Why DVT Treatments May Differ

Deep vein thrombosis (DVT) is a condition that causes blood clots to form in the large deep veins in your body, usually in the legs. This can be dangerous because a clot can clog up the vein and cut off blood circulation. That could prevent blood from getting where it needs to go and cause swelling. It’s a serious problem that causes nearly 50,000 deaths each year in the United States.

The most dangerous DVT complication happens when the blood clot, or a part of it, travels from your leg to other body parts -- especially your lungs. A large clot in your lung makes it hard to breathe. In severe cases it can lead to death. This condition is called a pulmonary embolism (PE).

Depending on how severe your DVT is, there are many ways to treat it. In milder cases, pills or shots may be enough to get the clot under control. If you have low risk of side effects, the doctor may be able to treat you in their office. But if the clot is too big or you have other health concerns, chances are you’ll need more complex treatment. DVT is considered an emergency so if you think you have it, get medical help as soon as possible.

Doctors will run tests to see where and how big the clot is. Whatever the treatment, the goal is to:

  • Stop your clot from getting bigger
  • Prevent it from traveling to other parts of your body, like your lungs
  • Lower your chances of forming more clots in the future

Blood Thinners

Anticoagulants, or blood thinners, are the most common treatment. Despite the name, these medications don’t thin blood or dissolve your clot. Instead, they prevent complications and help stop new clots from forming.

There are different types of blood thinners. You could get the drug as a pill, shot, or into a vein (IV). It depends on where the clot is, what caused it, your medical history, and risk of future clots. Cost reasons can also play a role.

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When you’re first diagnosed with DVT, you’ll probably get a drug called heparin under your skin and later through an IV for up to 10 days. Or the doctor might skip the IV and give you pills like apixaban (Eliquis), dabigatran etexilate (Pradaxa), edoxaban (Savaysa), or rivaroxaban (Xarelto). This can be a good option if you don’t like shots.

If you’re at higher risk for the clot moving to your lungs, the doctor will give you heparin first in an IV. You may get another anticoagulant later as a pill.

How Long Should You Be on Blood Thinners?

Experts suggest you take blood thinners for at least 3 months. If your DVT resulted from things like trauma or surgery, or if you’re on bed rest, you may have to take them until the risk goes away. You may also take them longer or indefinitely if the doctor doesn’t know what caused your DVT. You’ll get regular checkups while you’re on the drug.

One of the major side effects of blood thinners is bleeding. If you’re bruising or bleeding too much, tell your doctor right away. Pregnant women, people with active cancers, or kidney problems may not be able to take some blood thinners. Ask your doctor about the pros and cons and which options may be best for you.

Clot Busters

If you have severe blood clots, you may have to go to the hospital. While you’re there, the doctor could give you a powerful medication called thrombolytic therapy, or a clot buster. Unlike blood thinners, clot busters, as their name suggests, can dissolve clots in a few days. You might get the medication through an IV or a catheter tube placed directly where your clot is located.

Clot busters aren’t for everyone. Heavy bleeding is a side effect, so you won’t get it if you have a high risk for severe bleeding or a greater chance of the clot traveling to your lungs.

Inferior Vena Cava Filter

If your bleeding risk is too high for blood thinners or clot busters, the doctor may suggest an inferior vena cava (IVC) filter to prevent a PE. The IVC is your largest vein. It brings blood back to your heart from the lower part of your body.

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The filter will catch a clot as it travels through your bloodstream. To insert it, the doctor will make a small cut in your leg or neck and slide a flexible tube called catheter into the IVC. They’ll thread the filter, a wire-like device, through the catheter.

The IVC filter doesn’t treat, dissolve, or prevent your body from forming clots. Depending on your risk for future DVTs and PE, the doctor may leave the filter inside you permanently or remove it after a while. You’ll have a follow-up visit about 4 to 6 weeks after the insertion to decide if they’ll remove it or leave it in place.

Post-thrombotic Syndrome

Post-thrombotic syndrome (PTS) is another common DVT complication. It can cause leg pain, swelling, and blood pooling in your leg. It usually happens a few weeks or months after a DVT.

About 20% to 50% of people with DVT end up with PTS. It can affect your overall quality of life. But there are things you can do to avoid having it, like:

  • Walking. Experts recommend you try to walk as soon and as much as you can handle when you have DVT. This may help avoid PTS after treatment and make your calf muscles stronger.
  • Compression stockings. Compression can boost blood flow in your veins and prevent PTS symptoms. They’re like a tight pair of socks that hit below the knee. You wear them during the day. You can find over-the-counter compression socks, but prescription options may work better. Experts say it’s best to use them after you’ve finished blood thinner treatment.

DVT is a serious medical emergency that can lead to death if it isn’t treated or if the clot travels to other parts of your body. If you have a family history of DVT or health issues that make it more likely for you to have blood clots, ask your doctor about the best treatment.

WebMD Medical Reference Reviewed by Brunilda Nazario, MD on February 03, 2021

Sources

SOURCES:

UpToDate: “Overview of the treatment of lower extremity deep vein thrombosis (DVT),” “Patient education: Deep vein thrombosis (blood clots in the legs) (The Basics),” “Patient education: Deep vein thrombosis (DVT) (Beyond the Basics),”  “Patient education: Warfarin (Beyond the Basics),” “Venous thromboembolism: Initiation of anticoagulation (first 10 days),”

Mayo Clinic: “Deep vein thrombosis (DVT).”

ClotCare: “FAQs About Warfarin (brand name Coumadin).”

Johns Hopkins Medicine: “Inferior Vena Cava (IVC) Filter Placement,” “Percutaneous Transcatheter: Treatment of Deep Venous Thrombosis (DVT).”

Cleveland Clinic: “Deep Vein Thrombosis (DVT): Management and Treatment.”

Memorial Sloan Kettering Cancer Center: “About Your Inferior Vena Cava (IVC) Filter Placement.”

Cedars-Sinai.org: "Post-Thrombotic Syndrome."

Hematology: “The post-thrombotic syndrome.”

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