Venous Thromboembolism (VTE) Reducing the Risk– Orthopaedic Department

  • Reference Number: HEY-500/2019
  • Departments: Orthopaedics

Introduction

This leaflet informs you about Venous Thromboembolism (VTE). It explains what it is, why you are at risk and how you can reduce the risk. It is not meant to replace discussion between you and your doctor but can act as a starting point for discussion. If after reading it you have any concerns, questions or require further explanation please discuss this with a member of the healthcare team.

What is a Venous Thromboembolism?

Venous thromboembolism (VTE) is a blood clot that can develop in the deep veins of the body, most commonly in the leg. A clot most often will remain in the leg where it can cause pain, redness and swelling. Less commonly it can travel in the bloodstream to the lungs where it can cause symptoms such as breathlessness or chest pain. This is obviously a serious potential complication and it is important that precautions should be taken where possible.

Why am I at risk?

You are at risk because you have suffered a leg injury, have been fitted with a cast, boot or brace and may be unable to walk around easily or have reduced mobility. Your leg muscles do not work normally as a result and their blood pumping action is less, which increases the risk of clots.

Clots can occur in anyone at any age. However, it has been identified that there is a greater risk for people who are immobile (not walking around), those who have had a major operation, and those who have a variety of medical conditions requiring hospital admission.

What can I do to reduce the risk?

You may be given white knee length stockings to wear (TEDS). These will be measured to fit you. You may be prescribed anticoagulant medication (a blood ‘thinning’ drug) instead of, or in addition to the stockings.

Because anticoagulants thin your blood, it can make you bleed more easily. If you are at risk of bleeding problems your doctor may decide not to prescribe this medication.

The anticoagulant currently recommended for use in Hull University Teaching Hospitals NHS Trust is called Dabigatran. It is a capsule to be taken once a day. You should also read the information leaflet in the packet as it will tell you more about the possible side effects of dabigatran.

Dabigatran has been approved for use to prevent blood clots in a variety of circumstances, for example in patients after hip or knee replacement surgery and in those who have an irregular heartbeat. It has not however been approved for use to prevent blood clots in people with plaster casts. At this hospital senior doctors and pharmacists have decided that it is safe to use dabigatran in this way. You may hear this called “off label” or “unlicensed” use. You can ask your doctor or nurse for a copy of Hull University Teaching Hospitals NHS Trust “Unlicensed” and “Off-Label” Medicines Information leaflet to explain more or you can access this online at:

https://www.hey.nhs.uk/patient-leaflet/unlicensed-off-label-medicines/

If you are unhappy with taking dabigatran talk to your doctor, nurse or pharmacist. There are other medicines that could be used (such as low molecular weight heparin injections). Heparins are porcine-derived (from pigs) although other drugs are available for people whose religious or ethical views would prevent the use of porcine products. Heparins are advised for those patients where surgery is planned and in this circumstance is used instead of dabigatran until after surgery has been performed.

What do I do with blood thinning medicines once I go home?

Sometimes patients are advised to continue with blood thinning injections or capsules after they are discharged home. If you are advised that you need to give yourself a daily injection the ward or clinic staff will show you how to do this. If you are unable to do this we will show a family member how to give the injections or arrange for a District Nurse to come to your home. Used needles should be placed in a yellow sharps bin which you will be given. Used sharps bins can be returned to hospital or community pharmacies for safe disposal or arrangement for collection can be made through your local council (Hull 300300; East Yorkshire 393939).

What should I do if my calf becomes swollen, red and painful?

Contact the hospital ward or clinic where you were a patient via the switchboard (01482) 875875 for advice. Alternatively, you can contact your GP or Emergency services (111).

You should in the meantime, remove stockings if wearing them and raise your leg slightly on a footstool.

What should I do if I become breathless, develop chest pains or cough up blood?

Attend the Emergency Department immediately.

What happens afterwards?

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Trauma & Orthopaedic Department on telephone (01482) 674378

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.