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 aPulmonary 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 apulmonary 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
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.
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
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
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.
Here is a simple exercise you can do, even when you
are lying in bed, to help your blood to move around
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:
Ward __________________ on 0114
Sheffield Teaching Hospitals NHS Foundation Trust 2007
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Current Protocols in the Hematology /Oncology Clinic as of 06/01/2013 Breast 1. AMGEN 20110147 : Randomized, Phase 2 Study to Estimate the Effect of Prophylactic Intervention with Naproxen or Loratadine on Bone Pain in Breast Cancer Subjects Receiving Chemotherapy and Pegfilgrastim 2. NSABP B-43 : A Phase III Clinical Trial Comparing Trastuzumab Given Concurrently with Radiation
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