Patient information factsheet Blood clots Venous thrombotic events: deep vein thrombosis (DVT) and pulmonary embolism (PE). Causes Venous thrombotic events, including DVT and PE, are also known as blood clots. They can happen for a number of reasons. Sometimes illness, breaking a bone, an operation or having a baby affects the way your body makes blood clots. Dehydration, smoking and sitting still for a long journey, can all affect clotting. Some families have a history of blood clots. If there is no obvious reason why your blood clot formed, then your GP may arrange further follow up. Treatment We will assess you to decide the safest place for your treatment. This will either be at home (or where you are staying locally), or you will be admitted to hospital for five to ten days. Both treatments are safe as long as you adhere to the advice given. You may be prescribed heparin injections, warfarin tablets or a combination, depending on your individual needs. Heparin injections A heparin injection makes the blood clot in your limb soft and more secure, so that your body can help absorb the clot. Warfarin tablets Warfarin tablets work by preventing your body making blood clots as quickly as usual. This allows your body to start dissolving the clot over about six weeks. It takes about five to six days to find the right dose of warfarin tablets for each person. If you have been given a supply of warfarin tablets, take the number advised in your yellow book and written on the white pill box for the first two days. After your blood test on the third and following days, the DVT nurse from Southampton General Hospital will phone you at home. The nurse will tell you how many 1mg (brown) tablets you need to take that evening. You must not take any warfarin until the nurse phones. Pain relief Do not take tablets containing ibuprofen or aspirin. If you need pain relief it is best to take paracetamol with warfarin. Follow the instructions on the packet of paracetamol and do not take more than the maximum dose. www.uhs.nhs.uk Patient information factsheet We may give you some co-dydramol tablets. These are stronger painkillers and must only be taken 4 times in 24 hours, with a minimum of 4 hours between each dose and cannot be taken with any other additional paracetamol. You must tell the nursing staff about any remedies you take that are not prescribed by your doctor, such as cod liver oil. These may be from a health food shop or over the counter at a pharmacy. The yellow book We will give you a yellow anti-coagulant booklet. You should keep this with you at all times while you are on warfarin. It is a record of your treatment and contains some helpful advice. You also have an anticoagulation alert card, which you can keep in your purse/wallet. Follow up appointments You will need to make an appointment to see a doctor at your GP surgery two to three days after you have finished your injections. Please tell the receptionist that you will also need to have an appointment with the practice nurse for a blood test as well, before you see the GP. This appointment does not need to be the same day as your GP appointment – it could be the day before if necessary. To see your practice nurse on……………………….. To see the GP by……………...................................... Your district nurse The district nurse will visit you every morning to give you your injections and to ask you if you took your warfarin tablets the night before. On the third day, through to the sixth day of your treatment, the district nurse will take a blood test. The DVT nurse will phone in the late afternoon at about 6pm to tell you what warfarin tablets you should take that evening. If the district nurse has not visited by midday, please call the clinic. Important information While you are under our care you must rest at home. Do not go out. You can walk around gently at home, but try and rest the affected limb as much as possible. When sitting or lying down, rest your arm or leg on an arm rest or foot stool to help the swelling go down. Do not do activities such as gardening, hoovering or anything that involves heavy lifting. You must not drive while under our care. Check with your insurance company before you start driving again, as they may not cover you without up-to-date information. www.uhs.nhs.uk Patient information factsheet Food and drink It is a good idea to eat lots of fresh fruit, protein and vegetables as these help the healing process. However, you should not eat a lot of green leafy vegetables and certain fruit juices. See the separate leaflet on dietary advice for more information. Avoid changing your diet drastically without medical advice. Alcoholic drinks prevent your body absorbing the warfarin tablets. You should not exceed the national guidelines for alcohol – no more than three units a day for men and no more than two units a day for women. Further information For more information while receiving care telephone the clinic on 023 8079 6284, Monday to Friday, 9am to 7pm; Saturday, Sunday and bank holidays, 9am to 5pm. Outside of these hours, if you feel very unwell with difficulty breathing, start bleeding heavily, have chest pain or a head injury telephone 023 8079 6496 or go straight to the emergency department. At the emergency department ask to speak to the nurse in charge and explain you are being treated via the ambulatory care unit. Take your pack with you. We recommend that patients taking warfarin watch the short video available at www.uhs.nhs.uk/warfarinvideo You should discuss any questions arising from this with the person monitoring your blood tests. DVT clinic Ambulatory care unit C level North Wing Southampton General Hospital SO16 6YD If you need a translation of this document, an interpreter or a version in large print, Braille or on audio tape, please telephone 023 8079 4688 for help. Version 1. Published April 2012. Due for review April 2015. ACU002.01 www.uhs.nhs.uk