TABLE OF CONTENTS

100 Questions and Answers

About Deep Vein Thrombosis and Pulmonary Embolism

Part 1: The Basics

  • What is blood?
  • What is the purpose of blood vessels?
  • How and why does blood clot?
  • What is deep vein thrombosis (DVT)?
  • How common is DVT?
  • Where does DVT occur?

Part 2: Diagnosis and Symptoms

  • What are the symptoms of DVT?
  • What is the difference between DVT and superficial vein thrombosis or superficial thrombophlebitis?
  • How is DVT diagnosed?
  • What are the consequences of DVT?
  • What is the post-phlebitic or post-thrombotic syndrome?
  • What is pulmonary embolism (PE)?
  • What are the symptoms of PE?
  • How is PE diagnosed?

Part 3: Initial Treatment

  • What are the goals of treatment of DVT?
  • What is the initial treatment of DVT?
  • What is heparin?
  • How does heparin work?
  • What is the difference between heparin and low-molecular-weight heparin (LMWH)?
  • How is the dose of heparin or LMWH determined?
  • What is the activated partial thromboplastin time (aPTT)?
  • How does fondaparinux work?
  • What is the initial treatment of PE?
  • What are the side effects of standard heparin or LMWH?
  • What is warfarin?
  • How does warfarin work?
  • Why is warfarin not used for initial treatment of DVT or PE?
  • What is a vena caval filter?
  • What if the DVT or PE is limb- or life-threatening?

Part 4: Long-term Treatment with Warfarin

  • How long will I require treatment with warfarin?
  • How long can warfarin be taken?
  • What are the risks of treatment with warfarin?
  • Why are frequent blood tests required?
  • What is the prothrombin time (PT) test?
  • Where do I go to have my PT or INR measured?
  • Can I monitor my own INR at home?
  • What is vitamin K and what does it do?
  • Why must I pay attention to my intake of vitamin K while taking warfarin?
  • What foods have vitamin K in them?
  • While taking warfarin, is wine, beer or liquor allowed?
  • What about dietary supplements and herbal medications while taking warfarin?
  • How can the risks of bleeding with warfarin be reduced without increasing the risk of a clot?
  • Is there an alternative to warfarin for long-term treatment or prevention of DVT and PE?

Part 5: Risk Factors

  • What conditions increase the likelihood of blood clots?
  • What is the factor V Leiden?
  • What is the prothrombin gene mutation?
  • What is the antiphospholipid syndrome?
  • Can children get blood clots?

Part 6: Pregnancy

  • Does pregnancy cause blood clots?
  • Why is warfarin unsafe during pregnancy?
  • Why is heparin or low-molecular-weight heparin (LMWH) considered safe?
  • How are blood clots treated during pregnancy?
  • How are blood clots prevented during pregnancy?
  • What precautions are taken at the time of delivery?
  • When are anticoagulants restarted after delivery?
  • Are anticoagulants safe to take while breastfeeding?

Part 7: Menstruation and Birth Control

  • Is it true that birth control pills cause blood clots?
  • Can a woman take birth control pills if she has had a blood clot in the past?
  • What if a woman has thrombophilia but has never had a blood clot?
  • Can anticoagulation cause heavy periods or other gynecological problems?
  • How can heavy menstrual bleeding be managed?

Part 8: Menopause and Hormone Therapy

  • Does estrogen cause blood clots?
  • Can a woman who has had a blood clot in the past take estrogen?

Part 9: Medical Problems

  • What if cancer is present?
  • What if kidney failure is present?
  • What if heart disease is present?
  • What if diabetes is present?
  • What if liver disease is present?
  • What if high blood pressure is present?

Part 10: Surgery and Trauma

  • What happens if I am on warfarin and I have to have surgery?
  • What if I am taking warfarin and I have to have emergency surgery or I am injured?
  • How will I be protected from blood clots at the time of surgery or injury if I am not taking warfarin?

Part 11: Travel

  • What measures can be taken to prevent blood clots during travel?
  • How is anticoagulation managed during travel?

Part 12: Activity, Sports and Recreation

  • What limitations do I have?
  • May I dive?
  • May I hike or climb?

Part 13: Complications

  • Can DVT cause permanent damage?
  • How can the post-phlebitic or post-thrombotic syndrome be prevented?
  • What are the consequences of PE?
  • Can PE cause permanent damage?
  • How is swelling treated?
  • How is pain treated?
  • How are leg ulcers treated?
  • How are recurrent blood clots treated?

Part 14: Prevention of Recurrent Clots

  • What is the chance of my having another DVT or PE?
  • Are there foods or medications that should be avoided?
  • If I am not taking anticoagulants are there special precautions I should take?
  • Does aspirin prevent blood clots?

Part 15: Family and Genetic Issues

  • If I have had a blood clot, do I need to be tested for thrombophilia?
  • If I learn that I have an inherited thrombophilia, what should I tell my family members?
  • If I have a family member who has had a blood clot or thrombophilia, but I have never had a blood clot, what are my risks?
  • If I have a family member who has had a blood clot or thrombophilia, but I have never had a blood clot, should I be tested for thrombophilia?

Part 16: Miscellaneous

  • Do I need to wear a medical identification bracelet or necklace?
  • What does insurance usually pay for?
  • Who treats DVT and PE?
  • Where can I find an expert in the field?
  • Where can I go for additional information?

Glossary

Index

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