Question: Am I at increased risk of developing deep vein thrombosis (DVT)?
Answer: Anna Jewell, Information Manager, Pancreatic Cancer
What is venous thrombosis?
Blood contains platelets and proteins which can act as clotting
factors and sometimes form a kind of plug to stop bleeding when
A venous thrombosis is a blood clot which forms inside a vein
abnormally, blocking the vessel and reducing or preventing blood
flow. It often occurs in deep veins, and this is known as a deep
vein thrombosis (DVT). DVT is most common in the lower leg (calf),
thigh or pelvis. A part or all of the blood clot may come free and
travel to the lungs; this is called a pulmonary embolism. It is not
common but it can be very serious.
Most clots can be successfully treated so it is important to
report any symptoms to your health care team as soon as
Risk of venous thrombosis in pancreatic cancer patients
The risk of venous thrombosis is increased in cancer patients
and pancreatic cancer patients are at higher risk than patients
with many other cancer types. Pancreatic cancer cells activate
platelets in the blood and release substances that promote the
formation of blood clots for example tissue factor and
Patients with advanced or metastatic pancreatic cancer are
particularly at risk. It is estimated that these patients have a 1
in 5 chance of developing a venous thrombosis.
Having major surgery, such as the Whipples operation for
pancreatic cancer is a risk factor along with the reduced mobility
which will occur during recovery from this surgery. Reduced
mobility is a risk factor because normally the movement of the legs
helps to pump blood back to the heart.
Deep vein thrombosis most often occurs in the lower leg or
Common symptoms of venous thrombosis (blood clots)
Bloods clots often do not cause any symptoms. However, there are
a number of symptoms of blood clots that you can look out for. If
you think you are experiencing these symptoms you should contact
your health care team at the hospital or your GP urgently.
Symptoms of deep vein thrombosis (DVT)
- Pain, swelling or tenderness in one of your legs (or calf)
- Warm skin or redness of skin in the affected area
- Heavy ache in the affected area
Symptoms of pulmonary embolism (where clot has moved to
- Shortness of breath
- Pain in chest (especially on breathing in)
- Coughing up blood
How is a venous thrombosis diagnosed?
If a DVT is suspected you will usually undergo an ultrasound
scan of the affected area and a D-dimer test (a blood test).
If a pulmonary embolism is suspected your hospital team will
usually arrange a computed tomography pulmonary angiogram (CPTA) to
look for the clot.
Reducing the risk of venous thrombosis
Risk assessment in hospital
National guidelines have been produced on reducing the risk of
venous thrombosis in patients admitted to hospital. These
guidelines state that all patients should be assessed on admission
to hospital to identify people at increased risk of a venous
thromboembolism (VTE). (NICE Reducing the risk of venous
Patients are thought to be at increased risk of VTE if they have
had reduced mobility for three days or more, or are expected to
have on-going reduced mobility compared to their usual state and
have one or more of the following risk factors:
- Active cancer or cancer treatment
- Over 60 years
- Critical care admission
- Known thrombophilias
- Medical co-morbidities
- Personal history or first degree relative with history of
- Use of hormone replacement therapy
- Use of oestrogen-containing contraceptive therapy
- Varicose veins with phlebitis.
Ways to reduce the risk
In hospital if you are identified as being at increased risk of
developing a VTE a number of strategies will be used to help reduce
- You will be encouraged to get moving as soon as possible,
particularly after surgery.
- You will be encouraged to keep well hydrated.
- You will be given anti-embolism stockings to wear
- Foot impulse devices or intermittent pneumatic compression
devises may be used while you are inactive.
- You may be given a drug to reduce your risk of developing a
clot. The drug most commonly used is low molecular weight heparin
When you are discharged from hospital you will be given
information on the signs and symptoms of deep vein thrombosis and
pulmonary embolism and how to seek help if you develop any
Patients receiving chemotherapy or radiotherapy treatment for
pancreatic cancer, do not routinely receive drugs to reduce the
risk of clots. However, you should still be aware of the signs and
symptoms of DVT and PE and have been given information on ways to
reduce the risk of developing blood clots such as keeping mobile
and keeping hydrated.
Treatment for venous thromboembolism (blood clot)
If a venous thromboembolism (blood clot) is found the standard
treatment is to use anticoagulation drugs. These are drugs which
thin the blood to prevent the clot getting bigger or further clots
developing. The drug most often used in patients with active cancer
and a confirmed DVT or PE is low molecular weight heparin (LMWH).
The drug will usually be given for at least six months.
You should be given information on how to take the drug, how
long for, the side effects and when to seek help. You should also
be given an alert card for anticoagulants to carry with you.
Published February 2012
Review date February 2014