Deep Vein Thrombosis - Treatment Overview

Treatment Overview

The main goals of treatment for deep vein thrombosis are:

• To prevent the blood clot from becoming larger.
• To prevent the blood clot from traveling to the lungs (pulmonary embolism).
• To prevent postthrombotic syndrome, a condition that can cause pain, swelling, and sores of the affected leg.
• To prevent the recurrence of blood clots.

Initial treatment

If you have symptoms of deep vein thrombosis, testing will begin immediately to determine whether you have a blood clot in your leg. Alternately, if a blood clot is discovered in your lung (pulmonary embolism), your doctor may test you for deep vein thrombosis.

When you are diagnosed with deep vein thrombosis, treatment begins immediately to reduce the risk that the blood clot will grow or that a piece of the clot might break loose and flow to the lungs (pulmonary embolism). Early treatment also reduces the risk of postthrombotic syndrome.

Deep vein thrombosis is usually treated with anticoagulant medicines: heparin and warfarin (such as Coumadin). Heparin is given through a vein (intravenously, or IV) or as an injection, and it acts immediately. Warfarin is given by mouth, and it takes several days to become effective. Often both medicines are started at the same time, then heparin is discontinued after warfarin becomes effective. Some people may take low-molecular-weight heparin (LMWH) long term instead of warfarin.

If you have a blood clot in your upper (proximal) leg vein, you will likely need to take warfarin for 3 to 6 months, and possibly longer.¹ After 3 to 6 months and depending upon your risk factors, your doctor may recommend that you continue on lower doses of warfarin (such as Coumadin) on an ongoing basis to prevent deep vein clots from recurring.²

Two types of heparin are available for treatment of deep vein thrombosis. Unfractionated heparin (UH) is given in the hospital, whereas low-molecular-weight heparin (LMWH) can be self-injected at home, which usually is more convenient. Low-molecular-weight heparin usually does not require periodic blood tests to monitor its effects, although both of these anticoagulants are equally effective.^{7, 1}

Typically, if you have a blood clot in the lower (distal) deep leg veins (in your calf), you will need to take medicine to prevent more blood clots (anticoagulant medicine) for about 3 to 6 months. The length of time will vary based on your own health. Sometimes your doctor won't start this medicine right away. He or she may wait 24 to 48 hours to see if your blood clot is growing. For symptom relief, your doctor may recommend a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen.

Your doctor may also recommend that you elevate your leg when possible, use a heating pad, take walks, and wear compression stockings. These measures may help reduce the pain and swelling that can occur with deep vein thrombosis.

If you are not able to take anticoagulants, you may need a vena cava filter or different medicines.

Ongoing treatment

For deep vein thrombosis in the upper leg, you will probably need to take warfarin (such as Coumadin) for 3 to 6 months and possibly longer after initial treatment.¹ Some people may take low-molecular-weight heparin (LMWH) long-term instead of warfarin.

After 3 to 6 months, your doctor may recommend that you continue anticoagulants to prevent deep vein clots from recurring.²

When you are taking an anticoagulant, you will have blood drawn regularly so that your doctor can monitor how the anticoagulant medicine is working. The test that measures how long it takes your blood to clot is called prothrombin time, or pro-time.

Medications (especially antibiotics), diet, and daily habits can affect how anticoagulant medicines work. Your doctor will check your blood regularly and may need to adjust the dose of your medicine. For more information, see:

Taking anticoagulants for deep vein thrombosis.

Eating a steady amount of vitamin K when you take warfarin (Coumadin).

Treatment if the condition gets worse

If your clot continues to grow or if you develop pulmonary embolism while on anticoagulation medicines, a vena cava filter may be inserted into a vein. This rarely occurs.

What To Think About

Although medical experts do not agree on the usefulness of compression stockings, they are sometimes recommended to help relieve swelling and pain. One study showed that these stockings can cut your chance of developing postthrombotic syndrome nearly in half.⁵

Pregnant women are generally not given oral anticoagulants—warfarin (such as Coumadin)—because they can cause birth defects. However, anticoagulants given through an IV (unfractionated heparin) or that are injected (low-molecular-weight heparin) usually can be given throughout the pregnancy. Oral anticoagulants can be started immediately after the baby is born.