Can DVT be Prevented and/or Treated?

YES. Injectable blood-thinning drugs and mechanical leg compression devices are highly effective in preventing DVT and PE, and are widely available. Unfortunately, doctors and hospitals often fail to properly prescribe the above preventive measures for patients who are at risk. When being admitted to the hospital for surgery or a medical illness, patients and family members should ask their physicians and nurses what measures are being taken to prevent DVT.

If you or a family member are diagnosed with DVT, consider discussing the following treatment options with your health care provider:

Anticoagulant Drugs

Blood clots (DVT) are most often treated with anticoagulant drugs (also referred to as blood-thinning drugs). Blood-thinning drugs are very effective in treating DVT and preventing Pulmonary Embolism (PE).  There are many options for blood thinning drugs now – they can be given through an intravenous line (heparin), injected under the skin (low molecular weight heparins), or in pill form (warfarin, dabigatran, rivaroxaban, apixaban, edoxaban).

Patients with DVT typically require treatment with these medications for at least 3 – 6 months.

Graduated Elastic Compression Stockings

Patients with DVT can benefit from wearing properly-fitted, prescription elastic compression stockings on a daily basis to reduce their leg swelling.  Because the leg can be very swollen and tender during the initial days after DVT diagnosis, wrapping of the leg with compressive bandages is sometimes used before converting the patient to stockings.

Inferior Vena Cava Filters

Certain patients may be unable to take anti-coagulant medications because of increased risk or occurrence of bleeding which may be associated with an underlying medical condition. To catch any blood clots that are moving towards the lungs, these patients may undergo a minor procedure to place a small metal “filter” device within the large vein in the abdomen (inferior vena cava (IVC) that drains blood from the legs and the lower body. When it becomes safe to start blood-thinning drugs, the filter should be removed in a separate minor procedure.

Pharmacomechanical Catheter-Directed Thrombolysis (PCDT)

In addition to blood-thinning drugs, some patients with DVT may also be treated using Pharmacomechanical Catheter-Directed Thrombolysis (PCDT). This refers to a procedure that involves the administration of clot-busting drug directly into the blood clot through a specially designed catheter (plastic tube) or catheter-mounted device that may also break up the clot and/or remove the clot fragments. The ATTRACT Trial that we conducted found that PCDT did not prevent PTS from developing and did increase the risk of bleeding complications; however, PCDT seemed to improve recovery from DVT (by reducing leg pain and swelling) and reduce the severity of PTS.  This is why it is used only in a small subset of DVT patients.

References

  1. The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. U.S. Department of Health and Human Services report, 2008.
  2. Kahn SR, Shrier I, Julian JA, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med 2008; 149(10):698-707.
  3. Prandoni P, Lensing A, Cogo A, et al. The long term clinical course of acute deep venous thrombosis. Ann Intern Med 1996; 125:1-7.
  4. Kearon C, Kahn SR, Agnelli G, Goldhaber SZ, Raskob G, Comerota AJ. Antithrombotic therapy for venous thromboembolic disease. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Ed). Chest 2008; 133:454S-545S.