General information post diagnosis of DVT
Date issued: September 2019
For review: September 2021
Ref: A-427/Medicine/ZL/General information post diagnosis v2
PDF: General information post diagnosis of DVT [pdf] 169KB
Are there any side effects?
The most common side effects of any anti-coagulant are bleeding and bruising. It can be in the form of prolonged bleeding from cuts, bleeding that does not stop by itself, nose bleeds, small or large bruises under the skin, bleeding gums when brushing the teeth.
More serious bleeding may present as red or dark brown urine, red or black stools, or coughing or vomiting blood stained fluid or a nosebleed that won’t stop. Although these problems
Are, fortunately rare, if they do occur they can be serious and you should see your GP urgently or go to your nearest Accident and Emergency department.
If you are involved in any kind of accident (for example, a car accident or falling down and hitting your head on the pavement) go to the nearest Accident and Emergency department. You will need to get checked for internal bleeding.
Other medications
It is important to continue taking all medications prescribed by your consultant or GP. Some drugs affect how your particular anti-coagulant works. If your doctor prescribes any new medication, please ask him or her whether it interferes with your anticoagulant.
Avoid all aspirin-based drugs and non-steroidal anti-inflammatory preparations such as ibuprofen unless prescribed by your doctor. Always seek advice from a pharmacist before purchasing any over the counter medicines, food or health supplements (this includes creams and ointments).
You need to tell your doctor and pharmacist what herbal products you are taking, especially bromelains, coenzyme Q10, danshen, dong quai,fenugreek, horse chestnut, red clover, sweet clover and sweet woodruff, ginger, garlic, Ginkgo biloba,and St.John's wort. Do not start taking any herbal products without talking to your doctor or pharmacist. This also includes some aromatherapy oils and muscle rubs such as “deep heat” which contains Methyl salicylate, which can increase the body’s sensitivity to warfarin.
Pregnancy
It is very important NOT to become Pregnant while taking oral anti-coagulation.
Tell your doctor if you are or plan to become pregnant.
If you become pregnant or think you may be while taking anti coagulation therapy, consult your doctor immediately.
Oral contraception (OCP)
While taking an anti-coagulant you are very well protected against a further DVT and a decision regarding whether to stop these compounds does not need to be taken immediately. However you should discuss future contraception to be used for when you have completed your anti coagulation course. You must discontinue the OCP at least 4 weeks prior to stopping anti coagulation. Progesterone only compounds (e.g. mini-pill or Depot-Provera) are safe from a VTE (Venous Thrombo Embolism) viewpoint
It is very important NOT to become Pregnant while taking oral anti-coagulation.
Hormone replacement therapy (HRT)
While taking anti coagulation, you are very well protected against a further DVT. A decision regarding whether to stop this medication does not need to be taken immediately however HRT will need to stop at least 4 weeks prior to stopping anti-coagulation. If bone protection is required then non-hormone compounds are available and should be discussed with your GP. For peri-menopausal symptoms, the situation may be difficult but alternatives to HRT are paramount.
Other hormone based treatments
Obviously, these treatments need to be continued and need to be discussed carefully with your Oncologist. The nurses in the DVT clinic will inform your oncology team about your DVT diagnosis, as there may be alternative treatments that can be
prescribed for you which may carry less risk of a further DVT. DO NOT stop taking this medication unless your oncologist or GP tells you to do so.
Travel
It is advisable to discuss your travel plans with your GP before any overseas travel.
Please ensure that you have valid medical insurance for your travel and that it covers you for anti-coagulation treatment.
Remember to pack sufficient quantities of your tablets for the length of your stay. It is advisable to take two packs one in your main luggage and one in your hand luggage. During your journey please keep as mobile as possible and keep well hydrated this advice applies for all types of travel: train, bus, plane and car. If you are driving please consider regular stops during your journey.
Compression stockings
It is recommended once the initial period of swelling and pain has subsided and your warfarin treatment is stable to wear compression stockings. This treatment has been shown to reduce the risk of a recurrent DVT, and can also reduce the risk of developing long-standing changes to your legs, called post-thrombotic syndrome. You should wear the stockings daily, for at least two years.
The best type of stockings (or elastic compression hosiery as they are known) is grade 3 strength. This means that they are able to squeeze the legs, with a certain degree of force. This also means that they will feel very tight. This is normal. It will not be as comfortable as the socks, tights or stockings you are used to wearing, and they can take some getting used to. Some people find that they cannot tolerate grade 3 stockings, and so grade 2 stockings (which create less of a squeezing force) can be used instead. You will need to see your GP, as Grade 3 compression requires a prescription from your GP.
Note: a compression stocking used following a DVT should be fitted professionally after an assessment and accurate measurement. Some people are not suitable for compression stockings owing to other conditions they may have. Do not just buy over-the counter support stockings or flight socks that may be the wrong class or size and which may potentially cause more damage. Your stockings will also need replacing every 3-6 months. If you are advised to wear a compression stocking, you should put it on each morning. Wear it all day until you go to bed, or until you rest in the evening with the leg raised. Take the stocking off before going to bed.
The pressure from the stocking helps to prevent fluid seeping into the calf tissues from the outer veins, which carry the extra-diverted blood following a DVT. The stocking also reduces, and may prevent, calf swelling. This in turn reduces discomfort and the risk of skin ulcers forming.
Post-thrombotic syndrome
Without treatment, up to 6 in 10 people who have a DVT may develop long-term symptoms in the calf. This is called post-thrombotic syndrome. Symptoms occur because the increased flow and pressure of the diverted blood into other veins can affect the tissues of the calf. Symptoms can range from mild to severe and include: calf pain, discomfort, swelling, and rashes. An ulcer on the skin of the calf may develop in severe cases. 30% of people develop post thrombotic syndrome after DVT diagnosis, even if they are treated effectively.
Walking regularly / exercise
You should keep as active and mobile as possible, if you are able please walk regularly. Walking is thought to improve circulation in the affected leg and may help to reduce your risk of further DVT. Try to avoid standing still / in the same position for long periods of time. If you are normally very active e.g. run, cycle or swim you can continue these activities as your symptoms begin to resolve however; you may find
you need to restart at a lower intensity to begin with. Please keep well hydrated when exercising. Contact sports are not recommended while taking anticoagulants due to the increased risk of injury and therefore internal bleeding with these sports.
Raising your leg whilst resting, raising your leg when resting reduces the pressure in the calf veins, and helps to prevent blood and fluid from pooling in the calves. “Raised” means that your foot is higher than your hip so gravity helps with blood flow returning from the calf.
Work
You may return to work, as you feel able, depending on your level of pain and swelling. If you are unable to return to work immediately you can self-certificate yourself for the first 7 days. After that you will require a sick certificate from your GP.
If you have an occupational health department you should inform them that you are taking an anticoagulant as this may restrict some of your duties e.g. fire service /military services.
If you are working in a potentially dangerous environment e.g. building site, we strongly recommend that you inform your manager / supervisor / work mate that you are taking an anticoagulant. If an accident occurred they would be able to inform emergency services that you are on anticoagulation if you were unable to do so yourself
Other healthcare / Alternative health professionals
You must inform your dentist that you are taking an anti-coagulant in most cases this will not affect your treatment. You should inform any practitioner who is treating you or seeing you in clinic that you are on an anti-coagulant. This includes physiotherapist, chiropractor, chiropodist, osteopath, herbalist, acupuncturist, aromatherapy, massage therapist, reflexology, if in doubt it is far better to tell them you are on an anti-coagulant as they may need to revise their treatment plan with you.
Other commonly asked questions
What do I do if I forget to take my tablet?
If you remember your tablet before midnight on the day you should have taken it then you can take it. Do not double the dose to compensate for the missed day.
How should I store my anti coagulation?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat, light and moisture (not in the bathroom). Return any medication that is out of date or no longer needed to your local pharmacy.
Can I have a tattoo while receiving anti coagulation?
It is normally recommended NOT to have a tattoo because of the increased risk of bruising. Some people find the image can be “blurred”. You should inform the person who will be doing the tattoo, as the decision to proceed has to be made by yourself and your chosen tattoo artist.
Can I have a body piercing while receiving anti coagulation?
It is normally recommended NOT to have a body piercing because of the increased risk of bruising and bleeding. This is particularly in areas with a very good blood supply such as the tongue; you should inform the person who will be doing the piercing as the decision to proceed has to be made by yourself and your Chosen practitioner.
You should carry your yellow anticoagulation card with you at all times accidents can happen at any time and in any place and the emergency services will need to know if you are taking an anti-coagulant.
