How Deep Vein Thrombosis Is Treated

A doctor evaluating a woman's leg.

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If you've experienced symptoms of deep vein thrombosis (DVT), it is important to contact your doctor or local emergency room. DVT is a serious condition that can lead to a life-threatening pulmonary embolism. The goal of DVT treatment is to prevent the blood clot in your leg from growing bigger and prevent it from breaking loose and traveling to your lungs.

Longer-term treatment focuses on preventing both complications and future clots. In most cases, treatment involves anticoagulant drugs alone, although other treatments like thrombolytic therapy and blood filters are an option in certain cases. With adequate treatment, most people who have DVT can recover completely.

Prescriptions

DVT is often treated with a combination of several medications and therapies.

Anticoagulants

Anticoagulant drugs, often called blood thinners, are used to prevent abnormal blood clotting. Although these drugs cannot dissolve blood clots that have already formed, they are an important and potentially life-saving medication for people with DVT or pulmonary embolism (PE).

Blood thinners work by interrupting the clotting process. In people with DVT, they prevent existing clots from getting bigger and prevent future clots from forming.

When DVT is present, immediate treatment with anticoagulation therapy (blood thinners) will help prevent further blood clotting in the leg veins while reducing the chances of developing a pulmonary embolism.

There are several different types of anticoagulant drugs. The best choice for you will depend on several factors, including the seriousness of your DVT, your pre-existing conditions, and your risk of bleeding complications. 

Initial treatment is aimed at rapidly stopping the spread of blood clots. If you are in the hospital, you may be given IV or injectable anticoagulants. Heparin and related drugs work very quickly when given as an injection, so they are often used in emergency situations. Your doctor may start you on an oral anticoagulant, like Coumadin (warfarin), which can take a few days to reach therapeutic levels.

Your doctor might choose to start you on one of the newer anticoagulants, which are known as direct oral anticoagulants (DOACs) because they start working immediately. DOACs come in once or twice daily pills. Examples include Pradaxa (dabigatran), Eliquis (apixaban), Xarelton (rivaroxaban), and Savaysa (edoxaban).

Treatment typically begins immediately after DVT is diagnosed and continues for at least three to six months. If DVT is recurrent, the underlying cause (such as heart failure) is still present, or if a large pulmonary embolus has occurred, treatment is usually continued indefinitely.

Guidelines released by the American Society of Hematology (ASH) in 2020 recommend that patients with chronic DVT or PE take blood thinners indefinitely. This means blood thinners could be a regular part of your medication routine, depending on your doctor's evaluation of your risks.

Anticoagulant Risks

Despite the known benefits, there are risks involved with anticoagulants that your doctor will explain during the beginning phases of your treatment. The most common complication of anticoagulant use is excessive bleeding. These drugs work to prevent clotting, which impairs your body's natural ability to heal wounds.

Even minor injuries, like cutting your hand while preparing food or scraping your leg, can cause prolonged bleeding. Blunt traumas like hitting your head or falling down the stairs could also cause dangerous internal bleeding.

Some anticoagulants carry a higher risk of excessive bleeding than others. People taking warfarin, for example, need to go in for regular blood work to make sure their current dose is working properly. Newer anticoagulants do not require regular blood tests, but they are considerably more expensive than warfarin.

INR Test

These regularly scheduled blood tests make sure that your blood is "thin" enough to prevent clots, but not so thin that you are at risk of severe bleeding.

Another risk of anticoagulant therapy is the way these drugs interact with other common medications. Taking certain painkillers like Motrin (ibuprofen) and aspirin while you are on a blood thinner can increase your chances of bleeding.

Be sure to let your doctor know about all the medications and supplements you're taking as you work together to create a DVT treatment plan.

Deep Vein Thrombosis Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Man

When to Call Your Doctor

During treatment, keep an eye out for warning signs of excessive bleeding, such as:

  • Coughing or vomiting blood
  • Dizziness or weakness
  • Severe headache or stomachache
  • Blood in urine or bowel movements
  • Heavy menstrual bleeding

Pregnancy

Pregnant women should avoid taking warfarin, as it can cause a specific type of birth defect called "warfarin embryopathy," and the DOAC drugs have not been adequately tested during pregnancy. For this reason, most experts recommend using heparin alone for treating DVT in pregnant women.

Over-the-Counter Therapies

Compression Stockings

Compression stockings, which help the leg veins return blood to the heart, are an important part of DVT treatment. Compression stockings are made from an elastic material that allows them to fit snugly around your ankles and lower legs. They keep the veins compressed and prevent pooling of blood, which can lead to clotting.

Compression stockings can be part of a DVT treatment regimen or used as a preventive measure anytime movement is restricted, such as during a long flight. They should be strongly considered for at least two years after a DVT diagnosis. You can find them in most drugstores or online.

Surgeries and Specialist-Driven Procedures

Serious cases of DVT sometimes require more invasive treatments.

Thrombolytics

Thrombolytics are medications that break up and dissolve blood clots. These potent medications are typically reserved for people with severe, limb-threatening DVT. While they are best suited for younger patients with a low risk of severe bleeding, they are also the second line of defense for people who don't respond well to anticoagulants.

Thrombolytics work to immediately improve DVT symptoms. They also help minimize damage to your leg veins, which can lead to complications like chronic venous insufficiency.

Typically, thrombolytics are administered in a cardiac catheter lab where the medication can be delivered directly to the clot.

  1. Your surgeon will put you under mild sedation
  2. They will insert a thin plastic tube into your vein through a tiny hole in your knee, neck, or groin.
  3. They then feed the tube all the way to the site of the clot, where the medication is administered.
  4. In some cases, your surgeon may use a suction device to physically break up and remove the clot.
  5. After the procedure, you will stay at the hospital for one to three days.

During the procedure, your surgeon might find that the vein has narrowed. This narrowing may have contributed to the clot formation. If so, they can conduct an angioplasty.

During an angioplasty, the surgeon uses the long tube to insert and expand a balloon to prop open the vein. They may also insert a small device called a stent to keep the vein from narrowing again.

Blood Filter

If preexisting conditions prevent you from taking anticoagulants, your doctor may recommend an inferior vena cava filter. This small, wiry device is inserted through a catheter placed in a vein in your groin or neck. The device is placed inside a large vein known as the inferior vena cava.

Blood from the lower body flows back to the heart through this important vein. The heart then pumps blood to your lungs, where it picks up the oxygen it needs. The vena cava filter works to catch blood clots before they travel to the lungs and cause a pulmonary embolism. The device is able to do this because of its umbrella-like design, which allows it to expand and stick to the walls of the vein.

The filter can stay in the body permanently or be removed after some time. While helpful, it doesn't reduce the size of the blood clot or prevent new ones from forming.

Lifestyle

Lifestyle changes are an important part of DVT treatment and prevention.

  • Walk frequently, clocking at least 10,000 steps a day.
  • Avoid situations where you need to remain seated for prolonged periods of time. If that's impossible, get up every hour to stretch and move around.
  • Work to get to a healthy weight if you are overweight or obese.
  • Stay hydrated.
  • If you smoke, try to kick your habit.
  • Closely follow treatment recommendations for other conditions that may affect your clotting risk, including heart failure and diabetes.
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Article Sources
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