Treatment

What are the aims of the treatment?

  • Preventing clot from increasing in size
  • Preventing clot from breaking loose and causing PE
  • Reducing your chances of having DVT again.

How is it treated?

This includes:

  • Leg elevation at night.
  • Mid-thigh stockings during the day.) These stockings are put for 2-3 years.
  • Anticoagulation for clot dissolution and prevention of Pulmonary embolism.

What are blood thinners?

These are drugs that reduce the ability of the blood to clot. They cannot dissolve the existing organized clot but they prevent a fresh clot from forming and thus reduce the chances of old from extending.

How are blood thinners given?

The first injection of heparin is given for a few days. This is a Low Molecular Weight Heparin (LMWH) followed by oral drugs (Warfarin or Xarelto). These blood thinners are given for at least 3 months. They have serious side effects if the dose becomes excessive and therefore they have to be regularly monitored by blood tests.

What are the side effects of these blood thinners?

Bleeding which can be involving any organ of the body.

  • Brain – stroke
  • Skin – Bruising
  • Kidneys – bleeding with urine.

How can I be careful?

  • Watch for bleeding from the gums while brushing your teeth daily
  • Watch for bruising with a minor injury
  • Watch for bleeding in the urine
  • Do regular blood tests as prescribed by your doctor.
  • Avoid blood thinners during pregnancy

Is there any other way to dissolve clots?

There are clot-busters (Thrombolysis) that act fast and immediately but are very dangerous and can cause serious extensive bleeding which could be life threating and so have to be given with a lot of caution. They are administered only in if all other treatment options have failed.
They are given intravenous or directly within the clot. It has to be administered in the ICU.

How can clots be prevented from going to the lungs?

This is achieved by introducing IVC filters which are introduced from the groin and placed in the large vein in the abdomen just below the kidneys. These veins take the blood back to the heart and then go to the lungs.

What is your routine lifestyle once you are on long term blood thinners?

  • Watch for any signs of bleeding.
  • Regular blood tests as prescribed by your doctor.
  • Take your medication without fail in the same dose as prescribed by your doctor. It is generally once a day dose and should be taken for over 3-6 months and only stopped once your colour doppler study shows no clots in the veins.
  • Alcohol a green leafy vegetables (Contain Vitamin K) have to be avoided. Consult your doctor.
  • Physical activity is a must which prevents more clots from forming. After about 10 days clots organise and there is a very small possibility of them detaching and passing to the lungs.
  • Wear stockings regularly during the day and elevate your legs at night.

How can I prevent DVT?

1. Avoid sitting still by:

  • Move your legs in bed even if you have had surgery. Your doctor will try to mobilise you as soon as it is safe.
  • Avoid sitting cross-legged as it limits blood flow.
  • During long travel walk regularly by stopping the car every hour and taking a little walk or walking on the aisle during the long flight.
  • If waking is not possible then move your ankles regularly by raising your heels with toes fixed on the ground and then raise your toes with your heel stuck tot he ground.

2. Make lifestyle changes – lose weight, quit smoking as they enhance the chances of having DVT.

3. Regular exercises – This is very essential to reduce the risk of developing DVT in those who sit long hours during work or frequent travel.