What Are the Risks of Blood Clots and RA

What Are the Risks of Blood Clots and RA

Rheumatoid Arthritis and Blood Clots

Recent research has discovered a connection between rheumatoid arthritis (RA) and harmful blood clots. Between 11 and 30 percent of people who develop these harmful blood clots die within a month, so your knowledge and prevention methods can actually save your life.

In 2014, a cohort study published in the Annals of Rheumatic Diseases found that people with RA are at an increased risk of developing blood clots including deep vein thrombosis and a pulmonary embolism. This study investigated 29,238 patients with RA and discovered they are 3.36 times more likely to develop a deep vein thrombosis and 2.07 times more likely to experience a pulmonary embolism.

Blood clots are clumps of gelatinous blood that form in your blood vessels, most often in your thighs and calves. Blood clots are dangerous because they can travel through your blood vessels and clog your heart, lungs, or brain, resulting in severe damage or death. Deep vein thrombosis is a dangerous type of clot that can lead to a pulmonary embolism.

Deep Vein Thrombosis

Deep vein thrombosis occurs when blood clumps together in a vein inside a muscle. It is most prevalent in people over the age of 50. Rheumatoid arthritis increases your risk of developing a DVT, along with:

  • Being overweight
  • Smoking cigarettes
  • Taking birth control pills
  • Undergoing hormone therapy such as estrogen supplementation
  • Having a catheter placed in a vein
  • Pregnancy
  • Recent joint replacement surgery
  • Sitting still for a long period of time such as in a car or on an airplane

Deep vein thrombosis usually occurs in your leg and may cause the following symptoms:

  • Swollen foot, ankle or leg, usually only on one side of the body
  • Pain and cramping that begins in the calf
  • Unexplained and severe pain in your leg
  • An area of skin that feels unusually warm
  • The skin over the painful areas turning white, reddish, or bluish

If you develop any of these symptoms, you should call your healthcare provider immediately. Unfortunately, only half of people who have a deep vein thrombosis exhibit symptoms. Some people may not be aware that they have a deep vein thrombosis until they develop a pulmonary embolism, a life-threatening complication.

Pulmonary Embolism

A pulmonary embolism occurs when a blood clot, such as deep vein thrombosis, travels through the body and blocks the arteries in your lungs. The risks of developing a pulmonary embolism are the same as those associated with deep vein thrombosis.

Symptoms of a pulmonary embolism include:

  • Unexplained shortness of breath
  • Lightheadedness
  • Pain while taking breaths
  • Coughing up blood or a dry cough
  • Rapid breathing
  • Fast heart rate or a sensation of abnormal heartbeats

Both deep vein thrombosis and pulmonary embolism result in serious, life-threatening problems if not treated quickly; about one-third of people with an untreated pulmonary embolism do not survive. If you think you are experiencing a pulmonary embolism, please call your healthcare provider immediately.


Preventing blood clots is the best way to prevent pulmonary embolism. Because those with RA are at such a high risk of deep vein thrombosis and pulmonary embolism, you should take aggressive measures to prevent clots before they happen. Key prevention measures include:

  • Wearing compression stockings
  • Engaging in frequent physical activity
  • Elevating your legs, especially at night in bed
  • Drinking lots of water
  • Maintaining a healthy body weight
  • Using pneumatic compression
  • Taking anticoagulant medication as prescribed

Compression stockings that squeeze your leg muscles help blood flow more efficiently. These stockings are cheap and can be purchased online or at a local pharmacy. Pneumonic compression uses thigh-high or calf-high cuffs that inflate and deflate throughout the day to massage your legs.

Physical activity can help you stay healthy, and maintain a healthy weight. Just a short, simple walk around the block will increase blood flow and reduce your risk of blood clots. If you are traveling and stuck in a sitting position for a while, fidget in your seat and flex your ankles every 15 minutes.

Elevating your legs whenever possible helps blood flow more effectively. When sitting on the couch, elevate your legs using pillows or an ottoman. You might want to raise the foot of your bed with books by four to six inches to keep your legs elevated while you sleep.

Dehydration can increase your risk of blood clots, so be sure to drink lots of water throughout the day. Experts recommend that you drink half your body weight in ounces of water per day. For example, if you weigh 120 pounds, you should be drinking 60 ounces of water per day.

Your physician or nurse practitioner may prescribe you an anticoagulant medication to prevent clots from forming. Examples of anticoagulant medications include apixaban, dabigatran and rivaroxaban. Be sure to take this medication exactly as prescribed in order for it to be effective.


Annals of Rheumatic Diseases (Rheumatoid arthritis increases the risk of deep vein thrombosis and pulmonary thromboembolism: a nationwide cohort study)

National Heart, Lung, and Blood Institute (What Are the Signs and Symptoms of Deep Vein Thrombosis?)

Mayo Clinic (Pulmonary Embolism Prevention)

American Heart Association (Anti-Clotting Agents Explained)

Melissa DeCapuaMelissa DeCapua

Dr. Melissa DeCapua is a board-certified psychiatric nurse practitioner. She currently works as a consultant for small healthcare technology companies, and she was recently won the Seattle Health Innovator award.

Apr 11, 2016
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