What will treating a DVT, a blood clot deep in a vein, do for you?
- It will keep the clot from growing.
- It lowers the risk of long-lasting complications such as leg pain and swelling.
- It can help prevent future blood clots.
Often, medication and taking care of yourself will do the trick. But you may need surgery. Talk to your doctor about which treatments are right for you.
These drugs, also called anticoagulants, are the most common treatment for DVT. They can keep a clot from growing or breaking off, and they prevent new clots from forming. But they can't thin your blood, despite their name. And they won’t get rid of an existing clot.
Your doctor may want you to take blood thinners for 3 months or longer. If your blood clots developed after a surgery, you may be on medication for a shorter time. In some circumstances, your doctor may want you on blood thinners for more than a few months or indefinitely.
Sometimes you will start your treatment taking blood thinners by IV or injection. The most prescribed of these medications are:
- Enoxaparin (Lovenox), an injectable
- Fondaparinux (Arixtra), another injectable
- Heparin, taken by IV
After a few days, your doctor may switch you to a blood thinner in tablet or capsule form, such as:
- Dabigatran (Pradaxa)
- Warfarin (Jantoven)
Other blood thinner tablets can be prescribed and taken immediately after a DVT diagnosis, skipping the IV or injectable medications. Many doctors believe these medications, also known as IX inhibitors, can dissolve blood clots with less risk of bleeding. These blood thinners include:
- Apixaban (Eliquis)
- Edoxaban (Lixiana, Savaysa)
- Rivaroxaban (Xarelto)
Apixaban, edoxaban, and rivaroxaban are all pills. Fondaparinux is a shot that people who are having hip fracture, hip replacement, knee replacement, or abdominal surgery get to prevent DVT. Your doctor might also prescribe it with warfarin to treat a serious DVT or to treat a clot that gets stuck in your lung, called a pulmonary embolism.
Dabigatran is a pill that stops a certain protein that helps your blood clot from working. That's why it's called a direct thrombin inhibitor.
When you go to the hospital with a new blood clot (called acute DVT), your doctor may give you heparin at first, through an IV needle into your vein or as a shot. You may have to keep taking shots once you’re home, once or twice daily. When you get heparin by IV, you'll need blood tests, too. But you won't need them if you're taking shots of low-molecular-weight heparin under your skin.
You may also take warfarin by pill once a day, starting while you're on heparin and then usually for 3 to 6 months or more. While you take it, you'll need regular blood tests to make sure you've got the right amount in your system. Too little won't prevent clots, and too much makes dangerous bleeding more likely. It can also interact with other medicines, vitamins, and foods with a lot of vitamin K, which is another good reason to get your blood checked often.
Let your doctor know if you're pregnant because warfarin can cause birth defects. You'll have to take something else.
Make sure to take your blood thinners exactly as prescribed to avoid potentially serious side effects. These can include:
- Brown or red coloring in your urine, bowel movements, or vomit from internal bleeding
- Deep bruising
- Severe headaches or stomachaches
- Unusually heavy menstrual bleeding
Contact your doctor immediately if you start to have these side effects. Also remember, pregnant women shouldn’t take certain blood thinners.
Blood thinners can change the way other medications work and vice versa. Make sure your doctor knows about all the medicines you take.
Some studies show that taking aspirin regularly can cut the risk of DVT clots returning by one-third without increasing the risk of bleeding. But aspirin has the most impact when you take it regularly after you finish with prescription medication that you take after DVT surgery. And since aspirin therapy is not part of routine treatment of DVT, you should talk about it first with your doctor.
Your body will dissolve the blood clot over time. But in the meantime, it could damage the inside of your vein. Your doctor may recommend a clot-busting medicine called a thrombolytic agent if you:
- Have large clots causing pain, swelling, and problems with circulation
- Are at high risk for a pulmonary embolism
- Have DVT in your arm rather than your leg
This procedure quickly breaks up a clot and restores blood flow. It may also save the valves in that vein. But it's riskier than taking blood thinners. You have a higher chance of bleeding problems and stroke.
You'll go to the hospital to get it done. Using an X-ray as a guide, a specialist will put a thin tube called a catheter into your vein and work the tip of it into your DVT. Then, they'll use the catheter to send the drug directly into the clot.
If your vein seems narrow, they may widen it and help prevent future blockages by doing a balloon angioplasty or placing a stent.
The most commonly used medications of this type include:
- Alteplase (Activase)
- Anistreplase (Eminase)
- Reteplase (Retavase)
- Tenecteplase (Metalyse, TNKase)
When taking blood thinners or clot-busting isn't possible or doesn't work well, your doctor may want to try a more involved procedure.
Inferior vena cava (IVC) filter. An IVC filter is a small metal device that looks like an upside-down umbrella and can stop blood clots in your veins from moving. It goes in your body’s main vein, called the inferior vena cava (IVC). This vein runs through your belly. It sends blood from the lower half of your body back to your heart.
The procedure to put the filter in usually takes around an hour, and you can go home the same day. In the hospital, the doctor will put a medication that makes you feel sleepy and relaxed into a vein in your arm. You’ll also receive a shot to numb the area at the base of your neck or near your groin. This is where the doctor will make a small cut and insert a thin, flexible plastic tube called a catheter into your vein. Using an X-ray to guide them, the doctor will thread the filter into place in the vein. It will expand and attach to the walls of the vein. After the surgery, you may need pain medicine. When it’s time to go home, you’ll need a friend or family member to drive you.
An IVC filter traps blood clots before they cause a pulmonary embolism and is used only to prevent pulmonary embolisms. It doesn’t protect against DVT or treat the condition itself.
Your doctor may recommend an IVC filter if you have DVT along with one of these issues:
- Hemorrhagic, or bleeding, stroke
- Bleeding in your digestive tract. Many things can cause this, including tumors, ulcers, and inflammatory bowel disease.
- Malignant hypertension (very high blood pressure)
- Bleeding in your brain because of a fall or accident
- Recent brain, eye, or spinal cord surgery
They may also recommend IVC filters because of:
- Blood thinner failure. These drugs don’t work for some people.
- Circulation problems, which your doctor might call hemodynamic instability
- Serious injuries to your spinal cord or other organs. They can raise your risk for blood clots.
- Blood clots that move from place to place (mobile thrombus)
- DVT in your inferior vena cava and iliac veins. These are the veins that run from your heart to your lower body and pelvis.
There are two types of IVC filters. One stays in your body permanently. The other is designed to be removed. Your doctor may use a removable IVC filter if there’s a chance that your risk of a pulmonary embolism will drop. For example, you may be able to start taking blood thinners.
Venous thrombectomy. In very rare cases, you may need to have a deep vein clot cut out.
Treating DVT at Home
When you go home after DVT treatment, your goals are to get better and prevent another blood clot. You’ll need to:
- Take medications as directed. After a DVT, you'll take blood thinners for at least 3 to 6 months. Your doctor will tell you exactly how long to take these medications. It might be different based on which drug you use. You may need to take oral blood thinners for a longer time if the reason for your clot is still present in your body.
It’s important to follow your doctor’s recommendations so you can shift from managing your health with blood thinners to just aspirin.
- See your doctor often. They’ll let you know if your medications are helping and make adjustments if you need them. If you're taking warfarin, you'll get a blood test to see how well your blood is clotting.
- Make sure you aren’t bleeding too much. This is a side effect of blood thinner medications. Even a small cut can get serious when you're taking blood thinners.
- Be safe. Talk to your doctor about things that can lead to bruises or cuts. Try not to bump or injure your legs. Don’t cross your legs.
- Stay active. Even if you've been on bed rest after surgery or for other reasons, get moving. That’s a sure way to prevent more blood clots. Don’t sit or stand still for more than an hour at a time. Change positions often, especially if you’re on a long trip.
- Wear compression stockings. The most common kinds of these special socks go from the arch of your foot to just below or above your knee. They can relieve the pain and swelling in your legs, and they help prevent more clots. Compression stockings come in different levels of pressure. You can get mild ones over the counter, but you'll need to get fitted and a prescription for stronger ones. Your doctor will help you figure out what kind you need. You may have to wear them for 2 years or longer after you have DVT.
- Eat a healthy, low-salt diet. Extra pounds put more pressure on the veins in your pelvis and legs. Salt boosts your blood pressure. Keeping your sodium and cholesterol levels low can help you avoid another blood clot.
- Work on losing weight if you're carrying extra pounds.
- Quit smoking. It affects blood flow and circulation, which can raise your odds of getting another clot.
- Lift up. Raise the bottom of your bed 6 inches off the ground. You can use blocks, books, or special risers you can find online or at home stores.
Some people with DVT might need to take blood thinners for the rest of their lives. Your doctor will make this decision based on how likely you are to have another blood clot. They’ll also consider your risk of bleeding when they suggest longer treatment with blood thinners.
You’re at higher risk for another clot if you:
- Have cancer
- Are going through chemotherapy
- Have had a blood clot in a vein before
- Are male
- Have a positive D-dimer test, which shows if your body has more blood clot formations