How is DVT treated?

Depending on your condition, you may be admitted to the hospital for DVT treatment, or you may receive treatment on an outpatient basis.

Treatments include medications, compression stockings, elevation of the affected leg, and if the blood clot is extensive, more invasive diagnostic and treatment procedures. The main goals in treating deep vein thrombosis are to:

  • Stop the clot from getting bigger;
  • Prevent the clot from breaking off in your vein and moving to your lungs;
  • Reduce the risk of another blood clot;
  • Prevent long-term complications from the blood clot (chronic venous insufficiency or the post-thrombotic syndrome or, if in the lungs, a condition known as chronic thromboembolic pulmonary hypertension).

Medication Guidelines

Take your medications exactly as prescribed and at the same time every day.

Have blood tests as directed by your doctor and keep all scheduled laboratory appointments so that your response to the medication can be monitored. If you are taking warfarin, the blood test will evaluate how well your medicine is working.

A blood test called a Protime or PT/INR measures how fast or slow your blood clots. The PT test results are reported as an international normalized ratio (INR). Your medications may be changed or adjusted based on the results of this test.

If you are prescribed one of the newer medications such as rivaroxaban or dabigatran, you will not need routine monitoring. However, most physicians advocate checking the patient's renal (kidney) function from time to time with these newer anticoagulants.

Talk to your doctor before taking any other medications, especially over-the-counter medications.

Talk to your doctor about your diet, because certain foods affect how well your warfarin medication works. The newer anticoagulants (rivaroxaban and dabigatran) are not affected by your food intake.

Medications

There are several medications used to treat and/or prevent DVT:

Anticoagulants (sometimes called blood thinners) decrease your blood's ability to clot. They are used to stop clots from getting bigger and to prevent a blood clot from moving. They are also often used in patients who are hospitalized to prevent clots from forming. Anticoagulants do not break up blood clots that have already formed. Your body's natural system may help dissolve the clot. In some cases, however, the clot will not completely dissolve.

Anticoagulants can either come as a pill, such as warfarin (Coumadin) or as an injection or shot, such as heparin or low molecular weight heparin (including enoxaparin sodium [Lovenox] or dalteparin sodium [Fragmin]). Another medication called fondaparinux sodium (Arixtra) can also be used and is given as an injection. There are several new medications that are all given orally (by mouth). They include rivaroxaban (Xarelto) and dabigatran (Pradaxa). These newer anticoagulants do not require monitoring.

Heparin, the low molecular weight heparin, fondaparinux, and warfarin may be given at the same time. Heparin and fondaparinux will act quickly, while the warfarin will take 4 to 5 days before it starts to work. Once the warfarin is working, the other anticoagulants will be stopped, but usually only after a minimum of 5 days of combined therapy. Pregnant women cannot take warfarin and will be treated with heparin or low molecular weight heparin only.

Heparin, low molecular weight heparin, or fondaparinux can also be given with the new anticoagulant, dabigatran, over a five-day overlap. Once the five days are completed, dabigatran can be used alone.

The other new anticoagulant, rivaroxaban, does not need an overlap and can be used alone and long-term for the treatment of patients with DVT and/or pulmonary embolism. Pregnant women cannot take warfarin and will need to be treated with heparin or low molecular weight heparin only.Treatment for DVT with anticoagulants usually lasts for 3 to 6 months. The following situations may change the length of treatment:

  • If your blood clot occurred after a short-term risk like surgery or trauma, your treatment with anticoagulants may be shorter(3 months).
  • If you have had clots before, you may need longer treatment
  • If you are being treated for another illness (such as cancer), you may need to take an anticoagulant as long as the risk factor(cancer) is present

The most common side effect of anticoagulants is bleeding. You should call your doctor right away if you are taking warfarin, heparin, low molecular weight heparin, fondaparinux, dabigatran, or rivaroxaban and experience easy bruising or bleeding.

Thrombolytics are medications given to quickly dissolve the blood clot. These medications are delivered through a catheter that is directed into the area of the clot. They are used to treat large clots causing severe symptoms. Because they increase the risk of bleeding, they are only used in special situations determined by your physician. These situations may include massive swelling of an arm or leg or in situations where a blood clot in the lungs (pulmonary embolism) has left the patient very short of breath or with low blood pressure.

Direct thrombin inhibitors are medications that interfere with the clotting process. They are used to treat some types of clots and may be prescribed for patients who cannot take heparin or low molecular weight heparins.

Compression Stockings

Your doctor should prescribe graduated compression stockings to reduce the chronic swelling that can occur in the leg after a blood clot has developed. The swelling often occurs because the valves in the leg veins have become damaged or the vein remains blocked from the blood clot.

Most compression stockings are worn just below the knee. These stockings are tight at the ankle and become more loose as they go up the leg. This causes gentle external compression (or pressure) on your leg.

Activity Guidelines

Once DVT occurs, getting around may become more difficult at first. You should gradually return to your normal activities. If your legs feel swollen or heavy, lie in bed with your heels elevated 5 to 6 inches. This will help improve circulation and decrease your leg swelling.

In addition:

  • Exercise your lower leg muscles if you are sitting still for long periods of time.
  • Stand up and walk for a few minutes every hour while awake.
  • Don't wear tight-fitting clothing that could decrease the circulation in your legs.
  • Wear compression stockings as recommended by your doctor.
  • Avoid activities that may cause a serious injury.

DVT Treatment Procedures

Catheter-directed thrombolytic therapy is a nonsurgical treatment for DVT that dissolves blood clots. It is performed in a catheterization laboratory by a specially-trained physician and a team of nurses and technicians. The doctor and his team will use clot-dissolving medications referred to as thrombolytics.

First, the patient receives medication for relaxation. The doctor numbs the area where the procedure is to be performed. A guide wire followed by a sheath (thin, plastic tube) is inserted into the vein. A long, slender tube called a catheter is inserted through the sheath and guided through the vein to the segment where the blood clot is located. A clot-dissolving drug is infused through the catheter into the clot.

The clot usually dissolves in a matter of hours to a few days. The physician often uses a venogram or duplex ultrasound to evaluate the progress of the medication. At times, the narrowed area of the vein will need to be treated with angioplasty and/or a stent to prevent further clots from forming.

Angioplasty is a nonsurgical treatment for DVT that is used to widen the vein after the blood clot has been dissolved. During angioplasty, a small balloon at the tip of the catheter is inflated to stretch the vein open and increase blood flow. A stent may be necessary at times and is placed during the angioplasty procedure to keep the vein open.

A stent is a small, metal mesh tube that acts as a scaffold and provides support inside the vein. A balloon catheter, placed over a guide wire, is used to insert the stent into the narrowed vein. Once in place, the balloon is inflated and the stent expanded to the size of the vein holding it open. The balloon is deflated and removed, and the stent stays in place permanently.

Inferior vena cava filters are used when you cannot take any of the blood thinners, or if you are taking blood thinners and continue to develop clots. The filter can prevent blood clots from moving from the vein in your legs to the lung (pulmonary embolism). During a small surgical procedure, the filter is inserted through a catheter (thin tube) into a large vein in the groin or neck, then into the vena cava (the largest vein in the body). It can catch clots as they move through the body to the lungs. This treatment will help prevent a pulmonary embolism, but will not prevent the development of more clots.