The goal of treatment is to preventing:
- Death from pulmonary thromboembolism.
- Recurrence of DVT.
- The post-thrombotic syndrome.
The majority of the time, anticoagulants like heparin and warfarin are used to do this. For the first 5-7 days, we inject some type of heparin subcutaneously. After that, we determine whether to continue the injectable therapy for several months or switch to Warfarin pills.
New anticoagulants have been available in recent years. In the United Kingdom, rivaroxaban (Xarelto), a direct inhibitor of activated factor X (factor Xa), has been approved since 2012 for the treatment of DVT and the prevention of recurrent DVT. It is administered orally, does not need for regular anticoagulant monitoring, but costs more 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. Nevertheless, thrombolysis is often reserved for young individuals and in specific circumstances, such as rather extensive DVT of the iliac or ilio-femoral venous axis producing severe leg edoema, because the risk of bleeding (especially in the brain) is higher than that with 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.
Today, open surgery to remove a venous clot is only used in the most extreme cases of DVT, when 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 to prevent 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 significantly reduced if anticoagulation is started early in the course of DVT, and if compression stockings are properly used for a period of at least two years.
You should refrain from living a sedentary lifestyle and standing up for extended periods of time. 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 measures of prophylaxis will be taken by your surgeon depending upon your risk for DVT. These may include anticoagulation, antithromboembolism stockings, early ambulation etc.
If you are planning to travel – Do not wear tight clothes. Move your feet up and down at the ankles, stretch your legs and go for a walk up and down the aisle. Do not get dehydrated: drink plenty of water and avoid alcohol drinks. If you are a person at high risk for DVT, ask your doctor if you need to use compression stockings during your travel or even have Heparin injections.
