Discharge Instructions for Deep Vein Thrombosis (DVT)

A blood clot or thrombus that forms in a large, deep vein is called a deep vein thrombosis (DVT). If a DVT is not treated, part of the clot (embolus) can break off and travel to your lungs. This is called a pulmonary embolus (PE). This can cut off the flow of blood to part or all of the lung. PE is a medical emergency and may cause death.

Healthcare providers use the term venous thromboembolism (VTE) to describe these two conditions: DVT and PE. They use the term VTE because the two conditions are very closely related. And their prevention and treatment are also closely related.

Follow all instructions for taking your medicine, follow-up care, and diet and lifestyle changes.

Medicine

Your healthcare provider will usually prescribe a blood-thinner (anticoagulant) medicine. This medicine helps prevent new blood clots. Blood thinners can be given by mouth (oral), by shot (injection), or by IV (intravenous). Commonly used blood thinners include warfarin and heparin. Newer blood thinners may also be used. They include rivaroxaban, apixaban, dabigatran, and enoxaparin. Your healthcare provider will give specific instructions on how to take your medicine. You may take more than one type for a period of time.

Take your blood thinner exactly as directed. If you miss a dose, call your healthcare provider to find out what you should do. These medicines increase the chance of bleeding. So it's very important to take them correctly. Be sure to tell all of your healthcare providers, including dentists, that you are taking a blood thinner.

Follow-up monitoring

You’ll need to have your blood tested on a regular schedule. Your healthcare provider will tell you how often you need to have your blood tested. This is to make sure you’re taking the right amount of warfarin. Too much can cause excess bleeding, which can be very serious. Too little may not prevent blood clots from harming you.

The blood tests check your international normalized ratio (INR) and prothrombin time (PT). These show how quickly your blood clots. Together the test is called PT/INR.

You may need to visit a hospital or clinic to have your blood tested. Or a nurse may come to your home and test your blood. In some cases, you may be able to test your blood at home with a small machine. Talk with your healthcare provider to find out what’s best for you. Don't miss any appointments to get your blood tested. If you have a blood test outside of your healthcare provider’s office, make sure to call them as soon as you get your test results.

After the blood test, your healthcare provider may tell you to change your dose of warfarin. Take the medicine exactly as directed. Don’t stop taking it unless your healthcare provider tells you to.

Diet and warfarin

Vitamin K can interact with warfarin and reduce its ability to thin your blood. Vitamin K helps your blood clot. So sudden changes in vitamin K intake can affect the way warfarin works. You don’t need to stop eating foods with vitamin K. Instead, keep the amount you eat about the same each day. Foods high in vitamin K include:

• Leafy green vegetables such as spinach, cabbage, and kale

• Avocado

• Asparagus

• Egg yolks

• Oils like canola, olive, and soybean

When taking warfarin, don't change your diet without first checking with your healthcare provider.

The other blood thinners don't have the same interaction with vitamin K that warfarin does.

Medicines and your anticoagulant

Some medicines may cause problems with blood thinners. Check with your healthcare provider before making any changes to your medicines. And don't take over-the-counter (OTC) medicines without checking with your provider. Some medicines interact with your blood thinner and make your blood too thin. This increases your risk of bleeding. Others may stop your blood thinner from doing its job, making your blood too thick. So it's very important to tell your healthcare provider about all of the medicines you take, including OTCs and herbal supplements. Don't start or stop taking any medicine, including OTCs, unless your healthcare provider tells you to.

Medicines that may cause problems with your blood thinner include:

• Some antibiotics

• Some heart medicines

• Cimetidine

• Aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen

• Some medicines for depression, cancer, HIV infection, diabetes, seizures, gout, high cholesterol, or thyroid disease

• Vitamins with vitamin K

• Some herbal products, such as St. John's wort, garlic, coenzyme Q10, turmeric, and ginkgo biloba

Home care

To help prevent blood clots, try the following:

• Wiggle your toes and move your ankles while sitting or lying down.

• When traveling by car, make frequent stops to get up and move around.

• On long airplane rides, get up and move around when possible. If you can’t get up, wiggle your toes, move your ankles, and tighten your calves to keep your blood moving.

• If you have to stay in bed, do leg exercises.

• Wear support or compression stockings, if prescribed by your healthcare provider.

• Rest and put your legs up whenever they feel swollen or heavy.

• Raise the foot of your mattress 5 to 6 inches, using a foam wedge.

Lifestyle changes

To help you stay healthy, especially your heart and blood vessels, you should:

• Start an exercise program if you are not exercising. Ask your healthcare provider how to get started. Try walking, inside or out.

• Stay at a healthy weight. Get help to lose any extra pounds.

• Keep blood pressure in a healthy range.

• If you smoke, make a plan to quit. Ask your healthcare provider about stop-smoking programs to help you quit.

Call 911

Call 911 right away if you have the following symptoms. They may mean a blood clot in your lungs:

• Chest pain

• Trouble breathing

• Fast heartbeat

• Sweating

• Fainting

• Coughing (may cough up blood)

• Heavy or uncontrolled bleeding

When to call your healthcare provider

Call your healthcare provider if you have pain, swelling, or redness in your leg, arm, or other area. These symptoms may mean a blood clot.

If you take blood thinners and are bleeding, you may have:

• Blood in the urine 

• Bleeding with bowel movements

• Very dark or tar-like stool

• Vomiting with blood

• Coughing with blood

• Bleeding from the nose

• Bleeding from the gums

• A cut that will not stop bleeding

• Bleeding from the vagina