Treatment for deep vein thrombosis (DVT)
Deep vein thrombosis, or DVT is a blood clot in a vein, which can be life-threatening and require urgent treatment.
Treatment for DVT ranges from keeping legs raised and wearing special compression stockings, to taking blood thinning medicine to stop the clot causing damage to the body.
Goals of treatment for a DVT
There is more than one goal of treatment for a DVT. The goals include:
- Preventing a clot from growing.
- Preventing a clot from breaking off and travelling to a lung or other organ.
- Avoiding long-lasting complications, such as leg pain and swelling.
- Preventing blood clots from recurring.
Blood thinners for a DVT
Blood thinners, also called anticoagulants, are the most common type of treatment for a DVT. The two main types of anticoagulants are heparin and warfarin.
Anticoagulants can keep a clot from growing or breaking off and prevent new clots from forming. They cannot thin blood - despite their name - or dissolve an existing clot
Heparin: Traditionally, people have received heparin intravenously in the hospital for about five to seven days. However, low-molecular-weight heparin is a newer DVT treatment given as an injection under the skin. It's effective within hours, reducing complications and hospitalisations. And because it is more consistent and predictable, it doesn't require regular blood tests.
Warfarin: As a DVT treatment, you take warfarin as a tablet, once a day. Treatment may continue for three to six months. While on warfarin, you will need regular blood tests to ensure you have the correct dosage - too little increases your clot risk, too much increases your risk of bleeding. Warfarin can also interact with other medicines, vitamins or certain foods rich in vitamin K (like dark leafy greens) - making regular monitoring even more important.
At the start of your treatment, you are likely to be given heparin and warfarin together as heparin injections act faster than warfarin, which will take a few days to be effective.
If you're pregnant, your GP may prescribe an alternative treatment to warfarin, as it can cause birth defects. If you can't take warfarin, your GP may recommend that you take heparin injections for the full length of treatment.
DVT and catheter-directed thrombolysis
If you have a DVT, your body will dissolve a blood clot over time, but damage can occur inside your vein in the meantime. For this reason, your doctor may recommend a clot-busting drug called a thrombolytic agent. This is not a routine treatment for a DVT but may be considered in certain circumstances such as:
- For larger clots
- If you're at high risk or have a pulmonary embolism (PE)
- If you have DVT in an arm, instead of a leg.
Catheter-directed thrombolysis rapidly breaks up a clot, restoring blood flow. It may also preserve valve function in the vein that contained the clot. The procedure is done in hospital and carries a higher risk of bleeding problems and stroke than anticoagulant therapy.
This is how a catheter-directed thrombolysis is done to treat a DVT:
- With imaging guidance, an interventional radiologist (a specialist doctor) inserts a thin tube (catheter) into and through a vein in your leg.
- The radiologist then puts the tip of the catheter into the clot and infuses a clot-busting drug directly into it.
- If the vein appears narrowed, the radiologist may do a balloon angioplasty or stent placement to widen it and help prevent future blockages.