Venous Thromboembolism (VTE):

Information for the Patient

Venous thrombembolism (VTE) refers to an abnormal blood clot that develops in a vein or the lung.An abnormal blood clot in the leg is called deep vein thrombosis (DVT) and an abnormal blood clot in the lungs is called pulmonary embolism (PE). DVT and PE are serious conditions but they are treatable.

DVT and PE

DVT is a condition in which an abnormal blood clot, also called a “thrombus”, forms in one or more of the veins deep in the body, generally in a leg. Sometimes, part of a DVT from the leg can break off and travelto the lung, where it is known as PE.

Symptoms and Signs of DVT and PE

Common symptoms of a DVT may include:

  • Swelling of the leg
  • Pain and tenderness of the leg
  • Warmth over the affected area
  • Changes in skin colour (e.g. turning red or purple)

Symptoms of a PE may include:

  • Chest pain that is sharp and is worse when taking a deep breath
  • Sudden difficulty breathing
  • Feeling light-headed, dizzy, or faint
  • Unexplained sweating
  • Rapid heart beat
  • Coughing up blood

What are some risk factors for DVT and PE?

Certain people are more likely to develop DVT and/or PE. Risk factors include:

  • Surgery
  • Trauma
  • Immobility or paralysis
  • Cancer and cancer treatments
  • Increasing age
  • Previous DVT or PE
  • Family history of DVT or PE
  • Medical illness such as heart failure, infection
/
  • Pregnancy
  • Birth control pills or hormone replacement therapy
  • Obesity
  • Inflammatory bowel disease
  • Chronic kidney disease
  • Prolonged travel
  • Abnormalities of blood clotting (inherited or not inherited)

How are DVT and PE treated?

DVT and PE are treated with medicines called anticoagulants. Anticoagulants do not dissolve existing blood clots. They keep the clot from getting bigger and prevent future clots from developing. Some of these anticoagulants come as injections and others come as pills.
There are three main methods to treat a DVT or PE:

  1. Useof an anticoagulant called a low molecular weight heparin (LMWH), given for at least 5 days. This is an injection that is given just under the skin. A tablet anticoagulant called warfarin is usually started at the same time as the LMWH injection and is continued in the long term. The LMWH injections are usually stopped within the first week.
  2. LMWH injections alone (no warfarin) for the entire duration of treatment.
  3. The newest option is to use an oral anticoagulant called rivaroxaban (Xarelto®), which is taken daily for the entire duration of treatment.

Your doctor will discuss the best choice of treatment for you and how long you will need to be treated. Most patients are treated for at least three months. Some patients need to be treated for longer (and some are treated indefinitely).

The main side effect of anticoagulant treatment is bleeding which is not common and is usually minor. For example, you might get:

  • A nose bleed that lasts for less than 5 minutes
  • Easy bruising
  • Bleeding gums while brushing teeth.

Some bleeding can be more serious; however this is rare.

What happens to the DVT or PE?

Some patients will experience improvement of symptoms within days or weeks while others may take longer. Some patients with DVT can develop post-thrombotic syndrome, which is leg swelling and/or discomfort caused by damage to the veins. Compression stockings will help reduce the severity of this complication.

If you had a DVT, signs that we expect there will be:

  • Reduced leg swelling
  • Reduced pain
  • Improved ability to walk

If you had a PE, signs that we expect there will be:

  • Improvement in shortness of breath and chest pain

How long it will take to see these changes is different for each person.

General tips to consider while being treated for DVT or PE:

Take your medication every day, at approximately the same time. Forgetting to take your anticoagulant puts you at risk of worsening of the clot or developing a new clot.
Talk to your doctor if you are taking antiplatelet medications (acetylsalicylic acid [Aspirin®], clopidogrel [Plavix®], ticagrelor [Brilinta®], prasugrel [Effient®]). These medications increase your risk for bleeding and should only be taken if strongly recommended by a doctor.
Move around!The sooner you get moving, the faster you will feel better.
Exercise daily.There is no need to restrict your activity. / Adopt a healthy lifestyle. Lose weight if you are overweight. Quit smoking and control your blood pressure. Maintain or start a healthy diet.
Wear compression stockingsif your doctor recommends them.
See your doctor regularly, at least at 3 months and then every 6 to 12 months.
Talk to your doctor if you notice unexpected bleedingincluding extremely dark stools, cough up blood, bleeding in the urine or from the rectum, large bruises on body without being injured, and nosebleeds that won’t stop.

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