FAQs

If you feel very short of breath you should immediately see your doctor. However, after a PE, you may have lung infarction/scarring/tissue damage which can affect breathing for some time. Most pain should go away in a couple of days, but shortness of breath can last for weeks. If symptoms do not go away within a few weeks, or if they worsen, you should call your doctor.

It is common to have leftover swelling in the leg after the initial treatment of a blood clot in your leg (DVT). When you wear graduated compression stockings (pressure stockings that are tighter around your ankle and get looser as they move up your leg) daily, they help increase blood flow in the legs and reduce swelling. There is a complication of DVT called post-thrombotic syndrome (PTS) that has many of the same symptoms of a DVT and is due to damaged valves. This is more common in blood clots experienced in the upper part of the leg.

Over time, the body will re-model the fibrin clot (an insoluble protein that is produced in response to bleeding and is the major component of the blood clot) termed “fibrinolysis” with retraction of the clot into the blood vessel wall, this happens for most blood clots. That is why it is uncommon to obtain a repeat CT scan of the lungs particularly since over 4-12 weeks the chest pain and shortness of breath usually resolves for most patients.

Some patients will be fine without pain medication or have adequate pain control with acetaminophen (i.e., Tylenol). If that is inadequate, a short course of anti-inflammatory medication may be prescribed but typically the non-steroidal anti-inflammatory drugs (NSAIDs i.e., Aspirin, Ibuprofen, Naprosyn) used for inflammation will increase the bleeding risk by affecting the platelets while on anticoagulant medication to prevent further clots. In cases like that, your provider may prescribe Celebrex which does not affect platelet function unlike the NSAIDs. It is also important to have a low threshold for calling the doctor since symptoms cause frequent anxiety.

You can take them in moderation, and there are many different options out there. This question is a good one to consult with your doctor on. Some medications pose higher risk than others and some can contribute to bleeding. Tylenol in low doses is okay but in high doses can make Coumadin more powerful. When on full dose anticoagulant you should only take anti-inflammatory Aspirin products like Ibuprofen or Naprosyn sparingly and only if you are not having any bleeding at that time like bruising or heavy menses. If you are ever on half dose anticoagulant, then these anti-inflammatory medications can be used more frequently.

Usually, a follow up scan is done if symptoms do not improve between 3-6 months and/or when stopping the anticoagulant to have a new baseline.

Heat, not ice, may help reduce the associated muscle spasm and relieve some of the inflammation. It is best to use wet heat instead of dry heat because wet heat penetrates deep tissue faster than dry heat to provide pain relief and reduce tissue damage.  

This is never normal. 1 in 10 patients will cough up blood. If you are coughing up blood it could be due to high pressure around the lung and can worsen on an anticoagulant. Blood clots usually don’t leave a scar in the lung, and pain is usually associated with pulmonary infarction.

Most of the time there will be no damage. The two places you could have lasting issues are in your leg and in your lung.  Damage in the leg would be from both the blood clot and the destruction of the valves that move blood along and cause swelling in the leg.  Most of the time this is just an inconvenience, but if you get significant swelling it may prevent you from doing a job where you must stand up repeatedly.  You may need to wear compression stockings to squeeze the blood back to the upper part of the body. As far as the lungs are concerned, 96% of the time there will be no serious damage, but 3 to 4% of patients develop post thromboembolic pulmonary hypertension where you might have some continued shortness of breath that requires a specialist to repair the damage done to the vessels in the lungs.

• After PE: Shortness of breath and mild pain or pressure in the lungs are common. You are likely to notice pain when you exert yourself, during physical activity, or whenever you take a deep breath. Shortness of breath gets better over time, and exercise helps you use your breath more efficiently. These symptoms should resolve in several weeks.
• After DVT: Post-Thrombotic Syndrome (PTS); persistent swelling, pain, and discoloration of the skin in the affected arm or leg. These symptoms may persist to some degree and are long term in one third to half of cases. Wearing knee high compression stockings for the first 3 months may reduce this risk.