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