What's the treatment for deep vein thrombosis?
Deep vein thrombosis can be treated with drug therapy, bed rest, and gradient elastic stockings. Medications include anticoagulants that "thin" blood to prevent further growth of blood clots, as well as clot-dissolving drugs. Heparin is a common injectable anticoagulant, and is usually followed by coumadin tablets for at least three months. Bed rest with the patient's legs elevated is necessary until the condition improves. Gradient elastic stockings should then be worn, and
standing for long periods of time avoided. In some cases, a filter is placed in the major vein (the inferior vena cava) to trap emboli or clots before they get to the heart and lungs. Deep vein thrombosis must be treated promptly. Once the diagnosis is confirmed, the individual is kept in bed with the foot of the bed elevated.
Bed rest. Individuals with DVT usually require bed rest until symptoms are relieved. The leg should be elevated to a position above the heart to reduce swelling (the foot of the bed is elevated about six inches to achieve this). Moist heat may be applied to the affected region to relieve pain.
Compression stockings. Physicians frequently recommend that people who have DVT wear compression stockings (also called support hose) to reduce symptoms. Compression stockings improve circulation by providing a graduated pressure on the leg to help return the venous blood to the heart.
Blood-thinning drugs. Treatment with anticoagulants (commonly known as blood thinners) is required in most cases of DVT. The anticoagulant drugs heparin and warfarin are used primarily to prevent the formation of new clots, and, thus, reduce the chance of pulmonary embolism. Heparin is the anticoagulant drug of first choice. It must be administered intravenously (an injection made directly into a vein). Warfarin (also called coumarin) is taken by mouth. Treatment with heparin normally lasts seven to 14 days. Treatment with warfarin is usually continued from two to six months, depending on the age of the person, the severity of the DVT, and whether risk factors are present.
Thrombolytic medications. Drugs called thrombolytic agents (clot-dissolving medications) are used to help dissolve existing clots and reopen clogged veins. The most commonly used thrombolytic agents are urokinase, streptokinase, and recombinant tissue plasminogen activator (rt-PA). The best results occur when this treatment is given to people who have had DVT for less than 48 hours. When effective, the clot usually breaks up within 24 to 48 hours. Thrombolytic agents can also cause internal and external bleeding, and require careful monitoring. Treatment with thrombolytic agents usually lasts for only 24 to 72 hours. Thrombolytic medications carry a very high risk for causing severe bleeding. Furthermore, they have not been shown to be more effective than standard blood thinners in the treatment of DVTs or pulmonary emboli. The one situation in which thrombolytics are used is when a patient's life is threatened by a major pulmonary embolus that is blocking the main pulmonary arteries.
Surgery. If an embolus develops, surgery may be necessary to prevent the spread of the clot to the lung. Surgery, however, is performed only as a last resort. Surgery for complications resulting from DVT involves the insertion of a filter into a large blood vessel to trap any blood clots headed toward the lungs. The filter allows blood to flow through it normally, but traps the traveling clots. The procedure is called vena cava interruption because the filter is placed in the inferior vena cava, the large vein in the pelvic area that receives the blood returning from the deep femoral (thigh) veins. The most severe cases of DVT may require the surgical removal of the blood clot from the vein, a procedure known as venous thrombectomy. The patient is given anticoagulant therapy with heparin during the surgery, and warfarin for a period of at least six weeks to three months following the operation.
Swelling of the legs can be reduced by resting in bed and elevating the legs or by wearing compression bandages from the base of the toes to the knee. Improperly applied, the bandages may be wrapped more tightly around the upper calf than around the foot and ankle, resulting in a tourniquet effect. Therefore, only a trained doctor or nurse should apply compression bandages. During this time, walking is important. If the swelling does not completely subside, the bandages must be reapplied. The veins never completely recover after deep vein thrombosis develops, and surgery to repair the valves of the veins is experimental. After the compression bandages are removed, elastic stockings are worn every day to prevent swelling from recurring. The stockings do not have to be worn above the knee; swelling above the knee is of little concern and causes no complications. Usually, thick elastic stockings or strong elastic pantyhose is not needed.
If painful skin ulcers develop, properly applied compression bandages can help. When these bandages are applied once or twice a week, the ulcer almost always heals because blood flow in the veins improves. The ulcers are almost always infected, and pus and a foul-smelling discharge appear on the bandage each time it is changed. The pus and discharge can be washed off the skin with soap and water. Skin creams, balms, and skin medications of any kind have little effect.
Deep vein thrombosis can be life-threatening and must be treated with conventional medical therapies. However, there are alternative therapies that can be used in conjunction with emergency treatments to dissolve the clot that help support the body and prevent recurrence. A trained alternative health care practitioner should be consulted due to the severity of this condition. |
