Deep vein thrombosis (DVT)

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1 Deep vein thrombosis (DVT) Information for patients What is deep vein thrombosis? A deep vein thrombosis (DVT) is a blood clot which forms in a deep vein, usually in the leg, but can occur else where in the body. Deep veins are large blood vessels which return blood to the heart. These veins lay deep within the body and cannot be seen. What causes a deep vein thrombosis? There are many risk factors which increase the likelihood of a person developing a blood clot. Some of these factors are: reduced mobility, old age, surgery, damage to the blood vessel, the contraceptive pill or hormone replacement therapy (HRT), pregnancy, dehydration, obesity, ill health, conditions which cause the blood to clot more easily than normal, long journeys, and people with cancer. However some blood clots occur for no apparent reason. If there is no obvious reason why your blood clot has occurred, further investigations maybe arranged. This can include blood tests and scans. What are the symptoms of a deep vein thrombosis? These will vary according to the size and position of the clot. Not everybody experiences all of these symptoms. Usually you will experience some pain, swelling, and discolouration of the area and sometimes it can be hot and sore to touch. Further advice on how to manage these symptoms can be found further on in this leaflet. What tests will I have in hospital? Blood tests - you will have blood taken from a vein in your arm, this maybe a routine blood test or to monitor you whilst taking medication to treat your DVT. Doppler ultrasound - this gives the radiologist a picture of the veins and the sound of the blood flowing in them, thus showing whether or not a clot is there. This process takes about 15 minutes. Chest x-ray - occasionally part of the clot can dislodge and travel in the blood stream to the lungs (this is known as a pulmonary embolism). Although the chest x-ray does not diagnose this it can help the doctor to decide if there is any other condition present (such as infection) and if any other test is needed (usually a scan).

2 Once diagnosed, what is the treatment of a DVT? Your body will naturally break down the blood clot, but in order to do so safely, you will need to take anticoagulant medication. Anticoagulant medication will prevent the clot from getting bigger or moving, or new clots from forming. Anticoagulation may be given in the form of warfarin tablets, heparin injections, a combination of the two, or one of the newer oral anticoagulants, for example, rivaroxaban or apixaban. Warfarin tablets come in three different colours and doses: - 1mg: brown tablets - 3mg: blue tablets - 5mg: pink tablets. When taking warfarin, you will have regular blood tests to monitor your INR (international normalised ratio). This is a measure of how long it takes for your blood to clot. The dose of warfarin will differ according to your INR. Your specialist will inform you what to take, and when, according to the blood test. Heparin injections are given according to your weight and kidney function. Heparin is usually given once daily (occasionally twice daily) into the skin of the abdomen. You may be taught how to administer it yourself or a nurse may administer it for you. You will also require a blood test on day five and day 10 of treatment. New oral anticoagulants (also known as direct oral anticoagulants) have the advantage of not requiring frequent blood tests to monitor the INR. However they are not suitable for everyone and your specialist will advise you on the best treatment for you. Rivaroxaban is an oral anticoagulant, and if taken from when blood clot is diagnosed, it is taken 15mg twice daily for 21 days and then 20mg once daily thereafter. The dose usually does not change and there is no need for blood tests to monitor its effect but your kidney and liver tests will need to be checked before and during treatment with this drug. Apixaban is an oral anticoagulant, and if taken from when blood clot is diagnosed, it is taken 10mg twice daily for seven days and then 5mg twice daily thereafter. Like with rivaroxaban the dose usually does not change and there is no need for blood tests to monitor its effect but your kidney and liver tests will need to be checked before and during treatment with this drug. Dabigatran and Edoxaban are also licensed for the treatment of deep vein thrombosis and your specialist will advise you if one of these drugs would be better for you. 2 Deep vein thrombosis (DVT), October 2016

3 What are the side effects of anticoagulants? All anticoagulants increase your risk of bleeding as they reduce the blood s ability to clot. Be extra careful when cutting nails, shaving, or using sharp implements. If you do experience any bleeding please apply pressure on the affected area and seek medical advice from your GP or specialist if it does not stop. If you notice blood in your stools or urine or you start to suffer with gastric disturbances please seek medical advice from your GP or specialist. If you fall or injure yourself severely please call 999. There are some medications, such as aspirin, which often should not be taken with anticoagulants. Your specialist will advise you on this. Some herbal medications and food types also interact with certain anticoagulants. Your specialist will advise you on this. You should inform any doctor or nurse when they are prescribing you new medication that you are taking warfarin, so that they can review for any potential interactions. You should also advise your dentist if you are taking anticoagulants. What will happen if I do not want to take anticoagulants? You are strongly advised to take the anticoagulants. If untreated, a DVT can break off and the clot can travel to the lungs where it causes a pulmonary embolism (PE), which can be fatal. Most people who have a DVT and take anticoagulants usually recover without complications. Do I need to stay in hospital? Not usually. If you are relatively well with your DVT, you are most likely to be treated as an outpatient on the ambulatory care pathway. How long will I be on the anticoagulants? You will need anticoagulant medication for at least six weeks to three months. You will be referred to the anticoagulant clinic at your nearest hospital who will arrange to see you as an outpatient and decide the length of your treatment. Treatment length depends on the size, location, and cause of your blood clot. If taking warfarin, once your INR becomes therapeutic (has reached the desired level), you will be referred to the anticoagulant clinic as an outpatient. This usually occurs between five and seven days after commencing warfarin. The anticoagulant clinic staff will continue to monitor your INR and warfarin. Once your INR is stable (remains at an acceptable level), you will be referred to an anticoagulant clinic closer to home. Your first appointment with the clinic will be arranged by the DVT clinic and you will be informed of when to attend. If you are on an alternative treatment to warfarin, you will be referred to the anticoagulant outpatients early on in your treatment. The clinic will contact you by phone or by post and arrange an appointment. 3 Deep vein thrombosis (DVT), October 2016

4 What can I do to help recovery? Try and stay mobile and walk normally as much as you can. Try not to walk on tip toe, as this may cause you to develop a still knee joint and cause more problems later on. If you are having any problems please let us know. If you experience pain and swelling for more than two weeks after starting treatment, wearing support hosiery may help. Your GP may be asked to assess and prescribe British Grade 3/ European Grade 2 (25 to 35 mmhg) below the knee compression stockings, to be worn during the day for two years (not at night). Listen to your body. If you do anything that makes you feel breathless or increases pain, stop. Take painkillers which have been prescribed for you. Avoid over the counter pills unless discussed with your specialist. Until the DVT starts to improve, you may experience some discomfort. Stay mobile, mobilise as your pain allows. But when sitting, keep your legs elevated. Ideally above the level of your hips, unless told otherwise by your specialist. This will help with blood flow and reduces the level of leg swelling. Look after yourself. Eat a healthy diet and drink plenty of fluid. Your mobility may be restricted initially due to pain and breathlessness and this will increase your risk of constipation. When attending your appointment please bring a list of your medications with you. You may also be asked to discuss your medical history. It is important that this information is shared with the doctor or nurse who is seeing you so we can safely treat and manage your diagnosis. All information is kept private and confidential. Useful contact numbers Ambulatory Care Clinic, Kent and Canterbury Hospital, Canterbury Telephone: Ambulatory Care Clinic, Queen Elizabeth the Queen Mother Hospital, Margate Telephone: Ambulatory Care Clinic, William Harvey Hospital, Ashford Telephone: Deep vein thrombosis (DVT), October 2016

5 Any complaints, comments, concerns, or compliments If you have other concerns please talk to your doctor or nurse. Alternatively please contact our Patient Advice and Liaison Service (PALS) on or , or Further patient information leaflets In addition to this leaflet, East Kent Hospitals has a wide range of other patient information leaflets covering conditions, services, and clinical procedures carried out by the Trust. For a full listing please go to or contact a member of staff. After reading this information, do you have any further questions or comments? If so, please list below and bring to the attention of your nurse or consultant. Would you like the information in this leaflet in another format or language? We value equality of access to our information and services and are therefore happy to provide the information in this leaflet in Braille, large print, or audio - upon request. If you would like a copy of this document in your language, please contact the ward or department responsible for your care. Pacjenci chcący uzyskać kopię tego dokumentu w swoim języku ojczystym powinni skontaktować się z oddziałem lub działem odpowiedzialnym za opiekę nad nimi. Ak by ste chceli kópiu tohto dokumentu vo vašom jazyku, prosím skontaktujte nemocničné pracovisko, alebo oddelenie zodpovedné za starostlivosť o vás. Pokud byste měli zájem o kopii tohoto dokumentu ve svém jazyce, kontaktujte prosím oddělení odpovídající za Vaši péči. Чтобы получить копию этого документа на вашем родном языке, пожалуйста обратитесь в отделение, ответственное за ваше лечение. We have allocated parking spaces for disabled people, automatic doors, induction loops, and can provide interpretation. For assistance, please contact a member of staff. This information has been produced with and for patients Information produced by Chiara Hendry (VTE Prevention Sister) and Dr Gillian Evans (Trust Thrombosis Lead) Date reviewed: October 2016 Next review date: February 2019 EKH049