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Deep vein thrombosis (DVT) Q&As

Published by Bupa's health information team, June 2009.

Answers to questions about deep vein thrombosis (DVT)

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

 

If I have had DVT, will I get more blood clots in the future?

As many as one in four people who have DVT will develop it again within five years. As time goes on though, your chances of developing DVT again continue to fall and get less year after year. What caused you to develop DVT can affect whether you are likely to have it again. You can reduce your risk of developing DVT again by following the treatment plan given to you by your doctor.

Explanation

Having DVT does increase your chances of having it again in the future. You're more likely to develop DVT again if you had it the first time because of an underlying medical condition which hasn't gone away. You're less likely to have it again if you developed DVT because of a one-off event like an operation.

If you develop DVT, your doctor will prescribe an anticoagulant medicine such as warfarin. How long you will need to take it depends on how likely you are to develop DVT again. For example, DVT that develops after you have had surgery is less likely to happen again, once you stop your treatment, than DVT that developed on its own. Your doctor will work out how long you need to take anticoagulants based on your individual circumstances and medical history. The greater your risk of developing another DVT, the longer you will need to take treatment - in some cases you may need to take treatment for life. You might also be asked to wear special compression stockings for up to two years, particularly if you had DVT in your thigh or if you have repeated DVTs.

Once you have stopped anticoagulant therapy, you may be given short-term anticoagulant treatment again (prophylaxis) during periods when you're at increased risk of developing another thrombosis, for example, after an operation or during pregnancy.

Because you have already had DVT, you will be more likely to develop it after a long-haul flight or journey than someone who has never had DVT. For this reason, you should talk to your GP and discuss your treatment and your options before you book a long journey.

Further information

Sources

  • Deep vein thrombosis. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 23 January 2009
  • Thromboembolism. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, accessed 23 January 2009
  • Simon C, Everitt H, Kendrick T. Oxford handbook of general practice. 2nd ed. Oxford: Oxford University Press, 2007:366
  • Travel after thrombosis. The Thrombosis Charity. www.thrombosis-charity.org.uk, accessed 23 January 2009
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I'm going in for an operation. How do I reduce my risk of getting DVT?

There are lots of things you can do to help prevent DVT. These include wearing special compression stockings, taking anticoagulant medicines and doing foot and leg exercises while you're in bed or inactive. You can reduce your chances of developing DVT by following the therapy your surgeon or nurse has planned for you, such as getting up and about as soon as possible after your operation and taking the medicines that have been prescribed for you.

Explanation

One in every five people having a major operation will develop DVT. The risk is higher if you are having an operation on your bones, for example, a hip or knee replacement. DVT may not cause any symptoms. However, it can be very serious so it makes good sense to do all that you can to prevent it.

Being immobile - for example spending a lot of time in bed and being inactive - increases your risk of getting DVT. This is why you're more likely to get DVT after you have an operation. Many of the steps you can take to prevent DVT are all about keeping your legs moving and keeping the blood that flows through them moving well.

Your surgeon or nurse will assess you when you go into hospital for your operation and will develop a plan to help prevent you getting DVT. He or she should give you information about your risk of developing DVT, what you can do to prevent it and what you need to do once you go home. If you don't receive this information, ask for it. Ways to reduce your risk may include the following.

  • Don't travel by bus, train, car or plane for more than three hours continuously, if you can't get up and move around, in the month leading up to your operation.
  • If you are taking the contraceptive pill, your surgeon may ask you to stop this, and use other methods of contraception for the month before your operation.
  • You may be asked to wear special stockings, called compression stockings, during and after your operation, until you are back to your usual level of mobility. These help to make sure that the blood flows well through your legs, helping to prevent clots from forming. Sometimes these can be attached to a special machine which fills the stockings with air and then deflates them, helping to squeeze your leg muscles.
  • Your surgeon or nurse will also teach you some foot and leg exercises to do while you are in bed or not very active. These help to keep the blood flowing well in your legs, which can help to prevent clots.
  • Get up and move around as much as you can, as soon as you can after your operation.
  • Make sure you are drinking enough fluids, as soon as you are able to after your operation. This will help to keep you hydrated, which can help to prevent blood clots from forming.
  • You might need to have injections of a medicine called heparin to help thin your blood. You will need to have these injections until you're up and about and back to your usual level of mobility, and in some cases (for example, after a hip replacement) for up to 6 weeks. This will mean having heparin injections at home. Your nurse can show you how to do these yourself, or arrange for a nurse to come in every day to give them to you. There are also new drugs that are now available in tablet form (eg rivaroxaban) that you may be given as an alternative to injections. But these are not suitable for everyone and there is limited experience of their use.

Further information

Sources

  • Venous thromboembolism. Reducing the risk of venous thromboembolism in in-patients undergoing surgery. National Institute for Health and Clinical Excellence (NICE). 2007. www.nice.org.uk
  • Alexander M. Fawcett J, Runciman P. Nursing Practice: Hospital and Home. The Adult. 3rd ed. London: Churchill Livingstone. 2006:910-11
  • Prevention of deep vein thrombosis by intermittent pneumatic compression devices (IPC). The Thrombosis Charity. www.thrombosis-charity.org.uk, accessed 23 January 2009
  • Joint Formulary Committee. British National Formulary. 55th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008
  • Fragmin: Summary of product characteristics. Electronic Medicines Compendium. www.emc.medicines.org.uk, accessed 23 January 2009
  • Venous thromboembolism - rivaroxaban: final scope. National Institute of Health and Clinical Excellence. August 2008. www.nice.org.uk
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Are there any precautions I need to take when taking warfarin?

Like all medicines, anticoagulants have side-effects but you can reduce the risk of these by taking the medicine every day as your doctor prescribed. You will also need to have regular blood tests.

Explanation

Warfarin is the most common anticoagulant taken by people after DVT. Warfarin is taken as a tablet and it's important that you take it at the same time every day. Like all medicines, anticoagulants have side-effects, but you can reduce the risk of these by following the advice below.

  • Make sure you attend for your blood tests. You will have regular blood tests when taking warfarin to monitor how well the medicine is working and to make sure you're taking the right amount. This is important because too much anticoagulant can cause bleeding and too little can increase the risk of a clot forming. You will need blood tests every day or every other day when you first start taking the medicine, but up to every 12 weeks after you have been taking it for a while.
  • Carry an anticoagulant card or wear a medical bracelet. It's important that any health professional who treats you knows that you're taking an anticoagulant. This is because it can affect your treatment and can interfere with other medicines. Tell any doctor, nurse or pharmacist who treats you or gives you any kind of medicine that you are taking anticoagulants. This includes over-the-counter medicines that don't need a prescription and any complementary or alternative medicines.
  • Don't drink cranberry juice if you're taking warfarin. Cranberry juice can affect the way in which warfarin works within your body. Large amounts of green vegetables (eg broccoli) can also interact with warfarin because they contain a lot of vitamin K, so make sure you only eat them in moderation. Grapefruit juice has also been reported to interact with warfarin.
  • Look out for signs of abnormal bleeding such as excessive bruising, bleeding that won't stop by itself, bleeding gums, blood in the urine, black faeces, or nose bleeds. These symptoms may mean that your dose of anticoagulant is too high. Tell your GP straight away if you get any of them.
  • Warfarin can damage an unborn baby so women who think that they may be pregnant should stop taking the drug immediately and seek urgent advice from their GP or haematologist about alternative anticoagulants.

Further information

Sources

  • Joint Formulary Committee. British National Formulary. 56th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008: 127
  • What are anticoagulants? Anticoagulation Europe. www.anticoagulationeurope.org, accessed 23 January 2009
  • Deep vein thrombosis. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 23 January 2009
  • Starting anticoagulation. GP Notebook. www.gpnotebook.co.uk, accessed 23 January 2009
  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007:366-7
  • Patient Briefing 18: Making it safer for patients taking anticoagulants. National Patient Safety Agency, 2007. www.npsa.nhs.uk
  • Long term treatment. Lifeblood - the Thrombosis Charity. www.thrombosis-charity.org.uk, accessed 23 January 2009
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Related topics

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This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: June 2009

Deep vein thrombosis (DVT) factsheet

 

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