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DVT



NHS Choices Syndication

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Deep vein thrombosis (DVT)

'I got DVT from flying'

Journalist Mark Pownall from north London developed deep vein thrombosis (DVT) on a long-haul flight from New Orleans to London.

He had been in the US for a medical conference in March 2004, reporting on topics including DVT. The night before his journey home, Mark had a few drinks.

The flight was hard work, with a six-hour transit in Washington DC because of delays. “Door to door, it was a 20-hour trip,” says the 46-year-old from north London.

“I arrived at Heathrow feeling like I’d slept quite badly. I felt a cramp in my left leg, and it got worse over the next few days.”

It was only when Mark began limping because of the pain that he got medical attention. And that was only at the insistence of his wife, Jill.

“My leg was hot and swollen,” says Mark. His GP diagnosed DVT and Mark was sent to the Whittington Hospital in north London, where he received an ultrasound that found a blood clot stretching from his calf to his mid-thigh. “The clot had spread quite a bit,” says Mark.

He was kept in at the hospital and had to remain there for a few days. He received daily injections of the anti-clotting treatment heparin and was put on a course of warfarin tablets to prevent further blood clots.

“It’s ironic that I got DVT after attending a conference on it,” says Mark. “I should have known better and gone straight to my GP.”

Doctors were puzzled by Mark’s DVT. He didn’t have any of the risk factors: he was male, a non-smoker, was a healthy weight and there was no family history of DVT. They said the long flight, dehydration and a lack of movement contributed to it.

After six months, Mark stopped taking warfarin because doctors thought he was unlikely to have another clot.

But he did. In June 2007, Mark developed pain in the same leg. And the consequences could have been far worse.

“It was a dull muscular pain, which came and went,” says Mark. But even then, despite having experienced DVT, Mark didn’t realise what it was. “I think I was in denial,”  he says.

After a few days, he developed severe chest pains. He went to hospital, where a spiral CT scan found five blood clots in his lungs, known as a pulmonary embolism (PE). “Part of the clot in my leg had broken off and got into my pulmonary artery,” says Mark. PE is a potentially fatal condition.

He was in hospital for four days, where he was treated with heparin and warfarin. “I was very lucky,” says Mark. “I was healthy, and that’s why I’m still alive.

“With the first DVT I just thought I was unlucky, but with the second one it was the first time I had come face to face with my own mortality.

“Doctors blamed the PE on the fact that I was sitting down for hours on end at my desk without moving, and not drinking enough water,” he says.

Mark is now in a high-risk category and he’ll probably need to continue taking warfarin for the rest of his life. When flying, he wears compression stockings to boost the circulation in his legs (flight socks have a similar effect).

“During the flight I make sure I drink water regularly, don’t drink alcohol or coffee, and exercise,” he says. “I try not to fall asleep either, because that means I’m not moving.”

Published Date
2014-06-09 10:25:55Z
Last Review Date
2014-02-03 00:00:00Z
Next Review Date
2016-02-03 00:00:00Z
Classification
Anticoagulant drugs,Deep vein thrombosis,Pulmonary embolism,Thrombosis


NHS Choices Syndication

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Deep vein thrombosis (DVT)

'I woke up and couldn't feel my left leg'

Helen Cannings developed venous thromboembolism (VTE) at around 30 weeks of pregnancy. Her father also died of pulmonary embolism at the age of just 49.

“My dad died suddenly 10 years ago from a pulmonary embolism (PE). He was only 49 and it was a real shock for my whole family. Before he died I didn’t know much about VTE, apart from that you could get DVT from flying and should try to move your legs around on long flights.

“After dad died I had to have tests to check that I didn’t have any genetic conditions that make your blood clot. I was given the all-clear, so didn’t think I was at risk.

“I was about 29 weeks into my pregnancy when I woke up one morning and couldn’t feel my left leg. It felt numb and dull. I thought it was cramp, so got up and walked around, but it was hard to walk and the pain seemed to get worse. When I looked at my leg it was really swollen and an ashen grey colour.

“My partner, Tony, persuaded me to go to hospital to get it checked out. Luckily it was a quiet Saturday morning, so I was admitted to the labour ward straight away.

“As the morning went on I could feel the pain in my leg getting worse. The doctor measured the size of my leg, felt the temperature, looked at the appearance of the skin and asked me a lot of questions about how I was feeling and my family history. It was confirmed that I had DVT and then I had to have an ultrasound scan to show the extent of the clot. It was just above the back of my knee and a few centimetres long.

“I was shocked and scared after my diagnosis. Because Dad had died from a pulmonary embolism, I was worried that the clot could move up to my lung. The whole thing brought a lot of emotions flooding back. Thankfully, I was reassured that my baby was ok. I was just worried about what could happen to me.

“I was put straight on to an anticoagulant medication. I couldn’t take warfarin tablets because I was pregnant, so I had to have heparin. Heparin has to be taken as an injection, so I learned to do this myself before I left the hospital. I had to inject myself twice a day in the thigh. It was hard at first, but I soon got used to it. Taking the medication made me feel safer because I knew it would stop my blood from clotting.

“Looking back, it was a stressful time. I was heavily pregnant and really worried about my health. I was told to rest and elevate my leg, but the pain didn’t go away for about a month. I couldn’t drive and could only really walk short distances, otherwise my leg would swell up. I was worried I’d never be able to move my leg normally again and worried about giving birth.

“My consultant and the team at the hospital took a while to decide how they were going to manage my labour. They decided I should have a natural birth, but would need to come off the heparin 12 hours before so I didn’t lose too much blood. In the end, everything went well and my son Joseph was born healthy and happy.

“After giving birth, I was only discharged from the hospital after a visit to the anticoagulant clinic to check how fast my blood was clotting. They found I was still at risk, so I was put on warfarin.

“I have to take the warfarin tablets for six months and then have another review. I also have to wear compression stockings every day for the next two years. I’ve been told that if I ever have any chest pains, I should go straight to hospital because I’m at risk of pulmonary embolism.

“Although I knew there was a higher risk of blood clots in pregnancy, I didn’t think I was high risk. I’m much more aware now and I think the fear of having another clot, and it being more serious, will always be at the back of my mind.”

Published Date
2014-06-09 10:21:33Z
Last Review Date
2014-02-03 00:00:00Z
Next Review Date
2016-02-03 00:00:00Z
Classification
Deep vein thrombosis,Pulmonary embolism


NHS Choices Syndication

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Deep vein thrombosis (DVT)

'Stay positive and be as informed as you can be'

Battling through three different cancers meant that getting blood clots was the last thing on Jeremy Smith’s mind.

“Over the past three years I have been treated for non-Hodgkin’s lymphoma (NHL), thyroid cancer and bowel cancer, and have had two DVTs.

“I got the first DVT after I was diagnosed with NHL. It was a traumatic time. I had a large tumour at the base of my spine and smaller tumours dotted around the lymph nodes of my abdomen. I was really quite ill, awaiting treatment and feeling very emotional. Even though I knew I had a family history of clots and strokes and that NHL put me at an increased risk, DVT was the last thing on my mind.

“My right leg became gradually swollen, but I thought it was probably just a reaction to the other things going on in my body. I thought it might be caused by the growing tumour in my spine pressing on the nerves of my leg.

“Eventually, I went to my spinal consultant to get it checked out. He did a pulse test on both my legs and found it was different in each one. He immediately thought I might have a clot. I was sent for an ultrasound scan that confirmed a large clot in a vein on the inside of my right leg.

“Having a DVT didn’t seem like a big deal at the time because I had so many other things going on in my body and it was just another thing to deal with. As well as the other treatments I was having for cancer, which included chemotherapy and surgery, I had treatment for DVT. I had to wear compression stockings and take warfarin to protect me from getting further clots.

“I was on and off the warfarin because I had to have surgery to treat my cancer. You can’t take warfarin if you’re having surgery because it thins the blood and you could lose a dangerous amount of blood. When I wasn’t on warfarin, I was on the alternative drug heparin.

“One side effect of taking warfarin was the bruising. You become so sensitive; small bumps give you massive bruises and if you cut your skin, you bleed a lot. Small chores, like peeling potatoes, became quite a hassle.

“I came off warfarin after a year and after battling NHL I was diagnosed with cancer in my thyroid and bowel. During treatment for thyroid and bowel cancer, my second DVT was diagnosed. The clot was in my right leg again, but this time it was really painful – it felt like someone was sticking a needle into my calf muscle. The pain passed, but I think this clot may have caused more lasting damage. I still get pains in that leg, especially when I’m sitting down or when I have my feet up.

“I am very aware that DVT is a risk for me now more than ever, and I know that one day I may have to take warfarin again, maybe even permanently. But I don’t let the idea get me down. I just feel very lucky to be alive.

“In all my treatment for cancer and DVT, the biggest thing I’ve learned and the best advice I could give others is to stay positive and be as informed as you can be. Don’t be afraid to ask questions.”

Published Date
2014-06-09 10:17:26Z
Last Review Date
2014-02-03 00:00:00Z
Next Review Date
2016-02-03 00:00:00Z
Classification
Anticoagulant drugs,Deep vein thrombosis


NHS Choices Syndication

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Deep vein thrombosis (DVT)

Causes of deep vein thrombosis (DVT)

Deep vein thrombosis (DVT) sometimes occurs for no apparent reason. However, the risk of developing DVT is increased in certain circumstances.

Inactivity 

When you are inactive your blood tends to collect in the lower parts of your body, often in your lower legs. This is usually nothing to worry about because when you start to move, your blood flow increases and moves evenly around your body.

However, if you are immobile (unable to move) for a long period of time – such as after an operation, because of an illness or injury, or during a long journey – your blood flow can slow down considerably. A slow blood flow increases the chances of a blood clot forming.

In hospital

People in hospital have a higher risk of getting a blood clot because DVT is more likely to happen when you are unwell or inactive, or less active than you usually are.

As a patient, your risk of developing DVT depends on the type of treatment you are having. You may be at higher risk of DVT if any of the following apply:

  • you are having an operation that takes longer than 90 minutes, or 60 minutes if the operation is on your leg, hip or abdomen
  • you are having an operation for an inflammatory or abdominal condition, such as appendicitis
  • you are confined to a bed, unable to walk, or spending a large part of the day in a bed or chair for at least three days

You may also be at a higher risk of DVT if you are much less active than usual because of an operation or serious injury and have other DVT risk factors, such as a family history.

When you are admitted to hospital you will be assessed for your risk of developing a blood clot and, if necessary, given preventative treatment.

Blood vessel damage

If the wall of a blood vessel is damaged, it may become narrowed or blocked, which can result in the formation of a blood clot.

Blood vessels can be damaged by injuries such as broken bones or severe muscle damage. Sometimes blood vessel damage that occurs during surgery can cause a blood clot, particularly in operations on the lower half of your body.

Conditions such as vasculitis (inflammation of the vein wall), varicose veins and some forms of medication, such as chemotherapy, can also damage blood vessels.

Medical and genetic conditions

Your risk of DVT is increased if you have a condition that causes your blood to clot more easily than normal. These conditions include:

  • cancer – treatments such as chemotherapy and radiotherapy can increase this risk further
  • heart and lung disease
  • infectious diseases, such as hepatitis
  • inflammatory conditions, such as rheumatoid arthritis
  • thrombophilia – a genetic condition that makes your blood more likely to clot
  • Hughes syndrome – when your blood becomes abnormally “sticky” 

Pregnancy

Pregnancy makes your blood clot more easily. This is your body’s way of preventing too much blood loss during childbirth. 

Around 1 in 1,000 pregnant women develop DVT at some point during their pregnancy. See DVT – Helen’s story for an example of this.

Contraceptive pill and hormone replacement therapy (HRT)

The combined contraceptive pill and hormone replacement therapy (HRT) both contain the female hormone oestrogen. Oestrogen causes the blood to clot slightly more easily, so your risk of getting DVT is slightly increased. There is no increased risk from the progestogen-only contraceptive pill.

Other causes

Your risk of developing DVT is also increased if you or a close relative have previously had DVT and you are:

  • overweight or obese
  • a smoker
  • dehydrated 
  • over 60 – particularly if you have a condition that restricts your mobility

Glossary

HRT
Hormone replacement therapy or HRT involves giving hormones to women when the menopause starts, to replace those that the body no longer produces.
Vein
Veins are blood vessels that carry blood from the rest of the body back to the heart.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
Chemotherapy
Chemotherapy is a treatment of an illness or disease with a chemical substance, e.g. in the treatment of cancer.
Inflammation
Inflammation is the body’s response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Heart
The heart is a muscular organ that pumps blood around the body.
Obesity
Obesity is when a person has an abnormally high amount of body fat.
Genetic
Genetic is a term that refers to genes- the characteristics inherited from a family member.
Published Date
2014-06-09 11:46:52Z
Last Review Date
2014-06-02 00:00:00Z
Next Review Date
2016-06-02 00:00:00Z
Classification
Blood,Deep vein thrombosis,HRT,Thrombosis


NHS Choices Syndication

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Deep vein thrombosis (DVT)

Complications of deep vein thrombosis

The two main complications of deep vein thrombosis (DVT) are pulmonary embolism and post-thrombotic syndrome.

Pulmonary embolism

A pulmonary embolism is the most serious complication of DVT. It happens when a piece of blood clot (DVT) breaks off and travels through your bloodstream to your lungs, where it blocks one of the blood vessels. In severe cases this can be fatal.

If the clot is small, it might not cause any symptoms. If it is medium-sized, it can cause breathing difficulties and chest pain. A large clot can cause the lungs to collapse and result in heart failure, which can be fatal.

About 1 in 10 people with an untreated DVT develops a severe pulmonary embolism.

Post-thrombotic syndrome

If you have had a DVT, you may develop long-term symptoms in your calf known as post-thrombotic syndrome. This affects around 20-40% of people with a history of DVT.

If you have DVT, the blood clot in the vein of your calf can divert the flow of blood to other veins, causing an increase in pressure. This can affect the tissues of your calf and lead to symptoms that include:

When a DVT develops in your thigh vein, there is an increased risk of post-thrombotic syndrome occurring. It is also more likely to occur if you are overweight or if you have had more than one DVT in the same leg.

Published Date
2014-06-09 10:47:21Z
Last Review Date
2014-06-02 00:00:00Z
Next Review Date
2016-06-02 00:00:00Z
Classification
Deep vein thrombosis,Pulmonary embolism,Thrombosis


NHS Choices Syndication

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Deep vein thrombosis (DVT)

Diagnosing deep vein thrombosis

If you think that you may have deep vein thrombosis (DVT), see your GP as soon as possible. 

Your GP will ask you about your medical history and your symptoms. However, it can be difficult to diagnose DVT from symptoms alone, so your GP may recommend one of the following tests:

D-dimer test

A specialised blood test known as the D-dimer test is used to detect pieces of blood clot that have been broken down and are loose in your bloodstream. The larger the number of fragments found, the more likely it is that you have a blood clot in your vein.

However, the D-dimer test is not always reliable. Blood clot fragments can increase after an operation or injury, or if there is inflammation in your body (when your immune system reacts to an infection or disease). This means that additional tests, such as an ultrasound scan, need to be performed to confirm DVT.

If the D-dimer test is negative, it rules out the possibility of a DVT in up to 97% of cases.

Ultrasound scan

An ultrasound scan can be used to detect clots in your veins. A special type of ultrasound known as a Doppler ultrasound can also be used to find out how fast the blood is flowing through a blood vessel. This helps doctors identify when blood flow is slowed or blocked, which could be caused by a blood clot.

Venogram

If the results of a D-dimer test and ultrasound scan cannot confirm a diagnosis of DVT, a venogram might be used. 

A special dye is injected into a vein in your foot, which travels up the blood vessels of your leg. An X-ray is taken to see the dye. If there is a blood clot in your leg, the dye will not be able to flow round it and will show up as a gap in your blood vessel.

Glossary

Ultrasound
Ultrasound scans are a way of producing pictures of inside the body using sound waves.
Ultrasound scan
Blood vessel
Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.
Vein
Veins are blood vessels that carry blood from the rest of the body back to the heart.
X-ray
An X-ray is a painless way of producing pictures of inside the body using radiation.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Blood test
During a blood test, a sample of blood is taken from a vein using a needle, so it can be examined in a laboratory.
Published Date
2014-06-09 11:16:05Z
Last Review Date
2014-06-02 00:00:00Z
Next Review Date
2016-06-02 00:00:00Z
Classification
Deep vein thrombosis,Ultrasound scan


NHS Choices Syndication

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Deep vein thrombosis (DVT)

Introduction

Deep vein thrombosis (DVT) is a blood clot in one of the deep veins in the body.

Blood clots that develop in a vein are also known as venous thrombosis.

DVT usually occurs in a deep leg vein, a larger vein that runs through the muscles of the calf and the thigh.

It can cause pain and swelling in the leg and may lead to complications such as pulmonary embolism. This is when a piece of blood clot breaks off into the bloodstream and blocks one of the blood vessels in the lungs.

DVT and pulmonary embolism together are known as venous thromboembolism (VTE).

Who is at risk?

Each year, 1 in every 1,000 people in the UK is affected by DVT.

Anyone can develop DVT, but it becomes more common with age. As well as age, risk factors include:

  • previous venous thromboembolism
  • a family history of blood clots
  • medical conditions such as cancer and heart failure
  • inactivity – for example, after an operation
  • being overweight or obese

Read more information about the causes of DVT.

Warning signs

In some cases of DVT, there may be no symptoms, but it is important to be aware of the signs and risk factors of thrombosis.

See your GP as soon as possible if you think you may have a blood clot. DVT can cause pain, swelling and a heavy ache in your leg.

Read more information about the symptoms of DVT.

Treating DVT

Treatment for DVT usually involves taking anticoagulant medicines, which help reduce the ability of the blood to clot.

You will also be prescribed compression stockings to wear every day, as these help prevent complications and improve symptoms.

Read more information about treating DVT.

Avoiding DVT

There are several things you can do to help prevent DVT occurring, such as stopping smoking, losing weight if you are overweight, and walking regularly to improve the circulation in your legs.

There is no evidence that supports taking aspirin to reduce your risk of developing DVT.

Read more information about preventing DVT.

Published Date
2014-07-18 12:36:40Z
Last Review Date
2014-06-02 00:00:00Z
Next Review Date
2016-06-02 00:00:00Z
Classification
Deep vein thrombosis,National Institute for Health and Clinical Excellence,Pulmonary embolism,Thrombosis


NHS Choices Syndication

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Deep vein thrombosis (DVT)

Preventing deep vein thrombosis

If you are admitted to hospital or are planning to go into hospital for surgery, your healthcare team will assess your risk of developing a blood clot while you are there.

Surgery and some medical treatments can increase your risk of developing DVT – see causes of DVT for more information.

If you are considered at risk of DVT, there are various recommendations your healthcare team can make to prevent a blood clot occurring.

Before you go into hospital

If you are planning to have an operation and are taking the combined contraceptive pill or hormone replacement therapy (HRT), you will be advised to stop the drugs temporarily four weeks before you have your operation.

Similarly, if you are taking a drug to prevent blood clots, such as aspirin, you may be advised to stop taking this one week before your operation.

There is less risk of DVT when you have a local rather than general anaesthetic. If it is possible for you to have a local anaesthetic, your healthcare team will discuss this with you.

While you are in hospital

There are a number of things your healthcare team can do to help reduce your risk of DVT while in hospital.

They should make sure you have enough to drink and do not become dehydrated. They should also make sure you start to move around as soon as you are able to.

Depending on your risk factors, you may also be offered:

Compression stockings are worn around your feet, lower legs and thighs, and fit tightly to encourage your blood to flow more quickly around your body.

Compression devices are inflatable and work in the same way as compression stockings, inflating at regular intervals to squeeze your legs and encourage blood flow.

Read more about treating DVT.

When you leave hospital

You may need to continue treatment with compression stockings or an anticoagulant medicine when you leave hospital.

Before you leave, your healthcare team should advise you how to use your treatment, how long it should continue for, and who to contact if you are having any problems.

Exercise

Your healthcare team will usually advise you to engage in regular walking exercise once compression socks have been prescribed.

This can help prevent symptoms of DVT returning and may help improve or prevent complications of DVT, such as post-thrombotic syndrome.

Smoking and diet

You can reduce your risk of DVT by making changes to your lifestyle, such as:

Travelling

If you are at risk of getting a DVT or have had a DVT previously, consult your GP before embarking on long-distance travel.

If you are planning a long-distance plane, train or car journey (journeys of six hours or more), ensure that you:

  • drink plenty of water
  • avoid excessive alcohol, as it can lead to dehydration
  • avoid taking sleeping pills, as it can cause immobility
  • perform simple leg exercises, such as regularly flexing your ankles
  • take occasional short walks when possible
  • take advantage of refuelling stopovers, where it may be possible to get out and walk about
  • wear elastic compression stockings

Travel insurance

When travelling abroad, it is very important to make sure that you are prepared should you or a member of your family fall ill.

Make sure you have full travel insurance to cover the costs of any healthcare you may need to receive. This is particularly important if you have a pre-existing medical condition, such as cancer or heart disease, that may increase your risk of developing DVT.

DVT can be a very serious condition, and it is important that you receive medical assistance as soon as possible. Prompt treatment of DVT will help minimise the risk of complications.

Read more information about travel health.

Published Date
2014-06-09 10:45:58Z
Last Review Date
2014-06-02 00:00:00Z
Next Review Date
2016-06-02 00:00:00Z
Classification
Deep vein thrombosis,Pulmonary embolism,Travel health,Weight management


NHS Choices Syndication

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Deep vein thrombosis (DVT)

See what the doctor sees with Map of Medicine

The Map of Medicine is used by doctors throughout the NHS to determine the best treatment options for their patients. NHS Choices offers everyone in England exclusive and free access to this cutting-edge internet resource, which lets you see exactly what your doctor sees.

The information in the Map has been approved by the UK’s leading clinical experts, is based on the best available clinical evidence, and is continually updated. To take advantage of this unique resource go to:

Map of Medicine: deep vein thrombosis

Published Date
2013-08-28 17:06:36Z
Last Review Date
2012-03-25 00:00:00Z
Next Review Date
2014-03-25 00:00:00Z
Classification


NHS Choices Syndication

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Deep vein thrombosis (DVT)

Symptoms of deep vein thrombosis (DVT)

In some cases of deep vein thrombosis (DVT) there may be no symptoms, but possible symptoms can include:

  • pain, swelling and tenderness in one of your legs (usually your calf)
  • a heavy ache in the affected area
  • warm skin in the area of the clot
  • redness of your skin, particularly at the back of your leg below the knee

DVT usually affects one leg, but this is not always the case. The pain may be made worse by bending your foot upward towards your knee.

If DVT is not treated, a pulmonary embolism (a blood clot that has come away from its original site and become lodged in one of your lungs) may occur. 

If you have a pulmonary embolism, you may experience more serious symptoms, such as:

  • breathlessness, which may come on gradually or suddenly
  • chest pain, which may become worse when you breathe in
  • collapsing suddenly 

Both DVT and pulmonary embolism are serious conditions that require urgent investigation and treatment.

Read more about complications of deep vein thrombosis.

Published Date
2014-06-09 13:21:54Z
Last Review Date
2014-06-02 00:00:00Z
Next Review Date
2016-06-02 00:00:00Z
Classification
Deep vein thrombosis


NHS Choices Syndication

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Deep vein thrombosis (DVT)

Treating deep vein thrombosis (DVT)

If you have deep vein thrombosis (DVT), you will need to take a medicine called an anticoagulant.

Anticoagulation

Anticoagulant medicines prevent blood clots getting bigger. They can also help stop part of the blood clot breaking off and becoming lodged in another part of your bloodstream (an embolism).

Although they are often referred to as “blood-thinning” medicines, anticoagulants do not actually thin the blood. They alter chemicals within it, which prevents clots forming so easily.

Two different types of anticoagulants are used to treat DVT:

  • heparin
  • warfarin

Heparin is usually prescribed first because it works immediately to prevent further clotting. After this initial treatment, you may also need to take warfarin to prevent another blood clot forming.

Heparin

Heparin is available in two different forms:

  • standard (unfractioned) heparin
  • low molecular weight heparin (LMWH)

Standard (unfractioned) heparin can be given as:

  • an intravenous injection – an injection straight into one of your veins
  • an intravenous infusion – when a continuous drip of heparin is fed through a narrow tube into a vein in your arm (this must be done in hospital)
  • a subcutaneous injection – an injection under your skin

LMWH is usually given as a subcutaneous injection.

A dose of standard heparin can work differently from person to person, so the dosage must be carefully monitored and adjusted where necessary. You may need to stay in hospital for 5 to 10 days and have frequent blood tests to ensure you receive the right dose.

LMWH works differently from standard heparin. It contains small molecules, which means its effects are more reliable and you will not have to stay in hospital and be monitored.

Both standard and LMWH can cause side effects, including:

  • a skin rash and other allergic reactions
  • bleeding 
  • weakening of the bones (if taken for a long time)

In rare cases, heparin can also cause an extreme reaction that makes existing blood clots worse and causes new clots to develop. This reaction, and weakening of your bones, is less likely to occur when taking LMWH.

In most cases, you will be given LMWH because it is easier to use and causes fewer side effects.

Read more about heparin.

Warfarin

Warfarin is taken as a tablet. You may need to take it after an initial heparin treatment to prevent further blood clots occurring. Your doctor may recommend that you take warfarin for three to six months. In some cases, warfarin may need to be taken for longer, even for life.

As with standard heparin, the effects of warfarin vary from person to person. You will need to be closely monitored with frequent blood tests to ensure you are taking the right dosage.

When you first start taking warfarin, you may need to have two to three blood tests a week until your regular dose is decided. After this, you should only need to have a blood test every four weeks at an anticoagulant outpatient clinic.

Warfarin can be affected by your diet, any other medicines that you are taking, and by how well your liver is working.

If you are taking warfarin, you should:

  • keep your diet consistent
  • limit the amount of alcohol you drink (no more than three to four units a day for men and two to three units a day for women)
  • take your dose of warfarin at the same time every day
  • not start to take any other medicine without checking with your GP, pharmacist or anticoagulant specialist
  • not take herbal medicines

Warfarin is not recommended for pregnant women, who are given heparin injections for the full length of treatment.

Read more about warfarin.

Rivarixoban

The National Institute for Health and Care Excellence (NICE) recommends rivarixoban as a possible treatment for adults with DVT, or to help prevent DVT.

Rivarixoban prevents blood clots forming in blood vessels by stopping a substance called Factor Xa from working.

Treatment usually lasts for three months and involves taking rivarixoban twice daily for the first 21 days, followed by once daily until the course ends.

Read the NICE guidance on rivarixoban for the treatment and prevention of deep vein thrombosis.

Compression stockings

Compression stockings help prevent calf pain and swelling, and lower the risk of ulcers developing after having a DVT. They can also help prevent post-thrombotic syndrome. This is damage to calf tissue caused by the increase in venous pressure that occurs when a vein is blocked (by a clot) and blood is diverted to the outer veins. See complications of DVT for more information.

After having a DVT, stockings should be worn every day for at least two years because symptoms of post-thrombotic syndrome may develop several months or even years after having DVT.

Compression stockings should be fitted professionally and the prescription is reviewed every three to six months. They need to be worn all day, but can be taken off before going to bed or in the evening while you rest with your leg raised. A spare pair of compression stockings should also be provided.

Exercise

Your healthcare team will usually advise you to engage in regular walking exercise once compression socks have been prescribed.

This can help prevent symptoms of DVT returning and may help to improve or prevent complications of DVT, such as post-thrombotic syndrome.

Raising your leg

As well as wearing compression stockings, you might be advised to raise your leg whenever you are resting. This helps to relieve the pressure in the veins of the calf and stops blood and fluid pooling in the calf itself.

When raising your leg, make sure that your foot is higher than your hip. This will help the returning blood flow from your calf. Putting a cushion underneath your leg while you are lying down should help raise your leg above the level of your hip.

You can also slightly raise the end of your bed to ensure that your foot and calf are slightly higher than your hip.

Read more information about preventing DVT.

Inferior vena cava filters

Although anticoagulant medicines and compression stockings are usually the only treatments needed, inferior vena cava (IVC) filters may be used as an alternative. Usually, this is because anticoagulant treatment needs to be stopped or is not suitable.

IVC filters are small mesh devices that doctors can place in a vein. They trap large fragments of a blood clot and stop it travelling to the heart and lungs.

They may be used to help prevent blood clots developing in the legs of people diagnosed with:

  • deep vein thrombosis (DVT)
  • pulmonary embolism
  • multiple severe injuries

They can be placed in the vein permanently, or newer types of filters can be removed once the risk of a blood clot has decreased.

The procedure to insert an IVC filter is performed using local anaesthetic (where you are awake but the area is numb). A small cut is made in the skin and a catheter (a thin, flexible tube) is inserted into a vein in the neck or groin area. The catheter is guided using an ultrasound scan. The IVC filter is then placed through the catheter into the vein.

Glossary

Ulcers
An ulcer is a sore break in the skin, or on the inside lining of the body.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Veins
Veins are blood vessels that carry blood from the rest of the body back to the heart.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Dosage
Dose is a measured quantity of a medicine to be taken at any one time, such as a specified amount of medication.
Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  
Swelling
Inflammation is the body’s response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Anticoagulant
Anticoagulant is a substance that stops blood from clotting (prevents coagulation). For example warfarin.
Embolism
An embolism is the sudden blockage of a blood vessel, usually by a blood clot or air bubble.
Lungs
Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.
Published Date
2014-06-09 11:13:29Z
Last Review Date
2014-06-02 00:00:00Z
Next Review Date
2016-06-02 00:00:00Z
Classification
Anticoagulant drugs,Blood,Deep vein thrombosis,Thrombosis

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