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Deep Vein Thrombosis

How Is Deep Vein Thrombosis Treated?

Thursday, June 14, 2012 - 13:02

Contributing Author: Guy Slowik FRCS

Treatment of DVT is aimed at:

  • Easing symptoms
  • Preventing worsening of the clot
  • Preventing the clot from traveling to the lungs

Treatment usually requires hospitalization, primarily to facilitate monitoring of medications. Because DVT occurs in post-surgical patients, however, the person might already be in the hospital when DVT is diagnosed.

Deep vein thrombosis must be treated promptly. Once the diagnosis is confirmed, the individual is kept in bed with the foot of the bed elevated.

  • Bed rest. Individuals with DVT usually require bed rest until symptoms are relieved. The leg should be elevated to a position above the heart to reduce swelling (the foot of the bed is elevated about six inches to achieve this). Moist heat may be applied to the affected region to relieve pain.
  • Compression stockings. Physicians frequently recommend that people who have DVT wear compression stockings (also called support hose) to reduce symptoms. Compression stockings improve circulation by providing a graduated pressure on the leg to help return the venous blood to the heart.
  • Blood-thinning drugs. Treatment with anticoagulants (commonly known as blood thinners) is required in most cases of DVT. The anticoagulant drugs heparin and warfarin are used primarily to prevent the formation of new clots, and, thus, reduce the chance of pulmonary embolism.
    • Heparin is the anticoagulant drug of first choice. It must be administered intravenously (an injection made directly into a vein).
    • Warfarin (also called coumarin) is taken by mouth.
    • Treatment with heparin normally lasts seven to 14 days. Treatment with warfarin is usually continued from two to six months, depending on the age of the person, the severity of the DVT, and whether risk factors are present.
  • Clot-busting medication. Drugs called thrombolytic agents (clot-dissolving medications) are used to help dissolve existing clots and reopen clogged veins. The most commonly used thrombolytic agents are urokinase, streptokinase, and recombinant tissue plasminogen activator (rt-PA).

    Need To Know:

    Anticoagulants (blood-thinning medications) can cause internal or external bleeding as a result of the blood being diluted to prevent unnecessary clotting. People taking anticoagulants require regular blood tests to ensure that the correct dosage is maintained.

    The dosage of the blood-thinning drugs is adjusted as appropriate to achieve an INR between two and three. The INR is a test that compares how long it takes the patient's blood to clot while on blood thinners, against normal clotting times.

    A person on anticoagulant medication should carry a card naming the anticoagulant drug and stating the dosage.

    The best results occur when this treatment is given to people who have had DVT for less than 48 hours.

    When effective, the clot usually breaks up within 24 to 48 hours.

    Thrombolytic agents can also cause internal and external bleeding, and require careful monitoring. Treatment with thrombolytic agents usually lasts for only 24 to 72 hours.

  • Surgery. If an embolus develops, surgery may be necessary to prevent the spread of the clot to the lung. Surgery, however, is performed only as a last resort.

    Surgery for complications resulting from DVT involves the insertion of a filter into a large blood vessel to trap any blood clots headed toward the lungs. The filter allows blood to flow through it normally, but traps the traveling clots. The procedure is called vena cava interruption because the filter is placed in the inferior vena cava, the large vein in the pelvic area that receives the blood returning from the deep femoral (thigh) veins.

The most severe cases of DVT may require the surgical removal of the blood clot from the vein, a procedure known as venous thrombectomy. The patient is given anticoagulant therapy with heparin during the surgery, and warfarin for a period of at least six weeks to three months following the operation.

Deep Vein Thrombosis