/ EMERGENCY DEPARTMENT
PATIENT INFORMATION FOR YOUR CARE /

Care of the Patient with a Coagulation Issue

(DVT, PE, Blood thinners, Epistaxis)

□DVT (Deep Vein Thrombosis) and PE (Pulmonary Embolism)

  1. A DVT occurs when a blood clot forms in a deep-lying vein, usually in the legs. This can occur for many different reasons.
  2. The danger associated with this clot is that it can break off and travel through the bloodstream, and ultimately get trapped in the arteries in your lungs (a pulmonary embolus). This can cause permanent lung damage, and at its worst may even be deadly.
  3. The treatment for DVT and PE is to thin your blood, using anticoagulant medication. The goals of this treatment are to:
  4. Prevent new clots from forming
  5. Prevent existing clots from enlarging
  6. Prevent existing clots from breaking off and embolizing (traveling to your lungs or other places)
  7. Allow time for the existing clot to be dissolved by your body.
  8. You will need to be treated for at least 3 months, and possibly as long as forever. Ask your doctor about your specific case.
  9. The medicines used include dalteparin (Fragmin) and warfarin (Coumadin). See below for more details about these medicines.
  10. You should return to the Emergency Department immediately (call 911) if you develop:
  11. Severe shortness of breath
  12. Bluish discoloration of the lips and tongue
  13. Severe chest pain

□Blood thinners

  1. Dalteparin (Fragmin) is an injected blood thinner that thins your blood for approximately 24 hours per injection. Therefore it needs to be given once a day. You do not need to have routine blood tests while on dalteparin.
  2. Dalteparin can be given at your home by Home Care, by returning to the ED, or at your Family doctor’s office. You will get your shots at ______
  3. Dalteparin will be given until:
  4. You have had a diagnostic test to see if you have a blood clot (ultrasound or CT scan), and the test is normal
  5. Your blood is properly thinned using warfarin (Coumadin), if you have been diagnosed as having a clot.
  6. Coumadin is an oral blood thinner that is used on a longer term basis to thin your blood. The dose you require will be individualized for you by measuring the thinness of your blood until it is stable at the right level.

□Blood thinners (continued)

  1. Because of this, you will need to have routine blood tests while you are on warfarin. At the beginning the tests are done very frequently (up to every 2-3 days). Your next blood test will be on ______(date) at ______(location). Your target blood level is ______(target INR). B
  2. Make sure your doctor, dentist, and any other health care provider (e.g. massage therapist, chiropractor) know that your blood is thinned.
  3. You should wear a medic-alert bracelet stating that you are on blood thinners.
  4. Before taking any new medications, including over-the-counter drugs, check with your family doctor or pharmacist. Many medications will interfere with warfarin.
  5. You should return to the Emergency Department if you develop:
  6. Severe shortness of breath
  7. Bluish discoloration of the lips and tongue
  8. Severe chest pain
  9. Lightheadedness or feeling faint when you stand up
  10. Severe headache
  11. Severe stomach pain
  12. Red or brown urine
  13. Red or black stools
  14. Cuts or nosebleeds that won’t stop bleeding
  15. Bruises that increase in size without any injury.

□Epistaxis (nosebleeds)

  1. Most nosebleeds come from the blood vessels at the front of your nose, on the septum (the wall between the nostrils).
  2. The most common causes of nosebleeds are trauma (e.g. picking your nose), being on blood thinners, dry air, and patients with a history of high blood pressure.
  3. If you have a nosebleed, you should apply pressure to the bleeding area by squeezing your nostrils closed right at the front. You should not be able to breathe through your nose if you are doing it properly.
  4. Hold the pressure on your nose for 20 minutes without letting go. This can be helped by the use of a noseclip – ask for one before you leave the ED.
  5. If your nosebleed was treated with packing (gauze stuffed up your nose), leave it in place. You should go to ______on ______(date)to get the packing Bremoved.
  6. If your nose was not packed, you may gently apply Vaseline to the inside of your nose to lubricate it.
  7. Try to avoid sneezing (blow the sneeze out your mouth) and blowing your nose.

These instructions are not intended to be all-inclusive, and may not cover all possibilities. If a new problem develops, or if you have any further concerns or questions please contact your primary care provider, Telehealth Ontario at (866) 797-0000, or return to the ER.

RoyalVictoriaHospital of Barrie, 201 Georgian Drive, Barrie, OntarioL4M 6M2 (705)728-9802

RVH-3292 (Rev Nov 29, 2006)