The treatment of DVT and pulmonary embolism (PE) are similar. In DVT, the main goal of treatment is to prevent a PE. Other goals of treatment include preventing the clot from becoming larger, preventing new blood clots from forming, and preventing long-term complications of PE or DVT.
The primary treatment for venous thrombosis is anticoagulation. Other available treatments, which may be used in specific situations, include thrombolytic therapy or placing a filter in a major blood vessel (the inferior vena cava).
Anticoagulation — Anticoagulants are medications that are commonly called “blood thinners.” They do not actually dissolve the clot, but rather help to prevent new blood clots from forming. There are several different medications that might be given after a DVT diagnosis (referred to as “initial anticoagulation”), including:
●Low molecular weight heparin, which is given as an injection under the skin – Options include enoxaparin (brand name: Lovenox), dalteparin (brand name: Fragmin), and tinzaparin (brand name: Innohep).
●Fondaparinux (brand name: Arixtra), also given by injection
●Unfractionated heparin, which is given into a vein (intravenously) – This may be the preferred choice in certain circumstances, such as if the patient has severe kidney failure or unstable blood pressure.
●Direct oral anticoagulants – These are available in pill form; they include rivaroxaban (brand name: Xarelto) and apixaban (brand name: Eliquis).
Initial anticoagulation is continued for 5 to 10 days. After that, long-term anticoagulation is continued for 3 to 12 months (see ‘Duration of treatment’ below). In most cases, the direct oral anticoagulants are the preferred choice for long-term anticoagulation; these pills include rivaroxaban (brand name: Xarelto), apixaban (brand name: Eliquis), dabigatran (brand name: Pradaxa), and edoxaban (brand name: Savaysa). In some situations, another oral medication called warfarin (sample brand name: Coumadin) is given instead. For patients taking warfarin, the clotting factors in the blood need to be measured on a regular basis with a blood test called the International Normalized Ratio (INR), whereas this is not needed for patients on direct oral anticoagulants (see “Patient education: Warfarin (Coumadin) (Beyond the Basics)”). Less commonly, the patient does not take warfarin or any of the direct oral anticoagulants but takes a daily injection of low molecular weight heparin or fondaparinux for the entire treatment period.
The choice of anticoagulant depends upon multiple factors, including the preference of the patient and the healthcare provider, the patient’s medical history and other conditions, and cost considerations.
Duration of treatment — Anticoagulation is recommended for a MINIMUM of three months in a patient with DVT.
●In patients who had a reversible risk factor contributing to their DVT, such as trauma, surgery, or being confined to bed for a prolonged period, the person is often treated with anticoagulation for three months or until the risk factor is resolved.
●Expert groups suggest that people who develop a venous thrombosis and who do not have a known risk factor for thrombosis may need treatment with an anticoagulant for an indefinite period of time . However, this decision should be discussed with the person’s healthcare provider after three months of treatment, and then reassessed on a regular basis. Some people prefer to continue the anticoagulant, which may carry an increased risk of bleeding, while others prefer to stop the anticoagulant at some point, which may carry an increased risk for repeat thrombosis.
●Most experts recommend continuing anticoagulation indefinitely for people with two or more episodes of venous thrombosis or if a permanent risk factor for clotting is present (eg, antiphospholipid syndrome, cancer).
Walking during DVT treatment — Once an anticoagulant has been started and symptoms (eg, pain, swelling) are under control, the person is strongly encouraged to get up and walk around. Studies show that there is no increased risk of complications (eg, pulmonary embolus) in people who get up and walk, and walking may in fact help the person feel better faster.
Thrombolytic therapy — In some cases, a healthcare provider will recommend an intravenous medicine to dissolve blood clots. This is called thrombolytic therapy. This therapy is reserved for patients who have serious complications related to PE or DVT, and who have a low risk of serious bleeding as a side effect of the therapy. The response to thrombolytic therapy is best when there is a short time between the diagnosis of DVT/PE and the start of thrombolytic therapy.
Inferior vena cava filter — An inferior vena cava (IVC) filter is a device that blocks the circulation of clots in the bloodstream. It is placed in the inferior vena cava (the large vein leading from the lower body to the heart). The IVC filter typically is inserted through a small incision in a leg vein with the use of a local anesthetic and takes 20 to 30 minutes to perform. An IVC filter is often recommended in patients with venous thromboembolism who cannot use anticoagulants because of a very high bleeding risk. However, in the long term, IVC filters can increase the risk of developing blood clots.