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 elsewhere 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.

A hospital-associated blood clot occurs in patients when they are in hospital, and up to ninety days after a hospital admission.

What are the symptoms of a DVT?

These will vary according to the size and position of the clot. Not everybody has any or all these symptoms but usually you will have some pain, swelling, and discolouration of the area, and sometimes it can be hot and sore to touch.

What tests may I need to have?

• Blood test.
  • You may have blood taken from a vein in your arm.
• Ultrasound scan.
  • This gives the clinician a picture of the veins and the blood flowing in them, showing whether a clot is there. This takes about 15 minutes and should be painless.

Depending on when you are assessed, you might be able to have the scan on the same day. If not, you will be sent home and given a date to return for your scan, usually, this will be the next day. While you are waiting for your scan, you will be given treatment for a DVT, to ensure that if there is one, we are already treating it.

What is the treatment for a DVT?

Your body will naturally break down the clot, but to do this safely you will need to take anticoagulant medication. Anticoagulant medication works to prevent the clot from getting bigger or moving, or from new clots forming.

If a clot becomes dislodged and passes through your blood vessels it can reach your lungs, this is called a Pulmonary Embolism (PE). Symptoms include coughing (with blood stained phlegm), chest pain and breathlessness. If left untreated a PE can potentially be fatal so if you have any of these symptoms, call 999.

Anticoagulation may be given as tablets, injections, or a combination of the two. It is most often given as oral anticoagulant tablets called direct acting anticoagulants (DOAC).

• Apixaban is an oral anticoagulant. If taken from when a blood clot is first diagnosed, it is taken at a higher loading dose for one week, and then continues on a lower dose twice daily thereafter. After the first one week loading period, the treatment dose usually does not change.
  Your kidney and liver blood tests will need to be checked before and every three to six months during treatment with this drug.  Treatment will last for 3 months.

• Rivaroxaban is an oral anticoagulant. If taken from when a blood clot is diagnosed, it is taken twice daily for three weeks and then once daily thereafter. After the first three weeks, the dose usually does not change.
  Your kidney and liver blood tests will need to be checked before and every three to six months during treatment with this drug.  Treatment will last for 3 months.
• Heparin injections are given according to your weight and kidney function. Heparin is usually given once daily (occasionally twice daily) into the skin of your abdomen. It is often given as a low molecular weight heparin such as Enoxaparin. You may be taught how to administer it yourself, or a clinician may do this for you. You may have to take a heparin injection until fully diagnosed.

What are the side effects of anticoagulants?

All anticoagulants increase your risk of bleeding. Be extra careful when cutting nails, shaving, or using sharp implements. If you do have any bleeding, apply extra pressure on the affected area and seek medical help if it does not stop. You are also at an increased risk of bruising.

Some people complain of feeling cold when taking anticoagulants.

Heparin can potentially cause your platelets (a clotting component in your blood) to drop in the first few weeks of taking it. Your blood may be tested when you first start taking heparin to check for this.

There are some medications such as aspirin and clopidogrel which often should not be taken with anticoagulants or be taken with dosage adjustment; your clinician will advise you on this. You will also be given advice if you are taking any anti-inflammatory medication such as Ibuprofen, Naproxen or Diclofenac.  Some herbal medications and food types also interact with certain anticoagulants; your clinician will advise you on this.

It is important that you make sure the person starting you on an anticoagulant knows all the medications you are taking. You should tell any doctor, dentist, nurse, or physiotherapist that you are taking an anticoagulant when you attend for an appointment.

What will happen if I do not want to take anticoagulants?

You are strongly advised to take the medication. If untreated, a DVT can break off and the clot can travel to your lungs where it causes a pulmonary embolism (PE), which can be fatal. Most people who have a DVT and take anticoagulants recover without complications.

Do I need to stay in hospital?

Not usually. If you are relatively well with your DVT, you will be treated as an outpatient.

How long will I be on anticoagulants?

You will need anticoagulants for at least six weeks, often 3 months, but sometimes longer. We do not routinely rescan your leg during or after your treatment.

Your clinician will confirm the length of your treatment and arrange follow-up appointments as needed.

What can I do to help my recovery?

• Try and stay mobile and walk as normally as you can.
• Until the DVT starts to improve, you may feel some discomfort. Take the painkillers which have been prescribed for you.
• Look after yourself. Eat a healthy diet and drink plenty of fluid.
• No smoking. Smoking makes your blood more prone to blood clots.
• Finish your treatment for the DVT. Stopping the treatment early, even if you feel better, could cause the DVT to come back or slow down your recovery.