Deep Vein Thrombosis Treatment

Basic precautions are taken at the beginning of deep vein thrombosis treatment. Most of the treatment consists of preventive, blood thinning, and anticoagulant drug treatment that would prevent a new clot. Mechanical "catheter-mediated treatment" and "drug therapy for dissolution of the existing clot" can be applied to suitable patients who require intervention.

Deep vein thrombosis, which occurs in veins of smaller sizes and does not cause a critical clinical finding but recovers with medication. Although it was used more frequently in the past, surgical treatment in the form of deep vein thrombosis surgery aimed at removing the clot is applied very rarely and in the case of fatal complications.

Many factors are considered in the course of deciding on a treatment option to be applied. The patient’s age, whether or not the deep vein thrombosis is detected for the first time, and whether the clot is above or below the groin level are critical. Also, the presence of an accompanying pulmonary embolism and whether the swelling in the leg prevents arterial blood flow are taken into consideration. Finally, the decision is made according to the presence of other accompanying medical conditions (cancer, a recent operation, pregnancy, birth, or bleeding) in the patient.

Deep Vein Thrombosis Treatment Options

Basic precautions: Physical activity is limited in the early period, but long-term and complete bed rest are inadvisable. The aim is to mobilize the patient as soon as possible. When the patient rests, his/her legs are kept slightly up by supporting them with a pillow from below. Also, compression stockings in suitable sizes and models are worn.

Anticoagulant Drugs Used in the Prevention and Treatment of the Deep Vein Thrombosis

• Heparin and Warfarin (Coumadin): These drugs are prescribed to prevent further progression of the existing clot and the formation of new clots. Its ability to dissolve the clot is considerably low. At the beginning of the treatment, heparin and warfarin are prescribed together. Then, in line with the INR blood test result showing the coagulation status, the treatment continues only with warfarin. In a patient using Coumadin due to deep vein thrombosis, the aim is to usually have an INR value in the range of 2.0-3.0. 
  
  
• New generation anticoagulant drugs: These oral medications, developed in recent years, have begun to be used instead of warfarin in treating deep vein thrombosis. They are similar to warfarin. Besides, they have advantages such as not requiring patient-specific dose adjustment or blood test (INR) and being unaffected by other drugs or diet. This group consists of dabigatran, rivaroxaban, apixaban, and edoxaban.
  
  
• Catheter-mediated therapies: This treatment method is applied to dissolve and dissolve the clot in the vein both mechanically and with the help of medication. Catheter; It is a medical device for therapeutic purposes in different lengths and thicknesses placed in a vein. The catheter tip is placed closer to the clot in the vein, and the clot-dissolving drug can be administered through it. There may also be a rotating part at the catheter tip that mechanically breaks the clot.

To be able to apply catheter-mediated treatments in deep vein thrombosis, the patient must meet the following conditions;

• Clot above the groin level (common femoral and iliac vein),
• At most 14 days have passed since the onset of the patient's complaints,
• The expected life expectancy of the patient is more than one year,
• The patient does not have a condition, which prevents the use of anticoagulants and causes bleeding.

Catheter-mediated treatments are provided in an angiography unit or hybrid operating rooms with appropriate imaging devices. Since the radiopaque substance is given for imaging during the procedure, the patient’s kidney function status is critical before the procedure. During the catheter-mediated treatment, the patient may need to stay at the hospital for a total of two or three days. After the procedure, in line with the control angiography findings, a stent may be required on the vein (iliac vein) above the groin level.

Surgical Treatment

Deep vein thrombosis surgeries were more frequent in the past but are now less common because the intravascular (endovascular) treatment methods are more prominent, and the surgery results are controversial in some aspects. Besides, surgery may require in the rare case of fatal complications.

Other Treatment Methods Applied in the Treatment of Deep Vein Thrombosis

• Vena Cava Filter: It is used when the patient cannot take blood thinners or when blood clots occur again despite taking blood thinners. This filter is placed in a large vein called "vena cava" and prevents "pulmonary embolism" from going to the lungs of blood clots that break up in a vein. Besides, it cannot avoid a new blood clot formation.
  
  
• Compression Stockings: These stockings are worn on the legs in a way that the arch of the foot is above or below the knee. They reduce swelling and complaints caused by the formation of blood clots in the leg. Graduated compression stockings tightly wrap the ankle and apply higher pressure, while the degree of pressure applied decreases as they move upward. The pressure applied by the socks reduces edema in the legs and prevents another blood clots formation. The doctor of the person determines how long to wear the graduated compression stockings.