DVT (DEEP VEIN THROMBOSIS)

Deep vein thrombosis is the formation of a blood clot in one of the large veins of the body, usually in the calf and thigh, and less often in the arm or pelvis. The clots form when circulation to a particular part of the body is abnormally sluggish or when damage has been done to a blood vessel.

The danger occurs if the clot breaks free and travels through the veins where it can reach the lungs, obstructing the pulmonary artery or its branches, which supply the lungs with blood. A pulmonary embolism can cause sudden death. Therefore if you suspect you are at risk for DVT it is important to seek treatment immediately.

Risk factors for developing blood clots include pregnancy, obesity, recent surgery, chemotherapy treatment, estrogen use, prolonged immobilization, birth control pills and having cancer. Genetics may also be a factor.

The symptoms of DVT include swellingof the affected leg or arm. The area may also feel warm and look redder, it may also ache or feel tender, although occasionally there are no symptoms at all, particularly with smaller clots.

If your doctor suspects you have DVT you will probably have an ultrasound test done to measure the blood flow through your veins. If the results are still unclear the doctor will usually do an MRI or CT scan.

It is vitally important to begin immediate treatment. As one who likes to use natural means whenever possible, this is an instance in which I choose to use conventional medications. Treatment involves taking blood thinners (anticoagulants) like heparin and warfarin (coumadin). Heparin is given by injection or IV and begins working immediately, and is usually discontinued when the warfarin/coumadin (a pill) has kicked in. Based on the cause and severity of the problem, treatment with blood thinners is usually for a period of at least 3 - 6 months to prevent existing clots from growing and preventing the formation of new clots.

Suggestions for home treatment include elevating the area, wearing compression stockings, and using a heating pad for 20-30 minutes, 3-4 times a day.

To reduce your risk of developing DVT :

• talk to your doctor about taking anticoagulants after surgery
• exercise to improve circulation, especially when you are sitting for long periods of time – especially during long airplane flights. (try this exercise: point your toes up toward your head so that the calves of your legs are stretched, then relax)
• get out of bed as soon/as often as possible when you are ill or recovering from surgery
• talk to your doctor about compression stockings as they can help to prevent DVT if you are at risk
• Garlic has been indicated as helpful in reducing platelet aggregation and thrombosis (formation of plaque in the body) and having and anit-clogging affect on the body according to www.healthcastle.com, so you may want to discuss using garlic supplements or adding garlic to your diet on a daily basis ( the American Dietetic Association recommends 600-900 mg. or 1 fresh clove per day for general health). Garlic supplementation is not recommended if you are using apsirin or taking other blood thinners.

If diagnosed with DVT and you are put on Warfarin, (the most popular brand is Coumadin) and or other blood thinners you will also be cautioned to watch your diet – it is important to try to eat the same amount of foods that contain Vitamin K each day as Vitamin K helps the blood to clot and can counter the effects of your medication. Vitamin K is prevalent in green leafy vegetables like broccoli, kale, spinach, brussel sprouts, lettuce, etc. Certain oils and dressings are high in vitamin K as well so watch your intake of canola and soybean oils, and don’t have more that 7 tablespoons per day. Discuss any and all herbal products that you take with your doctor as they can also impact the effectiveness of your medication.

In order to ensure you are taking the correct dose of Coumadin/Warfarin your blood clotting factor will need to be check regularly. The goal is to have the level between 2 and 3 - if it is too high (above 3) you are at an increased risk for bleeding, or too low (below 2) and you risk clotting.

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The Cleveland Clinic is a great source for health information, and has the following information about Warfarin on their website: http://www.clevelandclinic.org/health/

Anticoagulant Medication Warfarin (Coumadin)

Disclaimer
References in this document to Coumadin, the brand name used by Bristol-Myers Squibb to market its product, warfarin, are made solely for the ease of patient identification. Other equivalent brands of anticoagulant medications may be available and appropriate for patient use.

* Throughout this document, the anticoagulant medication will be referred to by the commonly used generic name of warfarin.

Introduction
The better you understand your medication, the more successful your anticoagulation therapy will be and the less likely you are to have complications from the medication.

If you have any questions about your medication, please discuss them with your health care provider (doctor, pharmacist, or nurse).

What warfarin does and how it works
Your doctor has prescribed an anticoagulant medication. "Anti" means against and "coagulant" means causing blood clotting. Warfarin is a type of anticoagulant medication that helps prevent clots from forming in the blood.

You have been prescribed warfarin because your body may be making blood clots or you may have a medical condition known to promote unwanted blood clots. Blood clots can move to other parts of your body and cause serious medical problems. Warfarin will not dissolve a blood clot; however, over time the blood clot may dissolve on its own. Warfarin may also prevent other clots from forming or prevent clots from becoming larger.

Blood testing
In order for your health care provider to determine the correct dose of warfarin, it will be necessary for you to have blood tests. The tests are performed in a laboratory or anticoagulation clinic, usually once a week to once a month, as directed by your doctor.

The prothrombin time (PT or protime) test is used to calculate your International Normalized Ratio (INR). Your INR will help your health care provider determine how fast your blood is clotting and whether your medication dose needs to be changed.

Illness, diet, medication changes, and physical activities may affect your INR. Tell your health care provider about changes in your health, medications (prescription and over-the-counter) or lifestyle so appropriate dosage adjustments can be made in your warfarin therapy.

Tablet appearance
Coumadin brand tablets are round and scored, which means they can be broken in half. Each tablet color represents a different strength. The strength of the tablet is measured in milligrams (mg) as follows:

• 1 mg - pink
• 2 mg - lavender
• 2.5 - mg green
• 3 mg - tan
• 4 mg - blue
• 5 mg - peach
• 6 mg - teal or blue-green
• 7.5 mg - yellow
• 10 mg - white

Other brands of warfarin should have the same colors and strengths as the Coumadin brand tablets. However, other brands of warfarin tablets may have a different shape or appearance. For example, they may be oval or square.

How to take your warfarin
Take your warfarin dose as instructed once a day. Try to take it at the same time every day. Some physicians recommend taking your warfarin early in the evening (such as between 5:00 and 6:00 p.m.). Warfarin can be taken with or without food.

Do Not Take a Double Dose to make up for a missed dose. Also, never change your dose without first discussing the change with your doctor.

Storage conditions
As with any medication, store your warfarin at room temperature, away from extreme cold, heat, light, or moisture. Bathroom cabinets are usually NOT suitable for storing medications because of dampness. All medications, including warfarin, should always be kept out of the reach of children and pets.

Precautions when taking warfarin
It is important that you follow these precautions when taking warfarin to reduce the risk of side effects and improve the effectiveness of your medication.

Medications and dietary supplements
Many medications and dietary supplements can affect the way warfarin works. These may include:

• Prescription medications
• Nonprescription medications such as aspirin, acetaminophen (Tylenol) nonsteroidal anti-inflammatory drugs or NSAIDs (some examples are ibuprofen, naproxen or ketoprofen), cough or cold remedies, and medications for pain or discomfort
• Herbal products, natural remedies, or nutritional supplements
• Products containing vitamin K

Before taking any new medication, including over-the-counter medication or medication prescribed by another doctor or dentist, check with the doctor who monitors your warfarin medication. Your warfarin doctor may need to adjust your warfarin dosage or may recommend another medication less likely to interfere with warfarin.

Diet

• Eat a sensible, well-balanced diet.
• Talk with your doctor if you are planning any major dietary changes such as following a weight-reducing diet or adding nutritional supplements.
• Large amounts of food high in vitamin K may change the way warfarin works. Try to keep the amount of these foods in your diet about the same from week to week.
• It is best to avoid alcohol while taking warfarin. Alcohol interferes with the effectiveness of warfarin.

Activities

• Check with your doctor before starting any exercise or sports program. Your doctor may want you to avoid any activity or sport that may result in a serious fall or other injury.
• Use a soft toothbrush. Brush and floss gently to prevent bleeding from the gums.
• Be careful when using razors. We suggest using an electric razor or hair-removing cream to minimize the chance of cuts. If you do cut yourself, follow the guidelines below.

Illness and emergencies

• If you cut yourself and the cut is small, apply constant pressure over the cut until the bleeding stops. (This may take up to 10 minutes.) If the bleeding doesn't stop, continue to apply pressure and go to the nearest emergency room.
• If you cut yourself and the cut is large, apply constant pressure and get help immediately either by phone or by going to the nearest emergency room.
• Call your doctor if you have any symptoms of illness such as vomiting, diarrhea, infection or fever. Illness can change the way warfarin works.
• It is recommended that you wear or carry identification that states you are taking warfarin.
• Avoid situations at home or at work where you may get injured.

Pregnancy
If you are a woman who is taking warfarin and are planning to become pregnant, talk with your doctor about the possible risks and ways to reduce those risks.

Tell your doctor right away if you become pregnant or think you might be pregnant.

Surgery and dental work
Before any treatment is provided, tell all your doctors and dentists that you are taking warfarin. Before having a surgical or dental procedure, you may need to have a blood test, and you may need to stop taking warfarin for a few days.

Do not stop warfarin without conferring with the doctor who monitors your INR.

Travel
Check with your doctor before you travel. Before you go on vacation, you may need to have a blood test and your warfarin dose may need to be adjusted.

While traveling, carry your medications with you at all times. Do not put medications in checked baggage, and do not leave your medications in the car.

When to call your doctor
Call your doctor if you notice any of the following signs of bleeding or illness that can affect the way your warfarin works:

• Feeling more weak or tired than usual or looking pale (symptoms of anemia)
• Bleeding from cuts that won't stop after applying pressure for 10 minutes
• Coughing or vomiting blood (which may look like coffee grounds)
• Bleeding from the nose, gums, or ears
• Unusual color of the urine or stool (including dark brown urine, or red or black, tarry stools)
• Unusual bruising (black-and-blue marks on your skin) for unknown reasons
• Menstrual bleeding that is heavier or lasts longer than normal
• A fever or illness that gets worse
• A serious fall or a blow to the head
• Unusual pain or swelling
• Unusual headache
• Dizziness
• Difficulty breathing

If you notice any of these symptoms, your doctor may want to do a blood test, stop the warfarin, or prescribe medication to stop the bleeding.

Dietary precautions: Foods high in vitamin K
Vitamin K is needed for normal blood clotting. When you are taking warfarin, large changes in the amount of vitamin K in your diet may affect the way warfarin works.

It is important to keep your diet consistent.  If you plan to make major changes in your diet, please inform your health care provider.  Avoiding vitamin K containing foods is not necessary.

Do not start consuming the following herbal teas and supplements because they may affect the INR, causing it to be too high or too low.

Herbal teas

• Chamomile
• Tonka beans
• Melitot (sweet clover)
• Sweet woodruff

Herbal supplements

• Alfalfa/alfalfa sprouts
• Angelica (dong quai)
• Borage
• Bromelain
• Celery*
• Clove*
• Coenzyme Q-10 (ubiquinone, CoQ10)
• Danshen
• Devil's claw
• Echinacea
• Fenugreek
• Feverfew
• Garlic*
• Ginger*
• Gingko biloba
• Ginseng
• Green tea
• Horse chestnut (buckeye, aesulus)
• Kelpware
• Licorice
• Meadow
• Papain
• Parsley*
• Passion flower
• Quassia
• Quinine
• Red clover
• Reishi mushroom
• Rue
• St. John's wort

*Certain foods like celery, clove, garlic, ginger, and parsley are usually safer if they are used in small amounts in cooking or as a seasoning. They should not be used in the form of a supplement.

Do not start taking the following unless specifically approved by your physician:

• Any vitamin supplement that provides more than 100 percent of the Recommended Daily Intake (RDI) for vitamins A, E, and C
• Fish oil supplements
• Garlic oil supplements
• Ginger supplements
• Onion extract pills
• Any other herbal supplement listed in this document

Do NOT stop or start taking any medications, herbal products, natural remedies, or nutritional supplements without first talking to the doctor who monitors your warfarin medication.

Some medications may increase or decrease the anticoagulant effect of warfarin and therefore, may increase your risk for side effects. If you take any of the medications listed, your warfarin dosage may need to be adjusted.

You may need to get blood tests more often when you stop, start, or increase the dose of medications that are likely to affect the way warfarin works. Talk to your doctor about any changes in your medications.

This is NOT a complete listing of medications that can affect the way warfarin works. Always check with your health care provider whenever there is a change in ANY of your medications. 

Important points to remember

• Take your warfarin as instructed and at the same time each day.
• Have your blood tested as instructed to check how quickly your blood is clotting.
• Discuss all medications you are taking -- even over-the-counter medicines -- with your doctor and pharmacist since many drugs can interact with warfarin.
• Tell anyone providing medical or dental care that you are taking warfarin.
• Eat about the same amount of foods with vitamin K each week, as these foods can affect the way warfarin works.
• It is best to avoid alcohol while taking warfarin.
• If you forget to take a pill, DO NOT take a double dose. Take the missed dose as soon as possible on the same day. DO NOT take a double dose of warfarin the next day to make up for the missed dose.
• Watch for signs of abnormal or excessive bleeding and bruising. Call your health care provider right away if you suspect something is wrong.
• DO NOT change warfarin products without first checking with your doctor. Different brands of warfarin products may NOT be identical, and you may need to have your dose checked and adjusted more frequently if you change brands.
• DO NOT STOP your warfarin even for a minor procedure like dental work without first checking with the doctor who monitors your therapy.

© Copyright 1995-2005 The Cleveland Clinic Foundation. All rights reserved

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There are other alternative products that show some potential for treating/preventing clotting disorders like DVT, but are unproven and therefore not currently recommended substitutes for conventional medicines. But they might be worth looking into if you are predisposed to clotting and are searching for alternative treatments to prevent the onset of a problem. I would discuss this with your medical doctor as clotting is a serious and potentially life-threatening problem that you don’t want to fool around with.

Ginkgo biloba, which is believed to improve blood flow to the brain by thinning the blood, also reducing inflammation and act as an antioxidant to fight cell damage. "Because of this, ginkgo has been used in the treatment of a variety of conditions including blood flow disorders like thrombosis and Raynaud's phenomenon, and in the treatment of problems associated with memory and concentration, likely caused by decreased blood flow to the brain," says Nicole Nisly, MD, UI Hospitals and Clinics Complementary and Alternative Medicine Clinic. Ginkgo also has been useful in treating asthma and allergies causing inflammation in the respiratory system.

If you are interested in taking ginkgo, be sure to check with your doctor. "Because of its ability to thin the blood, people who are already taking medications to thin the blood, such as aspirin or warfarin, should not take ginkgo without recommendation from their physician," Nisly says.

Nattokinase is an enzyme isolated from the vegetable cheese, Natto – a typical and popular soybean food in the Japanese diet. It has been found to have blood clot dissolving abilities and preventing the aggregation of red blood cells. But no clinical trials have been to done on humans to determine its effectiveness and or potential side effects, so speak with your physician before taking this product.

Other sources of information:

http://www.webmd.com/heart-disease/tc/Deep-Vein-Thrombosis-Topic-Overview
http://familydoctor.org/online/famdocen/home/common/blood/244.html
http://www.raysahelian.com/nattokinase.html
http://www.drweil.com/drw/u/QA/QA33112/
http://www.uihealthcare.com/
http://www.mayoclinic.com/health/thrombophlebitis/DS00223/DSECTION=1