Deep Vein Thrombosis (DVT) is a blood clot that forms the blood vessels carrying blood back to the heart from the legs.
Treatment aims to prevent:
- Death from a pulmonary thromboembolism
- recurrence of DVT
- The post-thrombotic syndrome.
It is often achieved with anticoagulants, like Heparin and VKA (Warfarin/Acitrom). We initially administer some form of Heparin in subcutaneous injections for 5-7 days. Then, it is decided whether the injection therapy will continue for several months or whether Warfarin tablets will replace it. In recent years, new anticoagulants have emerged. Rivaroxaban (Xarelto), a direct inhibitor of activated factor X (factor Xa), has been licensed to treat DVT and prevent recurrence since 2012. It is given orally and does not require routine anticoagulant monitoring, but it is more expensive than Warfarin.
Even huge clots may be broken up with thrombolytic medications, which are medicines injected directly into the vein where the clot is located via a tiny catheter. However, thrombolysis is typically only used in young patients and in exceptional circumstances, such as when a quite extensive DVT of the iliac or iliofemoral veins is causing significant leg swelling. This is because the risk of bleeding (particularly in the brain) is higher than that of anticoagulants. It is possible to implant a temporary filter in the inferior vena cava before the lysis for safer thrombolysis for DVT in a lower leg. There are certain indications for permanent inferior vena cava filter implantation.
Today, surgical venous clot removal is only done in the most extreme DVT instances where the leg’s viability is at risk.
Following an episode of DVT, the use of a graduated compression stocking (of suitable size and class) is highly recommended, mainly with the goal of preventing the post-thrombotic syndrome, i.e., chronic venous insufficiency; this may occur as a result of reflux of blood in the veins which have undergone damage in their valves because of the thrombosis.
Generally speaking, the risk of developing post-thrombotic syndrome is reduced if anticoagulation is commenced early after an episode of DVT and if a compression stocking is properly used for a period of at least two years.
Your vascular surgeon will advise you regarding the type of stocking which is best for you and how it should be used.
You should avoid standing for long periods and having a sedentary life. If you need to remain seated, don’t sit with the legs bent for hours, but stretch your legs out from time to time, and move your feet up and down at the ankles or stand up and stretch your legs.
If you are planning to have surgery – Appropriate preventive measures will be taken by your surgeon depending on your DVT risk. These may include anticoagulation, antithromboembolism stockings, and early mobilization.
If you are planning to travel – Do not wear tight clothes. Move your feet up and down at the ankles, stretch your legs and walk up and down the aisle. Do not get dehydrated: drink plenty of water and avoid alcoholic drinks. If you are at high risk for DVT, ask your doctor if you need to use compression stockings during travel or even have Heparin injections.
