Module: Understanding and Diagnosing VTE
Expert Video - What is venous thromboembolism (VTE)?

When a blood clot forms in the veins of the body it’s called VTE, or venous thromboembolism. In this video, expert pulmonologist Dr Sandra Adams explains what VTE is and also describes the three types of VTE: (1) superficial vein thrombosis, (2) deep vein thrombosis (DVT) and (3) pulmonary embolism (PE). DVT and PE are the most dangerous types of VTE.

Expert Video - What is a blood clot and when are they dangerous?

In this video, Dr Sandra Adams explains what blood clots are and when they can be dangerous. When we get injured, blood clots normally form in the body to help stop bleeding. They usually go away once the body has healed. Dr Adams explains that blood clots that form in the deep veins can block blood flow, and might cause pain or swelling. A blood clot can be very dangerous if it breaks off from one of the deep veins and moves through the bloodstream into the vessels of the lungs. This clot blocks blood from moving normally through the vessels of the lungs and can cause low oxygen and even death.

Expert Video - What are the symptoms of deep vein thrombosis (DVT)?

Deep vein thrombosis (DVT) is a blood clot that forms in a vein deep in the body. In this video, Dr Sandra Adams explains that these kinds of clots most often form in the legs, hips or pelvis but sometimes in the arms, neck or chest area. These deep clots can clog up the veins and slow down the blood flow. Common symptoms or warning signs of DVT are swelling in one leg, pain in one leg, and/or a change in color such as redness of the skin close to the blood clot. Sometimes the skin around the swollen area feels warm to touch. If you have any of these problems, you should get medical help as soon as possible.

Expert Video - What are the symptoms of pulmonary embolism (PE)?

When a blood clot travels through the bloodstream to the vessels of the lungs it is called a pulmonary embolism (PE) and it can cause a lot of problems, as pulmonologist Dr Sandra Adams explains in this video. The most common signs and symptoms include shortness of breath, cough, chest pain (particularly when breathing in), coughing up blood, fainting or feeling dizzy, breathing fast or having a fast heartbeat for no reason. A PE is an emergency and requires immediate medical attention. The good news is that if a PE is recognized quickly and you get the right care, you can recover from it. If you have any signs of a dangerous blood clot, see your doctor or call 911 immediately.

Expert Video - What are the risk factors for VTE blood clots?

In this video, Dr Sandra Adams describes who is at risk for VTE blood clots. While dangerous blood clots can happen to anyone, three kinds of risk factors make them more likely to occur. The first is not moving for a long time. This may happen when someone cannot move because of injury, illness or hospitalization. Lack of movement could also come from simply sitting too long when working, watching TV, or traveling by car or plane. The second risk factor for VTE is having too many things in the blood, called clotting factors that cause the blood to clot more than usual. Examples of this include: taking birth control pills, smoking, having cancer, inheriting a condition from your parents or getting a disease that causes an imbalance of these clotting factors in the body. The third risk factor for VTE blood clots is damage to blood vessels. Physical injury to a blood vessel, such as damage or scarring caused by an intravenous, or IV catheter, a broken bone, or a previous blood clot can make VTE blood clots more likely. The more of these factors someone has, the higher the risk of developing dangerous blood clots or VTE.

Expert Video - How is VTE diagnosed?

In this video, expert physician Dr Sandra Adams describes the common tests and procedures that are used to diagnose venous thromboembolism (VTE). If you have signs of a DVT blood clot in the leg, hip or pelvis, or in the arm, neck or chest, your doctor may order an ultrasound of the deep veins. If you have signs of a pulmonary embolism, or PE, your doctor may order a CT scan of the chest with IV contrast or a VQ scan of the chest. Also, an ultrasound of the heart (called an echocardiogram or echo for short) can sometimes discover a blood clot in the lungs.

Expert Video - Why is timely diagnosis of DVT and PE important?

As Dr Sandra Adams explains in this video, it is important to recognize a DVT and PE blood clot right away so that it can be treated as soon as possible and so that damage can be kept to a minimum. Prompt diagnosis and treatment can prevent scarring of the blood vessels and may keep additional clots from forming. Without treatment, blood clots can cause life-long health problems and can be life threatening. Recognizing and getting treatment for a dangerous clot early is your best defense.

Expert Video - Why are VTE, DVT and PE difficult to diagnose?

VTE, DVT and PE can be difficult to diagnose and a number of other conditions can cause the same or similar symptoms, explains Dr Sandra Adams in this video. While some patients may have several symptoms of VTE, others may only have a few symptoms, or may not be aware of what is happening to them. If you think you may have a dangerous blood clot, seek medical help right away. Write down your symptoms so you can discuss them with your doctor. If you know you have risk factors for VTE blood clots (such as having recently been in the hospital, suffered an injury, taken a long trip, or if you have previously had a dangerous blood clot) be sure to tell your healthcare provider.

Expert Video - How can family, caregivers and friends support people who have VTE?

In this video, Dr Sandra Adams describes how family members, caregivers and friends can support people with VTE blood clots by being aware of the symptoms, risk factors, and understanding the importance of receiving the right treatment quickly. For patients who have had surgery, family members or caregivers can help by reminding patients to be as active as possible and take any medicines or therapy, recommended by their physician.

Module: Treating VTE
Expert Video - What medications are used for VTE blood clots? What are anticoagulants or blood thinners?

Anticoagulants (also referred to as “blood thinners”) are the medications most commonly used to treat venous thromboembolism (VTE) blood clots. In this video Dr Sandra Adams explains that blood thinners make it harder for blood to clot, lower the chances of patients forming new clots, reduce the risk of existing clots growing bigger, and allow the body to dissolve the clot over time. Blood thinners include heparin, low molecular weight heparin, warfarin, fondaparinux, apixaban, dabigatran, edoxaban, and rivaroxaban. On rare occasions, other medications may be needed.

Expert Video - Old and new blood thinners: How do they work?

In this video, Dr Sandra Adams explains how older and newer blood thinners work for the treatment of VTE blood clots, and how they are taken. The main older blood thinner used is called warfarin, which blocks the liver from making the clotting proteins that require vitamin K. If you are taking Warfarin you will need frequent monitoring with blood tests. Warfarin is also affected by other medications and your diet because high levels of Vitamin K are found in dark green or leafy vegetables. The newer blood thinners fall into two groups. The first group includes low molecular weight heparin and fondaparinux that are taken as shots. These medications are much more predictable than warfarin and do not require frequent monitoring with blood tests. The second group includes pills that are taken by mouth, such as apixaban, dabigatran, edoxaban, and rivaroxaban. They do not require monitoring, are not affected by other medications or food, and work very quickly. All of these medications have been shown to work well to prevent more blood clots from forming.

Expert Video - Which type of blood thinner is best for me?

Dr Sandra Adams explains in this video that a number of factors go into deciding what is the best blood thinner for each patient with VTE blood clots, including: how well your kidneys work, if you have any liver damage, your weight, what you usually eat, any other illnesses you may have, and how often you can see a healthcare professional for follow up visits and monitoring. Your physician will evaluate your current condition and your medical history to recommend a blood thinner that best suits you.

Expert Video - Can blood thinners cause bleeding? Are they safe?

Blood thinners are lifesaving medications because they can treat or prevent VTE blood clots. The biggest safety concern for anyone taking a blood thinner is the risk of bleeding, explains Dr Sandra Adams in this video. This risk of bleeding may be slightly lower with the newer agents than for warfarin. If you are taking blood thinners, you should be very careful to avoid hurting yourself. Because blood thinners prevent clotting, a tiny cut or bruise will bleed a lot more if you are taking blood thinners. Even if you don't have a cut or bruise, a bump or fall could cause you to bleed internally. Therefore, when taking blood thinners, your body may need help to stop the bleeding. Be sure to discuss the benefits and risks of blood thinners with your health care professional.

Expert Video - How often should I see my doctor when I’m on blood thinners?

Dr Sandra Adams explains in this video that if you are taking blood thinners you should have regular follow up visits with your doctor to make sure your medications are working well and that there are no serious side effects. If you are on warfarin, you will need to go in for more frequent check-ups to make sure that you are getting enough to reduce the risk of blood clots, but not so much that you have a high risk of bleeding. Most patients take blood thinners for at least 3 months, but the length of time will vary based on your personal risk factors. People with cancer need to be treated until the cancer is gone. People who have had blood clots before may need to take blood thinners for the rest of their lives.

Expert Video - Is warfarin safe for me to take?

In this video, Dr Sandra Adams explains that warfarin is in the same family as some of the older chemicals that were used to kill rats, but it is not rat poison. Warfarin has been used in humans with good results for many years. It is still a very effective and safe medication when used correctly and monitored closely. Any blood thinner can cause bleeding and should be monitored closely. Be sure to discuss the benefits and risks of blood thinners with your health care professional.

Expert Video - What are clot-buster medications (thrombolytic therapy)?

The most commonly used medications to treat VTE blood clots are anticoagulants (also referred to as “blood thinners”). But there are also “clot busting” medications called thrombolytics which quickly dissolve or get rid of clots. As Dr Sandra Adams explains in this video, thrombolytic therapy may be used depending on the resources available at your hospital and your doctor’s opinion of how likely your clot will cause harm in the long run. Clot buster medications increase the risk for major bleeding so they are usually reserved for patients with very extensive clots and for life-threatening situations.

Expert Video - Will I need surgery to remove a blood clot?

Most patients will recover from their blood clot after it is recognized and treated, but as Dr Sandra Adams explains, sometimes surgery is needed for patients with high-risk blood clots. In a small number of patients whose bodies are not able to completely dissolve their blood clots, surgery may be needed to remove the scars caused by the blood clots. Other patients cannot be treated with blood thinners due to a high risk of bleeding or because they started to bleed on a blood thinner. If a patient with VTE blood clots cannot take blood thinners, a wire basket or filter may be placed in the large vein (or vena cava) to catch any clots that might break off from the leg veins and go to the lungs.

Module: Preventing VTE
Expert Video - What’s the risk of getting another dangerous blood clot?

In this video, pulmonologist Dr Sandra Adams explains what the risks are of getting another dangerous blood clot if you’ve had one already. Once a VTE blood clot is found and treatment has started, most patients will do very well. Still, about half of people who have had one VTE blood clot will have another within 10 years. Patients can get another blood clot even during the first 3 months they are on blood thinners. Another blood clot has the same risks as the first blood clot, including the same symptoms, and on rare occasions can be deadly. Talk to your doctor about your risk of getting another dangerous blood clot, and be aware of the symptoms to watch out for. Seek immediate medical attention if you experience any symptoms.

Expert Video - What factors increase my risk of another serious blood clot?

Certain factors can increase your risk of having another serious VTE blood clot. Dr Sandra Adams explains that the most common risk factor for having another serious blood clot is if you have had a previous blood clot. Other risk factors include genetics, diseases such as cancer, smoking, certain medications such as birth control pills, and sitting or lying down most of the time. Even if you can’t move much, it is important to try to move your arms, legs and feet and to do stretching exercises to increase blood flow and help lower your chance of getting another blood clot.

Expert Video - Can compression stockings prevent all blood clots?

Compression stockings may be helpful to prevent or lower your chances of getting a dangerous blood clot, but as Dr Sandra Adams explains, compression stockings are not a substitute for blood thinners or physical activity. Compression stockings may reduce the risk of blood clots in some patients who have had surgery and cannot move much. Some doctors recommend compression stockings for people who take long flights to keep blood from pooling in their legs. Compression stockings can also prevent scarring in the veins from deep vein thrombosis (DVT) blood clots. However keep in mind that compression stockings are not as effective as blood thinners in preventing clots from forming.

Expert Video - What exercises can I adopt to lessen my risk of blood clots?

In this video, pulmonologist Dr Sandra Adams explains that daily exercise and moving about frequently can reduce your risk of developing dangerous blood clots. Try to walk or exercise for 30 minutes every day. If you must sit for a long time, raise your legs off the floor when possible. When traveling, take regular breaks to walk and move your legs even if you stay seated. Stretching your legs and pointing and flexing your toes can help. You can do leg exercises even in bed. Raise your feet and make ankle circles or flutter your feet. Keep the blood in your legs moving.

Expert Video - I have had one episode of VTE, how can I prevent it from happening again?

If you have had one dangerous VTE blood clot you may be at risk for developing a second clot, therefore it is very important to work with your doctor to understand your risk factors and take steps for prevention of another clot. In this video Dr Sandra Adams talks about the different steps you can take to prevent VTE blood clots and protect your health. Regular exercise is a great way to prevent another clot, and if you smoke it’s time to quit. A few risk factors, like cancer and heart failure, will require ongoing treatment to control. Staying on blood thinner medication for the time your doctor recommends is also very important. Once you stop taking a blood thinner, your doctor may recommend taking aspirin to lower the risk of another blood clot.

Expert Video - What is post-thrombotic syndrome?

In this video, Dr Sandra Adams explains that when a clot forms in a blood vessel, it can cause scarring and damage to the valves in the veins that keep blood moving in the right direction. This damage can lead to a condition called post-thrombotic syndrome. Post-thrombotic syndrome can cause swelling, pain, discoloration, and even shallow wounds on the skin, called ulcers. Dr Adams explains that about half of people who have had a blood clot in their leg will have some degree of post-thrombotic syndrome. Medication and compression stockings can reduce the risk of developing the syndrome.

Expert Video - Will I have to worry about VTE blood clots all my life?

Patients who have had a dangerous blood clot should be alert to the signs of VTE for the rest of their lives, explains expert pulmonologist Dr Sandra Adams. If you have any symptoms, call your doctor immediately. Not every patient who has had a blood clot will get another one, but many will. Be sure to talk to your doctor about ways you can prevent having another dangerous blood clot. To reduce your risk of another blood clot, you should:

  • Take blood thinners or aspirin as your doctor recommends
  • Avoid sitting for a long time
  • Walk around, or at least move your legs and feet
  • Get regular exercise
  • Eat healthy food
  • Maintain or reach a healthy weight
  • Quit smoking.