Blood Clots, Stroke & VTE

Stroke — Act FAST: Face dropped on one side · Arms can't be lifted · Speech slurred or jumbled · Time to call 999. Every minute lost during a stroke destroys about 1.9 million neurons.^[6]NHS

Pulmonary embolism — call 999 if you suddenly become breathless, develop sharp chest pain that's worse on breathing in, cough up blood, or collapse.^[2]NHS

A deep vein thrombosis (DVT) usually forms in a calf vein — symptoms are a swollen, hot, painful leg, often with reddened or darkened skin. If part of that clot breaks off and travels to the lungs it becomes a pulmonary embolism (PE), which can be fatal within hours. NICE NG158 recommends apixaban or rivaroxaban as first-line anticoagulation.^{[1]NHS DVT[3]NICE NG158}

Who's at higher risk: recent surgery (especially hip/knee), cancer, pregnancy and the 6 weeks after birth, long-haul travel > 4 hours, the combined oral contraceptive pill or HRT, immobility, obesity, and inherited thrombophilias. Every adult admitted to an NHS hospital should be VTE-risk-assessed within 14 hours.^{[4]NICE NG89}

About 85% of UK strokes are ischaemic (a clot blocking a brain artery) and 15% are haemorrhagic (a bleed). For ischaemic stroke, thrombolysis (alteplase or tenecteplase) should be given within 4.5 hours, and thrombectomy can be considered up to 24 hours after onset in selected patients.^{[7]NICE NG128}

A transient ischaemic attack (TIA) is a stroke whose symptoms resolve within 24 hours. It is a medical emergency — one in 12 people will have a full stroke within a week. Anyone with TIA symptoms should be seen by a specialist within 24 hours.^{[7]NICE NG128}

About 1.5 million people in the UK are diagnosed with atrial fibrillation (AF), and hundreds of thousands more are undiagnosed. Untreated AF increases stroke risk five-fold. NICE NG196 recommends anticoagulation (apixaban, rivaroxaban, edoxaban or dabigatran) for anyone with a CHA₂DS₂-VASc score of 2+ (or 1+ in men).^{[9]NICE NG196[10]BHF}

• 999 · suspected stroke, suspected pulmonary embolism, collapse, severe chest pain or breathlessness
• NHS 111 · free, 24/7, for a swollen painful leg or other urgent advice that may need same-day assessment
• Stroke Association Helpline · 0303 3033 100 (Mon–Fri 9am–5pm, Sat 10am–1pm) · stroke.org.uk^{[8]Stroke Association}
• Thrombosis UK · clinician-led patient charity for DVT, PE and thrombophilia · thrombosisuk.org^{[5]Thrombosis UK}
• British Heart Foundation Heart Helpline · 0808 802 1234 (Mon–Fri 9am–5pm) · bhf.org.uk
• Anticoagulation UK · patient charity for people on warfarin or DOACs · anticoagulationuk.org
• Different Strokes · support for younger stroke survivors · differentstrokes.co.uk