This page is about the care and treatment of people who are at risk of  developing Venous Thromboembolism while in hospital.  

What is Venous Thromboembolism? 

Sometimes a blood clot called a deep vein thrombosis (DVT) can develop in  the legs or pelvic veins. If the blood clot comes loose it can travel through your  bloodstream to your lungs. This is called pulmonary embolism (PE) and it can cause  chest symptoms such as chest pain and shortness of breath. DVT and pulmonary  embolism together are known as venous thromboembolism (VTE).  

Who is at risk? 

Each year, one in every 1,000 people in the UK is affected by DVT. Anyone can develop a DVT, although it becomes more common with age.  Risk factors include: 

• previous venous thromboembolism 

• a family history of thrombosis 

• medical conditions such as cancer and heart failure 

• inactivity (for example, after an operation)  

• being overweight or obese 

• extreme dehydration 

• poor circulation

Avoiding DVT 

There are several things you can do to help prevent DVT occurring, such as losing  weight if you are overweight. To improve the circulation in your legs, walk  regularly if you can or ensure your lower limbs are moved regularly, with  repositioning or passive movements by your therapist or nurse. 

Am I at risk of developing a DVT in hospital? 

DVT is more likely to happen when you are unwell and inactive or less active  than usual.  

DVT can happen at any time during a stay in hospital or in the weeks after leaving  hospital.  

Your risk of developing a DVT may be related to the clinical reason that you have  been admitted to hospital and to the type of treatment you will have, for example  whether you are having an operation.  

Your healthcare team will assess your risk of DVT when you are admitted  to hospital. They will take into account a range of risk factors including your  reason for admission, your mobility in hospital, your age, your medical history  and medicines that you may already be taking. If you are at risk of DVT your  healthcare team will also assess whether bleeding might be a problem during your  hospital treatment. They will discuss with you whether you should have a drug to  help prevent DVT or whether the risk of having problems with bleeding is higher  than your risk of DVT.  

What are the consequences of developing a DVT? 

There are three main consequences of deep vein thrombosis (DVT): • The DVT itself can produce swelling and pain in the limb because of blockage of   the return of blood from the limb 

• Risk of pulmonary embolism 

• Risk of post-thrombotic syndrome

Pulmonary embolism 

This is the most serious complication of DVT. A pulmonary embolism (PE) happens  when a piece of blood clot (DVT) breaks off and travels through your bloodstream  to your lungs, where it blocks one of the blood vessels. This is serious and in  severe cases, can cause sudden death. 

If the pulmonary embolism is small, it might not cause any symptoms. If it  is medium sized, it can cause breathing difficulties and chest pain. A large  pulmonary embolus can cause the lungs to collapse and result in heart failure and  possible death. 

Post-thrombotic syndrome 

If you have had a DVT, you may develop long-term symptoms in your calf, known  as post-thrombotic syndrome. 

If you have a DVT because the blood clot in the vein of your calf stops blood flow,  the blood can divert, to other veins, causing an increase in pressure that can affect  the tissues of your calf. Symptoms include:  

• calf pain 

• swelling 

• a rash and 

• (in severe cases) ulcers on the calf. 

When a DVT develops in your thigh vein, there is an increased risk of post thrombotic syndrome occurring. It is also more likely to occur if you are  overweight, or you have had more than one DVT in the same leg.  

How can I reduce the risk of developing a DVT? 

Before admission - certain drugs e.g the combined contraceptive pill and hor mone replacement therapy (HRT) can increase the risk of developing a DVT. If any  changes need to be made to your drug treatment before admission this will be  discussed with you at your pre-operative assessment. Please make sure you make  the healthcare team aware of all medicines you are currently taking. 

If you have had a DVT or pulmonary embolism before and are currently taking  medication for this e.g. warfarin, please discuss this with your healthcare team. 

In hospital 

• Make sure that you have enough fluids so that you do not become dehydrated.  • Your healthcare team will encourage you to move around as soon as you are able,  or a member of the physio team will provide passive exercises. 

• Depending on your risk assessment you may be offered an injection or sometimes  a tablet or capsule to help to prevent clots from forming. If you need to continue  with this after you leave hospital make sure you are able to administer the  treatment or have someone available to help you. Your healthcare team will tell  you how long you need to continue with treatment. 

• If an injection is prescribed for you this may be a heparin, which is a drug used to  reduce the risk of clots forming. Heparin is derived from a porcine (pig) source  and is generally accepted by Muslim and Jewish patients, as the heparin from a  porcine source is accepted under religious law. Vegans and vegetarians may also  object to the origins of this medication. If you have any concerns please ask your  healthcare team for more information.  

• You may be offered foot pumps whilst in hospital. These are worn on your feet.  They inflate automatically at regular intervals. When these devices are inflated  they apply pressure, which helps keep the blood in your legs circulating. It is  important to use your foot pumps for as much of the time as possible, both when  you are in bed and when you are sitting up in a chair. Your healthcare team will  show you how to use the device correctly and check regularly to make sure you  are getting the most benefit from it. 

• Regular deep breathing exercises and leg muscle tightening and relaxing as   instructed by a physiotherapist can also help prevent a DVT.  

After discharge from hospital 

• Continue to ensure that you have enough fluids so that you do not become  dehydrated.  

• Move around as much as you have been advised by your healthcare team. • Some patients will need to continue to have drug treatment to help prevent clots   after discharge from hospital. The hospital will supply all the injections or tablets/  capsules you need to complete your preventative treatment. It is important that   you complete your course of treatment. If you have any questions about this after   discharge contact the ward or the hospital medicines helpline (01691-404339).   If you think you may have developed a reaction to the injection contact your GP. 

How can I tell if I might have a DVT or Pulmonary Embolism? 

There are certain signs to look out for after your hospital treatment that may  mean you have developed a DVT or Pulmonary Embolism. You should seek help  immediately by contacting your GP or attending the Accident and Emergency  Department at your local hospital if you experience any of the following in the  days or weeks after your treatment.  

• You have increased pain or persistent swelling in your leg.  

• The skin on your leg feels hot or is discoloured (red, purple or blue), other than  bruising around the area where you have had an operation. 

• The veins near the surface of your legs appear larger than normal or you notice  them more. 

• You become short of breath.  

• You feel pain in your chest or upper back.  

• You cough up blood or frothy blood streaked sputum.