How Deep Vein Thrombosis Is Treated

Once you've been diagnosed with DVT, it's important to initiate treatment to reduce your risk of developing complications, including chronic circulation problems in your leg, or a pulmonary embolus. In most cases, this will require treatment with anticoagulant drugs, although other treatments may be used in people who can't take anticoagulants. With adequate treatment, most people who have DVT can recover completely.

Prescriptions

Anticoagulants. Anticoagulant drugs (“blood thinners”), are used to prevent further abnormal blood clotting. These drugs can't dissolve blood clots that have formed; your body dissolves them on its own with time. However, these drugs can be life-saving for people with a DVT or pulmonary embolism (PE). While blood thinners are an important part of treatment, people taking them should begin a prescribed course with awareness about their risks.

The most common complication is excessive bleeding. Any minor injury, like cutting your hand while prepping food or scraping your leg, can pose a special risk for too much bleeding because your body won't react to clotting as it normally would.

Blood thinners also pose notable drug interactions. Taking painkillers, like nonsteroidal anti-inflammatory drugs ( NSAID s), while you are on a blood thinner can increase your chances of bleeding. Herbal supplements like St. John's wort and omega-3 fatty acids can also increase the risk of bleeding and enhance the potency of your blood thinners.

Vitamin K, which is found in many leafy greens like spinach and kale, can also interact with some of these drugs and lessen their effectiveness.

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.

Choosing Treatment. Treatment should begin immediately after DVT is diagnosed. Several anticoagulant drugs are available, and the choice of drug(s) will depend on how your doctor assesses the seriousness of your DVT, and your risk of bleeding complications. 

Initial treatment is aimed at rapidly stopping the spread of blood clots, and usually consists of one of three strategies:

  • Initial low molecular weight heparin (such as Lovenox or Fragmin), followed by warfarin. LMW heparin is immediately effective, but must be given as an injection. Warfarin is a pill, but it takes several days to become effective. Once the warfarin has reached therapeutic levels, the LMW heparin can be stopped.
  • Treatment with rivaroxiban (Xarelto) or apixaban (Eliquis). These are two of the “new” oral anticoagulant drugs (the NOAC drugs) that can be used instead of warfarin. Because these drugs are effective immediately, there is no need to begin with LM heparin.
  • Treatment with LMW heparin followed by dabigatran (Pradaxa) or edoxaban (Savaysa). Pradaxa and Savaysa are also NOAC drugs, but unlike Xarelto and Eliquis, they have not been formally studied as monotherapy for DVT. For this reason, if they are being used to treat DVT, at least 5 days of LMW heparin is generally used first. 

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.

Pregnant women should avoid taking warfarin due to its miscarriage risk, and the NOAC drugs have not been adequately tested during pregnancy. For this reason, most experts recommend using LMW heparin alone for treating DVT in pregnant women. 

Anticoagulation therapy for DVT is usually continued for at least three 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.

You should also keep an eye out for warning signs of excessive bleeding, like coughing or vomiting blood, dizziness or weakness, severe headache or stomachache, blood in the urine or bowel movements, and heavy menstrual bleeding.

Specialist-Driven Procedures

If you're not able to take blood thinners, your doctor may recommend an inferior vena cava filter, a small, wiry device that is inserted through a catheter from a vein in your groin or neck and placed inside a large vein known, as the device's name suggests, as the inferior vena cava.

Blood that needs reoxygenation flows from the lower body back to the heart through this important vein. The heart then pumps the blood to your lungs to pick up the oxygen it needs. The filter works to allow blood to continue on in this journey while "catching" a blood clot so that it doesn't come along for the ride. 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 there 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.

Over-the-Counter Therapies

Compression stockings, which help the leg veins return blood back to the heart, are also helpful and should be strongly considered for at least two years after DVT has occurred. 

Similar in look to pantyhose, compression stockings are made from an elastic material that allows them to fit snuggly around your ankles and less-so further up your leg. This helps push fluid that may impede blood flow up, improving circulation and swelling.

Compression stockings can be part of a DVT treatment regimen or used as a preventive measure, say on a long flight. They can be easily found in most drugstores or online.

Lifestyle

The very lifestyle considerations recommended for the prevention of DVT in the first place are recommended during treatment as well:

  • 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, work 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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