Checklist for Blood Clot Risk Factors

Listed below are some of the most common risk factors for blood clots.
Put a check in the box next to any risk factors that might apply to you.

Hospitalization for illness or surgery
Major surgery, particularly of the pelvis, abdomen, hip, knee
Severe physical trauma, such as a car accident
Injury to a vein that may have been caused by a broken bone or severe muscle injury
Hip or knee replacement surgery
Cancer and cancer treatments
Use of birth control methods that contain estrogen, such as the pill, patch or ring
Pregnancy and up to 3 months after the baby is born
The use of hormone therapy with estrogen
Personal or family history of blood clots
Overweight
Confinement to bed or a wheelchair
Sitting too long, especially with legs crossed
Smoking
Age 55 or older
Long-term diseases such as heart and lung conditions, or diabetes

If any of these risks apply to you, speak with your cancer doctor or healthcare team.
To learn more about blood clots, visit www.stoptheclot.org/spreadtheword.