Deep Vein Thrombosis (DVT)

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1 Patient Information Service Bristol Royal Infirmary Deep Vein Thrombosis (DVT) Thrombosis Clinic Respecting everyone Embracing change Recognising success Working together Our hospitals.

2 This leaflet is about a condition known as Deep Vein Thrombosis (DVT). The information will explain the treatment that you will receive and how you can help the success of this treatment. Any words that you are unsure of should be explained in the glossary at the end. If, after reading the leaflet, you are unsure of anything relating to the condition or your care, please contact the thrombosis nurses on who will be pleased to help. Patient plan What will happen to you and the support you will receive? You may be referred to the BRI Thrombosis Clinic by your GP, NHS Walk-in-Centre or the Hospital Emergency Department. You will be referred because the doctor that you have seen is concerned that you may have had a Deep Vein Thrombosis (see below). You will be assessed by a specialist thrombosis nurse. A blood test and/or duplex scan will be carried out. If your results are negative you will be discharged back to the care of your GP. If your scan shows that you do have a Deep Vein Thrombosis you will probably be started on blood thinning treatment (an anticoagulant) and will have to attend the Thrombosis Clinic again. The frequency of visits will depend on what treatment is agreed upon. 2

3 You will be offered an option of Anticoagulant treatments. Warfarin (initially with daily Low Molecular Weight Heparin injections), Rivaroxaban or Low Molecular Weight Heparin only. What is Deep Vein Thrombosis? DVT is a blood clot which has formed in a deep vein. Clotting is the body s natural reaction to injury to prevent bleeding. This is why clots sometimes happen after operations - the body thinks it has had an injury. The veins become rough on the inside with age or disease and the blood forms clots around this rough area. Occasionally pieces break off and this clot may move up the veins causing pulmonary emboli (clots in the lung). Why are you on this medication and how does it help? You will need to take medication which helps prevent the body from developing more blood clots, or stops existing clots from growing any larger. It is sometimes referred to as blood thinner and the technical term for it is an anticoagulant. 3

4 4 What drugs are you likely to receive? The choice of treatment will be based on a number of things including: other health problems, other medicines that you are taking regularly. This will be discussed with you to help you decide on the best treatment to suit you. Warfarin comes in the form of tablets which are colour-coded according to their strength: 1mg brown, 3mg blue, 5mg pink (some people have 0.5mg white tablets, these should not be mistaken for 5mg tablets). Each person can respond differently to this medication. A blood test called an INR is needed to find out how much warfarin you need to take and it is likely that the dosage will need to be changed on occasion to suit your own needs. If your dosage does change it is not an indication that your condition is better or worse. Warfarin takes a few days to get into your system and so at the beginning you will need to have daily injections of a drug called Low Molecular Weight Heparin, these last for at least five days and may be needed for up to 10 days. You will need to be seen daily for INR blood tests and the injections. Once you are stable on the Warfarin you will still need to have blood tests but not every day. Some people have them once every month, others a bit more frequently this will either be done through the BRI Warfarin Clinic or through your GP. In both cases the blood tests will be done at your doctor s surgery. Low Molecular Weight Heparin injection will be given once a day as a small injection under the skin. Treatment may continue to be given whilst you are being stabilised on Warfarin and will be for a minimum of five days.

5 For some people, it is best for them to have daily injections of Low Molecular Weight Heparin and no other medication. If this is the case, it may be that you or your relative/carer can give the injections. Rivaroxaban comes in the form of tablets. The tablet will be taken twice a day for the first 21 days, and then the dose will be reduced to once a day. You do not need to have injections at the beginning and you will not have regular blood tests. This is a new treatment which offers some advantages over Warfarin as it does not need to be monitored with regular blood tests and there are few interactions with other drugs. The disadvantage is there is less experience with people taking it for long periods of time. How long will I need to be on treatment? This will depend on the type of clot that you have had and also on whether there was anything that caused it. The shortest time will be six weeks and some people need long term (lifelong) treatment. 5

6 What should you remember whilst being treated? If you take your medication as instructed it is unlikely that you will have any problems. However, you can give your treatment the best chance of success by following these guidelines: Tell your healthcare team of all other medicines you may be taking and if they change. If you seek any other treatment, e.g. from another doctor, dentist or pharmacist, tell them you are taking an anticoagulant. Do not take any new medicines without checking with your healthcare team first. Be careful when involved in activities which could cause you to bruise or cut yourself (e.g. contact sports). Do not change your diet radically. Tell your healthcare team if you are pregnant or planning to become pregnant. Keep all medicines in their original containers and safely out of the reach of children. Always carry your Anticoagulant alert card with you in case of emergency. 6

7 If taking Warfarin Take your medication and go for your blood tests exactly as instructed. Limit alcohol consumption to no more than one or two drinks a day. NEVER go on a binge! Do not change your diet radically. Try to take your medicine at the same time each day teatime or in the evening is often a good time. Remember to inform your Healthcare team if you think you have taken too much medication or missed a dose. What to do if you cut yourself Apply a clean cloth and press on the wound for at least five minutes. If the bleeding does not stop, contact your GP or healthcare team immediately. 7

8 Problems you may encounter The main side effect you may notice is bleeding, although there is only a small risk of this when your condition is well controlled. Once again, if you take your medicine as recommended, it is unlikely that you will have any problems. Please contact the hospital or your GP immediately if you: sustain any injury, especially to the head, eyes or joints. bleed excessively after a cut, or bleed from the nose or gums. get abnormally heavy menstrual bleeding during your period. notice any unexplained bruising, especially black or brown spots on the skin if you have not received an injury. see excessive bruising or redness around an injection site. vomit or cough up blood or material which looks like coffee grounds. pass unexplained red-coloured urine or produce dark brown/ black stools. experience any major changes to your general state of health e.g. vomiting, diarrhoea, fever. suffer chest pain or shortness of breath. 8

9 After care After a DVT your leg may continue to be swollen and tender to touch. It may also swell from time to time. This is to be expected. To help the veins to recover it is important to look after your legs following a DVT. It is advised that you: wear support tights. avoid standing for long periods. put your feet up when sitting down. take PLENTY of exercise - up to pain threshold. keep the skin on your legs supple - if they become dry use a moisturising cream. take paracetamol or co-codamol for pain relief. Travel advice Long distance travel Do not take excessive alcohol or sleeping tablets. Wear compression stockings. Flex your ankles regularly. Seek advice if flying within two to four weeks of a new DVT/ PE. Some patients with a history of DVT (or PE) and additional risk factors for recurrence of thrombosis may be prescribed Low Molecular Weight Heparin at the discretion of their doctor. There is no evidence to support the use of aspirin (British Committee for Standards in Haematology guidelines 2005). 9

10 Key points Make sure you keep all appointments. Take the correct dose - try not to miss any tablets. Tell your healthcare team if you have accidentally taken too much medication or have missed a dose. Inform your healthcare team of any marked bruising or blood loss. Avoid medication which has not been prescribed by your doctor. If you buy any over-the-counter medicines always inform the pharmacist that you are taking an anticoagulant. Eat a well-balanced diet. Avoid activities which could cause injury. Glossary of terms Anticoagulant (i.e. warfarin and heparin) The technical term for a medicine which thins the blood. Blood clot Blood will clot naturally in response to injury, but sometimes this takes place in the blood vessels of the leg forming a plug which can interrupt the normal flow of blood in a vein. Duplex scan A simple test done to determine if there is a blood clot in the veins in your thigh. The test is painless and involves moving an instrument up and down your legs. It can detect a blood clot by sending out sound waves and then registering the echo they make. 10

11 INR International Normalised Ratio. A test to determine how well warfarin is working for you. It is carried out on a small sample of your blood. Low Molecular Weight Heparin (LMWH) An anticoagulant which is available as an injection and which is used to prevent the development or growth of a blood clot. At the time of writing, the LMWHs available in the UK are: Innohep (tinzaparin), Clexane (enoxaparin) and Fragmin (dalteparin). Pulmonary embolism A term for a blood clot which has broken off from one in the legs and has travelled to the lungs. This type of clot can cause chest pain and difficulty in breathing but is usually treated in the same way as other types of blood clot. Thrombus The technical name for a blood clot. Warfarin An anticoagulant tablet which is taken to prevent the development or growth of blood clots. As each person responds differently to warfarin blood tests are needed to find the dose which is best for you. Rivaroxaban An anticoagulant tablet which is taken to prevent the development or growth of blood clots. 11

12 As well as providing clinical care, our Trust has an important role in research. This allows us to discover new and improved ways of treating patients. While under our care, you may be invited to take part in research. To find out more please visit: or call the research and innovation team on For access to other patient leaflets and information please go to the following address: information-for-patients/ Please shred & recycle after use Hospital Switchboard: Minicom: For an Interpreter or Signer please contact the telephone number on your appointment letter. For this leaflet in Large Print, Braille, Audio, or , please call the Patient Information Service: / 3725 w w Front cover image (NHS Photo Library): Crown copyright 2013 University Hospitals Bristol Published: 19/03/13 Expires: 31/03/16 MEDICINE/DVT/MAR13

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