DVT/Pulmonary Embolism

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Treatment

The goals of treatment in patients who have deep venous thrombosis (DVT) are to prevent the blood clot from getting larger, prevent the blood clot from moving to the lungs (pulmonary embolism), and reduce the risk for developing additional blood clots.

Treatment for DVT usually involves medications. Compression stockings, which often are used in patients during and after surgery to help prevent blood clots, also can be used to treat swelling associated with DVT.

Anticoagulant drugs "thin" the blood and can help prevent blood clots from getting bigger and help prevent other blood clots from forming. However, they do not dissolve clots that have already formed. Common anticoagulants include warfarin (Coumadin®) and heparin. Warfarin is administered orally, as a pill, and usually takes about 2 or 3 days to work. Heparin is administered in an injection or through an IV (intravenously) and works quickly.

In most cases, patients with deep vein thrombosis are treated with anticoagulants for 3–6 months. Blood tests are used to determine if the drug is working properly. Anticoagulant drugs can cause bleeding and bruising.

Thrombin inhibitors (e.g., lepirudin, bivalirudin, desirudin) may be used to reduce the risk for blood clots in some patients who cannot take heparin. Thrombolytics (e.g., r-PA, t-PA, tnk-PA, streptokinase) are "clot-busting" medications that may be used to dissolve blood clots in patients with severe DVT. These drugs can cause sudden excessive bleeding, which can cause stroke if it occurs in the brain, so they are only used to treat large clots that are life threatening.

Anticoagulants and thrombolytics also may be used to treat patients with pulmonary embolism. In some cases, a flexible tube (catheter) is passed through a blood vessel in the upper thigh (groin) into the lungs and medications are delivered through the catheter to dissolve the blood clot. The clot also may be removed through the catheter. Rarely, surgery (called thrombectomy) is necessary to remove a blood clot.

Patients who continue to develop blood clots in spite of treatment may benefit from a device called a vena cava filter, which can be inserted into the largest vein in the body (called the vena cava). This treatment can prevent pulmonary embolism, but it does not prevent DVT.

Prevention

DVT cannot be prevented in all cases. Patients who have had deep venous thrombosis should take medications as directed by a physician. Patients who are at increased risk for developing blood clots should exercise the lower legs frequently when sitting for long periods of time (e.g., get up and walk as much possible on a long flight, stop and stretch during long car rides).

Patients who have had surgery should wear compression stockings, receive medications (e.g., heparin) as directed by a physician, and get out of bed and walk around as soon as possible following the procedure. Patients who have DVT are at risk for developing a pulmonary embolism and should see a qualified health care provider regularly. Anyone who develops symptoms of deep vein thrombosis or pulmonary embolism should seek immediate medical care.

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