How is Deep Vein Thrombosis (DVT) Treated?

Deep Vein Thrombosis treatment is designed to be preventive, a way to manage serious or life-threatening risks. It is intended to prevent pulmonary embolism, reduce the chance of death, and prevent or minimize the risk of developing the post-thrombotic syndrome.^1-2 This is a condition that can develop following a DVT.^2-3 It can cause symptoms including chronic pain and swelling. It can develop over time in the weeks or months after DVT.

Blood thinners

Blood is a carefully balanced substance that nourishes the body. Normal blood has a balance of clotting factors.⁴ These help the blood to clot and to keep it thin enough to flow smoothly. Once a DVT is diagnosed by physical exam, blood tests, and diagnostic imaging, your healthcare team can determine the best treatment approach based on the size and location of the clot.^2,4

The normal treatment is anticoagulation.⁵ It typically involves the use of blood-thinning medications called anticoagulants.¹ Most people can be treated with just medications.⁴ Blood thinners can be injected or taken by mouth, depending on what the doctor prescribes. They cannot break up existing blood clots but are used to prevent clots from growing and lowering the risk of developing additional clots.³

Types of anticoagulants

The first approach to treating DVTs was to use blood thinners called vitamin K-antagonists (VKAs). Direct oral anticoagulants (DOACs) are newer treatments than VKAs and have fewer drug-drug interactions.² They can be taken by mouth and don’t need regular blood test monitoring.⁴ With more treatment options available, your healthcare team can better incorporate disease and patient-specific needs into the medical management of DVT.⁴

There are several different kinds of anticoagulants:^2,4 Heparin and warfarin are two of the original anticoagulants used to treat DVT. Heparin is an injectable medication; warfarin is a pill. Both drugs are effective but require regular blood tests to evaluate clotting.
Newer blood thinners include:^2,5

• Apixaban known as the brand Eliquis
• Dabigatran known as the brand Pradaxa
• Edoxaban known as the brand Savaysa
• Enoxaparin known as the brand Lovenox
• Fondaparinux known as the brand Arixtra
• Rivaroxaban known as the brand Xarelto

Treatment at different stages

During the first 5–10 days of DVT treatment, injectable heparin, Enoxaparin, and Fondaparinux are often used to reduce clot formation and help the body’s natural response to reduce any symptoms and reduce the risk of new clots or progression to PE.⁴ After the initial blood thinning, oral medications like warfarin (Coumadin) or dabigatran (Pradaxa) can be started. There are other pills that can be prescribed without first having the IV treatment.

Blood thinners that can be given in pill form without the need for an injectable blood thinner include rivaroxaban (Xarelto), apixaban (Eliquis) or edoxaban (Savaysa). Your doctor may tell you to take pills for three months or longer, depending on your individual circumstances.³ Some people cannot use anticoagulants. If that is the case, another option is a filter that is placed into the vena cava, a large vein in the abdomen.¹ It prevents any clots that break off from reaching the lungs.^1-3

Other treatments

Other than blood thinners, DVT treatment can include other medicines used to manage pain and reduce inflammation, break up clots keep new clots from forming. Clot busters (thrombolytics) are prescribed to treat some kinds of DVTs and pulmonary emboli; or when other medications aren't working. They are administered by IV or through a catheter to quickly break up clots.³ They can cause bleeding, so they are used for serious clots.

Support stockings, sometimes called compression stockings, can help prevent or reduce swelling that can occur with DVT. Many people will wear these stockings, they go from the foot to the knee, for several years to prevent pooling and clotting.³ You can also raise the affected limb and apply wet heat to reduce swelling.

Prevention

Many DVTs will resolve with no complications.² DVT can be preventable in most cases. Education is a key element, being aware of the chance of developing and knowing how to prevent them.⁵ Your healthcare team should tell you if you are at risk and what you can do to prevent DVT.

Some steps to take to lower your risk include:^2-4

• Don’t sit still for prolonged periods of time
• Stand or walk during the day
• Don't cross your legs when you sit, it can restrict blood flow
• Lose weight
• Don’t smoke
• Exercise regularly
• Stretch your legs and take a walk