a few months. Patients who are left with some symptoms after several weeks of months may ask whether they can expect any further improvement. The best predictor as to whether a patient will improve further is probably how the person has done so far: if improvement has leveled off and there hasn’t been any further improvement in several weeks, then the patient may not improve any further. However, if there has continued to be improvement, even if only a slow one, then the patient may expect further improvement in the coming weeks and months.
How active to be after a clot?
Patients with a newly diagnosed DVT or PE should use common sense and listen to their body. Physically, they should only do what they feel comfortable doing. They do not speed up recovery by pushing themselves aggressively through symptoms. And, on the other hand, they do not make things worse by being active. Classically, it is fine for the patient to be physically active right after the diagnosis of an acute DVT or PE – walk, do light household or other work. However, if somebody has a lot of leg pain from the DVT or shortness of breath from the PE, the person should take it easy. A blood clot really causes trauma to the body and a patient / the body needs time to heal and recover. It is appropriate to take time off from work and let the body recover. However, if the DVT or PE was only small and the patient feels fine and wants to go back to work, then that is certainly fine, too.
It appears that being highly active one month after a DVT is not detrimental; it may, actually be beneficial and lead to less symptoms of postthrombotic syndrome [ref 1]. This can be used as an argument to encourage individuals to return to physical activity relatively soon after a DVT. No official guidelines exist as to when and how quickly an athlete might return to exercising. Each patient will need an individualized exercise plan. It seems appropriate to refrain from any athletic activities for the first 10-14 after an acute DVT or PE until the clot is more attached to the blood vessel wall and the risk of having the clot break loose (causing a PE) has decreased. To lessen deconditioning during this period of relative inactivity, the athlete may do some strength training – arm and trunk exercises in the case of a leg DVT, leg and trunk exercises in the case of an arm DVT. The athlete may then increase activity between week 2 and 4 and return to pre-clot activity levels by week 4, if the body lets him/her. A similar approach is probably wise regarding yoga: it seems safest to take it easy and avoid yoga activites associated with more extreme body positions in the first 4 weeks after a clot.
I advise against airline travel in the first 4 weeks after a DVT or PE. Why do I recommend that? Some data have indicated that the hypobaric (low pressure) condition in the airline cabin activates our clotting mechanism and that that is one of the reasons why people who fly long-distance have an increased risk for developing DVT and PE [ref 2,3]. However, whether that is truly of clinical relevance is not known. Thus, it is fair to say that it is not known whether airline travel in the first few weeks after an acute DVT or PE is truly detrimental and should really be avoided. Thus, my advice to patients to may be not fly in the first few weeks after a DVT is not a “you must not fly” direction, but rather a suggestion.
- Shrier I, Kahn SR: Effect of physical activity after recent deep venous thrombosis: a cohort study. Medicine and Science in Sports and Exercise 2005;37: 630-634.
- Schreijer AJ et al. Activation of coagulation system during air travel: a crossover study. Lancet 2006;367:832-838.
- Bendz B et al. Association between acute hypobaric hypoxia and activation of coagulation in human beings. Lancet 200;356:1657-658.
Disclosures: I have no financial disclosures relevant to this blog entry.
Last updated: May 15th, 2012