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 because 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 an anticoagulant medicine. This medicine is a blood thinner that helps to prevent new blood clots. Anticoagulants can be given by mouth (oral), by injection, or into your vein (intravenous or IV). Commonly used anticoagulants include warfarin and heparin. Newer anticoagulants may also be used. They include rivaroxaban, apixaban, dabigatran, and enoxaparin. Your healthcare provider will provide specific instructions on how to take your anticoagulant. You may take more than one type for a period of time.

Make sure to take your anticoagulant 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 is very important to take them correctly. Be sure to tell all of your healthcare providers, including dentists, that you are taking an anticoagulant.

Follow-up monitoring

If you are taking warfarin, you will need regular blood tests to see how it is working. These blood tests include a prothrombin time (PT), also reported as an international normalized ratio (INR). Your dose of warfarin may be changed based on the test results. It is very important that you keep your testing appointments after you leave the hospital.

Be sure you understand the following information before you go home:

• My next PT/INR blood draw will be on ______________ (date) at _______________ (time) at __________________________________________ (name of healthcare provider or clinic and address).

• The name of the healthcare provider who will monitor my anticoagulation is ________________________ and the phone number is _________________________.

Depending on which anticoagulant you are prescribed, you may need other blood tests. Before you are discharged, your healthcare provider will review what testing is needed in detail.

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 avoid foods with vitamin K. Instead, keep the amount you eat about the same each day. Foods high in vitamin K include:

• Leafy green vegetables like 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 anticoagulants don't have the same interaction with vitamin K that warfarin does. 

Medicines and your anticoagulant

Some medicines may cause problems with anticoagulants. 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 anticoagulant and make your blood too thin. This increases your risk of bleeding. Others may stop your anticoagulant from doing its job, making your blood too thick. So it is 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 anticoagulant include:

• Some antibiotic medicines

• Some heart medicines

• Cimetidine

• Aspirin or other nonsteroidal anti-inflammatory medicines (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:

• Begin 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