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Treating Deep Vein Thrombosis, DVT, is quite standard world wide. Recently there has been the introduction of new medications which by-pass follow-up scans and monitoring. This section does not include this because it is yet to be a standard treatment.


Anticoagulation


Anticoagulants are a class of drugs that work to prevent the coagulation (clotting) of blood. Such substances occur naturally in leeches and blood-sucking insects.


Anticoagulant medicines prevent blood clots getting bigger. They can also help stop part of the blood clot breaking off and becoming lodged in another part of your bloodstream (an embolism).


Although they are often referred to as "blood-thinning" medicines, anticoagulants do not actually thin the blood. They alter the chemicals within it, which then prevents the clots from forming so easily.


Anticoagulant medicines prevent blood clots getting bigger. They can also help stop part of the blood clot breaking off and becoming lodged in another part of your bloodstream (an embolism).


Two different types of anticoagulants commonly are used to treat DVT in the UK are;


Heparin

Heparin is a naturally occurring anticoagulant produced by basophils and mast cells.


Warfarin

Warfarin is a synthetic derivative of Dicoumarol.


Popular brand names: Coumadin, Jantoven



Heparin is usually prescribed first because it works immediately to prevent further clotting. After this initial treatment, you may also need to take Warfarin to prevent another blood clot forming.

        

Heparin can be given as;


   Intravenous Injection – An injection straight into one of your veins.


   Intravenous Infusion – A continuous drip of Heparin is fed through a narrow tube    into a vein in your arm (this must be done in hospital)



   Subcutaneous Injection – an injection under your skin

   (LMWH is usually given as a subcutaneous injection)



A dose of standard Heparin can work differently from person to person, so the dosage must be carefully monitored and adjusted where necessary. You may need to stay in hospital for 5 to 10 days and have frequent blood tests to ensure you receive the right dose.


LMWH works differently from standard Heparin. It contains small molecules, which means its effects are more reliable and you will not have to stay in hospital and be monitored.


Both Standard and LMWH can cause side effects, including:


    • Skin rash and other allergic reactions

    • Bleeding

    • Weakening of the bones (if taken for a long time)


Warfarin


Warfarin is taken as a tablet. You may need to take it after an initial Heparin treatment to prevent further blood clots occurring. Your doctor may recommend that you take Warfarin for three to six months after the initial DVT treatment. In some cases, Warfarin may need to be taken for longer, even for life.


Commonly, Warfarin will be replaced as a long term management of post-DVT by Aspirin.


As with standard Heparin, the effects of Warfarin vary from person to person. You will need to be closely monitored with frequent blood tests to ensure you are taking the right dosage.


When you first start taking Warfarin, you may need to have two to three blood tests a week until your regular dose is decided. After this, you should only need to have a blood test every four weeks at an anticoagulant outpatient clinic.


Warfarin can be affected by your diet, any other medicines that you are taking, and by how well your liver is working.


If you are taking Warfarin, you should:


    •Keep your diet consistent


    •Limit the amount of alcohol you drink (no more than three to four units a day for      men and two to three units a day for women)


    •Take your dose of Warfarin at the same time every day


    •Not start to take any other medicine without checking with your GP, pharmacist or      anticoagulant specialist

    

Warfarin is not recommended for pregnant women, who are given Heparin injections for the full length of treatment.


Rivaroxaban


The National Institute for Health and Care Excellence (NICE) UK recommends Rvaroxaban as a possible treatment for adults with DVT, or to help prevent DVT.


(Rivaroxaban is an oral anticoagulant invented and manufactured by Baye)


Rivaroxaban prevents blood clots forming in blood vessels by stopping a substance called Factor Xa from working.


Treatment usually lasts for three months and involves taking Rivaroxaban twice daily for the first 21 days, followed by once daily until the course ends.


Read the NICE guidance on Rivaroxaban for the treatment and prevention of deep vein thrombosis.



Apixaban


The National Institute for Health and Care Excellence (NICE) UK recommends Apixaban as a possible treatment for adults with DVT, or to help prevent DVT.


Apixaban prevents blood clots forming in blood vessels by interfering with a substance in the body called thrombin.


Treatment usually lasts for at least three months and involves taking Apixaban twice daily.


Read the NICE guidance on Apixaban for the treatment and prevention of deep vein thrombosis.


Compression stockings


Compression stockings help prevent calf pain and swelling, and lower the risk of ulcers developing after having a DVT. They can also help prevent post-thrombotic syndrome. This is damage to calf tissue caused by the increase in venous pressure that occurs when a vein is blocked (by a clot) and blood is diverted to the outer veins. See complications of DVT for more information.


After having a DVT, stockings should be worn every day for at least two years because symptoms of post-thrombotic syndrome may develop several months or even years after having DVT.


Compression stockings should be fitted professionally and the prescription is reviewed every three to six months. They need to be worn all day, but can be taken off before going to bed or in the evening while you rest with your leg raised. A spare pair of compression stockings should also be provided.



Exercise


Your healthcare team will usually advise you to engage in regular walking exercise once compression socks have been prescribed.


This can help prevent symptoms of DVT returning and may help to improve or prevent complications of DVT, such as post-thrombotic syndrome.



Raising your leg


As well as wearing compression stockings, you might be advised to raise your leg whenever you are resting. This helps to relieve the pressure in the veins of the calf and stops blood and fluid pooling in the calf itself.


When raising your leg, make sure that your foot is higher than your hip. This will help the returning blood flow from your calf. Putting a cushion underneath your leg while you are lying down should help raise your leg above the level of your hip.


You can also slightly raise the end of your bed to ensure that your foot and calf are slightly higher than your hip.



From a viewpoint of personal experience, raising your leg to be higher that your hip is all too often impossible in practice


This is the advised or suggested method, however, an elderly or frail person will rarely be able to comply outside of being in a bed!



It is simply not possible as often as it is commonly suggested. As a 45 year old male, I found it almost impossible to do on my own. I had to resort to laying on the floor and perching my feet on a chair. However, as a requirement it can be managed with difficulty, as an everyday procedure it is neither practical nor possible.”     JS London


My mother suffered a DVT which was followed by years of associated problems. The Doctor telling her to raise her legs higher than her heart, became a ridiculous balancing act with cushions until I bought a recliner settee that took up half the room. It became part of daily life and not a simple routine. It’s all very understandable being asked to do this, but by no means is it something that someone without help can easily do ”      GJ UK


How could I raise my leg without a hoist? I spent 8 hospitalized with a mechanical syringe pushing drugs through my body and I have a hip disability following an auto crash. Then when I got home, I was told to keep my leg elevated but not how I could do that alone, and I was just 48. I needed to get a friend to come by twice daily to help lift my leg. All OK if you are young and strong, not if you have health problems”     KJ NY. NY

Treating DVT

Inferior vena cava filters


Although anticoagulant medicines and compression stockings are usually the only treatments needed, inferior vena cava (IVC) filters may be used as an alternative. Usually, this is because anticoagulant treatment needs to be stopped or is not suitable.


IVC filters are small mesh devices that doctors can place in a vein. They trap large fragments of a blood clot and stop it travelling to the heart and lungs.


They can be placed in the vein permanently, or newer types of filters can be removed once the risk of a blood clot has decreased.


The procedure to insert an IVC filter is performed using local anaesthetic (where you are awake but the area is numb). A small cut is made in the skin and a catheter (a thin, flexible tube) is inserted into a vein in the neck or groin area. The catheter is guided using an ultrasound scan. The IVC filter is then placed through the catheter into the vein.

Inferior Vena Cava



            Filter



Blood Clot (captured)