Deep Vein Thrombosis

This leaflet has been written to help you understand what a deep vein thrombosis (DVT) is, how it is diagnosed and how it is treated. The information should answer your questions, but please ask your Doctor or Nurse about anything you are unsure of.

What is Deep Vein Thrombosis (DVT)?

A deep vein thrombosis is a blood clot, which has formed in the veins of your leg, arm or your pelvis.

What risk factors will make me more likely to have a DVT?

There are many different reasons and risk factors for having a DVT. You are more likely to develop a DVT if:

• You are over the age of 65.
• Are a smoker.
• Are overweight.
• Have had a DVT or a Pulmonary embolus (PE – blood clot on the lung) before
• You are less mobile than normal.
• Have cancer or are going through chemotherapy. (Chemotherapy is given to some non-cancer conditions as well).
• Have a blood condition which makes your blood more prone to clotting.
• Are taking medications such as the oral contraceptive pill or hormone replacement therapy (HRT).
• Are pregnant or have given birth within 6 weeks .
• Have a history of family members suffering from DVTs or PEs even if you have not yet had one yourself.
• Have travelled on a long journey by train or by car of more than three hours.
• Are in hospital or have recently been discharged.
• You have suffered heart failure.
• You have varicose veins.

What are the symptoms of DVT?

The common symptoms of DVT can include:

• Pain in your calf which can be like cramp or throbbing.
• Redness or congestion of the skin of your lower leg.
• The skin over the red or tender area may feel very warm to touch.
• Swelling of the calf of one leg, sometimes the whole of one leg can be swollen.
• Swollen veins of the calf, thigh or arms, which can be hard or tender to touch.

What tests will I have when I come to the hospital?

You will be seen in our Nurse led clinic. They will take a careful history of your symptoms, check your vital signs and examine you. They will also take some routine blood tests to check for other causes of your symptoms.

What will happen after the initial tests?

Once the team have the information they need, they will use this to calculate a Wells score.¹ This score takes account of your risk factors for a DVT and what the team have found when examining you.

This score helps to decide if you have low chance of a DVT or a moderate or high chance, and helps us work out which test is best to carry out next.

Low risk of DVT

If you have a low Wells’ score, then the team will do a blood test called a D-dimer. This blood test helps to screen for blood clots in your body. A combination of a low Wells score and a negative D-dimer is sufficient to rule out a DVT, and you would not need any further tests.

If your D-dimer blood test is high then you will need a scan to look for a DVT.

Moderate or high chance of DVT

If your Wells’ score is moderate or high, you will not have a D-dimer blood test, but you will move straight on to having a scan to look for a DVT.

Doppler Ultrasound scanning

If you need to have a scan to look for a clot, the team will arrange a Doppler Ultrasound scan of your leg or arm.

Some jelly is put onto the skin overlying the large veins in your legs. This is a painless test. Sound waves are used to “see” the veins and to check if the flow of the blood through them is normal, or if there is any blockage by a blood clot.

Arranging and preparing for the scan

This type of scan is done on most days of the week and usually takes place at Hartlepool Hospital. 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 and time to return for your scan.

While you are waiting for the scan, we will give you your treatment for a DVT, to ensure that if there was a blood clot, we are already treating it. This will decrease the risk of any serious complications.

Treatment while waiting for the scan

You will be given blood-thinning tablets called Apixaban. This medicine is to be taken twice a day. We will give you a supply that will last until you have your scan.

Some people cannot have this treatment, in which case we would arrange for you to have a daily blood thinning injection called Tinzaparin. This is given just under the skin of your tummy.

If you want to, you can give this medication to yourself while you wait for the scan. If you are not able to do this, we can teach a family member to administer it or we can arrange for a member of our community team to administer injection.

What treatment will I need if I have a DVT?

If the ultrasound scan shows that you have a DVT, then the treatment is a blood thinning medicine. The blood thinner is to prevent the clot getting any bigger or breaking off and travelling to your lungs. If the blood clot did travel to your lungs, it could cause a potentially fatal Pulmonary Embolism (PE).

The blood thinner does not dissolve the blood clot. Your body will absorb the blood clot itself over time, using the same process that your body uses to heal a bruise.

The different medications that can be used include:

Oral medications

This is the most common route used to treat blood clots. The first line medicine we use is a tablet called Apixaban. This tablet is given twice a day. It is safe and easy to take. It does not usually need any blood tests to monitor it.

Less frequently, if you are not able to take Apixaban, you will be given Warfarin tablets. Warfarin needs careful blood tests to monitor the level of it in your blood stream. It can also be affected by different foods and medicines you may be prescribed.

Blood thinning injections

Some patients are not suitable for the oral medicine described previously. This includes patients with cancer and pregnant women. Some patients may have allergies or other reasons not to take the tablets. In these situations, a daily blood thinning injection would be used, as described on the last page.

What will happen if I can’t have either of these treatments?

This is extremely rare and normally we can find a medicine that will suit your needs, this will be discussed with you. However, if there are no medicines that can be used, there are other possibilities.

• An inferior vena cava filter. This is where a small filter is placed inside the large vein in your abdomen (tummy) leading back to your heart. This acts as a filter and catches any blood clots that may be breaking off the DVT and travelling through your heart to your lung.
• Removing or dissolving the blood clot. Very occasionally, specialist X-ray Doctors or vascular (blood vessel) Surgeons can do a procedure either to remove the blood clot directly or inject a clot “busting” drug directly into the affected vein to break down the blood clot.

It is important to realise that all of these procedures are much less effective than blood-thinning medications at helping you to recover and stopping you from having more blood clots.

How long will my treatment last?

This will depend on how severe your DVT has been and if you have had one before.

• If this is your first DVT and there is no clear reason why it happened, you would usually be given 3-6 months of treatment, depending on the bleeding risk.
• If the DVT has made your whole leg swollen, we may ask you to take treatment for 6 months.
• If this is not your first DVT, we will normally recommend you stay in treatment for the rest of your life.

Will I need to have any more tests after I have been diagnosed with a DVT?

If this is your first DVT, you will not usually need any further tests.

We may ask you to have further tests if:

• You have had a DVT and are otherwise completely fit and well without a good reason for this to have happened.
• You have had more than one DVT, again without a good reason. This would be even more likely if you also had a family history of DVTs.

Any further tests will depend on what the team feel may be the possible underlying cause. They will explain if and what further tests you may need.

If my ultrasound scan is negative, will I need more tests?

Usually you will not need any further tests, unless the team feel there is another possible diagnosis, which has not been looked into.

There is a chance that you have a DVT, even if the ultrasound scan is normal. If we are concerned about this, we may ask you to stay on blood thinning medication and return for another ultrasound scan a week after the first scan.

Very rarely, blood clots may take time to show on the scan. It is quite rare for us to ask you come back for a second scan and we would explain exactly why you having to have a second scan if this is the case.

Could I have another DVT after this one?

Yes. If you have a DVT, you will have a higher chance of having another DVT in the future, even after you have completed your treatment.

You should look out for any of the symptoms you had for the DVT coming back and report these symptoms to your Doctor.

Will it be safe for me to exercise after I have had a DVT?

Yes. We ask you to get back to high-intensity walking regularly as soon as you are able to. As time goes on, you will be able to return to whatever exercise you enjoyed before the DVT. This will be depend on how quickly the pain and swelling in your leg allows you to do this comfortably.

While you are taking blood thinners, it would be a good idea to refrain from contact sports, or any other sport that puts you at risk of injury. This includes mountain biking, rock climbing or another adventure sport. If you are uncertain, please speak to your Doctor.

Can I travel after I have a DVT?

Yes. We would ask you to wait at least two weeks after starting your treatment before you travel. If you are going on a long journey while using treatment, make sure you take it with you.

Stay well hydrated during the journey. If it is possible, stand up and walk around regularly during the journey. If you are travelling by car, try to schedule regular breaks into the journey.

If you are flying, please consider wearing flight socks or compression stockings. Talk to your local Pharmacist for help in choosing these.

Please remember that if you are travelling abroad that you make sure that you tell your travel insurance provider that you have had a DVT and that you are still having treatment, if you are.

Are there any long-term problems after I have had a DVT?

Most patients will have no long-term problems after they recover from a DVT.

A smaller number of patients may be left with damage to the veins of the leg that they had the DVT in. This can lead to problems such as:

• Chronic pain and swelling of the leg.
• A change in colour or darkening of the skin pigmentation of the leg.
• Dermatitis.
• Skin ulcers.
• Recurrent infections.

These are more common in:

• Older patients.
• Patients who are overweight or obese.
• Patients who have had more than one DVT in the same leg or who have had a DVT affect their whole leg.

If you develop any signs of these problems, your Doctor may want you to see a blood vessel specialist to assess which treatment will be best for you.

What can I do to help myself get better?

There are things that you can do to help yourself get better and reduce the chances of this happening again.

We advise that you:

• Finish your treatment for this DVT. Stopping the treatment early, even if you feel better, could cause the DVT to come back or slow down your recovery.
• Stop smoking. Smoking makes your blood more prone to blood clots. If you smoke, stopping is one of the best things you can do to help yourself get better and to reduce the chance of future DVTs. We can make sure you get the right help to stop smoking.
• Exercise. This might be difficult at first, but exercise is one of the best things you can do to help your recovery. Exercise will also help with your general health.
• Elevate your leg. When you are not walking or exercising, keep the leg with the DVT elevated, so that your ankle is above the level of your hip. This will help promote blood flow and stop any fluid accumulating (gathering).

References

Deep vein thrombosis: Scenario: Management of deep vein thrombosis, NICE website (November 2020), https://cks.nice.org.uk/topics/deep-vein-thrombosis/management/management/

Further Reading

DVT (deep vein thrombosis), NHS website (2019): https://www.nhs.uk/conditions/deep-vein-thrombosis-dvt/

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Leaflet Reference: PIL1316
Date for Review: 12/05/2024