Your Guide to Deep Vein Thrombosis by Marcie Hoff - HTML preview

PLEASE NOTE: This is an HTML preview only and some elements such as links or page numbers may be incorrect.
Download the book in PDF, ePub, Kindle for a complete version.

and decide the measures that are required to reduce your risk of deep vein

thrombosis.

Your risk begins with the immobility that is associated with post surgery.

• If immobility is necessary then your leg should be elevated to the

position higher than your heart. This will reduce the chances of

swelling of the foot.

• Keep moving your legs. You may try swinging the legs from the sides

of the bed frequently through the day. You may try to bend your knees

too. Keep as mobile as possible, subject to your doctor’s advice.

• Take the anticoagulants prescribed by your doctor before or after the

surgery.

• During surgery, you may be required to wear a sleeve-like device on

your legs to compress them and maintain the blood flow in the veins.

• Wearing compression stockings during surgery can regulate the flow of

blood and may prevent blood pooling in the veins.

• Elevating the foot of the bed helps to avoid the blood clotting too.

• Within any limits required by your doctor, start moving around as soon

as you can after the surgery, or even when you are ill.

• Usually, the sooner you get moving, the less chance you have of

developing blood clots.

• Do some exercise of the legs and calves, as often as possible in line

with what your doctor advises.

Copyright © 2008 All right Reserved

- 34 -

"Your Guide to Deep Vein Thrombosis" By Marcie Hoff

Page 35 of 63

Treatment of D.V.T.

Treatment begins after careful assessment of the test results and your

symptoms.

Your doctor has to decide the likelihood of:

• the clot growing or

• the clot breaking loose and moving to the lungs

The doctor’s opinion, after reviewing the test results, will affect the

medication and other treatment that you get.

If the clot is on the upper leg vein, your medication might continue up to 6

months. After that, your doctor will recommend the next step for you.

If your clot is in the lower leg vein then you might be using the medication

for six to twelve weeks. The doctor may start the medication straight away or

wait for twenty-four to forty-eight hours.

Clots that form in the deep veins in your legs and pelvis area may be

potentially hazardous when they break off and travel to the smaller veins

around the heart and lungs.

Deep Vein Thrombosis Medications

The main treatment form of deep vein thrombosis (D.V.T.) is anticoagulant

medications. Rarely are any other forms of medication prescribed for the

same.

Anticoagulants

Anticoagulants prevent formation of new clots and discourage the existing

clots from enlarging. However, they have no effect over pre-existing clots.

The functions of anticoagulants are to:

• Treat the existing D.V.T.

• Prevent formation of blood clots that are associated with certain types

of surgery.

Copyright © 2008 All right Reserved

- 35 -

"Your Guide to Deep Vein Thrombosis" By Marcie Hoff

Page 36 of 63

• Prevent further formation of blood clots in people who are prone to

D.V.T.

Heparin

Heparin is a medicine that thins the blood. Thinning of the blood prevents

blood from clotting and prevents the pre-formed blood clots from enlarging.

Heparin is injected into the vein or under the skin.

Patients that are getting Heparin often need to stay in the hospital as the

condition and the effect has to be closely monitored.

There are two types of Heparin:

• LMWH or Low molecular weight Heparin, one can inject this type of

heparin at home. This is less expensive and convenient.

• UH or Unfractionated Heparin, this type of heparin is given

intravenously or through the vein. Therefore, it requires monitoring

and should be given under medical care

Heparin starts its effect immediately and is continued with the patient until

the medication containing warfarin starts its therapeutic effect.

Warfarin

Warfarin is the main active ingredient of oral anticoagulants, for example

Coumadin®.

There are studies underway to check whether a low-dose warfarin medication

might be as effective as the conventional dose and whether it decreases the

chances of bleeding which are present with current recommended dosages.

The duration of the medication is still being researched. Generally, treatment

lasts for three to six months. But, the duration of the medication depends on

various factors:

• If your risk factor for developing deep vein thrombosis is a short-term

one; for example because of surgery, then the oral anticoagulant

therapy will be for a short period.

Copyright © 2008 All right Reserved

- 36 -

"Your Guide to Deep Vein Thrombosis" By Marcie Hoff

Page 37 of 63

• If you have a continuous risk factor such as cancer or recurrent blood

clots, then the anticoagulant treatment continues while the risk factor

is present.

• If you have a genetic blood clotting disorder, then you may have to be

on an oral anticoagulant for an indefinite period.

Thrombolytics

Thrombolytics are medications that dissolve the blood clots rapidly. They are

used to treat large clots or clots that have formed recently and are causing

severe symptoms.

Application of these medications can increase the chances of bleeding, so

they are used for specific situations, under strict medical supervision.

Thrombolytics are used in extreme situations.

Thrombin Inhibitors

Thrombin inhibitors are new medications that interfere with thrombin’s

action. Thrombin is necessary for blood to clot.

Aspirin

Aspirin helps to prevent blood clots and reduces the chances of pulmonary

embolism. Studies and research reveals that aspirin reduces the chances of

pulmonary embolism after surgery by up to 33%. Some studies also assert

that aspirin is beneficial for people who are at the risk of developing blood

clots.

Copyright © 2008 All right Reserved

- 37 -

"Your Guide to Deep Vein Thrombosis" By Marcie Hoff

Page 38 of 63

Clinical Treatment of Deep Vein Thrombosis

Deep vein thrombosis needs immediate medical attention and requires

hospitalization. Hospitalization helps in proper monitoring of the medications.

The treatment for deep vein thrombosis varies from age to age, and from

person to person.

For newborns and infants, the course for medication is different.

It is always advisable that you consult your doctor for the right kind of

treatment before you ever start with self-medication.

The main objectives of treating D.V.T. (Deep vein thrombosis) are:

• To prevent any blood clot from growing larger

• To stop the blood clot from dislodging and traveling to your lungs

• To prevent occurrence of another blood clot in your veins

Once the inflammation of the vein is diagnosed, the patient is admitted to the

hospital for around fourteen days, for treatment with oral warfarin and IV

heparin.

Management of deep vein thrombosis (D.V.T.) means not just management

from the clinical point of view; it also involves management of the patient as

well.

Clinical Management

Compression Ultrasonography

The arrival of Compression Ultrasonography has changed the situation

greatly.

At the suspicion of D.V.T., the first test is Compression Ultrasound of the

femoral, calf trifurcation and popliteal (proximal) blood vessels.

If the ultrasound reveals proximal D.V.T., treatment starts immediately. If

the result is negative, the ultrasound is repeated again after two days and

then again after seven days.

If the result is negative, it rules out clinically significant D.V.T.

Copyright © 2008 All right Reserved

- 38 -

"Your Guide to Deep Vein Thrombosis" By Marcie Hoff

Page 39 of 63

Checking the Distal Calf Veins

Some think that D.V.T. of the distal calf veins are not dangerous, but it may

be when/if it spreads to the proximal veins. Then, serial ultrasonography is

done.

If there is no sign of progression, then the chances of pulmonary emboli are

rare.

However, when symptoms are found, then venography is done.

After a positive signal, the patient is likely to have a continuous intravenous

drip of heparin for four to six days, and then start the oral warfarin

treatment.

LMWH or the Low Molecular Weight Heparin

The advantage of LMWH over the unfractionated heparin is ready

bioavailability and the longer half-life; it is possible to give it once or twice in the day subcutaneously.

The patient's weight determines the dose and there are claimed to be lesser

chances of bleeding than when unfractionated heparin is used.

Medicines

There are medicines which treat deep vein thrombosis (D.V.T.) and some

designed to help prevent it.

Anticoagulants

The most common type of medication used to treat D.V.T. is anticoagulants.

They are also called blood thinners.

These medicines reduce the chances of clotting in the blood. They also

prevent the pre-existing blood clots from enlarging. However, these

medicines are unable to break up the blood clots that exist in the blood

vessel.

Blood thinners can be taken either as a pill or as an injection through a

needle or a tube that is inserted into the vein, a process known as IV

injection or intravenous injection.

Copyright © 2008 All right Reserved

- 39 -

"Your Guide to Deep Vein Thrombosis" By Marcie Hoff

Page 40 of 63

Heparin and warfarin are the blood thinners that are most often used in

treating deep vein thrombosis.

Heparin is given to the patient as an injection or through an IV tube, whereas

warfarin is given as an oral pill. Heparin comes in two different types and

your doctor will decide which option is most suitable for you.

Warfarin takes two to three days to start its healing process, but Heparin

acts sooner.

Your doctor may treat you with both at the same time or may just prescribe

one of them.

But, once the warfarin starts its healing procedure, heparin is discontinued.

Pregnant women complaining of deep vein thrombosis are generally treated

with only Heparin as warfarin is not a safe option for them.

Treatment for deep vein thrombosis with blood thinners may last from three

to six months.

The situations mentioned below may change the course or the length of the

treatment:

• If you have had blood clots before, your treatment may last longer.

• If the blood clot in your body appears shortly after surgery, then the

treatment may be shorter.

• If you are suffering from certain illnesses, such as cancer, you may

have to continue taking blood thinners as long as you are ill.

But, you need to be aware that the side effect of blood thinners is bleeding.

These situations arise if your blood becomes too thin. This can be life-

threatening to a patient.

The bleeding is inside your body. Therefore, people who are treated with

blood thinners, are advised to have a regular blood test to measure their

blood’s clotting ability. These tests are the PTT and PT tests.

Copyright © 2008 All right Reserved

- 40 -

"Your Guide to Deep Vein Thrombosis" By Marcie Hoff

Page 41 of 63

These tests are indicators to help the doctor check whether the amount of

medicine prescribed to you is right. If you bruise easily or bleed, this may be

due to too much thinning of your blood.

Then, you need to contact your doctor as soon as possible.

Thrombin Inhibitors

These medicines obstruct the process of blood clotting. They are used to

treat patients who cannot take Heparin.

Thrombin inhibitors prevent and treat D.V.T. The direct thrombin inhibitors

help to prevent the clots from interfering with the protein, thrombin.

Thrombin is considered the chief constituent in making the blood clot. These

medicines inhibit circulation.

Heparinoids

Heparinoids are compounds similar to heparin. They reduce the ability of the

blood to clot. Heparinoids are prescribed only after surgery to reduce the

chances of deep vein thrombosis in a patient.

They do not affect blood clots that are already there; but they prevent

formation of new ones.

Heparinoid are injected into the patient and they require monitoring, like

heparin. Patients can also use them at their home.

Thrombolytics

These dissolve the blood clot very quickly and are used in conditions where

the blood clots are massive and show the potential of causing serious

symptoms.

These medicines are only used when the condition is very severe because the

side effects of thrombolytics can be sudden bleeding.

Copyright © 2008 All right Reserved

- 41 -

"Your Guide to Deep Vein Thrombosis" By Marcie Hoff

Page 42 of 63

Other Treatments for D.V.T.

Graduated Compression Stockings

Graduated compression stockings are a special type of stocking that may

reduce swelling that is likely to follow a blood clot in your leg. These

stockings are knee length. They are light around the ankle and loosen up as

they move up the leg.

This helps to create a gentle pressure on the leg. This pressure is very

effective in preventing the blood from pooling and clotting.

A person with deep vein thrombosis should wear these stocking for a year,

once deep vein thrombosis is diagnosed.

Vena Cava Filter

A vena cava filter is used in conditions when you cannot take blood thinners

anymore or when, despite taking blood thinners, your body is continuously

developing blood clots.

This process involves inserting a filter in the large vein, vena cava.

These filters are also called the ‘umbrellas’ because their wire spokes

resemble an umbrella’s wire. This filter prevents the blood clots that have

dislodged and are traveling towards the lungs from reaching the lungs.

However, this process cannot stop formation of new blood clots.

Bed Rest

People with D.V.T. usually need bed rest until there is some relief in the

symptoms. The legs must be elevated so that they are above the heart.

This position will reduce the chances of swelling in the foot.

Application of the moist heat to the affected area can serve as a pain

reliever.

Dietary Considerations

Maintain a well-balanced and normal diet every day. This is because the

quantity of vitamin K in the body affects the working of warfarin. Inconsistent

Copyright © 2008 All right Reserved

- 42 -

"Your Guide to Deep Vein Thrombosis" By Marcie Hoff

Page 43 of 63

and unusual food consumption that has high amount of vitamin K may affect

the action and safety of warfarin.

Foods that are high with vitamin K are spinach, broccoli, liver, cauliflower,

kale, cabbage and dark green vegetables. You should avoid a vegetarian diet

that is rich in vitamin K while you are being treated with Warfarin.

If you are using any vitamin products or dietary supplements, check with

your doctor to be sure that they are not high in vitamin K.

You must avoid consumption of alcohol while under this medication because

this may increase the chances of bleeding in the stomach.

Surgery

If the blood clot or the embolus detaches from the blood vessel and moves

into the bloodstream, then surgery may be required to prevent the clot from

reaching the lungs.

But, surgery is the last resort, where the blood clot is removed from the

veins. During the surgery, the patient receives heparin with anticoagulant

therapy and then Warfarin for at least 6 weeks to 3 months after the

operation.

Copyright © 2008 All right Reserved

- 43 -

"Your Guide to Deep Vein Thrombosis" By Marcie Hoff

Page 44 of 63

Treating D.V.T. in Children

Children older than two months are mostly given intravenous heparin.

The treatment with heparin continues for five to ten days simultaneously with

oral anticoagulation.

Treatment of Newborns

The best possible treatment for anticoagulation in treating newborns with

deep vein thrombosis and pulmonary embolism is not certain. If

anticoagulation is used, it should be for a short course just lasting ten to

fourteen days. Intravenous heparin should be used.

A further clinical investigation needs to be done about the best course of

treatment with newborns.

Copyright © 2008 All right Reserved

- 44 -

"Your Guide to Deep Vein Thrombosis" By Marcie Hoff

Page 45 of 63

Alternative Treatments for Deep Vein Thrombosis

Deep vein thrombosis (D.V.T.) can be fatal if proper medical treatment is

not offered in time.

Some people claim that other alternative therapies can be combined with the

emergency treatment to help the clot dissolve faster and prevent the clot

from recurring in the future.

Alternative therapy starts with one being aware of the disease. The more you

are aware and the more you know about the signs and symptoms of deep

vein thrombosis, the better.

However, before you proceed with the alternative therapy, it is highly

recommended that you consult your doctor and follow his or her

recommendations fully.

If you do try alternative treatments, only consult trained and certificated

practitioners, because of the severity of the condition.

Soy and Pine-bark:

Soy and pine-bark are claimed by some to be a non-toxic natural

nutraceutical. One product claims that it has property to prevent D.V.T.

(deep vein thrombosis) but there is no independent science-based

corroboration of this claim.

The natural ingredient Pycnogenol, extracted from the maritime pine bark, is

claimed by some to have natural anti-inflammatory properties, which may be

beneficial for the cardiovascular system.

Garlic

Garlic is claimed by some to be helpful in reducing thrombosis and platelet

aggregation or plaque formation in the body.

Garlic is also supposed to have anti-clogging properties that prevents the

blood from clogging. Some people include garlic in their diet every day.

Copyright © 2008 All right Reserved

- 45 -

"Your Guide to Deep Vein Thrombosis" By Marcie Hoff

Page 46 of 63

If you are using aspirin, it is recommended that you do not take garlic

supplementation.

Water

Avoid dehydrating agents as far as possible because they cause the blood to

thicken and encourage deep vein thrombosis. Coffee, tea and alcohol have

the property of dehydrating the body.

Avoid them as much as possible, whenever you are traveling. Instead of

alcohol or coffee, have water. To enhance the taste, you may also add a dash

of lemon to your water.

Compression Stockings

Compression stocking are knee-high and fit very comfortably. Elastic

compression stockings are beneficial for people who are at risk of developing

deep vein thrombosis.

You must wear the stockings from the first month of the diagnosis of deep

vein thrombosis and must continue wearing for a minimum of one year for

best results.

Exercise

Exercise is another factor in reducing your risk of D.V.T..

As you grow older, you may tend to become less active, but the more active

you are, the better the chances of not developing D.V.T..

You need to keep your weight and your blood pressure under control.

Exercise is a great way to moderate both.

Walking: The more you walk, the more your leg muscles remain firm and fit.

There is less chance of developing clots in legs that are always active.

Copyright © 2008 All right Reserved

- 46 -

"Your Guide to Deep Vein Thrombosis" By Marcie Hoff

Page 47 of 63

Non-prescription Treatments for Deep Vein Thrombosis

The focus with any non-prescription treatment for deep vein thrombosis is

safety and they should never be considered without prior consultation with

your medical professional and only as a companion to your continuing use of

the anticoagulants because of the high risk of bleeding with this condition.

The first important point of deep vein thrombosis treatment is awareness. If

you are prone to deep vein thrombosis; have a genetic disorder or family

history, then you must be very cautious. However, knowing about the

disease itself is taking the first step of prevention.

If you have deep vein thrombosis, you must manage your diet properly. Do

not suddenly change your eating habits or include food in your diet that is

vitamin K rich. Those foods may interfere with the anticoagulant’s action and

make your blood clot too easily.

Check the components of your current diet.

Here are some non-prescription treatments that some people claim may be

beneficial for you:

Nattokinase:

Nattokinase is an enzyme that is derived from natto, a Japanese preparation

made of boiled and fermented soybeans.

Natto is claimed to enhance cardiovascular health. Many Japanese have

made it a part of their diet over many centuries.

They claim that some studies show nattokinase dissolves or even prevents

blood clots. It is also claimed to prevent heart attack, senility, hardened

arteries, stroke and angina.

They take nattokinase with or without having other food at the same time

but, if you are taking blood-thinning drugs, it is strongly recommended that

you