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The management of Deep Vein Thrombosis has evolved significantly, shifting from strict bed rest to active management that prioritizes both clot resolution and the preservation of long-term vein function. The therapeutic approach at Liv Hospital is multifaceted, integrating pharmacological anticoagulation, mechanical compression, and in select cases, advanced interventional procedures. The goals are threefold: prevent the clot from growing, prevent pulmonary embolism, and prevent the recurrence of thrombosis.
Anticoagulants are the cornerstone of DVT treatment. It is important to understand that these drugs do not actively dissolve the clot; rather, they inhibit the chemical cascade of coagulation, preventing the clot from getting larger while the body’s own fibrinolytic system slowly breaks it down.
Parenteral Anticoagulants
These are injectable medications used for rapid anticoagulation.
Oral Anticoagulants
In specific high-risk scenarios, simply stopping clot growth is not enough. Thrombolysis involves the administration of drugs (like tPA) that actively dissolve the fibrin mesh of the clot.
Catheter Directed Thrombolysis (CDT)
This is a minimally invasive procedure where a catheter is threaded through the veins directly into the clot. The thrombolytic drug is infused slowly right at the site of the blockage. This is often combined with ultrasound energy to help break up the clot (pharmacomechanical thrombolysis).
Indications
Thrombolysis is generally reserved for young patients with extensive proximal DVT (e.g., iliofemoral DVT) or those with limb-threatening ischemia (phlegmasia). The risk of bleeding is higher than with anticoagulation alone, so patient selection is rigorous.
For patients who cannot receive thrombolytic drugs due to high bleeding risk or for whom drugs have failed, mechanical removal of the clot may be necessary.
Percutaneous Mechanical Thrombectomy
Specialized devices are used to macerate (chew up) or aspirate (suck out) the clot from the vein through a small puncture site.
Surgical Thrombectomy
An open surgical incision is made in the vein to remove the clot. This is rarely performed today, reserved for massive clots causing gangrene potential, where catheter techniques are not feasible.
An IVC filter is a small, cage-like metal device inserted into the inferior vena cava, the large vein that carries blood from the lower body to the heart.
Mechanism
The filter allows blood to flow through but traps large clots, preventing them from reaching the lungs.
Indications
Filters are used when patients have an absolute contraindication to anticoagulation (e.g., active bleeding, recent brain surgery) or if they develop a PE despite being on adequate blood thinners.
Retrievability
Modern filters are designed to be “retrievable,” meaning they can be removed once the risk of PE has passed and the patient can tolerate blood thinners. Leaving them in permanently can pose long-term risks of filter thrombosis.
Graduated compression stockings are a vital part of DVT management.
Pressure Gradient
These stockings are engineered to exert the highest pressure at the ankle, with pressure gradually decreasing up the leg. This assists the veins in pushing blood upward against gravity, reducing pooling.
Prevention of PTS
Regular use of compression stockings (typically 30 40 mmHg) significantly reduces the incidence of Post Thrombotic Syndrome, characterized by chronic pain and swelling.
Timing
Stockings are typically started as soon as the acute pain allows and are recommended for at least two years post-DVT, or longer if symptoms persist.
How long a patient stays on anticoagulation depends on the cause of the DVT.
Provoked DVT
If the clot was caused by a temporary risk factor like surgery or a long flight, treatment usually lasts 3 to 6 months.
Unprovoked DVT
If there is no clear cause, the risk of recurrence is higher. Treatment is often extended, sometimes indefinitely, after a risk-benefit analysis of bleeding vs. clotting.
Cancer-Associated DVT
Patients with active cancer typically remain on anticoagulation (often LMWH or specific DOACs) for as long as the cancer is active or under treatment.
Patients are advised to use soft toothbrushes, electric razors, and to avoid contact sports or activities with a high risk of trauma.
Medication Adherence
Skipping doses can be dangerous. Consistency is key to maintaining protection against recurrence.
Pain Management
Pain relief should be managed carefully. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin can increase bleeding risk and are generally avoided unless prescribed by a specialist. Acetaminophen is the preferred analgesic.
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No. While hydration and diet support vascular health, they cannot dissolve an existing clot. Only the body’s enzymes or thrombolytic medications can break down the fibrin mesh.
Some oral medications (like warfarin) take days to become effective. Injections (heparin) work immediately. “Bridging” ensures you are protected during the window when the pill hasn’t fully kicked in yet.
It depends on the specific medication. Generally, you should take it as soon as you remember, unless it is close to the next dose. Never double-dose. Consult your doctor or pharmacist for specific instructions.
Not necessarily. They are strongly recommended for the first two years to prevent chronic damage. After that, their use depends on whether you still have swelling or symptoms of venous insufficiency.
You must be very cautious. Many supplements, such as St. John’s Wort, garlic, ginkgo biloba, and turmeric, can interact with blood thinners and increase bleeding risk. Always consult your doctor.
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