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.