Emergency and Urgent Care - Prevention of blood clots due to injury

Due to your leg being immobilized in a Plaster of Paris or orthopedic boot you have been given medication to help prevent a blood clot (VTE).

Venous thromboembolism (VTE) occurs when a blood clot, forms in a deep vein. VTE describes two separate, but often related conditions: deep vein thrombosis (DVT) and pulmonary embolism (PE).

Deep vein thrombosis (DVT) is a blood clot that develops within a deep vein in the body, usually in the calf or thigh areas of the leg.

DVT can cause pain and swelling in the leg and may lead to complications such as pulmonary embolism (PE), this is a serious condition that occurs when a piece of blood clot breaks off into the bloodstream and blocks one of the blood vessels in the lungs.

Symptoms of DVT

In some cases, there may be no symptoms of DVT. If symptoms do occur they can include:

• Pain, swelling and tenderness in one of your legs (usually your calf)
• A heavy ache in the affected area
• Warm skin in the area of the clot
• Red skin, particularly at the back of your leg below the knee
• DVT usually (although not always) affects one leg
• The pain may be worse when you bend your foot upward towards your knee

What causes DVT?

Each year, DVT affects around 1 person in every 1,000 in the UK. Anyone can develop DVT, but it becomes more common over the age of 40.

There are also a number of other risk factors, including:

• Lower limb immobilisation
• Having a history of DVT or pulmonary embolism
• Having a family history of blood clots
• Being inactive for long periods – such as after an operation or during a long journey
• Blood vessel damage – a damaged blood vessel wall can result in the formation of a blood clot
• Having certain conditions or treatments that cause your blood to clot more easily than normal – such as cancer (including chemotherapy and radiotherapy treatment), heart and lung disease, thrombophilia and Hughes syndrome
• Being pregnant – your blood also clots more easily during pregnancy
• Being overweight or obese

When you leave hospital it is recommended that you:

• Do not smoke
• Eat a healthy, balanced diet
• Take regular exercise
• Maintain a healthy weight or lose weight if you're obese

Pulmonary Embolism

If left untreated, about 1 in 10 people with a DVT will develop a pulmonary embolism. A pulmonary embolism is a very serious condition that causes:

• Breathlessness – This may come on gradually or suddenly
• Chest pain – which may become worse when you breathe in
• Sudden collapse

Both DVT and pulmonary embolism require urgent investigation and treatment.

Seek immediate medical attention if you have any of the above symptoms

Injections to prevent blood clots

These belong to a group of medicines called anticoagulants and help to prevent blood clots from forming in the veins of your leg (deep vein thrombosis) and/or in the blood vessels of your lungs (pulmonary embolism).

The recommended dose should be administered once a day by subcutaneous (under the skin) injection at approximately the same time each day.

Pre-filled syringes

The pre-filled disposable syringe is ready for immediate use.

The whole length of the needle should be introduced vertically (at a 90° angle to the skin) into a skin fold on your abdomen gently held between the thumb and forefinger. The skin fold should be held throughout the duration of the injection.

Subcutaneous injection technique

• Injections should be alternated between the left and right sides of the abdominal wall using a different site for each injection
• They contain no antimicrobial agent and should be used only once and then discarded
• The needles on the pre-filled syringes are covered in a silicon coating, to enable ease of penetration
• Do not wipe the needle or allow the solution to crystallize on the needle prior to use, as this will damage the silicon coating
• A “dart” injection technique should be used
• Do not rub the injection site after administration
• Bruising around the injection sites is normal and nothing to worry about

What should I do if I miss a dose?

• If you miss a dose, take the medicine as soon as you remember and then take the next dose at the usual time, then continue as normal
• If you are not sure what to do, ask your doctor or pharmacist

What should I do if I take too much

• Tell your doctor immediately if you have taken more than the prescribed dose of this medicine
• Take the medicine pack with you, even if there are no syringes left
• If you take more medication than is recommended, you may have an increased risk of bleeding

Things to note when taking this medication

• It is important you inform your pharmacist, dentist and other healthcare professionals that you are taking this medicine
• Inform your doctor or dentist that you are taking this medicine if you are having any surgical or dental procedures. You may need to reduce your dose or temporarily stop taking this medicine and your doctor or dentist will advise you on how to do this
• Make sure that you tell your doctor, pharmacist or dentist about any other medicines you are taking, including medicines you have bought yourself in the pharmacy without a prescription (e.g. aspirin for headaches or colds) and any herbal remedies youmay be taking (e.g. St. John’s Wort)
• Certain medicines and supplements can interfere with the anticoagulant effects of this medicine, increasing the risk of bleeding or making it less effective
• As with all anticoagulants, when taking this medicine it is important that you look out for any signs of bleeding and seek medical advice immediately if any signs of bleeding occur

Signs and symptoms of bleeding

These include:

• Bruising or bleeding under the skin (not at site of injection)
• Tar-coloured stools
• Blood in urine
• Nose-bleed
• Dizziness
• Tiredness
• Paleness
• Weakness
• Sudden severe headache
• Coughing up blood
• Vomiting blood or material that looks like coffee grounds

Please return to the Emergency Department straight away if you think any of these apply to you.

You SHOULD NOT take this medication if you:

• Are allergic to any of the ingredients
• Are bleeding excessively
• Have (or are thought to have) a condition that increases the risk of serious bleeding
• Have liver disease leading to an increased risk of bleeding
• Are taking medicines to prevent blood clotting