Treatment of deep vein thrombosis

Thrombosis — is the formation of blood clots in blood vessels. Normally, the appearance of thrombi is an important mechanism of the body’s reaction to vessel damage. Near the site of damage to a vein or artery, blood coagulates, forming a clot that blocks blood flow and stops blood loss. However, due to a number of diseases or coagulation disorders, this mechanism can start without bleeding. In such a case, clots are able to partially or completely block the lumen of vessels, and sometimes — detach and move through the circulatory system.

Phlebothrombosis — is the formation of a clot in the lumen of a deep vein, most often in the area of the lower limbs. In this article, under the concept of deep vein thrombosis, we will mean damage to the deep venous system of the legs, which requires timely diagnosis and treatment.

DVT can develop due to various factors that affect blood flow, the condition of the vascular wall and the work of the blood coagulation system. The risk of formation of a pathological clot increases if several provoking causes are combined simultaneously.

The main risk factors include:

• age — patients over 60 years old are more prone to the risk of formation of a venous thrombus;
• cancer diseases — primarily malignant formations of the intestine and pancreas;
• smoking, including passive smoking;
• pathologies in which increased blood coagulation is observed;
• taking certain hormonal drugs, in particular estrogens and oral contraceptives;
• insufficient motor activity;
• prolonged stay in an immobile position;
• limb injuries;
• excess weight;
• pregnancy and birth of a child;
• undergone surgical interventions.

In some cases, several risk factors are combined simultaneously, which significantly increases the likelihood of thrombus formation. That is why it is important to pay attention in a timely manner to symptoms of impaired venous circulation and not to postpone a doctor's consultation. Early detection of the disease helps to start treatment in a timely manner and reduce the risk of dangerous complications, in particular pulmonary artery thromboembolism.

The intensity and frequency of these manifestations may differ in different people. In some patients, leg thrombosis develops with moderate discomfort, while in others swelling and pain appear quickly and significantly limit mobility. Unpleasant sensations in the calf muscles may also be bothersome when bending the ankle joint, when the knee is extended. In some cases, body temperature rises to subfebrile values — approximately 37–37.9 °C.

Specialists of «Oxford Medical» warn: when thrombosis in the legs develops, it is important not to wait for the symptoms to pass on their own. In particular, if swelling, pain or a change in skin color occurred on one side, it is necessary to consult a doctor sooner.

Although a doctor may assume the likelihood of the disease based on the results of the patient’s examination, the basis of diagnosis, as with other phlebological pathologies, is ultrasound of the leg veins, that is, Doppler ultrasound or duplex scanning of the vessels.

During diagnosis, the following methods may be used:

• Ultrasound of the veins. With the help of an ultrasound examination, the doctor visualizes the vein and assesses the nature of blood flow through it. If thrombosis of the lower limb is suspected, the examination helps determine whether there is a clot, where exactly it is located and to what extent it impairs the patency of the vessel. In cases of such common pathologies as involvement of the femoral or popliteal vein, the sensitivity of ultrasound is more than 90%. With involvement of the vessels of the lower leg or iliac area, the informativeness of the method may be somewhat lower.
• Blood test for D-dimer. This is a laboratory indicator that reflects the presence of fibrin breakdown products — a protein that is the basis of a thrombus. An elevated level of D-dimer may indicate that processes of formation and breakdown of clots have recently occurred in the bloodstream. At the same time, this analysis does not show the exact localization of the problem, so it does not replace an ultrasound examination.
• Phlebography. This is an X-ray diagnostic method during which a contrast agent is introduced into the circulatory system. The method is used mainly when ultrasound did not allow the thrombus to be localized accurately or additional clarification of the clinical situation is required. The limited use of phlebography is associated with its invasiveness, radiation exposure and the risk of an allergic reaction to contrast. Ultrasound, on the contrary, is non-invasive, safe and comfortable for the patient.

If during the examination a thrombus in a vein on the leg is confirmed, the doctor determines the further treatment tactics taking into account the localization of the clot, symptoms, concomitant diseases and the risk of complications. Venous thrombosis always requires an individual approach, so it is not allowed to independently take drugs for blood thinning.

The treatment tactics depend on the localization of the thrombus, the severity of symptoms, the general condition of the patient, the risk of pulmonary artery thromboembolism and the presence of concomitant diseases. The main goal of therapy is to prevent enlargement of the thrombus, reduce the risk of its detachment, restore normal blood flow and prevent a recurrent episode of the disease.

The following methods may be used for treatment:

• Medication therapy. The basis of treatment is anticoagulants — drugs that reduce the activity of the blood coagulation system and prevent the formation of new clots. They do not always quickly dissolve an already formed thrombus, but they help stabilize the condition and reduce the risk of complications. During such therapy, it is important to strictly follow the doctor’s prescriptions, since incorrect use of the drugs may increase the risk of bleeding.
• Thrombolytic therapy. In certain cases, thrombolytics may be prescribed to eliminate already formed clots. One of the treatment methods is thrombolysis — medication dissolution of the thrombus with the help of special drugs. Such therapy is not used in all patients, since it is associated with an increased risk of bleeding. The decision to perform thrombolysis is made individually.
• Compression therapy. According to indications, the doctor may recommend compression knitwear, which helps reduce swelling, discomfort and the feeling of heaviness in the leg. The degree of compression, wearing regimen and duration of use are selected individually.
• Installation of a cava filter. In some cases, when anticoagulant therapy is contraindicated or there is a high risk of thromboembolic complications, a cava filter may be used. It is installed in the inferior vena cava in order to retain blood clots that may move through the bloodstream. The filter may be permanent or temporary — in such a case, it is removed after a certain period.
• Surgical removal of the thrombus. In the most severe cases, thrombectomy may be performed — surgical removal of the thrombus from the vessel. Such an intervention is used according to strict indications, when there is a high risk of severe complications or significant impairment of blood circulation in the limb.

The duration of treatment is determined by the doctor. In some patients, therapy may last from three to six months. If the risk factor was temporary, for example surgery, trauma or forced limitation of mobility, treatment usually has a defined duration. If the provoking factor persists constantly, for example in some oncological diseases or blood coagulation disorders, the use of medications may be longer.

Treatment of thrombosis in pregnant women must be carried out especially carefully, taking into account the woman's condition, the term of pregnancy, the risk of complications and the safety of therapy for the fetus. The basis of medication therapy is usually anticoagulants allowed for this period. Low-molecular-weight heparins are most often used, but the specific drug, dosage and duration of treatment are determined only by the doctor. It is not allowed to independently take blood-thinning agents or cancel the prescribed therapy.

After childbirth, the risk of clot formation remains increased for a certain time, so the woman may need further observation and preventive treatment. The management tactics depend on the individual situation, the course of pregnancy, childbirth and the presence of additional risk factors.

Doctors of «Oxford Medical» warn: thrombosis of the lower limbs is dangerous because clots can detach and move through the circulatory system, creating a risk of blockage of important vessels. If a thrombus enters the pulmonary artery or its branches, pulmonary artery thromboembolism (PATE) develops. This is an emergency condition that may pose a threat to life.

Complete or partial blockage of the veins in the leg can also lead to impaired blood outflow, increasing swelling, pain and skin changes. In the absence of adequate treatment, the risk of chronic venous insufficiency and post-thrombotic syndrome increases. These conditions may be accompanied by prolonged discomfort, heaviness in the legs, persistent swelling, change in skin color and the appearance of trophic ulcers.

Less often, the disease may lead to venous gangrene of the limb or infection of the thrombus. Such complications occur infrequently, but require emergency medical care.

The pathology may also recur. Such probability is higher in patients whose risk factors are permanent, for example in malignant tumors or persistent blood coagulation disorders. In patients whose provoking factors are temporary in nature — trauma, surgery, temporary limitation of motor activity, — the risk of a repeated episode is usually lower, but still requires a doctor’s assessment.

Prevention of clot formation is needed primarily for patients with prolonged limitation of mobility after serious surgical interventions, injuries or severe diseases. Prevention methods are selected after the doctor assesses the risk of developing the disease, the general condition of the patient and possible contraindications.

For prevention, the following may be recommended:

• early activation — reduction of the period of immobility, gradual increase of physical activity and simple movements to maintain blood circulation in the legs;
• preventive use of anticoagulants — use of drugs in preventive doses as prescribed by a doctor, taking into account the risk of clot formation and the possibility of bleeding;
• intermittent pneumatic compression — periodic compression of the legs with special cuffs connected to a pump to maintain blood flow in the lower limbs;
• lifestyle correction — increasing the level of physical activity, body weight control, quitting smoking and treatment of diseases that affect the condition of vessels or blood coagulation.

Any preventive drugs, compression means or additional methods of prevention should be used only after consultation with a doctor.

The cost of DVT treatment depends on the complexity of the clinical situation and the selected treatment method. In some patients, treatment may include medication therapy, whereas in other cases additional procedures or surgical intervention may be needed. You can preliminarily familiarize yourself with the prices here.

At the phlebology clinic «Oxford Medical», patients can undergo comprehensive diagnosis and treatment of diseases of the venous system. Modern diagnostic methods are used for examination, in particular ultrasound of the vessels of the lower limbs, which allows assessing the condition of blood flow and determining the localization of the thrombus.

The doctor will orient you in more detail regarding the necessary examinations, treatment tactics and cost of therapy during the consultation. Schedule an appointment at a convenient time for you by phone or through the online appointment form on the website.

The information is for informational purposes and does not replace a doctor's consultation.

Sources:

• Venous thromboembolic diseases: diagnosis, management and thrombophilia testing
• Guidelines for Management of Venous Thromboembolism
• Deep Vein Thrombosis and Pulmonary Embolism