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Almost One Million People A Year Get Blood Clots, But The Risks Aren't Always Obvious

Tori Kelly Photo illustration by Salon/Getty Images

"It's been a scary few days," singer Tori Kelly said in a handwritten note shared on her Instagram page on July 27. Four days earlier, the Grammy winner had been out to dinner in Los Angeles when she felt her heart racing, and reportedly passed out. Her companions took her to Cedars-Sinai Medical Center, where, according to reports, the medical staff discovered blood clots in her legs and lungs.

Now, nearly a week later, her husband says she's "smiling and feeling stronger," but "not fully out of the woods yet." How could a young and and otherwise seemingly healthy wind up in such a crisis, so quickly?

While blood clots rarely get the attention that other health conditions like heart disease or diabetes do, they're a common — and sometimes fatal — issue. The CDC estimates that 900,000 Americans experience them per year, and 100,000 of them die. The National Clot Alliance puts the number of fatalities even higher, up to 300,000 individuals a year. (The number is tricky to pin down because blood clots can often accompany other health issues.)

That, as the National Clot Alliance notes, is considerably higher than the number of people who die of car accidents, AIDS or breast cancer. Yet few of us with direct experience of blood clots even know what they are, let alone how to recognize the warning signs.

Anyone who's ever bled has some experience with clotting. As Tony Gilbert, a communications associate with the Masonic Medical Research Institute, a non-profit research center in Utica, explains, "A blood clot is simply a clump that occurs when blood hardens. When you cut yourself shaving, your body's nature response for blood clotting is actually preventing you from over-bleeding." He notes, "Blood clotting is not inherently bad or good, it all depends on the context."

For example, Gilbert says, "People with hemophilia are unable to clot blood properly, which means that even a minor cut can have serious consequences." And when a clot occurs inside the body, it can be life threatening.

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When Tori Kelly had her health scare, the Los Angeles Times reported that her doctors "found blood clots around the 'Never Alone' singer's lungs and in her legs," and that "a medical team was working to determine if clots were present near the Grammy winner's heart." In a blood clots crisis, determining exactly where they are in the body, and then containing them, can become a race against time.

"Being able to identify an active blood clot is important in medical treatment," Gilbert explains, "because an adult person has 60,000 miles of blood vessels in their body, which means that identifying the exact location of a blockage in that complicated system is crucial." He compares it to needing to find the scene of a traffic-blocking car accident on 60,000 miles of highway. "An imaging agent to identify blood clots is like a huge neon sign on the road pointing us to the exact location of the problem."

Clots in the veins, usually the arms or legs or pelvis, are known as deep vein thrombosis, or DVT. While they can happen to anyone at any time, lack of movement, even from sitting on long flights, can be a risk factor. More dangerous are clots that move to the lungs, causing pulmonary embolism, or to the heart, causing coronary thrombosis. Twenty years ago, NBC correspondent David Bloom died in Iraq of a pulmonary embolism. A blood clot that had started in his legs — perhaps due to his frequent traveling in cramped vehicles as a war correspondent — led to his sudden death at just 39.

Another high risk factor is the increased estrogen brought on by hormonal birth control, pregnancy and childbirth. Blood clots are a leading cause of maternal mortality in the United States, and the numbers have not gone down in the 20 years. Five years ago, Serena Williams revealed that she almost died of a pulmonary embolism after the C-section delivery of her daughter. Williams was, fortunately, proactive about her symptoms. "Because of my medical history with this problem, I live in fear of this situation," she wrote at the time. "When I fell short of breath, I didn't wait a second to alert the nurses… I am lucky to have survived."

Time is of the essence with blood clots — and it helps to have good guidance and good instincts. When I heard earlier this week about Tori Kelly's situation, I was thrust right back to the day my friend Kira calmly texted me that her arm was swollen and her doctor had recommended she go to the hospital. Because she'd been treated for breast cancer a few years earlier, she'd initially thought her symptoms might have been related to lymphedema.

Instead, by the time I met up with her in the emergency department, her doctors were scrambling to make sure that the clot in her subclavian vein under her collarbone wasn't moving toward her heart. "It didn't hurt," she recalls now. "It just felt a little bit strange and looked a little bit strange."

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Without her history of breast cancer, Kira might have been tempted to put off medical attention until the situation had become far more dire. "The people in the ER told me, 'Your case is the most serious thing we're dealing with right now,'" she says. "I was like, 'I feel fine.' And then I was in the hospital for three days." She was fast tracked for surgery to remove the clot, and for three months afterward, she says she "couldn't really use my dominant arm."

The risk factors for blood clots can be mysterious and the symptoms difficult to identify, but there are some things to be on the lookout for the minimize the chances of getting them or being seriously affected by them. Blood clots can happen to anybody, at any time, but people with heart disease, obesity, smokers and those with a family history of blood clots are higher risk.

Likewise, while the exact causes aren't known, early research suggests people who've had COVID-19 are at "significantly" higher risk of venous thromboembolism. Earlier this year, when I had a case of COVID so severe I felt like a felt like a fish flopping on a hook, I had to go for X-rays twice to rule out pneumonia and pulmonary embolism. Like Kira, I already knew I had a higher chance of blood clots because I have a history of cancer — in my case one that metastasized into my lungs.

So how do you know if you're experiencing a blood clot, and when to seek medical attention? Like my friend Kira did, take any unusual redness, swelling or tenderness in your legs or arms seriously — it could be an early warning sign of DVT. Sudden shortness of breath, chest pain, rapid heart rate or sudden light headedness or fainting — like Tori Kelly's reported symptoms — can be signs of a pulmonary embolism. Trust your gut: you know your body and if something doesn't feel right in it, listen to it and get it checked out.

Blood clots can move quickly and the after effects can linger long after treatment. But prompt action can save your life, and full healing is, eventually, possible. The Journal of Circulation assures that "Most patients with DVT or PE recover completely within several weeks to months without significant complications or long-term adverse effects."

Four years after my friend Kira's close call, she's healthy and has no further incidents or complications. And just a few days after her hospitalization, Tori Kelly shared to her fans that "I'm feeling stronger now & hopeful." Then she added, "Unfortunately there are still some things to uncover."

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What A Blood Clot Feels Like, According To Doctors

WHEN YOU CUT YOURSELF, your blood clots over the injury to keep you from bleeding excessively. Once the injury heals, your body naturally dissolves the clot. So, blood clotting, also known as coagulation, is an important natural process.

Sometimes, however, blood clots can form in your blood vessels or arteries without an injury, and they don't naturally dissolve. When blood clots block your blood vessels and restrict blood flow, a condition known as thrombosis, it can be dangerous and even life-threatening, says Erich De Paula, M.D., associate professor of hematology at the University of Campinas in Brazil, and vice chair of the World Thrombosis Day steering committee.

"Thrombosis is responsible for about one in four deaths worldwide," he says. "This statistic should prompt the interest in learning how to avoid them through lifestyle modifications, as well as by knowing the signs and symptoms and seeking medical attention when necessary."

And they can lead to serious complications too. Blood clots can interfere with blood getting to your organs. They can affect your heart, lungs, and brain.

One of the most common types is deep vein thrombosis (DVT), when a clot forms in a deep vein in your arm or leg. The blood clots can travel to your lungs, causing a pulmonary embolism. DVT and pulmonary embolism are known as venous thromboembolism, and this affects about 900,000 Americans every year, according to the Centers for Disease Control and Prevention.

Knowing the signs of different types of blood clots, which usually revolve around pain, could help save your life, Dr. De Paula says. "Information is key, so men who are prone to thrombotic-related diseases should make informed decisions with their doctors, as to when and how to prevent thrombosis events."

What Is a Blood Clot?

Blood clots are clumps that form when platelets, proteins, and cells in your blood stick together, according to Penn Medicine. Clotting is a necessary bodily process to stop bleeding and heal an injury, and clots normally later break down and go away. When clots form where they shouldn't or not as a result of an injury, they may not break down and can cause other health problems.

What's more, a blood clot can form anywhere in your body. It's known as deep vein thrombosis when it forms in your arm and leg veins. A pulmonary embolism develops when clots develop in your lungs. Blood clots that block blood flow to your brain can cause a stroke, and a heart attack when they form in your heart. Each type typically shows different symptoms.

Signs of a Blood Clot in Your Leg

Deep vein thrombosis (DVT) refers to blood clots that form in your body's deep veins, usually your legs or arms, according to the National Blood Clot Alliance. Symptoms might include:

Swelling, often in one arm or leg

Pain or tenderness, usually described as a cramp

Reddish or bluish skin

Leg or arm that's warm to touch

DjelicS - Getty Images

"It's sometimes hard to describe," says Bibhu Mohanty, M.D., a cardiologist and associate professor of medicine at the University of South Florida. "It's like I feel pain that won't go away, but I didn't pull a muscle or hurt myself. I feel something that's tight and just hurts."

DVT often happens after long periods of being sedentary—such as taking a long-haul flight or lengthy car trip or sitting for long periods of time, he says. Smoking, being over 60, and being overweight can increase your risk, according to the Mayo Clinic. Women who are pregnant or take birth control pills are also at a higher risk.

You can help prevent DVT by:

Moving as much as possible: Get up to stretch your legs every hour or so if you're on a plane or sitting at your desk for hours

Quitting smoking, which increases your risk for DVT

Managing your weight, as being overweight increases your risk for blood clots

Exercising regularly, which lowers your risk for blood clots

Signs of a Blood Clot in Your Lungs

When blood clots in your legs break off and travel to your lungs, it can cause a pulmonary embolism (PE). A PE is "the worst-case scenario" when you have a DVT, Dr. Mohanty says.

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Symptoms can vary depending on your overall health and the size of the blood clot, according to Penn Medicine, but as blood flow to your lungs becomes more restricted, you might experience:

Coughing that might produce bloody mucus

Dizziness

Heart Palpitations

Leg pain or swelling

Sudden shortness of breath

Sharp and sudden chest pain

A PE can be life-threatening, so call 911 if you experience these symptoms.

Sometimes PE has no symptoms, however, Dr. De Paula says. In other instances, "a severe and acute PE can be experienced with symptoms from sudden death to near-fainting, severe chest pain, and abrupt shortness of breath."

Since PE and DVT are closely related, the same groups are at risk, and moving more, managing your weight, and quitting smoking can reduce your risk for PE.

Signs of a Blood Clot in Your Heart

Blood clots can form in the arteries of your heart and block blood flow, causing a heart attack. Symptoms might include:

boytaro Thongbun / 500px - Getty Images

"It is common that patients do not point to a specific area of the chest, but rather to a more extensive and poorly defined area of the chest when asked to identify the pain point," Dr. De Paula says.

The symptoms can occur gradually or suddenly, Dr. Mohanty says. You might also experience sweating, gas, and bloating, and it might feel like acid reflux or heartburn. Symptoms also vary depending on which artery of the heart is affected and the size of the artery.

You can reduce your risk for a heart attack by:

Eating a healthy diet full of fruits, vegetables, lean protein, and whole grains, and limiting sugar and salt

Exercising regularly

Managing your weight

Following treatments for other health conditions

Signs of a Blood Clot in the Brain

Blood clots can also block blood vessels to the brain, which can cause an ischemic stroke, the most common type of stroke.

andreswd - Getty Images

A stroke can happen when a blood clot forms within a blood vessel that supplies blood to the brain, known as cerebral thrombosis, according to the American Stroke Association. It can also occur when a blood clot forms in the heart or another part of your circulatory system, breaks loose, and travels through the brain's blood vessels. This is known as a cerebral embolism.

The F.A.S.T. Warning signs can help you spot a stroke:

Face drooping

Arm weakness

Speech difficulty

Time to call 911

Numbness, confusion, trouble seeing, difficulty walking, and severe headaches can also signal a stroke.

"Basically, if you're noticing a marked change in your face, your ability to talk and move your hands or arms, one compared to the other, it is extremely important to go to the hospital," Dr. Mohanty says.

You can lower your risk for a stroke by:

When to Seek Emergency Care

The individual symptoms of different types of blood clots can vary, but any time you have chest pain or discomfort that's radiating to the upper limbs or neck, shortness of breath, or a cough, seek medical attention, Dr. De Paula says.

Also, if you have unexpected pain or cramping in your leg that's not related to an injury and doesn't seem to be going away, get checked out, Dr. Mohanty says.

Basically, any time "something isn't right and is different from your human experience, and it won't go away, it's definitely time to go in and have things looked at," he adds.

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Birth Control Pills: What You Should And Shouldn't Worry About

Six decades ago, the first birth control pill was approved by the U.S. Food and Drug Administration—and it was far from perfect. Extremely high doses of hormones led to unnecessary and dangerous side effects that scared people away from the contraceptive altogether.

Although pills on the market today contain hormone levels magnitudes lower and are much safer, questions still abound about how they work and their side effects—particularly as the FDA recently approved one version of the pill to be sold without a prescription.

As with any medication, some side effects and risks are to be expected, but experts who spoke to National Geographic say birth control pill benefits far outweigh the risks when used properly, especially when it comes to preventing pregnancy.

(Maternal mortality is shockingly high in the U.S.)

"We're still trying to figure out everything that the pill does, and while we know it does affect women, it's not dangerous," says Sarah Hill, a research psychologist who studies women's health and is the author of This Is Your Brain On Birth Control. "It's about making decisions that are right for you given your specific goals."

Here's your guide to the birth control pill.

What are the differences between birth control pills?

There are three types of birth control pills. They all work by releasing synthetic hormones that prevent ovaries from releasing an egg and thickening cervical mucus to block sperm from reaching the uterus.

The combination pill, also called "the pill," is most commonly prescribed and it contains synthetic versions of the hormones estrogen (ethinyl estradiol), which controls menstrual bleeding, and progesterone (progestin), which prevents pregnancy.

The progestin-only pill, sometimes called the "mini pill," contains only progestin. The FDA approved an over-the-counter version of this pill on July 13.

The continuous-use pill is a type of combination pill that includes more active pills per pack that could shorten your period, make it less frequent, or completely stop it. (Inactive pills, also known as placebo pills, don't contain hormones. These induce your period.)

(Delivering the first pill wasn't easy. Here's how it was designed.)

Most birth control pills contain the same type of estrogen. But there are several kinds of progestin used in pills that differ in terms of how they bind to active receptors on your cells, says Stephanie Teal, chair of the OB-GYN department at University Hospitals Cleveland Medical Center in Ohio.

This could explain why one type of pill may give you acne while another might clear it, Teal says.

Generic pills have the same active ingredients as brand name pills, which means they carry the same risks and benefits.

Besides preventing pregnancy, how might the pill help me?

All birth control pills can help make your periods lighter and less painful, and lower your risk of ectopic pregnancy, which occurs when a fertilized egg grows outside the uterus.

The combination pill specifically can make your period more regular, as well as prevent acne, bone thinning, cysts in your breasts, endometriosis symptoms, anemia, intense mood swings, and certain kinds of cancers (more on this later.)

(Endometriosis is common and incredibly painful—and often misdiagnosed.)

Synthetic hormones in the pills help balance natural hormonal fluctuations in your body that are responsible for many symptoms like acne and painful cramps.

Will the pill make me moody?

It depends, Hill says.

Mood changes are one of the most common side effects reported among pill takers, according to surveys. Depressive symptoms and increased risks of suicide, particularly among teens ages 15 to 19, are often associated with hormonal contraceptives.

It's believed that progestin stimulates receptors in the brain for the stress hormone cortisol, Hill says, which is why some people may feel anxious or depressed.

At the same time, other people may use the pill to treat premenstrual dysphoric disorder—severe irritability, depression, or anxiety in the weeks leading up to your period. This works by regulating your hormone levels.

That said, we all respond to hormonal changes differently, Hill says.

(Are your hormones unbalanced—and what does that even mean?)

Will I gain weight on the pill?

Studies have not found that the pill leads to significant weight gain. (The ring, patch, and intrauterine devices also aren't associated with weight gain.)

Studies of people who took the progestin-only pill found that they gained an average of about four pounds after six or 12 months on the medication, which was about the same as those using other birth control methods; researchers concluded that people may gain weight naturally over time regardless of contraceptive use.

It's tricky to blame the pill for weight gain because many factors like diet and stress can contribute.

"On the whole, we don't see a change in weight other than what we would expect somebody to gain just by aging," says Jennifer Kaiser, an OB-GYN and assistant professor of complex family planning at the University of Utah ASCENT Center for Reproductive Health. She adds that if you do experience weight gain, you can work with your doctor to adjust your dose or change birth control methods.

Does the pill increase my chances of developing blood clots?

About 1 in 3,000 women taking the pill will develop a blood clot, according to the National Blood Clot Alliance. Although this is one of the most significant risks associated with the pill, it's still extremely rare, experts say.

This risk applies to any birth control method involving estrogen because the hormone encourages the liver to produce more substances that can form clots, Kaiser says. This means progestin-only pills don't carry blood clot risks.

Meanwhile, pregnancy, which introduces a lot more estrogen in the body, carries a significantly higher clot risk, says Teal: People on the pill have about double the risk of getting a blood clot compared to those not on the pill. Pregnancy increases this risk 5- to 20-fold, Teal says, depending on their age, weight, and smoking status. In the first six weeks postpartum, it goes up 40- to 65-fold.

(Women's health concerns are dismissed more, studied less.)

That's what researchers call the relative risk, meaning the risk you get a clot while on the pill compared to your risk off of the pill. When it comes to absolute risk, which is the probability you actually develop a clot while on the pill, the odds are "incredibly low," Teal says.

Can the pill increase my risk of developing breast cancer?

Studies are conflicting, but some show that people who are currently using or recently used any hormonal birth control pill have about a 25 percent greater risk of developing breast cancer compared with non-users. Some data suggest this risk increases the longer you take the pill.

This risk declines when you stop taking it, and disappears completely after about 10 years.

Estrogen and progesterone stimulate the development and growth of some cancers. Because the pill contains synthetic versions of these hormones, it's assumed that it might fuel cancer growth in people who already have mutations in their breast tissue cells, says Heather Eliassen, professor of epidemiology at the Harvard T.H. Chan School of Public Health who studies breast cancer as director of the Nurses' Health Study II.

However, absolute risk is far lower, Eliassen says. That's because most people taking the pill are young and relatively healthy. As we age, breast cancer risk naturally increases.

People who have the BRCA1 and BRCA2 genes that increase their risk of breast cancer may be more likely to develop the disease while on the pill compared to those without the genes. But Kaiser thinks this magnified effect is "pretty minimal" when considering that these genes also increase risks for ovarian cancer, which the pill has been found to protect against. 

(Should you get tested for a BRCA gene mutation?)

Can the pill protect me from other cancers?

Yes. Research shows people who have ever used the pill have a 30 to 50 percent lower risk of ovarian cancer than those who have never used it.

Studies have also found that the pill can lower your risk of endometrial cancer by at least 30 percent and colorectal cancer by 15 to 20 percent, according to the National Cancer Institute.

Does the pill lower libido?

There's no solid evidence that suggests it does overall, but studies have found that anywhere between 5 percent and 48 percent of people on the pill report a drop in sexual desire.

This would make sense, Hill says, because the pill lowers testosterone levels, a hormone that promotes libido in women.

Is it safe to smoke cigarettes while on the pill?  

Smoking while on the pill can raise your risk for blood clots and high blood pressure—both of which are risk factors for heart attack and stroke—especially if you're age 35 or older.

Studies show that increased estrogen levels from the pill are associated with faster nicotine metabolism, which leads to greater dependence, cravings, and withdrawal symptoms.

Generally, if you smoke 15 or more cigarettes a day, don't use the pill or other birth control methods that involve estrogen like the patch and ring, according to Planned Parenthood. If you smoke or vape nicotine at all, talk with your doctor about what birth control method is safe for you.

It's safe to use progestin-only pills or other non-estrogen methods like the shot, implant, and IUD.

Can the pill make it harder for me to get pregnant?

No. You can get pregnant immediately after you stop taking the pill, no matter how long you've been on it.

In fact, you're highly likely to get pregnant the month after you get off the pill because your hormones experience a "rebound effect," Teal says, making you more fertile than usual. The pill may also protect you from pelvic inflammatory disease, an infection of the reproductive organs that can lead to infertility.

(What to know about freezing your eggs.)

However, fertility naturally declines with age, Kaiser warns. So if you started taking the pill at age 18 and you now want to get pregnant at 36, your baseline fertility is going to be different, Kaiser says, "not because of the pill but because you're older."

Should I be worried about long-term risks from the pill?

Absolutely not, Hill says. There's no evidence that the pill causes permanent changes in the body.

Side effects are normal, common, and temporary. About two to three months after starting the pill, your body will have adjusted to the hormonal changes and any uncomfortable symptoms should go away.

Am I better off not taking the pill?

Only you know what's best for you and your health at any given time. You may want to avoid certain types of pills if you've had conditions like uncontrolled hypertension, a blood-clotting disorder, severe diabetes, stroke, or lupus.

When it comes to health risks, however, there's no denying the fact that pregnancy is the most serious of them all, experts say. Pregnancy complications include depression, heart conditions, diabetes, anemia, infection, and death. Meanwhile, maternal mortality rates are rising in the U.S., standing at 32.9 deaths per 100,000 live births in 2021 compared to a rate of 23.8 in 2020, and 20.1 in 2019.

(This is one of the leading causes of maternal mortality. A new test could change that.)

"We talk a lot about risks with birth control because people feel like they're opting to take something that they don't necessarily have to," says Kristyn Brandi, an OB-GYN and complex family planning specialist who's the American College of Obstetricians and Gynecologists Darney-Landy Fellow.

"But at the same time," Brandi says, "being pregnant is always more dangerous than not being pregnant."

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