Venous Thrombosis and Pulmonary Embolism Treatment with Apixaban UHN Information for patients and families Read this booklet to learn: about venous thrombosis and pulmonary embolism how the medicine Apixaban is used to treat them what you need to know about taking this medicine what problems to look out for where you can find more information Please visit the UHN Patient Education website for more health information: www.uhnpatienteducation.ca 2016 University Health Network. All rights reserved. This information is to be used for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider for advice about a specific medical condition. A single copy of these materials may be reprinted for non-commercial personal use only. Author: Sarah Boross-Harmer, RN Created: 01/2016 Form: D-5250
What is venous thrombosis? Venous thrombosis is a blood clot inside a deep vein. The blood clot can form in deep veins anywhere in your body such as your leg, arm or abdomen. Can venous thrombosis be serious? Yes, in some cases. A pulmonary embolism happens when a blood clot breaks off and travels through your veins to the blood vessels in your lungs. A pulmonary embolism is dangerous and could be life threatening. The risk of a clot breaking off and becoming a pulmonary embolism is highest before starting treatment and in the first few days of starting treatment. After a week, the risk becomes very low. 2
What is the difference between blood clots in veins and blood clots in arteries? Veins carry blood from the different parts of your body back to your heart. Blood clots in veins may cause pulmonary embolism, venous thrombosis, or other problems depending on where the blood clot is. Arteries carry blood from your heart to all the different parts of your body. Blood clots in arteries may cause a stroke, a mini-stroke (also called a TIA or transient ischemic attack), or a heart attack. They may also block blood flow to your leg, arm or central artery, which can cause gangrene (some of your tissue to die) or other problems. The treatments for blood clots in veins and blood clots in arteries are different. The risks, symptoms and how they can be prevented are also very different. This booklet will talk about blood clots in veins. What if I have blood clots in veins close to the surface of my skin? Clotting in small veins close to the surface of your skin is called superficial thrombophlebitis. These blood clots may be very painful and cause your skin to become red and irritated. But, they are not dangerous. The risk of the clot breaking off and travelling to your lung (pulmonary embolism) is very small. Superficial thrombophlebitis is not always treated. This will depend on the size and where it is on your body. If it is treated, we may ask you to use a cold compress on the area and take anti-inflammatory medicine (for example, Advil, Aspirin or Motrin ) for about 2 to 6 weeks, or prescribe a short course of treatment. 3
How common is venous thrombosis? Venous thrombosis happens in about 1 of every 1,000 people, but the risk increases as you get older. What could cause venous thrombosis? There are many things that can increase the risk of venous thrombosis. These include: aging being overweight going through major surgery cancer or cancer therapy having an intravenous catheter (for example, a PICC line, port-a-cath, or Hickman line) an autoimmune disease or inflammatory disorder like Lupus, ulcerative Colitis or Crohn s disease a major injury or broken bone not being able to move as much while in a cast or wheelchair being pregnant, taking birth control pills or hormone replacement therapy a family history of venous thrombosis or clotting problems Sometimes the reason why a patient has venous thrombosis isn t clear. 4
Will I need to have a test to see why I have venous thrombosis? This will depend on many things like your family history, whether you are male or female, or your age. Your health care provider will talk to you if they decide you need to be tested. How is venous thrombosis treated? The medicine we will use to treat your venous thrombosis is an anticoagulant called Apixaban. Anticoagulants don t dissolve the blood clot. Anticoagulants do: slow down blood clotting in your body prevent your blood clot from becoming larger prevent you from developing new blood clots reduce problems such as swelling and pain in the area of your clot (for example your arm or leg) or problems breathing Once you start taking the medicines, your body will naturally break down or reabsorb the blood clot. In most patients the blood clot breaks down after many weeks or months. In some people the blood clot never completely goes away, but it changes to scar tissue. This scar tissue is not dangerous, and it can t break off. It becomes a part of your vein wall. Your body will create new veins to go around this scar tissue. Not all medicines are right for every patient. We will talk to you about the medicines that are best for you. 5
What do I need to know about Apixaban? Apixaban (also called Eliquis ) treats venous thrombosis and pulmonary embolism. You take this medicine by mouth with food and it starts to work within about 1 hour. You don t need to have regular blood tests while you are taking this medicine. It won t affect what you can eat or drink. If you drink alcohol don t drink more than these amounts daily: 1 to 2 bottles of beer or 1 to 2 glasses of wine or 1 to 2 ounces liquor What if I am pregnant or breastfeeding? If you are pregnant or breastfeeding, you can t take Apixaban because it may harm your unborn baby. We will give you a different anticoagulant medicine that is safe. Talk to your health care provider about what to do to avoid getting pregnant. If you are planning on becoming pregnant, please talk to your health care provider. If you become pregnant while taking Apixaban, call your health care provider right away. How much Apixaban should I take to treat a blood clot? You take 10 milligrams (mg) two times a day for the first 7 days with or without food After 7 days, you take 5 mg two times a day with or without food 6
What do I do if I forget to take my pill? If you forget to take an Apixaban pill, take it as soon as you remember. If you forget and it is time to take your next pill, do not take two pills. Only take your next dose. The next day take your Apixaban pills at the usual time. Who needs to know I am taking this medicine? Tell your family doctor, dentist, nurse, acupuncturist, or any health care provider that you are taking Apixaban (Eliquis ). This is very important if you are having a procedure that may cause you to bleed. Remind them each time you visit. Carry a wallet card so you will always have the name of the medicine with you. Tell your pharmacist you are taking Apixaban every time you buy any new medicines (even vitamins and cold remedies). This will allow them to check for problems that can happen when some medicines are taken together. Talk to your health care provider before stopping Apixaban. It may be dangerous to stop. You don t need to stop it before minor dental work. If you are having any surgery or procedure (for example a colonoscopy or biopsy) make sure the person doing the surgery or procedure knows you are taking Apixaban. If you have an accident, get medical help right away. You will need to be checked for signs of bleeding. 7
Can other medicines or vitamins affect how Apixaban works? Yes. If you are prescribed any new medicines, talk to your health care provider and pharmacist about any possible drug interactions. You should tell your health care provider if you start any new medicines, including vitamins, homeopathic treatments and medicines you can buy without a prescription (over the counter). When you are taking Apixaban, don't take: Non-steroidal anti-inflammatory medicines like Ibuprofen, Advil, Motrin, or Aleve Medicines with ASA (acetylsalicylic acid) like Aspirin or Anacin Some homeopathic or herbal supplements. Please call your pharmacist or health care provider to check. Any medicine which may increase your risk of bleeding (unless your doctor has prescribed it and knows that you are taking Apixaban). You may take: Acetaminophen (Tylenol ) for pain Allergy medicines such as Benadryl, Claritin or Reactine Most cough and cold medicines as long as they don t have Ibuprofen, (Advil, Motrin ) or ASA (Aspirin, Anacin ) 8
How much activity can I do? How much activity you can do will depend on: Where your blood clot is How you feel How much activity you are used to Other health problems you may have Listen to your body, and only do what is comfortable for you. Some people have few symptoms and are able to be active right away. But, some people have symptoms like leg pain or find it hard to breathe. It may take many weeks before they can increase the amount of activity they do. For the first 3 days after you start Apixaban: Rest. You can walk around your home and do light activities such as climbing up 1 to 2 flights of stairs. Don t do tiring activities such as running, biking, weight training, shoveling snow or gardening. After 3 days: You may increase your activity slowly. If the area of your clot is painful and swollen, wait until the pain and swelling decreases before doing more activities. Once your pain decreases, you can increase your activity slowly each day until you are back to your regular activities. You can usually go back to your regular activities about 1 month after having your venous thrombosis. But, recovery may take longer for some patients. As long as you are taking any anticoagulant medicines: Don t do contact sports (such as hockey, soccer or football) and other activities where there is a high risk you could get hurt. 9
Will I be able to travel by airplane? Yes. Once you start Apixaban and your blood clot is stable (usually after 1 week), you can fly. You cannot fly if you continue to be short of breath or have chest pain. Drink plenty of fluids and get up during flights to stretch your legs. Once you stop taking Apixaban or are close to stopping, talk to your health care provider about what safety steps to take before long flights (more than 5 hours). When will I feel better? Venous thrombosis Most people with venous thrombosis feel better in 2 to 3 weeks. It takes about this long for your body to start breaking it down and for the swelling in the area of the thrombosis to go down. If you don t feel better after 3 weeks or you feel worse, call your health care provider. They may recommend special support socks called compression socks. These socks will help ease any swelling you may have after having thrombosis. You will need to have a prescription and be measured for these socks to make sure they fit properly. You wear these socks during the day and remove them at night. Pulmonary embolism If you had a pulmonary embolism, you may: feel short of breath feel dizzy have heart palpitations (your heart isn t beating normally) have pain in your lungs feel very tired 10
This is normal for people with a pulmonary embolism. You may feel better in 2 to 3 weeks, but it may take many months before you feel better. If you continue to feel short of breath after 3 weeks, let your health care provider know. In a few people, the clot does not completely break down. You may need more tests to see if there is any damage to your lung or strain on your heart. If you feel much more short of breath than usual or you feel a crushing chest pain, go to your closest emergency department right away. How long will I need to take Apixaban? How long you will need to take it will depend on: the reason you developed the thrombosis where your thrombosis is anything that may increase your risk of having another thrombosis your risk of developing bleeding You may need to take this medicine for many weeks, months, or years. You may even need to take it for the rest of your life. Your health care provider will talk with you about this during your treatment. You should continue to take Apixaban (Eliquis ) until your health care provider tells you that you can stop. 11
What problems should I look out for? Go to the nearest emergency department if: You have a hard time catching your breath You have severe chest pain The pain you have from the thrombosis or pulmonary embolus gets much worse (you can expect your pain to stay about the same for 2 to 3 weeks) You have a very bad headache (worse than you have ever had before) You start vomiting blood or passing blood in your urine or bowel movements You hit your head hard or have a major accident Call your health care provider if you have any other questions or concerns. Where can I find more information about venous thrombosis? You can find more information about venous thrombosis at these websites: Thrombosis Canada Website: www.thrombosiscanada.ca Clot Connect Website: www.clotconnect.org National Blood Clot Alliance Website: www.stoptheclot.org Clot Care Website: www.clotcare.com 12