DVT : Treatment

Deep Vein Thrombosis (DVT) Treatment Options

For most DVTs, physicians recommend wearing graduated compression stockings, elevating the leg, and taking anticoagulant medications to prevent blood clotting. Anticoagulant medications prevents further clots from forming and diminishes the risk of a PE . It consists of heparin, which may be given intravenously or, more frequently, by subcutaneous injection, followed by warfarin (Coumadin), which can be given orally and continued usually for several months.

In severe cases, the physician may recommend thrombolysis, which is the use of an intravenous medication that dissolves clots. With this procedure, a catheter is threaded through the vein to the clot, and then a clot-dissolving drug is injected to dissolve it. The clot-dissolving drug is injected slowly through the catheter’s many tiny holes into the area of the DVT, much like a soaker hose. Sometimes a tiny device that works like a vacuum cleaner is used to remove or suck the softened clot out. Once the clot is gone, a balloon angioplasty or stenting may be necessary to keep open the narrowed vein, but this is common only in the iliac veins, located in the pelvic area. With this approach, the patient will also need anticoagulant medication (heparin and warfarin) to prevent new blood clot formation. Some patients cannot have clot-dissolving drugs. In these instances, a thrombectomy in which the clot extracted through a small incision at the groin may be recommended. Both approaches are designed to remove the clot and restore blood flow through the veins. These involve additional risk and expense and therefore are applied selectively by the appropriate vascular specialist. Clot removal, by either technique, is usually only recommended for major clots higher up in the leg, and particularly in active, healthy patients without any serious associated diseases. It can significantly reduce the serious consequences of DVT, such as chronic leg swelling, discoloration and, ultimately, ankle ulcers.

What are the late effects of DVT?

Small blood clots in the leg veins may dissolve without serious later consequences. However, larger blood clots, especially those located in the upper thigh and pelvic areas, are more likely to contribute to significant, long-term leg symptoms. The long-term consequences of a DVT can persist even when the use of medications has, in the short term, been "successful". For example, the leg veins can remain obstructed by remaining clot or scar tissue, or the valves in the vein may be damaged and not function properly. This may result in chronic swelling, skin discoloration, and ultimately, the development of chronic skin ulcers near the ankle. These problems can be diminished, if the individual who suffered a DVT will faithfully wear graduated compression stockings and elevate the legs periodically during the day.

Anticoagulant medications will reduce the risk of future DVT and PE’s; these medications cannot prevent the long-term tendency for leg swelling, discomfort, and skin changes, commonly called the "post-thrombotic syndrome" (PTS). These post-thrombotic symptoms are best treated by lifelong use of compression stockings. Unfortunately, it is not often appreciated that in some individuals, persistent leg swelling or discomfort may contribute to a real decrease in quality of life, body image, and even disability in some individuals.

Can DVTs be prevented?

Regular exercise will decrease the risk of DVT. Persons who undergo major surgery are at risk to develop DVT, therefore calf and leg exercises before surgery along with promptly resuming physical activity as soon as possible after the surgery will decrease the risk for DVT. Preventing a DVT is the major reason why hospitalized patients are encouraged to be up and walking as soon as possible after surgery. Regular stretching and leg movement are important for individuals who sit at a desk all day or are traveling on long trips, particularly air travel. As always, it is important to stop smoking, as smoking increases the tendency of the blood to clot. Avoid wearing tight garments that produce constrictions below the waist

Deep Vein Thrombosis section was last modified: March 10, 2008 - 11:12 am

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