Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)

Information for patients

Why does blood clot? When we cut ourselves, we bleed. To stop us from bleeding too much, the body triggers a protective mechanism and a scab forms on our skin. This is called the clotting process. Sometimes, a clot can occur inside a blood vessel in the body rather than on the skin. When this happens, it can slow down the flow of blood in that part of the body.

What is a DVT and why does it occur? If a clot occurs in the deep veins in the leg, it is called a Deep Vein Thrombosis (DVT). If a clot moves from here into the arteries of the lung it is called a Pulmonary Embolism (PE). During periods of inactivity, such as bed rest, or sitting for long periods with legs bent (see 'Am I at risk of developing a blood clot?' page 3), the blood in the deep veins moves more slowly. This can eventually lead to a blood clot.

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What is a Pulmonary Embolism (PE)? A DVT can settle as a result of being dissolved by natural processes, or following treatment in hospital or as an outpatient. However, sometimes part of a DVT can break off and travel through the blood stream (embolus) to other parts of the body where it may block arteries and cause serious problems. If a clot lodges in the arteries of the lung it is called a pulmonary embolism (PE).

How will I know if I have a blood clot? A DVT may cause symptoms of pain and swelling in the leg or heavy aching in the calf or ankle which is worse after standing or walking and tends to get better by resting and sitting with the legs in an elevated position. Another symptom is itchy skin, but a DVT can occur without any symptoms. A DVT can cause damage to or chronic blockage of the veins resulting in long term swelling of the legs and possibly skin problems such as leg ulcers. A PE can cause severe breathing problems, such as shortness of breath or pain in your chest that is worse when you breathe in. Symptoms of a DVT may also be present.

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Am I at risk of developing a blood clot? You may be at an increased risk of developing a blood clot if you have: • injured the deep veins in your leg either by breaking a bone or having surgery • been less active than usual, or on bed rest • a condition that increases the tendency for your blood to clot, for example cancer Other risk factors can include: • Age • Previous DVT or PE • Family history of blood clots • Some combined oral contraceptives/HRT • Medical conditions such as heart failure • Stroke or paralysis • Pregnancy • Surgical operations • Long distance travel • Being overweight

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What will the doctor or nurse need to know? To assess your risk of blood clots and to ensure you receive treatment to prevent them forming, your doctor or nurse will discuss the following with you. • Have you, or members of your family, ever had blood clots before? • Are you already taking tablets to thin your blood sometimes called anticoagulants? • Do you have any existing bleeding disorder, for example low platelet count? • Are you taking the combined oral contraceptive pill, or HRT? • Have you had injections in your stomach to thin your blood in the last 3 months?

What can be done to prevent blood clots? Do as much for yourself as possible! Move around! Depending on why you are in hospital and your answers to the questions above, you may be given exercises to perform, special support stockings to wear or medication known as an anticoagulant ('blood thinners'). On admission to hospital, you will have been assessed for your risk of thrombosis by a doctor or nurse. If you are having a planned procedure, you will have been assessed in a pre-admission clinic.

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Support Stockings One way of reducing the risk of blood clots is by wearing special stockings. These help by reducing leg swelling and preventing blood from collecting in the veins. If you are offered the stockings, a nurse will measure your legs to ensure you are given the correct size. It is important that the stockings are fitted correctly, without any folding over or wrinkling. The stockings will feel rather tight until you get used to them. If the stockings are uncomfortable and do not fit properly, tell your nurse. You will be shown when and how to take them off. These stockings are supposed to be tighter than normal, and in the beginning you may require some help to get them on and off. You should normally wear these stockings for about 6 weeks following the operation. Please ask your nurse for a leaflet on support stockings.

Anticoagulants (Blood Thinners) Our bodies naturally produce anticoagulants, which thin the blood allowing it to move freely around the body. Without them the blood would be constantly clotting and unable to move easily. Sometimes however our bodies need help. Anticoagulant medication works by thinning the blood. Anticoagulants come in 2 forms, as a tablet, or as an injection. If your doctor decides you need this medication, they will discuss this with you. 5

1. The tablet is called warfarin. It is sometimes used to prevent patients from developing blood clots after surgery, but is usually used to treat people who have developed DVTs or PEs. Like Enoxaparin, it does not dissolve existing clots, but it does help them from becoming any bigger or new clots from forming. Some people may be on this tablet for a long time. You will need regular blood tests to ensure you are receiving the right dose of this medicine. Some consultants prefer to use Aspirin to help prevent blood clots. This is usually taken once every day at the same time as another tablet called Lansoprazole. The Lansoprazole tablet helps to protect your stomach, as Aspirin can cause irritation and acid burning. 2. Enoxaparin is a blood thinning drug that is given at the same time each day by injection. It is injected into fatty tissue (usually in the stomach/abdomen). It is released slowly into the body. It is given to prevent blood clots forming. It is also used to treat individuals who have developed DVTs or PEs. It does not dissolve existing clots, but it does stop them from becoming any bigger.

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Exercises Here is a simple exercise you can do, even when you are lying in bed, to help your blood to move around your body. Lying on your back or sitting

Bend and straighten your ankles quickly. If you keep your knees straight during the exercise you will stretch your calf muscles.

Repeat _______ times.

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When you go home from hospital The risk of developing blood clots can continue for up to 4 weeks after you have gone home. Make sure that you remember to walk around as much as you are able. Drink plenty of water and do the simple leg exercises above. If you have been asked to wear support stockings at home, please wear them for the recommended time (usually 6 weeks after your operation). Some patients may be considered at very high risk, their consultant may decide that they need to home on the Enoxaparin injections into their stomach. Some patients are able to give this injection to themselves; others have theirs from the district nursing service.

If you have any questions or concerns regarding this information please ask a member of staff for advice. If you have any questions or concerns after you have gone home from hospital please contact: Ward __________________ on 0114 ________________ or your own G.P. surgery.

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© Sheffield Teaching Hospitals NHS Foundation Trust 2007. Re-use of all or any part of this document is governed by copyright and the “Re-use of Public Sector Information Regulations 2005” SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Tel: 0114 226 5153. Email [email protected]

PD 4510 PIL1502 (12/07)