Updated:
by
Caroly Guillen Aguirre, MD
Medically reviewed by Caroly Guillen Aguirre, MD
A hickey is proof that someone likes you, maybe a little too enthusiastically, but it is not a medical emergency. It is a bruise, plain and simple, and it almost never poses a health risk.
Still, the question is fair. A bruise and a blood clot both involve blood collecting where it does not belong, and a few sensationalized news stories have linked hickeys to strokes.
In this blog, we’ll outline what really happened in those sensationalized cases, why these types of clots are so rare, when trapped blood genuinely warrants concern, and what to do if deep vein thrombosis is suspected.
Strong, sustained suction against the skin ruptures the tiny blood vessels, called capillaries, just beneath the surface. Blood leaks out and pools in the surrounding tissue, creating the familiar red or purple mark. Cleveland Clinic calls this ecchymosis, the same process behind any ordinary bruise from a bump or fall.
As your body reabsorbs the blood, the mark shifts toward green, yellow, or brown before fading, usually within about two weeks. On deeper skin tones, it may look dark brown or nearly black with less obvious color change along the way. That progression is normal healing, not a warning sign of a health problem.
Here is the key distinction. The blood in a hickey has already left the blood vessel. It is sitting in the tissue under your skin, where your body treats it as debris to be cleaned up. A blood clot, by contrast, forms inside a blood vessel, where it can block blood flow. Those are two very different situations, and the difference is what makes hickeys so much less concerning than sensational headlines would suggest.
The fear traces back to a very small number of case reports, all involving intense suction over the carotid artery in the neck.
The one well-documented case appeared in the New Zealand Medical Journal in 2010. A 44-year-old woman developed weakness in her left arm several days after a love bite left a small bruise on her neck. Imaging found a partially obstructing clot in her right internal carotid artery. She was treated with blood thinners, recovered during her hospital stay, and had no lasting neurological problems.
Two details rarely survive the retelling. The authors called this an uncommon mode of blunt trauma, not a typical outcome, and blunt carotid injury appears in roughly one percent of blunt trauma patients, usually after car crashes. The patient also had lupus managed with steroids and methotrexate and was a smoker, both of which independently affect blood vessels and clotting.
The other case people cite is a 2016 report of a 17-year-old in Mexico who reportedly died of a stroke caused by a hickey. That account never appeared in medical literature, no autopsy findings were published, and fact-checkers traced the coverage to a single unreliable source. Physicians questioned the mechanism, noting the carotid artery sits deep in the neck beneath muscle.
That is essentially the entire body of evidence: one verified case, and one widely repeated story that was never confirmed.
Arteries carry oxygen-rich blood away from the heart. Veins carry blood back toward it. The rare hickey case involved an artery, a completely different mechanism from the venous blood clots that vein specialists diagnose and treat every day.
The venous clot that matters most is deep vein thrombosis, or DVT, which forms inside one of the deep veins of the body, most often in the leg. A hickey has no plausible connection to DVT. Suction affects capillaries at the skin surface, not the large, deep veins where dangerous clots develop. There are no reported cases in the medical literature of a hickey causing a DVT, and no known mechanism by which one could.
According to the Centers for Disease Control (CDC), venous thromboembolism affects up to 900,000 Americans every year, and an estimated 60,000 to 100,000 people die from it annually. When part of a deep vein clot breaks loose and travels to the lungs, it causes a pulmonary embolism (PE). In about one in four of those cases, sudden death is the first symptom. Among people who survive DVT, about half develop lasting swelling, aching, or skin changes in the affected limb.
According to Johns Hopkins Medicine, the most significant risk factors for DVT include:
DVT symptoms usually affect one side only, appear without an obvious cause, and do not improve with rest or stretching:
About half of DVTs cause no symptoms at all, and those that do overlap with muscle strain, a Baker's cyst, and cellulitis. A home assessment can tell you whether to be concerned, but only professional imaging can tell you whether there is a clot.
Suspected blood clots are time-sensitive, but not every case belongs in an emergency room. Here is how to sort it out.
Step 1: Rule out an emergency first
Call 911 or go to the nearest emergency department if you have any of the following, which can signal a pulmonary embolism:
Also seek emergency care for sudden weakness or numbness on one side of the body, trouble speaking, vision changes, or a severe headache. Those are stroke symptoms and require immediate evaluation regardless of cause.
Step 2: If symptoms are limited to a limb, get imaging within hours
Leg or arm swelling, pain, warmth, or discoloration without the emergency signs above still needs prompt evaluation. A clot that is treated early is far less likely to travel or to cause lasting damage. Waiting for a routine appointment next week is dangerous.
While you are waiting to be seen, skip the deep-tissue massage, the hot soak, and the wait-and-see approach. Get the scan.
Step 3: Call CVR’s DVT hotline
Center for Vein Restoration (CVR) offers a DVT rule-out service that provides high-priority, non-invasive DVT testing as an alternative to hospital ERs. Call the DVT hotline at 877-SCAN-DVT (877-722-6388).
A CVR vein specialist reviews your symptoms, risk factors, and medical history, then performs a duplex ultrasound, a painless, noninvasive scan that shows how blood moves through your veins. It is the standard test for diagnosing DVT and can rule a clot in or out the same day. A D-dimer blood test, which detects proteins released as a clot breaks down, is sometimes used alongside it.
Step 5: If a clot is found, treatment can start there
CVR’s one-stop management approach includes the scan plus treatment with anticoagulation, education, and follow-up care if needed. Anticoagulants do not dissolve an existing clot. They stop it from growing and give your body time to break it down while lowering the risk that a piece travels to the lungs. How long you stay on them depends on what caused the clot, where it is, and your own risk profile, which is a conversation to have with your physician.
Most DVT risk factors are not things you choose, but several respond to simple habits. The CDC notes that anyone traveling more than four hours by air, car, bus, or train has some elevated risk, though for most people the absolute risk stays small.
Most DVT risk factors are circumstances, not choices, but vein disease is different. Damaged valves let blood pool in your legs instead of moving efficiently back toward the heart, and that sluggish flow is one of the conditions that makes clots more likely to form.
That makes a vein evaluation at Center for Vein Restoration one of the few genuinely preventive steps available to you.
Q: Can a hickey cause a blood clot or stroke?
A: In everyday circumstances, no. One documented case worldwide has linked forceful suction over the carotid artery to a clot and a minor stroke, in a patient who also had lupus and smoked. A second widely shared case was never verified. Physicians consider hickeys, as a category, essentially harmless.
Q: Is a hickey the same thing as a blood clot?
A: No. A hickey is a bruise, meaning blood that has leaked out of broken capillaries into the surrounding tissue. A dangerous blood clot forms inside a blood vessel, where it can block flow.
Q: Can a hickey cause deep vein thrombosis (DVT)?
A: There are no reported cases in the medical literature of a hickey causing DVT and no known mechanism by which one could. DVT forms in the large, deep veins, usually in the legs, from causes like immobility, surgery, pregnancy, or inherited clotting disorders.
Q: How long should a hickey take to heal?
A: Most fade within about two weeks as the body reabsorbs the pooled blood, shifting from red or purple toward green, yellow, or brown. A bruise that shows no improvement after two weeks, or unexplained bruising elsewhere on your body, is worth discussing with a doctor.
Q: What are the warning signs of a real blood clot?
A: For DVT, watch for swelling, deep aching, warmth, or discoloration in one leg or arm, especially when it appears without an obvious cause. Sudden shortness of breath, chest pain when breathing in, a rapid pulse, or coughing up blood can signal a pulmonary embolism and require emergency care.
Q: Do I have to go to the emergency room for a suspected DVT?
A: Not always. If your symptoms are limited to a swollen, painful, warm, or discolored limb with no breathing or chest symptoms, a DVT rule-out appointment can give you the same imaging without an ER wait. Call 877-SCAN-DVT (877-722-6388) to schedule this. If you have any sign of a pulmonary embolism, go to the ER or call 911.
Q: How quickly can a DVT be diagnosed?
A: A duplex ultrasound is quick and painless, and results are usually available the same day. That is the point of a rule-out service: an answer in hours rather than days.
Q: Can a blood clot go away on its own?
A: The body can break down some clots over time, but there is no reliable way to know which ones will resolve safely and which will grow or travel. That is a decision that requires imaging and a physician, not waiting.
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