If you have deep vein thrombosis (DVT), you'll need to take a medicine called an anticoagulant. Show AnticoagulationAnticoagulant 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're often referred to as "blood-thinning" medicines, anticoagulants don't actually thin the blood. They alter proteins within it, which prevents clots forming so easily. Heparin and warfarin are 2 types of anticoagulants that are used to treat DVT. 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. HeparinHeparin is available in 2 different forms:
Standard (unfractioned) heparin can be given as:
LMWH is usually given as a subcutaneous injection. The dose of standard (unfractionated) heparin to treat a blood clot varies significantly from person to person, so the dosage must be carefully monitored and adjusted if 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 won't have to stay in hospital and be monitored. Both standard heparin and LMWH can cause side effects, including:
In rare cases, heparin can also cause an extreme reaction that makes existing blood clots worse and causes new clots to develop. This reaction, and weakening of your bones, is less likely to occur when taking LMWH. In most cases, you'll be given LMWH because it's easier to use and causes fewer side effects. WarfarinWarfarin is taken as a tablet. You may need to take it after initial treatment with heparin to prevent further blood clots occurring. Your doctor may recommend that you take warfarin for 3 to 6 months. In some cases, it may need to be taken for longer, even for life. As with standard heparin, the effects of warfarin vary from person to person. You'll need to be closely monitored by having frequent blood tests to ensure you're taking the right dosage. When you first start taking warfarin, you may need to have 2 to 3 blood tests a week until your regular dose is decided. After this, you should only need to have a blood test every 4 weeks at an anticoagulant outpatient clinic. Warfarin can be affected by your diet, any other medicines you're taking, and by how well your liver is working. If you're taking warfarin you should:
Warfarin isn't recommended for pregnant women who are given heparin injections for the full length of treatment. RivaroxabanRivaroxaban is a medication recommended by the National Institute for Health and Care Excellence (NICE) as a possible treatment for adults with DVT, or to help prevent recurrent DVT and pulmonary embolism. Rivaroxaban comes in tablet form. It's a type of anticoagulant known as a directly acting oral anticoagulant (DOAC). It prevents blood clots forming by inhibiting a substance called factor Xa and restricting the formation of thrombin (an enzyme that helps blood clot). Treatment usually lasts 3 months and involves taking rivaroxaban twice a day for the first 21 days and then once a day until the end of the course. Read the NICE guidance about rivaroxaban ApixabanNICE also recommends apixaban as a possible method of treatment and prevention for DVT and pulmonary embolism. Like rivaroxaban, apixaban is a DOAC that's taken orally as a tablet, and prevents blood clots forming by hindering factor Xa and restricting the formation of thrombin. Treatment usually lasts at least 3 months and involves taking apixaban twice a day. Read the NICE guidance about apixaban Compression stockingsWearing compression stockings helps prevent calf pain and swelling, and lowers the risk of ulcers developing after having DVT. They can also help prevent post-thrombotic syndrome. This is damage to leg 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. After having DVT, stockings should be worn every day for at least 2 years. This is because symptoms of post-thrombotic syndrome may develop several months or even years after having a DVT. Compression stockings should be fitted professionally and your prescription should be reviewed every 3 to 6 months. The stockings 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. ExerciseYour healthcare team will usually advise you to walk regularly once compression stockings 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 legAs well as wearing compression stockings, you might be advised to raise your leg whenever you're 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 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're 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. Read more about preventing DVT Inferior vena cava filtersAlthough anticoagulant medicines and compression stockings are usually the only treatments needed for DVT, inferior vena cava (IVC) filters may be used as an alternative. This is usually because anticoagulant treatment needs to be stopped, isn't suitable, or isn't working. IVC filters are small mesh devices that can be placed in a vein. They trap large fragments of a blood clot and stop it travelling to the heart and lungs. They can be used to help prevent blood clots developing in the legs of people diagnosed with:
IVCs can be placed in the vein permanently, or newer types of filters can be placed temporarily and removed after the risk of a blood clot has decreased. The procedure to insert an IVC filter is carried out using a local anaesthetic (where you're awake but the area is numb). A small cut is made in the skin and a catheter (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 inserted through the catheter and into the vein.
Deep vein thrombosis (DVT) is a blood clot that occurs in a deep vein; that is, a vein that is not on the surface of the skin. DVT can occur anywhere, but is most often seen in the leg. If you think you might have DVT, see a doctor. The most serious complication of DVT is pulmonary embolism, which is when a piece of the blood clot breaks off and lodges in the lung. This causes a serious illness and is potentially life-threatening.
The main signs and symptoms of DVT are pain and swelling in the affected area - usually your calf or thigh. Some people have no signs or symptoms. When to seek help?DVT is a serious condition, so if you think you may have DVT, you should see a doctor without delay. Call an ambulance on triple zero (000) if you:
 What causes DVT?Anything that slows blood flow in deep veins can cause DVT. People who have DVT may have: Women who are pregnant or who have recently had a baby are also at increased risk of DVT. So are people who are overweight, or who smoke. DVT can also happen spontaneously, with no apparent cause. Some people with spontaneous DVTs have a genetic condition that makes their blood more likely to clot. How is a DVT diagnosed?To diagnose DVT, the doctor will need to talk to you about your symptoms and examine you to look for signs of DVT, such as swelling and pain. After this, if your doctor thinks you may have DVT, they may suggest you have an ultrasound. A blood test called a D-dimer test can also be done to help detect blood clots. If the doctor thinks there is a risk that part of the blood clot has travelled to your lungs, they may order a chest CT scan. How is DVT treated?If you have DVT, you will be treated with medicine that reduces blood clotting (called anticoagulant medication). This can be given either as tablets or via injections and you will probably need to take it for several months. In very severe cases, a medicine is used to break down the clot. The person normally needs to stay in hospital when this is given as it can cause bleeding. You may also be asked to wear compression stockings to bring down the swelling. What are the complications of a DVT?Bits of the blood clot can break off and travel around the body, affecting the heart or lungs. After having a DVT, the leg can remain swollen and ulcers may develop. How is DVT prevented?If you are travelling or are hospitalised, you can reduce your risk of developing DVT by wearing compression stockings, moving your feet and legs as much as possible, and drinking plenty of water. If you have already had a DVT, it is very important to quit smoking, keep fit and maintain a healthy weight. Some people may need to stay on low-dose anticoagulant medication long-term or use it prior to long haul flights. |
What causes deep vein thrombosis
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