Deep vein thrombosis (DVT) occurs when a blood clot forms in the deep veins, usually in the legs. It is important to treat DVT because blood clots can break away from the affected vein, travel through the bloodstream to the heart, and lodge within the major arteries of the lungs. This complication, known as pulmonary embolism, can be fatal.
Blood thinners, called anticoagulants, are essential to prevent pulmonary embolism after a DVT diagnosis. In selected clinical scenarios, other treatments are considered, such as taking thrombolytic drugs or placing a device near the heart to trap the clot.
In this article, we will look at the treatment of DVT and the management of post-thrombotic syndrome, a common complication of DVT. Supportive treatments such as early ambulation and compression stockings are also briefly reviewed.
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Important note
Home or natural remedies, such as compression stockings, are supportive, not curative, in the treatment of DVT. Medical treatment is essential to treat DVT and prevent pulmonary embolism, among other complications.
Treatment of blood clots in the legs
The cornerstone of treatment for deep vein thrombosis is taking anticoagulants, also known as blood thinners.
In some cases, other options may be considered, such as administering powerful “clot-busting” drugs.thrombolytics) or placing a filter near the heart to help trap blood clots traveling up the leg.
anticoagulant
Anticoagulants do not dissolve blood clots. Instead, it impairs clot formation, giving the body's “fibrinolytic system” time to dissolve or break down the clot.
The main reason for taking anticoagulants for DVT is to prevent pulmonary embolism. Other goals include:
- Prevents existing blood clots from growing larger
- Prevention of recurrent blood clots
- Preventing long-term complications, such as post-thrombotic syndrome (discussed below)
Anticoagulants for the treatment of DVT include:
- Direct oral anticoagulants (DOAC) is a pill that is taken by mouth. This includes Eliquis (Apixaban), Pradaxa (Dabigatran), Sabisa (edoxaban), Xarelto (Rivaroxaban).
- low molecular weight heparin (LMWH) is injected under the skin. This includes Lovenox (Enoxaparin) and Fragmin(Dalteparin).
- Aristra (fondaparinux) It is administered by injection under the skin.
- heparin It is given by injection under the skin or intravenously (through a vein).
- Janthoven (warfarin) It is a pill and requires regular blood test monitoring.
The choice of anticoagulant therapy depends on several factors, including:
- bleeding risk
- Presence of an underlying condition (e.g. liver or kidney disease)
- Risk of Drug Interactions
- patient preference
- Convenience (e.g. need for monitoring)
thrombolytics
Thrombolytics are enzymes (plasmin) breaks down the fibrin (protein strands) that hold blood clots together.
Thrombolytic drugs can be administered in two ways:
- Catheter-Directed Thrombolytic Therapy It is performed by an interventional radiologist. Thrombolytic tissue plasminogen activator (tPA) is most commonly administered directly to the clot using a thin tube (catheter).
- systemic thrombolysis This involves administering thrombolytic drugs such as: streptokinase It is administered intravenously near the blood clot. This method is less common.
A disadvantage of thrombolytic drugs is the risk of significant bleeding. It is reserved for people who have extensive proximal (upper leg vein) blood clots or high-risk cases such as: Painful pale blue auscultation (PCD).
PCD is a serious complication of DVT that is associated with extreme leg swelling, pain, and bluish-purple skin discoloration. This is caused by a large blood clot that blocks blood flow through the affected leg.
IVC filter
An IVC filter is a small wire device placed in the inferior vena cava to filter traveling blood clots and prevent pulmonary embolism.
What is the inferior vena cava?
The inferior vena cava is a large abdominal vein that returns oxygen-poor blood from the lower half of the body to the heart.
IVC filters do not prevent new blood clots from forming and are not as effective as anticoagulants in preventing pulmonary embolism. That said, sometimes they are the next best and only option.
Interventional radiologists typically perform this procedure as an outpatient. This minimally invasive procedure involves guiding a catheter fitted with a folded filter through an incision in the groin or neck.
Once the filter is in place, it is opened (imagine an umbrella) and the catheter is removed. The filter is secured to the IVC wall and traps blood clots before they reach the heart while allowing blood to flow freely.
Indications for IVC filter placement include:
- Individuals with absolute contraindications to anticoagulants (e.g. active bleeding, planned surgery with high risk of bleeding, and severe trauma)
- Individuals who develop or fail to develop complications related to anticoagulants
How long does it take to treat a blood clot in the leg
Start anticoagulation immediately after DVT is discovered, unless there are clear contraindications such as active bleeding risk or high risk of bleeding.
The specific duration of anticoagulants will depend on the individual's risk of developing another blood clot. This means that anticoagulants are usually administered for at least 3 months. In some cases, it may last for 6 to 12 months or indefinitely.
Healthcare providers use a variety of tools to help predict the risk of a blood clot recurring. An individual's risk of major bleeding is also considered when determining the length of treatment.
Post-thrombotic syndrome management
Postthrombotic syndrome is the most frequent complication of DVT, occurring in 20-50% of people within 2 years of diagnosis.
This is a form of chronic venous insufficiency that occurs due to damage caused by blood clots in the affected leg veins.
Typical symptoms include:
- Leg heaviness, pain, swelling, and itching
- Skin changes, such as new varicose veins (bulging superficial veins), darkening of the skin, and thickening of the skin
- Venous ulcers (open ulcers) due to poor blood flow (in severe cases)
The key to preventing post-thrombotic syndrome is taking anticoagulant treatment exactly as directed and following your doctor's instructions closely.
If postthrombotic syndrome occurs, management strategies include:
- Wear graduated compression stockings
- Elevating the affected leg when resting
- Walking and various leg exercises to strengthen calf muscles and improve leg flexibility
- maintaining a healthy weight
Sometimes you may also consider a venous return assist device, which is a compression pump worn on the calf to optimize blood flow.
In people with severe symptoms, various surgical procedures, such as stent placement (tubes inserted into veins to improve blood flow), may be performed.
Habits that Promote Better Circulation
Early walking after anticoagulation treatment for blood clots in the legs is strongly recommended to prevent post-thrombotic syndrome, improve quality of life, and reduce leg pain and swelling.
Some people wear elastic graduated compression stockings for up to two years after a DVT diagnosis. However, keep in mind that research supporting its benefit for preventing post-thrombotic syndrome is mixed.
In addition to preventing post-thrombotic syndrome, early ambulation and wearing compression stockings in situations where the risk of leg clots is high (such as after surgery and during air travel) may also help prevent DVT.
Other lifestyle habits that can help prevent DVT include:
- no smoking
- maintaining a healthy weight
- Adopt a highly anti-inflammatory eating pattern (e.g., Mediterranean diet)
Certain medications (such as birth control pills, hormone replacement therapy (estrogen or estrogen and progesterone)) also carry a higher risk of DVT.
Talk to your health care provider
If you have a personal or family history of DVT or a clotting disorder, talk to your prescribing health care provider before taking any new medication to ensure that the medication is safe and appropriate for your treatment.
The complementary role of foods in dissolving blood clots in the legs
Certain herbs and supplements, such as turmeric, ginseng, and vitamin E, are known to have blood-thinning properties, but their ability to help prevent blood clots is not yet known.
Moreover, these herbs or supplements may interact with medications, including blood thinners, and should be taken only under the guidance of a healthcare provider.
Ultimately, natural remedies should not replace treatment for blood clots in the legs.
summary
Deep vein thrombosis (DVT) is a blood clot usually found in a vein inside the leg. The main concern with DVT is a potentially life-threatening complication called pulmonary embolism (when a blood clot travels through the bloodstream to the main pulmonary artery).
Taking anticoagulants (blood thinners) is the main treatment for DVT. Anticoagulants may help prevent other long-term DVT complications, such as pulmonary embolism, new blood clot formation, and post-thrombotic syndrome.
In some cases (for example, if you cannot take anticoagulants because of active bleeding), a small device called an IVC filter is placed near the heart to prevent blood clots from traveling to the lungs. Less commonly, medications that dissolve blood clots, called thrombolytics, may be given.
Supportive or home therapy plays a complementary role in the treatment of DVT, i.e. early ambulation after starting anticoagulation. Lifestyle habits, such as wearing compression stockings when traveling for long periods of time, maintaining a healthy weight, not smoking, and living an active lifestyle may also help prevent DVT.
Your healthcare provider should evaluate any suspected blood clots. Once a DVT of the legs is diagnosed, anticoagulation is essential to prevent it from traveling to the heart and potentially causing death.