Hailey Tran
Deep Vein Thrombosis (DVT) is a blood clot in a deep vein, usually in the leg, that prevents blood from flowing normally. DVT is a potentially serious condition that can occur with few or no symptoms. If left untreated, it can lead to a pulmonary embolism, which is life-threatening and requires immediate treatment. Treatment for DVT depends on the patient's condition and the severity of the clot. While some patients may be treated as outpatients, others may require hospitalization. Hospital treatments for DVT include anticoagulation therapy, compression stockings, and in some cases, surgery.
| Characteristics | Values |
|---|---|
| Treatment location | Inpatient or outpatient treatment |
| Treatment type | Anticoagulation therapy, compression stockings, elevating the affected leg, surgery, blood thinners, clot busters (thrombolytics), vena cava filter |
| Ultrasound | Required for diagnosis |
| X-ray | Required for diagnosis |
| Medication | Heparin, warfarin, direct oral anticoagulants (DOACs), low-molecular-weight heparin (LMWH), fondaparinux, unfractionated heparin |
| Treatment duration | 3 months or longer |
What You'll Learn
Blood-thinning medications
Direct oral anticoagulants (DOACs) are available in pill form and include apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), and rivaroxaban (Xarelto). DOACs do not require regular blood tests to monitor their effects. Low-molecular-weight heparin (LMWH) is another option, given as an injection under the skin. Examples include dalteparin (Fragmin), enoxaparin (Lovenox), and tinzaparin (Innohep). LMWH has been shown to be at least as effective as standard heparin, with fewer side effects and a longer duration of action. Fondaparinux (Arixtra) is also given by injection and has been approved by the FDA for treating DVT.
For more severe cases of DVT, clot busters (thrombolytics) may be used. These drugs are delivered directly into the clot through a tube (catheter) and can cause serious bleeding, so they are reserved for severe blood clots or when other medications are ineffective.
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Compression stockings
Studies have shown that compression stockings are effective in preventing DVT in hospitalized patients. One study found that only 9% of participants who wore compression stockings before and after surgery developed DVT, compared to 21% of those who did not wear them. Compression stockings have also been found to reduce the risk of DVT by up to 63% in surgical cases and during flights of at least four hours.
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Catheter-based procedures
The catheter may be used to deliver clot-dissolving medication directly to the clot, a process known as thrombolysis or thrombolytic therapy. This medication can break down the clot and improve blood flow. In some cases, a tiny, deflated balloon may be attached to the catheter, which can then be inflated at the site of the clot to help restore blood flow.
Several types of catheters are used for these procedures, including the Solent Omni and Proxi Catheters, which are suitable for veins greater than or equal to 3mm in diameter. The AngioJet system is another type of catheter that can be used, which has a Power Pulse feature allowing for the infusion of thrombolytics directly at the site of the clot. The AngioVac, ClotTriever, and EkoSonic catheters have also been used successfully to treat DVTs lasting longer than 14 days.
These procedures are not without risks, however. Major bleeding is a potential complication, and catheter-directed thrombolysis may not be suitable for patients with certain conditions, such as active internal bleeding, recent surgery, or pregnancy. Patients must sign a consent form before the procedure, acknowledging that they understand the risks and benefits.
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Thrombolytic therapy
The decision to use thrombolytic therapy is based on specific criteria. It is typically considered for individuals with iliofemoral DVT, which affects the thigh vein and carries a higher risk of progressing to a pulmonary embolism. Additionally, thrombolytic therapy may be recommended for those with severe DVT causing swelling or life-threatening proximal clots, DVT in the upper half of the body, and symptoms present for less than 14 days.
While thrombolytic therapy can be effective, it carries a higher risk of bleeding complications compared to standard anticoagulation therapy. This risk has decreased over time as doctors have become stricter about patient selection for thrombolytic therapy. Newer technologies, such as ultrasound-accelerated thrombolysis, offer faster treatment with a lower risk of complications.
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Vena cava filters
The procedure to place a vena cava filter is done through a small incision in a vein in the groin or neck. A thin, flexible catheter (tube) is inserted into this vein and gently moved into the IVC. A collapsed vena cava filter is sent through the catheter, which is then removed. The filter then expands and attaches itself to the walls of the IVC. It may be left in place permanently or removed later as an outpatient procedure. The removal procedure is typically performed when the risk of a clot travelling to the lung has passed and involves collapsing the filter inside a catheter and removing it through the same puncture hole.
The placement of a vena cava filter is an individualised decision and is reserved for patients who are unable to take blood-thinning medications or those with a high risk of developing recurrent DVT with pulmonary embolism. The procedure carries some risks, including the possibility of rare complications such as bleeding from the puncture site, reaction to the contrast dye, infection at the puncture site, and a small risk of pulmonary emboli.
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Frequently asked questions
The initial treatment for DVT is anticoagulation therapy, which involves the use of anticoagulants, commonly referred to as "blood thinners", to prevent blood clots from growing and allow the body to naturally destroy them. Blood thinners can be taken by mouth, given intravenously, or injected under the skin. Compression stockings are also used to prevent blood from pooling in the legs and reduce swelling.
There are many different types of blood-thinning drugs used to treat DVT, including:
- Direct oral anticoagulants (DOACs) such as apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), or rivaroxaban (Xarelto)
- Low-molecular-weight heparin (LMWH) such as dalteparin (Fragmin), enoxaparin (Lovenox), and tinzaparin (Innohep)
- Unfractionated heparin, which can be given intravenously or as an injection under the skin
- Fondaparinux (Arixtra), given by injection
Hospitalization is recommended for patients with certain conditions, such as recent surgery, trauma, thrombocytopenia, coagulopathy, or advanced cancer with intracerebral or intrahepatic metastases. These patients are at an increased risk of bleeding, and hospitalization ensures prompt detection and treatment if bleeding occurs. Additionally, patients with massive DVT, symptomatic pulmonary embolism, a high risk of bleeding with anticoagulant therapy, or comorbid conditions may require in-hospital treatment.
Most people with DVT can be treated as outpatients or at home without hospitalization. This includes the use of oral anticoagulants, compression stockings, leg elevation, and oral analgesics for symptom relief. Patients can also be taught how to self-administer injections of low-molecular-weight heparin (LMWH) to avoid hospitalization.
