Deep Vein Thrombosis
Treatment Overview
The main goals of treatment for deep vein thrombosis are:
- To prevent the blood clot from becoming larger.
- To prevent the blood clot from travelling to the lungs (pulmonary embolism).
- To prevent post-thrombotic 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.
Once 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 post-thrombotic syndrome.
Deep vein thrombosis is usually treated with anticoagulant medications: heparin and warfarin (such as Coumadin). Heparin is given through a vein (intravenously, or IV) or as an injection; warfarin is given orally. The heparin acts immediately, whereas warfarin takes several days to become effective. Both are started at the same time, but 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 usually 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 and less expensive. Also, low-molecular-weight heparin usually does not require periodic blood tests to monitor its effects, although both of these anticoagulants are equally effective.8, 1
Typically, if you have a blood clot in the lower (distal) deep leg veins, you will need to take medicine to prevent more blood clots (anticoagulant medicine) for 6 to 12 weeks.3 Sometimes your doctor won't start this medicine right away. He or she will wait 24 to 48 hours to see if your blood clot is growing. If for any reason you cannot take anticoagulants, your doctor may recommend that you take non-steroidal anti-inflammatory drugs (NSAIDs), such as ASA (Aspirin) or naproxen, and monitor the blood clot with ultrasound.
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.
If you are not able to take anticoagulants, you may need a vena cava filter or different medications.
Ongoing treatment
For deep vein thrombosis in the upper leg, you will probably need to take warfarin (such as Coumadin) for 3 to 6 months and possibly longer after initial treatment.1 Some people may take low-molecular-weight heparin (LMWH) long-term instead of warfarin.
After 3 to 6 months, your doctor may recommend that you continue anticoagulants to prevent deep vein clots from recurring.2 Currently, low-dose warfarin is being studied to determine whether it is as effective as a conventional dose while decreasing the risk of bleeding. The results of these studies are not conclusive.2
When you are taking an anticoagulant, you will have blood drawn regularly so that your doctor can monitor how the anticoagulant medication is working. The test that measures how long it takes your blood to clot is called prothrombin time, or pro-time.
Medications (especially antibiotics), diet, and daily habits can affect how anticoagulant medications work. Your doctor will check your blood regularly and may need to adjust the dose of your medication. For more information, see:
Taking anticoagulants for deep vein thrombosis.
Treatment if the condition gets worse
If your clot continues to grow or if you develop pulmonary embolism while on anticoagulation medications, a vena cava filter may be inserted into a vein. This rarely occurs.
What To Think About
Although medical experts do not agree on the usefulness of compression stockings, they are sometimes recommended to help relieve swelling and pain. A recent study showed that these stockings can cut your chance of developing post-thrombotic syndrome nearly in half.5
Pregnant women are generally not given oral anticoagulants—warfarin (such as Coumadin)—because they can cause birth defects. However, anticoagulants given through an IV (unfractionated heparin) or that are injected (low-molecular-weight heparin) usually can be given throughout the pregnancy. Oral anticoagulants can be started immediately after the baby is born.
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| Author: | Merrill Hayden Nancy Reid | Last Updated: April 5, 2006 |
| Medical Review: | Adam Husney, MD - Family Medicine Jeffrey S. Ginsberg, MD - Hematology | |
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