Deep Vein Thrombosis Treatments and Medications

Blood clots are part of the body’s healing process. Sometimes, however, unnecessary blood clots form inside the bloodstream and cause problems such as a pulmonary embolism, heart attack, or stroke, all of which are serious and life-threatening. Deep vein thrombosis happens when a blood clot forms inside a deep vein, usually in a leg. A deep vein blood clot can develop into a serious condition if it breaks loose. If it’s diagnosed in time, treatment can keep the hazard in check while the blood clot slowly breaks apart. Fortunately, DVT can be successfully treated with anticoagulants, medications that help to thin blood and reduce the body’s ability to form future blood clots. Early diagnosis, however, is critical in preventing potentially fatal complications.

How is deep vein thrombosis diagnosed?

Deep vein thrombosis is diagnosed based on risk factors, symptoms, a D-dimer test, and ultrasonography.

History and physical examination

A thorough history will help the physician identify risk factors such as:

• Immobility (bed rest, operations, long flights)

• Injury to the vein (injury, intravenous drug use, surgery, history of DVT)

• Conditions that increase blood clotting risk (dehydration or thrombocytosis)

• Conditions that increase coagulation (genetics, cancer, sepsis, heart failure, estrogen birth control pills, burns, smoking, high blood pressure, or diabetes)

• Conditions that increase the risk of blood clots (surgery, cancer, pregnancy, or obesity)

During the exam, the physician is also looking for symptoms of DVT, such as:

• Localized pain, swelling with tenderness, and/or redness over the site in question

The healthcare provider will use a scoring method to determine the clinical probability of DVT. The initial exam can be performed by a general practitioner or urgent care provider, but they might refer the patient to a hematologist (an internist who specializes in blood conditions) or even a vascular surgeon for further assessment and management.

D-dimer test

A D-dimer test alone cannot be used to confirm a DVT but can help rule out a DVT in patients who are at low to intermediate risk based on the history and physical. D-dimer is a leftover product of the blood clotting process, so a D-dimer test can determine if blood clots are forming in a person’s body. If the test comes back negative in a low-risk patient, there is a very minimal chance the patient has a DVT. If the test comes back positive, the healthcare provider will order an ultrasound for confirmation.

Ultrasonography

An ultrasound is a fairly accurate test for DVT. It can determine the presence and size of a blood clot, and how much of the vein is blocked. It is the first test given for patients with a high probability of DVT or to any patient with a positive D-dimer test. 

Venography

Venography is an expensive and more invasive procedure that is only performed when an ultrasound is uncertain, which may happen if the clot is in the calf. A contrast dye is injected into the bloodstream, and the nearby veins are imaged by X-ray to assess blood flow through the veins.

Deep vein thrombosis treatment options

DVT treatment focuses on preventing complications such as pulmonary embolism or post-thrombotic syndrome (PTS) using anticoagulant medications to prevent further blood clotting. For severe cases or patients who cannot take anticoagulants, a small blood clot filter can be implanted in the vein that runs to the heart.

Anticoagulant medications

Anticoagulants are the central pillar of DVT treatment. Depending on whether the DVT episode requires hospitalization, treatment may begin in a hospital setting with injectable anticoagulants due to their fast onset of action and predictable duration of action. Once the patient is stabilized, they can be treated on an outpatient basis with oral anticoagulants. Patients who do not require hospitalization may avoid injectable anticoagulants altogether and be initiated on an oral anticoagulant with close monitoring. The usual duration of therapy is at least three to six months. Patients with recurrent DVTs and/or other underlying conditions, such as cancer, typically receive therapy for longer.

Catheter-directed thrombolysis (CDT)

For severe DVT, a vascular surgeon will insert a catheter into a vein and inject a clot-breaking medication directly into the blood clot, called a thrombolytic. Clot-breaking medications have a high risk of causing internal bleeding, so CDT allows for a very small dose to be used. This approach has demonstrated a reduction in progression to PTS by preventing venous scarring. 

Mechanical devices

Mechanical devices are often used to improve blood flow as a preventative measure. These include compression stockings, intermittent pneumatic compression (IPC), and the venous foot pump.

Surgery

In severe cases or for patients who cannot safely take anticoagulants, surgery may be used to remove the blood clot via thrombectomy. Patients who cannot be put on anticoagulants will most likely have a filter implanted in the inferior vena cava (IVC), the large vein in the middle of the body that carries blood from the lower body to the heart. The inferior vena cava filter is implanted with a catheter and catches any blood clot that comes loose, preventing that blood clot from reaching the lungs and causing a pulmonary embolism. Depending on the patient’s risk for forming blood clots, the IVC filter may be installed permanently or removed after a few months.

Types of deep vein thrombosis medication

Deep vein thrombosis is treated with anticoagulants. Anticoagulants, often referred to as blood thinners, work at different parts of the blood clotting process to help prevent blood clots from forming. In severe cases, deep vein thrombosis may also be treated with medications that dissolve blood clots. 

Antithrombin activators

Antithrombin activators are fast-acting blood thinners and a first-line therapy for DVT. They are intended to quickly slow down and stabilize blood clotting. The most commonly prescribed are low molecular weight heparins (LMWH) such as enoxaparin, but unfractionated heparin (UFH) may be used in certain patients, such as those with kidney failure. Heparins, however, can have serious side effects. If they arise, healthcare providers may prescribe a similar drug called fondaparinux. 

Vitamin K antagonists (VKAs)

Vitamin K antagonists prevent cells from converting vitamin K into a version that can be used to form active blood-clotting factors. Warfarin was historically the first-line anticoagulant prescribed after a patient had been treated with enoxaparin or fondaparinux. Warfarin, however, has a narrow therapeutic range, so patients require close monitoring of the drug through regular blood work. 

Direct oral anticoagulants (DOACs)

Direct oral anticoagulants (DOACs) block proteins involved in blood clot formation. For DVT, DOACs include Xarelto (rivaroxaban), Eliquis (apixaban), Savaysa (edoxaban), and Pradaxa (dabigatran). All have similar efficacy to warfarin, but have a wider therapeutic range and do not require continual blood work monitoring.

Thrombolytics

Thrombolytic (“clot-dissolving”) medications break up blood clots and are most commonly prescribed for patients immediately after a stroke or heart attack due to a clot. Alteplase is one thrombolytic used in DVT patients, but only in very small doses injected directly onto the blood clot using catheter-directed thrombolysis (CDT). 

Over-the-counter DVT medicine

In some cases, patients may require aspirin in combination with a blood thinner, such as Xarelto. In many cases, however, taking aspirin or an NSAID (such as ibuprofen) with a blood thinner can increase bleeding risk. Any over-the-counter medicine should only be taken under the recommendation of a healthcare provider. 

Anticoagulant treatment of DVT follows well-researched protocols and is closely monitored. The “best” medication may vary depending on pre-existing conditions and side effects, and can only be determined by a healthcare provider. Below are some commonly prescribed drugs for deep vein thrombosis.

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Best medicine for deep vein thrombosis