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Blood Clots (DVT & Pulmonary Embolism)

A clot in a deep vein, usually in the leg (DVT), that can break off and travel to the lungs (pulmonary embolism). Common, serious and often preventable — know the warning signs and your own risk.

Possible pulmonary embolism — call 911 right away. Sudden shortness of breath or trouble breathing, chest pain that is sharp or gets worse with a deep breath or a cough, coughing up blood, a fast or irregular heartbeat, or feeling lightheaded or fainting can mean a clot has reached the lungs (CDC, MedlinePlus). Go to the emergency room or call 911 (MedlinePlus); the CDC says to seek medical help immediately (CDC).

Possible deep vein thrombosis — get medical care the same day. Swelling, pain or tenderness, warmth, and redness or discoloration in one leg or arm can be signs of a DVT (CDC, MedlinePlus). See a doctor as soon as possible (CDC) or call your provider right away (NHLBI) — the American Society of Hematology says immediately (ASH). If you also develop chest pain, trouble breathing, coughing up blood or fainting, call 911 (MedlinePlus).

About half of people with a DVT have no symptoms, and a PE can happen without any warning signs in the leg (CDC, CDC). Don’t rub or massage a leg you think may have a clot, and don’t wait to see whether it gets better. No chiropractic, herbal or other complementary approach can treat a clot.

What are DVT and pulmonary embolism?

Deep vein thrombosis (DVT) is a blood clot in a deep vein, most often in the lower leg, thigh or pelvis. A pulmonary embolism (PE) happens when part of the clot breaks off and travels to the lungs, which can be life-threatening (CDC, NHLBI). Together they are called venous thromboembolism (VTE) (NHLBI). A DVT can also form in an arm (CDC).

How common is it?

  • Up to 900,000 people in the U.S. are affected by VTE each year, and an estimated 60,000–100,000 Americans die of it each year (CDC).
  • Sudden death is the first symptom in about one in four people who have a PE (CDC).
  • About one in three people with a VTE will have another one within 10 years (CDC, NHLBI).
  • More than a third of cases are related to a recent hospital stay, and as many as 70% of health care–associated clots are preventable — yet fewer than half of hospital patients receive preventive measures (CDC).

Who is at risk?

How it is diagnosed

For a suspected DVT, duplex ultrasound of the vein is the standard imaging test. A D-dimer blood test helps too: a negative result means a clot is unlikely. For a suspected PE, CT pulmonary angiography (a CT scan with contrast dye) is the standard test; a ventilation-perfusion (V/Q) scan is used when CT isn’t available, and MRI is usually reserved for certain patients, such as pregnant women (CDC, NHLBI).

Complications

  • Post-thrombotic syndrome (PTS): one third to one half of people who have had a DVT develop long-term problems (CDC), mainly pain and swelling in the leg that can come and go (MedlinePlus). PTS can be long-lasting and disabling, often feels worse after standing for a long time, and in serious cases can cause skin sores (NHLBI). Other possible complications of DVT include varicose veins and skin color changes (MedlinePlus).
  • After a PE, it can take a year or more for clots to break up and blood flow to return to normal. After several months of treatment, some people are referred to a surgeon to discuss removing clots that remain in the lungs (NHLBI).

Clots in arteries are different

A DVT does not cause a heart attack or stroke. A clot in an artery, usually in the heart or brain, is called arterial thrombosis, and it can cause a heart attack or stroke (CDC). Arterial clots are usually tied to the build-up of plaque in the arteries (atherosclerosis) (ASH). A separate MBHA guide to stroke is on the way.

Call 911 right away for signs of a stroke — sudden numbness or weakness of the face, arm or leg (especially on one side), sudden confusion or trouble speaking, sudden trouble seeing or walking, or a sudden severe headache with no known cause (CDC) — or of a heart attack: chest pain or discomfort, shortness of breath, feeling weak or faint, or pain in the jaw, neck, back, arms or shoulders (CDC).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Blood thinners (anticoagulants) — heparin injections, warfarin, or direct oral anticoagulants such as apixaban and rivaroxaban — usually for at least 3 months. Clot-busting drugs, clot removal or a vein filter in selected cases, and a prevention plan in hospital and after surgery. Medicare’s negotiated price for a 30-day supply (from January 1, 2026): Eliquis $231, Xarelto $197. Medicare Part D out-of-pocket costs are capped at $2,100 in 2026. Warfarin and INR testing: cost estimate being researched. Treatment works to stop the clot from growing and prevent new ones while the body slowly breaks it down, which can take a year or more. The main risk is bleeding; never stop a blood thinner without talking to your prescriber.
Chiropractic No role in treating or preventing blood clots. A leg or arm with a suspected or known clot should not be manipulated or massaged — get it checked by a doctor. Not a treatment for blood clots, so no cost is listed. Tell any chiropractor you take a blood thinner. Neck manipulation has been linked to rare tears in neck arteries that can cause a stroke — a separate concern you should be told about beforehand.
Acupuncture No role in treating blood clots. If you take a blood thinner and want acupuncture for another reason, tell the acupuncturist first. Not a treatment for blood clots, so no cost is listed. Studies of people on anticoagulants mostly found minor bleeding such as a spot of blood at a needle site, but one large study found warfarin, DOACs and heparin raised the risk of bleeding after acupuncture.
Herbal medicine No herb or supplement treats a clot. The real issue is safety: many supplements interact with blood thinners. Not a treatment for blood clots, so no cost is listed. Ginkgo, garlic and turmeric may add to bleeding risk; St. John’s wort can weaken warfarin and interact with apixaban and rivaroxaban; vitamin K changes how warfarin works; check fish oil too. Show every product to your pharmacist.
Massage therapy Never massage a leg or arm with a suspected or known DVT. Not a treatment for clots. Not a treatment for blood clots, so no cost is listed. Leg massage can dislodge a clot and send it to the lungs. Once a clot is treated, ask your doctor before any massage, and tell the therapist about blood thinners.
MBHA Wellness Coach Moving during long travel and after surgery, staying hydrated, quitting smoking, a healthy weight, knowing your personal and family risk, taking blood thinners exactly as prescribed, and bleeding and fall safety. Cost estimate being researched. Quitlines (1-800-QUIT-NOW) are free. Supports — never replaces — your doctors. Many clots are preventable, and good habits on a blood thinner lower the risk of bleeding and of another clot.

Approach 1 of 6

Conventional medicine (AMA)

Blood clots are treated by doctors, often starting in the emergency room or hospital. The goals are to stop the clot from growing, prevent it from traveling to the lungs, and lower the chance of another clot (ASH, NHLBI).

1. Blood thinners (anticoagulants)

2. Bleeding: the main side effect

Bleeding is the most common side effect of blood thinners, and the risk is higher if you also take medicines such as aspirin (NHLBI, MedlinePlus). Warfarin can cause serious bleeding that can lead to death (MedlinePlus). Warning signs include:

Call your provider right away about any of these, and after a serious fall or a bump to the head (MedlinePlus, MedlinePlus). Go to the emergency room for signs of excessive bleeding (NHLBI).

3. If you take warfarin: INR tests and vitamin K

4. Other treatments

  • Clot-busting drugs (thrombolytics) are given through an IV for large clots that cause severe symptoms. Because they can cause sudden bleeding, they are used only for serious, life-threatening clots (NHLBI, CDC).
  • Catheter procedures use a thin tube to reach a clot in the lung or leg and break it up or deliver medicine to it (NHLBI); in rare cases surgery to remove the clot is needed (CDC).
  • A vena cava filter may be placed for people who can’t take blood thinners. It catches clots before they reach the lungs but doesn’t stop new clots from forming (NHLBI).

5. Compression stockings: what the evidence says

  • For symptoms after a DVT: your provider may prescribe compression stockings, which may help relieve the pain and swelling of post-thrombotic syndrome (NHLBI, Cleveland Clinic).
  • For preventing PTS: the evidence is mixed. MedlinePlus says stockings may help prevent long-term problems (MedlinePlus), but in the SOX trial of 806 people after a first “proximal” DVT (in the deep veins above the calf), wearing real stockings for 2 years did not prevent PTS compared with placebo stockings (14.2% vs 12.7%), and the researchers said the results don’t support routine use for that purpose (SOX trial, Lancet, 2014).
  • For long flights: a Cochrane review of 12 trials found high-certainty evidence that passengers on long flights (all over five hours) had far fewer symptomless clots when they wore graduated compression stockings; no symptomatic clots or PEs occurred in the trials, so that effect couldn’t be measured (Cochrane review, 2021). The CDC says some travelers may benefit and to ask your doctor (CDC).

6. Prevention in hospital and after surgery

If you have risk factors, ask before any procedure about a plan to prevent clots. It may include getting up as soon as possible after surgery, foot and calf exercises if you can’t walk yet, compression stockings or sleeves and boots that inflate with air, and blood thinners before surgery or during recovery at home — often in combination. The same steps can apply to hospital stays that don’t involve surgery (NHLBI). This matters: fewer than half of hospital patients receive these measures (CDC).

What it costs

  • Apixaban (Eliquis) and rivaroxaban (Xarelto): under Medicare drug-price negotiation, from January 1, 2026 the negotiated price for a 30-day supply is $231 for Eliquis (2023 list price $521, a 56% discount) and $197 for Xarelto (2023 list price $517, a 62% discount) (CMS fact sheet). These are the prices Medicare negotiated with the drug makers, not your copay; what you pay depends on your plan.
  • Medicare Part D out-of-pocket costs for covered drugs are capped at $2,100 in 2026; after that you pay nothing more for covered Part D drugs that year. Extra Help is available for people with limited income (Medicare.gov).
  • Home INR testing: Medicare covers home PT/INR monitoring for people taking warfarin for a DVT or PE, when a doctor prescribes it, after at least 3 months on warfarin and a face-to-face training program, with self-testing no more than once a week (CMS national coverage decision 190.11).
  • Warfarin, clinic INR tests and hospital care: cost estimate being researched.

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Approach 2 of 6

Chiropractic

Chiropractic care does not treat, dissolve or prevent blood clots, and we found no research suggesting it does. The important questions are about safety.

A leg or arm that might have a clot

Swelling, pain, warmth or redness in one leg or arm needs a medical check the same day (CDC), not an adjustment. As a precaution, MBHA suggests that no one manipulate, press on or massage a limb with a suspected or known DVT: in a published case, a leg massage dislodged an unrecognized clot and caused a life-threatening PE, and the authors concluded that leg massage should be avoided in people with DVT (case report, BMC Pregnancy and Childbirth, 2020).

If you take a blood thinner

Tell your chiropractor about every condition you have and every medicine you take, including blood thinners. Serious side effects of spinal manipulation are rare, but they may be more likely in people with underlying health problems (NCCIH). Blood thinners make bleeding and bruising more likely (MedlinePlus), so ask whether gentler techniques are an option and check with your prescriber if you’re unsure.

Neck manipulation and artery tears (a separate concern)

Manipulation of the neck has been linked to rare tears in neck arteries that can lead to a stroke. Experts disagree about whether manipulation causes them, but patients should be told about this possible risk (NCCIH). This is a clot problem in an artery, not a DVT. Sudden weakness or numbness on one side, trouble speaking or seeing, or a sudden severe headache means call 911 (CDC).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture does not treat or prevent blood clots, and it is never a substitute for emergency or medical care. Some people on blood thinners use it for other problems, so bleeding is the question.

Acupuncture and blood thinners

  • A 2015 review of 11 studies (384 people on anticoagulants, 3,974 treatments) found one moderate bleeding event, plus spot bleeding at needle sites of the kind seen with any needle, and concluded acupuncture appears safe in these patients when needles are placed at an appropriate location and depth (review, Permanente Journal, 2015).
  • A larger 2023 study of insurance records in Taiwan found that warfarin, DOACs and heparin each raised the risk of bleeding after acupuncture, though major bleeding was rare overall (about 4 per 100,000 needles), and urged practitioners to ask about medicines first (study, Complementary Therapies in Medicine, 2023).

Staying safe

Tell your acupuncturist that you take a blood thinner, and tell your doctors about any complementary approach you use (NCCIH). Acupuncture needles must be sterile and single-use (NCCIH). As a precaution, MBHA suggests avoiding needling in a leg or arm with a suspected or recent clot until your doctor says otherwise.

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Approach 4 of 6

Herbal medicine

We found no reliable evidence that any herb or supplement dissolves or treats a blood clot; clots are treated with prescribed medicines (CDC). Because almost everyone with a clot takes a blood thinner for months or longer, the real issue with supplements is safety: some add to bleeding risk and others make the medicine work less well.

Supplements that may raise bleeding risk

Supplements that may weaken or change your blood thinner

Before you take any supplement, herbal tea or vitamin, show it to your pharmacist or the doctor who prescribed your blood thinner (MedlinePlus, MedlinePlus). Never stop or change a blood thinner to make room for a supplement. We don’t list doses.

Approach 5 of 6

Massage therapy

Massage does not treat blood clots, and a leg with a clot is one place it can do real harm.

Don’t massage a leg or arm with a suspected or known DVT. In a published case, a pregnant woman with an unrecognized DVT collapsed with a massive pulmonary embolism shortly after a leg and foot massage. The authors concluded that leg massage in people with DVT can dislodge clots and cause a life-threatening PE, and should not be done (case report, BMC Pregnancy and Childbirth, 2020). NCCIH also lists a blood clot among the rare serious problems reported with massage, some of them involving vigorous or deep-tissue work (NCCIH).

Staying safe

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Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you build the habits that lower the chance of a clot, or of another one — alongside, never instead of, your doctors. Blood clots are preventable and treatable if found early (CDC).

Know your risk

A family history of blood clots, a hospital stay, pregnancy and cancer treatment all raise your chance of a clot (CDC), as do a previous clot, an inherited clotting disorder, and estrogen-containing birth control or hormone therapy (CDC). If your risk is high, ask about birth control that doesn’t contain estrogen (NHLBI). A coach can help you write down your history and questions before appointments, surgery or pregnancy.

Long trips

After surgery or illness

Get up and move as soon as your care team says you can; if you can’t walk yet, flex and stretch your feet to help blood flow in your calves (NHLBI). After a clot, keep moving regularly while you heal and ask your provider how much activity is right for you (NHLBI).

Smoking and weight

Smoking increases the risk of blood clots (MedlinePlus). Free, confidential coaching is available at 1-800-QUIT-NOW, and using counseling and medicine together gives you the best chance of quitting for good (CDC). Overweight and obesity also raise the risk (CDC); a coach can help with steady, realistic changes to eating and activity.

Living well on a blood thinner

Make sure the people close to you know the warning signs of a PE and DVT at the top of this page, and to call 911 for a possible PE.

Member stories

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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