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 inthe body rather than on the skin. When this happens,it can slow down the flow of blood in that part of thebody. 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, orsitting for long periods with legs bent (see 'Am I atrisk of developing a blood clot?' page 3), the blood inthe deep veins moves more slowly. This can eventuallylead to a blood clot.
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 andtravel through the blood stream (embolus) to otherparts of the body where it may block arteries andcause 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 asshortness of breath or pain in your chest that is worsewhen you breathe in. Symptoms of a DVT may also bepresent. 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
• been less active than usual, or on bed rest• a condition that increases the tendency for your
• 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
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
• Are you already taking tablets to thin your blood -
• Do you have any existing bleeding disorder, for
• Are you taking the combined oral contraceptive
• Have you had injections in your stomach to thin
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 youranswers to the questions above, you may be givenexercises to perform, special support stockings towear or medication known as an anticoagulant('blood thinners').
On admission to hospital, you will have been assessedfor your risk of thrombosis by a doctor or nurse. Ifyou are having a planned procedure, you will havebeen assessed in a pre-admission clinic. 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 measureyour legs to ensure you are given the correct size. It isimportant 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 yournurse 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 aninjection. If your doctor decides you need thismedication, they will discuss this with you.
1. The tablet is called warfarin. It is sometimes used
to prevent patients from developing blood clotsafter surgery, but is usually used to treat peoplewho have developed DVTs or PEs. Like Enoxaparin,it does not dissolve existing clots, but it does helpthem from becoming any bigger or new clotsfrom forming. Some people may be on this tabletfor a long time. You will need regular blood teststo ensure you are receiving the right dose of thismedicine.
Some consultants prefer to use Aspirin to helpprevent blood clots. This is usually taken onceevery day at the same time as another tabletcalled Lansoprazole. The Lansoprazole tablet helpsto protect your stomach, as Aspirin can causeirritation 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. 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.
Bend and straighten your ankles quickly.
If you keep your knees straight during the exerciseyou will stretch your calf muscles. 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 asmuch as you are able. Drink plenty of water and dothe simple leg exercises above. If you have beenasked to wear support stockings at home, please wearthem for the recommended time (usually 6 weeksafter your operation).
Some patients may be considered at very high risk,their consultant may decide that they need to homeon the Enoxaparin injections into their stomach. Somepatients are able to give this injection to themselves;others have theirs from the district nursing service.
If you have any questions or concerns regarding thisinformation please ask a member of staff for advice.
If you have any questions or concerns after you havegone home from hospital please contact:
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