Pharmacy Program

The Power of Your Choice

Your choice of the IHTC Pharmacy Program directly supports your IHTC team and patient services, and activities provided to the hemophilia community. The IHTC Pharmacy Program provides savings to you and your health insurance plan.

Every patient has the right to choose their clotting factor pharmacy provider. The IHTC supports your right of choice and will assist you in making an informed decision.

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Signs and Symptoms of Blood Clots

The signs and symptoms of blood clots range from deep vein thrombosis (DVT) to pulmonary embolism (PE). The symptoms of clotting depend on the location of the affected blood vessel and whether the vessel is totally or partially blocked by the clot.

 

Clinical Spectrum of Clotting

Deep vein thrombosis (DVT)

  • Blood clots may form in the deep blood vessels, most commonly in the legs and groin, and can block normal blood flow returning from the legs to the heart.
  • Clots in the veins (venous) that form in regions of slow to moderate flow are made of a mixture of red cells, platelets, and fibrin and are known as mixed platelet fibrin thrombi.
  • Clots in the deep veins of the legs or abdomen that partially block the vein may cause subtle symptoms and sometimes may not cause any symptoms until the normal blood flow is significantly disturbed.

Pulmonary Embolism (PE)

  • A PE occurs when a piece or all of a deep vein clot breaks off and is carried by the blood stream to the lung, where it blocks the blood vessel.
  • The size of the clot and the location of the blocked blood flow in the vessel determine the extent and severity of the PE.
  • Clots in veins that are closer to the body center (called proximal vein clots) are more likely to lead to deadly PE as compared to clots in the calf veins.
  • The occurrence of deadly PE can be greatly reduced if the DVT is treated with anticoagulant therapy.

Superficial Vein Swelling (Thrombophlebitis)

  • Superficial swelling of the veins (called thrombophlebitis) is the result of blood clots that form in veins that are closer to the surface of the skin and are associated with inflammation.
  • Superficial thrombophlebitis is often observed in individuals who are heterozygous or homozygous for the factor V Leiden mutation.

Signs and Symptoms

Deep Vein Thrombosis

  • Swelling, usually in one leg
  • Leg pain or tenderness
  • Reddish or bluish skin discoloration
  • Leg warm to touch
  • Some people with a DVT may not have any symptoms (called asymptomatic)

Pulmonary Embolism

The signs and symptoms of PE may be subtle and may include the following complaints, listed in order of frequency:

  • Sudden shortness of breath
  • Chest pain-sharp, stabbing; may get worse with deep breath
  • Rapid heart rate
  • Unexplained cough, sometimes with bloody mucus
  • Apprehension, anxiety
  • Sweats
  • Feeling faint
  • Fatigue
  • Some people with a PE may be asymptomatic

    Signs and Symptoms in Thrombophilic Conditions

    Pregnancy loss

    Inherited Deficiencies

    • Clots in the mesenteric vein are rare but characteristic of an inherited clotting disorder
    • Family history of blood clots
    • First clot at a young age, often younger than 40 years
    • Frequent recurrence
    • Neonatal purpura fulminans is a rare condition associated with homozygous protein C and S deficiencies
    • Most patients with an inherited or acquired clotting disorder may not have symptoms for a significant period of time. These patients may be diagnosed because of either a personal or family history suggestive of a clotting disorder

    Superficial Thrombophlebitis

    • These clots often partially block blood flow in affected veins and may cause pain and irritation.
    • Redness and inflammation along the vein may occur; if the area is hard and the skin is red, the affected vein is often visible and most commonly occurs in the legs or arms.
    • Other associated symptoms include warmth and tenderness, and itchiness
    • Pain along the vein: patients may report a throbbing or burning sensation beneath the skin’s surface. These symptoms may interfere with sleep as they progress.
    • Fever: Patients with swelling of the veins may develop a fever associated with an episode of thrombophlebitis.

    Hyperhomocysteinemia

    • Clinical signs of hyperhomocysteinemia are similar to those seen with other clotting disorders.
    • Reported rates of clotting events in cases of significant hyperhomocysteinemia include
      • DVT either with or without PE: ~64%
      • Superficial thrombophlebitis: ~24%
      • Thrombosis of cerebral or mesenteric veins: ~12%
    • Clotting signs and symptoms are often associated with other “triggering” factors such as use of oral contraception, trauma/surgery, pregnancy (both during and after), and immobilization.
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