Risk of blood clots whilst in leg immobilisation (plaster cast)

How do blood clots form?

There are many veins within the muscles of each leg. As you walk, run or move your feet, the muscles contract and squeeze the blood back towards the heart. When your leg is immobilised (held still) in a cast, splint or boot, the muscles move less and the blood flows more slowly. Rarely this can cause a blood clot- Known as a Deep Vein Thrombosis.

What are the signs and symptoms?

A blood clot can cause pain, swelling or discolouration in the legs. Very rarely, parts of the blood clot may break away and travel to the lungs; this is known as Pulmonary Embolism (PE, a blood clot in the lung).
Symptoms of a blood clot in the lung are chest pain, shortness of breath and sometimes coughing up blood streaked sputum. A blood clot in the lung is a serious condition that can be fatal if not treated.
If your calf or thigh area becomes swollen or painful, turn red or feel hot to touch,
contact your GP immediately. If the clot has broken off and travelled to your lungs, you may experience chest pain or difficulty in breathing and occasionally cough up blood streaked sputum.
If you develop severe shortness of breath or chest pain, please dial 999 immediately.

Who is at risk?

Blood clots rarely form when patients are in a plaster cast or splint. The Doctor or Nurse Practitioner will ask you some questions to find patients who are at a greater risk of developing a clot. These patients will be offered medications called anticoagulants (blood thinners) to stop a blood clot from forming.
Most patients are at a very low risk of a blood clot forming and do not need medication. You should not worry about a blood clot forming
- however there are some simple things all patients can do to prevent a blood clot such as drinking plenty fluids and simple exercises.

What treatments are available for high risk patients?

High risk patients will be offered an anticoagulant medication called Tinzaparin. This is given as an injection under your skin. The nurse will show you how to do this for yourself before you leave the Emergency Department.
This medication will need to be used at least until you are reviewed in the fracture clinic by the Orthopaedic Surgeon and is usually continued whilst your leg remains in the cast.
You should inform any other health professionals who look after you that you are taking this medication.
You should also consult a pharmacist should you be on any new medication or if you buy any medications over the counter. These injections are supplied by the hospital, not by your GP. If you run out or lose any before you are seen in the fracture clinic please contact us.

Are there any side effects of taking anticoagulants (blood thinners)?

Anticoagulants thin your blood and therefore can make you bleed more easily. If you are at significant risk of bleeding problems, your doctor or nurse may decide not to prescribe anticoagulants.
Please tell your doctor or your nurse if you notice that you are bruising more easily
than usual, or if you are feeling weak, tired or more short of breath than usual.
While taking anticoagulants, you need to go hospital if:
• You have bleeding that you cannot stop, or have a raised swollen area around a wound.
• You have a sudden very bad headache or a significant bang to the head.
• You have a swelling or pain in your tummy, black or bloody stools, or vomit blood or vomit which looks like coffee grounds.
If you have any other effects or bleeding that is concerning contact you GP immediately but do not stop taking the medication.

How can I reduce the risk of developing a blood clot?

• Drink plenty fluids.
• Mobilise as much as is comfortable.
• Stop smoking if you smoke -this will also help with the healing process.
• Perform the exercises described below
Any activity which promotes contraction of lower limb muscles will improve blood flow in the veins. Try and do the following 3 times a day.
• Wiggle your toes while lying in bed or whilst sat up with leg elevated. Do this for at least 10 seconds and as often as you can.
• Inside the cast and if safe to do so, try to move your ankle up and down. You will only be able to make small movements. Repeat 10 times.
• For the below the knee casts, bend your knee up and down while seated. Repeat 10 times. You can also do this by lying on
• your tummy and bending your knee to your bottom and back.
• Lie on your bed or sitting with your leg straight up. Keep your leg straight and brace your knee down by tightening your thigh muscles.

Useful sources of information

NHS Choices
NHS Choices provides online information and guidance on all aspects of health and healthcare to help you make decisions about your health.
Web: www.nhs.uk

Contact us

If you have any questions or concerns about blood clots whilst in a plaster cast, please contact the Emergency Department
 

NHS 111

You can call 111 when you need medical help fast but it’s not a 999 emergency. NHS 111 is available 24 hours a day, 365 days a year. Calls are free from landlines and mobile phones.

If you need this information in an alternative format, please contact the Patient Experience and Engagement Team on 01226 434922.

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