Best treatments for DVT

Introduction

Deep vein thrombosis, or DVT, is a serious and possibly life-threatening condition that causes a blood clot to form in one of the deep veins of the body, usually in the legs. These clots can cause pain, swelling, and other symptoms. If left untreated, they may break off and travel to the lungs, causing a dangerous condition called pulmonary embolism.

DVT is a major public health concern, with as many as 900,000 people affected by DVT or pulmonary embolism each year in the United States alone. However, many cases of DVT go undiagnosed and untreated, as symptoms can be subtle or attributed to other conditions.

In this guide, we'll take an in-depth look at what DVT is, how to recognize its signs and symptoms, and the various risk factors that can increase your chances of developing this condition. We'll discuss the best treatment options available, both surgical and non-surgical, as well as strategies for preventing future DVTs and managing the condition in the long-term.

What is DVT?

Deep vein thrombosis, or DVT, is a condition in which a blood clot, or thrombus, forms in one of the deep veins of the body. While DVT can develop anywhere, it most commonly develops in the deep veins of the leg, particularly in the calf or thigh.1

Deep veins are the larger, more central veins that are located deep within the muscles. They carry the majority of the blood back to the heart. When a clot forms in one of these deep veins, it can partially or completely block blood flow, leading to a range of symptoms and complications.

One of the most serious complications of DVT is pulmonary embolism (PE). This happens when a part of the blood clot breaks off and travels through the bloodstream to the lungs, where it can get stuck in one of the pulmonary arteries.2 The pulmonary arteries are the blood vessels that carry blood from the heart to the lungs to pick up oxygen. When one of these arteries gets blocked by a clot, it can prevent that area of the lung from receiving blood and oxygen.

PE is a medical emergency, as it can cause serious symptoms like chest pain, shortness of breath, rapid heartbeat, lightheadedness, and even loss of consciousness. If a large part of the lung is affected or if the clot is especially large, PE can be fatal.

While DVT itself often occurs in the legs, the clot can break off and travel anywhere in the body. Clots that travel to the lungs cause PE, but they can also travel to the brain causing a stroke, or to other organs causing damage.

DVT and PE together are known as venous thromboembolism (VTE). VTE is the third most common vascular diagnosis after heart attack and stroke, affecting about 300,000-600,000 Americans each year. About 60,000-100,000 Americans die from VTE each year.

While the exact cause of any specific blood clot can vary, most develop due to some combination of the following:

• Injury to the vein from surgery, fractures, severe muscle injury, or inflammation
• Slow blood flow from lack of movement, such as after surgery or during long plane or car trips
• Hypercoagulability, meaning the blood is more prone to clotting

DVT is treatable, and in many cases preventable, with the right care and precautions.

Symptoms and Risk Factors for DVT

The symptoms of DVT vary from person to person, and sometimes, there may be no noticeable symptoms at all. This is one reason why DVT can be difficult to detect without proper medical evaluation. However, when there are symptoms, they most commonly affect the leg where the clot has formed. Some symptoms of DVT in the leg are:1,2

• Swelling in the affected leg, ankle or foot: This happens because the clot is blocking blood from flowing properly, causing it to pool in the leg.
• Pain or tenderness: This discomfort often starts in the calf and can feel like a cramp or charley horse. The pain may worsen when bending the foot upward toward the knee.
• Warmth: The skin around the painful area or on the affected leg may feel warmer than surrounding skin or the other leg.
• Redness or discoloration: The skin on the affected leg looks more red or has a blue or purple tinge compared to the other leg.

These symptoms can also be caused by many other conditions, such as an injury, infection, or inflammation. It is important to see a healthcare provider to get an accurate diagnosis if you have any of these symptoms.

In some cases, the first sign of DVT may be symptoms of pulmonary embolism. These may include:2,3

• shortness of breath
• rapid breathing
• chest pain that may worsen with a deep breath
• rapid heart rate
• lightheadedness or fainting

Pulmonary embolism is a medical emergency that needs immediate treatment to prevent serious complications or death.

There are many factors that can increase a person's risk of developing DVT. Some of the most common risk factors include:1,3

• Age: The risk of DVT increases with age. It's most common in those over 50.
• Prolonged sitting or bed rest: When your legs remain still for long periods, your calf muscles don't contract to help blood circulate, which can increase the risk of clots. This can happen during long plane or car trips, after surgery, or during any extended period of bed rest.
• Injury or surgery: Injury to your veins or surgery can increase your risk of clots, especially in surgeries involving the legs, hips, belly, or brain.
• Pregnancy: Pregnancy increases the pressure in the veins in your pelvis and legs. The risk of blood clots from pregnancy can continue for up to six weeks after you have your baby.
• Birth control pills or hormone replacement therapy: These medications can increase clotting, especially if you smoke or are overweight.
• Excess weight: Being overweight increases the pressure in the veins in your pelvis and legs.
• Smoking: Smoking affects blood clotting and circulation, which can increase your risk of DVT.
• Family history of DVT: Some people inherit a disorder that makes their blood clot more easily. If a close family member has had DVT, you may be at greater risk.
• Inflammatory bowel disease: Bowel diseases like Crohn's disease or ulcerative colitis increase the risk of DVT.
• Heart failure: People with heart failure have a higher risk of DVT and pulmonary embolism. Heart failure can cause blood to pool in the legs and increase clotting.
• Cancer: Some cancers, especially pancreas, lung, stomach, brain, bone, ovary, and kidney cancers, can increase clotting. Chemotherapy also increases the risk of clots.
• Catheters: Having a central venous catheter or other type of catheter that goes into a vein can irritate the blood vessel wall and raise clotting risk.
• COVID-19: People who have severe symptoms of COVID-19 have an increased risk of developing blood clots, including DVT.

You won’t necessarily develop DVT just because you have one or more of these factors. However, you should be aware of the signs and take preventive measures.

Non-Surgical Treatments for DVT

The primary treatment for DVT is anticoagulant medication, also known as blood thinners. Despite their name, these drugs don't actually thin the blood. They prevent the blood clot from getting larger and stop new clots from forming.6,4

There are several types of anticoagulants used to treat DVT:

• Heparin: This fast-acting drug is usually given by injection or IV infusion in the hospital. It works quickly to prevent further clotting.
• Low-molecular-weight heparins (LMWHs): These drugs, such as enoxaparin (Lovenox), are given by injection under the skin and can often be self-administered at home. They are more predictable than heparin.
• Warfarin (Coumadin): This oral medication is a vitamin K antagonist that takes longer to start working. It's often started along with heparin or LMWH, which can be stopped once the warfarin has taken effect. Warfarin requires regular blood tests to monitor its effect and adjust the dose.
• Direct oral anticoagulants (DOACs): These newer drugs, such as rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa), are taken orally and don't need regular blood tests. They work by directly lowering clotting factors.

The choice of anticoagulant depends on the location and severity of the clot, overall health and bleeding risk, and ability to stick to the treatment plan.

In some high-risk cases, healthcare providers may also prescribe thrombolytic or "clot-busting" drugs like alteplase (Activase) or tenecteplase (TNKase). These medications are delivered directly to the clot using IV or catheter to help dissolve it more quickly.7 However, thrombolytics carry a higher risk of bleeding complications. They are typically used in people who are at high risk of serious complications from the clot itself, such as those with a large clot that is causing severe symptoms or threatening a vital organ.

Non-drug therapies are also important in DVT treatment. One of the most effective is compression socks.9,10 These snug-fitting stockings apply gentle pressure to the leg, with the most pressure at the ankle, gradually decreasing up the leg. This pressure helps prevent blood from pooling in the veins and reduces the risk of clotting.

Compression stockings come in different lengths and strengths, and they can be prescribed by a healthcare provider or purchased over the counter. People usually wear them during the day and take them off at night. Studies have shown that wearing compression stockings can significantly reduce the risk of post-thrombotic syndrome, a common complication of DVT that causes chronic pain, swelling, and skin changes in the affected leg.

Lifestyle changes are also an important part of DVT treatment and prevention. It is important to stay well hydrated, avoid sitting or standing for long periods without moving around, and perform simple exercises to keep the blood flowing.11 These exercises can include:

• Ankle circles: Rotate your foot clockwise and then counterclockwise, making a complete circle with your toes.
• Foot pumps: Alternate pointing and flexing your feet.
• Knee lifts: While sitting, lift your leg up so that your foot is a few inches off the ground. Hold for a few seconds, then lower and repeat with the other leg.

The goal of DVT therapy is to prevent the clot from getting bigger, stop new clots from forming, and reduce the risk of long-term complications.

Surgical Treatments for DVT

While non-surgical treatments like anticoagulants and compression stockings are usually tried first for DVT, there are times when surgery may be needed. This is often the case when the clot is very large, is causing severe symptoms, or isn't responding to medication. Some surgical options for treating DVT are:

• Thrombectomy: A surgeon makes an incision in the affected vein and physically removes the clot.15 This is usually done only if the clot is very large and causing serious problems, or if other treatments haven't worked.
• Catheter-directed thrombolysis: This minimally invasive procedure involves guiding a thin, flexible tube called a catheter through the blood vessels to the clot. Once in place, the catheter gives a high concentration of clot-dissolving medication directly into the thrombus.15 This targeted approach can help break up the clot more quickly than systemic medication and may lower the risk of bleeding complications.
• Venous stenting: In some cases, a DVT can cause long-term damage to the vein, leading to chronic obstruction. A surgeon may place a small, mesh tube called a stent into the vein to keep it open and allow blood to flow more freely.
• IVC filters: If you can't take blood thinners or are at very high risk of pulmonary embolism, an IVC filter may be surgically placed in the inferior vena cava.17 This small, cage-like device catches any clot fragments that break loose, preventing them from reaching the lungs. IVC filters can be permanent or removable, depending on your needs.

Preventing Future DVTs

For those who have experienced a DVT, preventing future clots is important. While anticoagulant medications are often prescribed to reduce the risk of recurrence, there are also several lifestyle changes and preventive measures that can help. Some of these change are:

• Staying active: Regular exercise helps keep the blood circulating and prevents it from pooling and clotting in the veins. If you do need to sit for long periods, such as during travel or at work, make sure to take frequent breaks to stand up, stretch, and walk around. Wearing compression stockings can also help improve blood flow and reduce swelling in the legs.18
• Eating a healthy diet: Eating a balanced diet rich in fruits, vegetables, and lean proteins can help keep your blood vessels healthy and your blood flowing smoothly.19 Some studies say that foods high in vitamin K, such as leafy greens, may help regulate clotting. However, vitamin K can also interact with certain anticoagulant medications, so it's important to discuss any dietary changes with your healthcare provider.
• Maintaining a healthy weight: Obesity is a significant risk factor for DVT.19 Excess body fat can put additional pressure on the veins and slow blood flow, increasing the likelihood of clotting. Losing weight through a combination of diet and exercise can significantly reduce your risk.
• Quitting smoking: Smoking damages the blood vessels and increases the stickiness of platelets, making the blood more prone to clotting. It also reduces circulation and increases inflammation throughout the body. Quitting smoking is one of the best things you can do for your vascular health.

For those with a history of DVT, your healthcare provider may recommend additional preventive measures based on your risk factors. This may include long-term anticoagulant therapy, more frequent check-ups, or testing for underlying clotting disorders.18,19

Conclusion

Deep vein thrombosis is a serious and potentially life-threatening condition. By understanding the risk factors, recognizing the signs and symptoms, and seeking quick medical attention, you can significantly reduce your risk of developing dangerous complications like pulmonary embolism.

There are non-surgical, surgical, and lifestyle changes that can help treat DVT and improve circulation.

Preventing DVT is important, especially for those at high risk. Lifestyle changes like staying active, maintaining a healthy weight, quitting smoking, and wearing compression stockings can help reduce the likelihood of developing a clot.

Citations:

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