Jim Davis/The Boston Globe
Tennis star Serena Williams went through a scary health experience earlier this week -- a blood clot in her lung, or pulmonary embolism, that could have killed her. According to news reports, the condition developed after Williams had routine foot surgery in New York, then hopped on a plane back to Los Angeles where she lives.
The formation of dangerous blood clots is always a risk, but after foot surgery in a 29-year-old athlete? "It can happen, despite the fact that she's a fit, young woman," says Dr. Michael Jaff, medical director for the Massachusetts General Hospital Vascular Center.
Jaff says the fact that Williams traveled on a long plane trip with an immobilized foot following surgery raised her risk of developing clots. Sitting for prolonged periods where blood can pool in the feet can cause increased clotting especially if the blood is unable to circulate easily due to a bandage or cast. Those clots can then break free and travel to the lungs, where they can be fatal.
"I tell patients to try not to go on long plane trips or car rides in a leg cast," Jaff says. "If it can't be avoided, I'll prescribe blood thinners before the trip."
It's not known whether Williams was taking a blood thinner. Nor is it known whether she was predisposed to a higher risk of blood clots due to having a gene mutation, found in 15 to 20 percent of the population. If she was also taking birth control pills, that would have increased her risk even further.
Some 6 million people develop blood clots every year, and about 600,000 wind up with a pulmonary embolism. "But research shows that women who take oral contraceptives have three times the risk, and those with a gene mutation have five times the risk; if you combine the two, though, a person has 17 times the risk," says Jaff.
While the average person doesn't need to worry about developing a pulmonary embolism after, say, a nose job or gallbladder surgery, those having hip, knee, or pelvic surgery are more at risk and are usually given mechanical pumps or compression stockings to wear on their legs during surgery to keep the blood circulating, Jaff says. Plus, they might get blood thinners afterward.
Increased age can also be a factor, as well as the amount of time spent in bed recuperating from a procedure. "I'd be worried about the blood-clot risk in a 70-year-old cancer patient having hip surgery," Jaff says.
Since the gene mutation test is expensive, doctors don't perform it routinely, but those with close family members who've had blood clots might want to consider it to know, say, whether to avoid birth control pills or hormone therapy for menopausal hot flashes, which can also raise the risk of clots.
Those experiencing symptoms of a pulmonary embolism -- sudden severe chest discomfort, shortness of breath, rapid heartbeat -- should seek emergency medical attention immediately.
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