and decide the measures that are required to reduce your risk of deep vein
thrombosis.
Your risk begins with the immobility that is associated with post surgery.
• If immobility is necessary then your leg should be elevated to the
position higher than your heart. This will reduce the chances of
swelling of the foot.
• Keep moving your legs. You may try swinging the legs from the sides
of the bed frequently through the day. You may try to bend your knees
too. Keep as mobile as possible, subject to your doctor’s advice.
• Take the anticoagulants prescribed by your doctor before or after the
surgery.
• During surgery, you may be required to wear a sleeve-like device on
your legs to compress them and maintain the blood flow in the veins.
• Wearing compression stockings during surgery can regulate the flow of
blood and may prevent blood pooling in the veins.
• Elevating the foot of the bed helps to avoid the blood clotting too.
• Within any limits required by your doctor, start moving around as soon
as you can after the surgery, or even when you are ill.
• Usually, the sooner you get moving, the less chance you have of
developing blood clots.
• Do some exercise of the legs and calves, as often as possible in line
with what your doctor advises.
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Treatment of D.V.T.
Treatment begins after careful assessment of the test results and your
symptoms.
Your doctor has to decide the likelihood of:
• the clot growing or
• the clot breaking loose and moving to the lungs
The doctor’s opinion, after reviewing the test results, will affect the
medication and other treatment that you get.
If the clot is on the upper leg vein, your medication might continue up to 6
months. After that, your doctor will recommend the next step for you.
If your clot is in the lower leg vein then you might be using the medication
for six to twelve weeks. The doctor may start the medication straight away or
wait for twenty-four to forty-eight hours.
Clots that form in the deep veins in your legs and pelvis area may be
potentially hazardous when they break off and travel to the smaller veins
around the heart and lungs.
Deep Vein Thrombosis Medications
The main treatment form of deep vein thrombosis (D.V.T.) is anticoagulant
medications. Rarely are any other forms of medication prescribed for the
same.
Anticoagulants
Anticoagulants prevent formation of new clots and discourage the existing
clots from enlarging. However, they have no effect over pre-existing clots.
The functions of anticoagulants are to:
• Treat the existing D.V.T.
• Prevent formation of blood clots that are associated with certain types
of surgery.
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• Prevent further formation of blood clots in people who are prone to
D.V.T.
Heparin
Heparin is a medicine that thins the blood. Thinning of the blood prevents
blood from clotting and prevents the pre-formed blood clots from enlarging.
Heparin is injected into the vein or under the skin.
Patients that are getting Heparin often need to stay in the hospital as the
condition and the effect has to be closely monitored.
There are two types of Heparin:
• LMWH or Low molecular weight Heparin, one can inject this type of
heparin at home. This is less expensive and convenient.
• UH or Unfractionated Heparin, this type of heparin is given
intravenously or through the vein. Therefore, it requires monitoring
and should be given under medical care
Heparin starts its effect immediately and is continued with the patient until
the medication containing warfarin starts its therapeutic effect.
Warfarin
Warfarin is the main active ingredient of oral anticoagulants, for example
Coumadin®.
There are studies underway to check whether a low-dose warfarin medication
might be as effective as the conventional dose and whether it decreases the
chances of bleeding which are present with current recommended dosages.
The duration of the medication is still being researched. Generally, treatment
lasts for three to six months. But, the duration of the medication depends on
various factors:
• If your risk factor for developing deep vein thrombosis is a short-term
one; for example because of surgery, then the oral anticoagulant
therapy will be for a short period.
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• If you have a continuous risk factor such as cancer or recurrent blood
clots, then the anticoagulant treatment continues while the risk factor
is present.
• If you have a genetic blood clotting disorder, then you may have to be
on an oral anticoagulant for an indefinite period.
Thrombolytics
Thrombolytics are medications that dissolve the blood clots rapidly. They are
used to treat large clots or clots that have formed recently and are causing
severe symptoms.
Application of these medications can increase the chances of bleeding, so
they are used for specific situations, under strict medical supervision.
Thrombolytics are used in extreme situations.
Thrombin Inhibitors
Thrombin inhibitors are new medications that interfere with thrombin’s
action. Thrombin is necessary for blood to clot.
Aspirin
Aspirin helps to prevent blood clots and reduces the chances of pulmonary
embolism. Studies and research reveals that aspirin reduces the chances of
pulmonary embolism after surgery by up to 33%. Some studies also assert
that aspirin is beneficial for people who are at the risk of developing blood
clots.
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Clinical Treatment of Deep Vein Thrombosis
Deep vein thrombosis needs immediate medical attention and requires
hospitalization. Hospitalization helps in proper monitoring of the medications.
The treatment for deep vein thrombosis varies from age to age, and from
person to person.
For newborns and infants, the course for medication is different.
It is always advisable that you consult your doctor for the right kind of
treatment before you ever start with self-medication.
The main objectives of treating D.V.T. (Deep vein thrombosis) are:
• To prevent any blood clot from growing larger
• To stop the blood clot from dislodging and traveling to your lungs
• To prevent occurrence of another blood clot in your veins
Once the inflammation of the vein is diagnosed, the patient is admitted to the
hospital for around fourteen days, for treatment with oral warfarin and IV
heparin.
Management of deep vein thrombosis (D.V.T.) means not just management
from the clinical point of view; it also involves management of the patient as
well.
Clinical Management
Compression Ultrasonography
The arrival of Compression Ultrasonography has changed the situation
greatly.
At the suspicion of D.V.T., the first test is Compression Ultrasound of the
femoral, calf trifurcation and popliteal (proximal) blood vessels.
If the ultrasound reveals proximal D.V.T., treatment starts immediately. If
the result is negative, the ultrasound is repeated again after two days and
then again after seven days.
If the result is negative, it rules out clinically significant D.V.T.
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Checking the Distal Calf Veins
Some think that D.V.T. of the distal calf veins are not dangerous, but it may
be when/if it spreads to the proximal veins. Then, serial ultrasonography is
done.
If there is no sign of progression, then the chances of pulmonary emboli are
rare.
However, when symptoms are found, then venography is done.
After a positive signal, the patient is likely to have a continuous intravenous
drip of heparin for four to six days, and then start the oral warfarin
treatment.
LMWH or the Low Molecular Weight Heparin
The advantage of LMWH over the unfractionated heparin is ready
bioavailability and the longer half-life; it is possible to give it once or twice in the day subcutaneously.
The patient's weight determines the dose and there are claimed to be lesser
chances of bleeding than when unfractionated heparin is used.
Medicines
There are medicines which treat deep vein thrombosis (D.V.T.) and some
designed to help prevent it.
Anticoagulants
The most common type of medication used to treat D.V.T. is anticoagulants.
They are also called blood thinners.
These medicines reduce the chances of clotting in the blood. They also
prevent the pre-existing blood clots from enlarging. However, these
medicines are unable to break up the blood clots that exist in the blood
vessel.
Blood thinners can be taken either as a pill or as an injection through a
needle or a tube that is inserted into the vein, a process known as IV
injection or intravenous injection.
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Heparin and warfarin are the blood thinners that are most often used in
treating deep vein thrombosis.
Heparin is given to the patient as an injection or through an IV tube, whereas
warfarin is given as an oral pill. Heparin comes in two different types and
your doctor will decide which option is most suitable for you.
Warfarin takes two to three days to start its healing process, but Heparin
acts sooner.
Your doctor may treat you with both at the same time or may just prescribe
one of them.
But, once the warfarin starts its healing procedure, heparin is discontinued.
Pregnant women complaining of deep vein thrombosis are generally treated
with only Heparin as warfarin is not a safe option for them.
Treatment for deep vein thrombosis with blood thinners may last from three
to six months.
The situations mentioned below may change the course or the length of the
treatment:
• If you have had blood clots before, your treatment may last longer.
• If the blood clot in your body appears shortly after surgery, then the
treatment may be shorter.
• If you are suffering from certain illnesses, such as cancer, you may
have to continue taking blood thinners as long as you are ill.
But, you need to be aware that the side effect of blood thinners is bleeding.
These situations arise if your blood becomes too thin. This can be life-
threatening to a patient.
The bleeding is inside your body. Therefore, people who are treated with
blood thinners, are advised to have a regular blood test to measure their
blood’s clotting ability. These tests are the PTT and PT tests.
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These tests are indicators to help the doctor check whether the amount of
medicine prescribed to you is right. If you bruise easily or bleed, this may be
due to too much thinning of your blood.
Then, you need to contact your doctor as soon as possible.
Thrombin Inhibitors
These medicines obstruct the process of blood clotting. They are used to
treat patients who cannot take Heparin.
Thrombin inhibitors prevent and treat D.V.T. The direct thrombin inhibitors
help to prevent the clots from interfering with the protein, thrombin.
Thrombin is considered the chief constituent in making the blood clot. These
medicines inhibit circulation.
Heparinoids
Heparinoids are compounds similar to heparin. They reduce the ability of the
blood to clot. Heparinoids are prescribed only after surgery to reduce the
chances of deep vein thrombosis in a patient.
They do not affect blood clots that are already there; but they prevent
formation of new ones.
Heparinoid are injected into the patient and they require monitoring, like
heparin. Patients can also use them at their home.
Thrombolytics
These dissolve the blood clot very quickly and are used in conditions where
the blood clots are massive and show the potential of causing serious
symptoms.
These medicines are only used when the condition is very severe because the
side effects of thrombolytics can be sudden bleeding.
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Other Treatments for D.V.T.
Graduated Compression Stockings
Graduated compression stockings are a special type of stocking that may
reduce swelling that is likely to follow a blood clot in your leg. These
stockings are knee length. They are light around the ankle and loosen up as
they move up the leg.
This helps to create a gentle pressure on the leg. This pressure is very
effective in preventing the blood from pooling and clotting.
A person with deep vein thrombosis should wear these stocking for a year,
once deep vein thrombosis is diagnosed.
Vena Cava Filter
A vena cava filter is used in conditions when you cannot take blood thinners
anymore or when, despite taking blood thinners, your body is continuously
developing blood clots.
This process involves inserting a filter in the large vein, vena cava.
These filters are also called the ‘umbrellas’ because their wire spokes
resemble an umbrella’s wire. This filter prevents the blood clots that have
dislodged and are traveling towards the lungs from reaching the lungs.
However, this process cannot stop formation of new blood clots.
Bed Rest
People with D.V.T. usually need bed rest until there is some relief in the
symptoms. The legs must be elevated so that they are above the heart.
This position will reduce the chances of swelling in the foot.
Application of the moist heat to the affected area can serve as a pain
reliever.
Dietary Considerations
Maintain a well-balanced and normal diet every day. This is because the
quantity of vitamin K in the body affects the working of warfarin. Inconsistent
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and unusual food consumption that has high amount of vitamin K may affect
the action and safety of warfarin.
Foods that are high with vitamin K are spinach, broccoli, liver, cauliflower,
kale, cabbage and dark green vegetables. You should avoid a vegetarian diet
that is rich in vitamin K while you are being treated with Warfarin.
If you are using any vitamin products or dietary supplements, check with
your doctor to be sure that they are not high in vitamin K.
You must avoid consumption of alcohol while under this medication because
this may increase the chances of bleeding in the stomach.
Surgery
If the blood clot or the embolus detaches from the blood vessel and moves
into the bloodstream, then surgery may be required to prevent the clot from
reaching the lungs.
But, surgery is the last resort, where the blood clot is removed from the
veins. During the surgery, the patient receives heparin with anticoagulant
therapy and then Warfarin for at least 6 weeks to 3 months after the
operation.
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Treating D.V.T. in Children
Children older than two months are mostly given intravenous heparin.
The treatment with heparin continues for five to ten days simultaneously with
oral anticoagulation.
Treatment of Newborns
The best possible treatment for anticoagulation in treating newborns with
deep vein thrombosis and pulmonary embolism is not certain. If
anticoagulation is used, it should be for a short course just lasting ten to
fourteen days. Intravenous heparin should be used.
A further clinical investigation needs to be done about the best course of
treatment with newborns.
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Alternative Treatments for Deep Vein Thrombosis
Deep vein thrombosis (D.V.T.) can be fatal if proper medical treatment is
not offered in time.
Some people claim that other alternative therapies can be combined with the
emergency treatment to help the clot dissolve faster and prevent the clot
from recurring in the future.
Alternative therapy starts with one being aware of the disease. The more you
are aware and the more you know about the signs and symptoms of deep
vein thrombosis, the better.
However, before you proceed with the alternative therapy, it is highly
recommended that you consult your doctor and follow his or her
recommendations fully.
If you do try alternative treatments, only consult trained and certificated
practitioners, because of the severity of the condition.
Soy and Pine-bark:
Soy and pine-bark are claimed by some to be a non-toxic natural
nutraceutical. One product claims that it has property to prevent D.V.T.
(deep vein thrombosis) but there is no independent science-based
corroboration of this claim.
The natural ingredient Pycnogenol, extracted from the maritime pine bark, is
claimed by some to have natural anti-inflammatory properties, which may be
beneficial for the cardiovascular system.
Garlic
Garlic is claimed by some to be helpful in reducing thrombosis and platelet
aggregation or plaque formation in the body.
Garlic is also supposed to have anti-clogging properties that prevents the
blood from clogging. Some people include garlic in their diet every day.
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If you are using aspirin, it is recommended that you do not take garlic
supplementation.
Water
Avoid dehydrating agents as far as possible because they cause the blood to
thicken and encourage deep vein thrombosis. Coffee, tea and alcohol have
the property of dehydrating the body.
Avoid them as much as possible, whenever you are traveling. Instead of
alcohol or coffee, have water. To enhance the taste, you may also add a dash
of lemon to your water.
Compression Stockings
Compression stocking are knee-high and fit very comfortably. Elastic
compression stockings are beneficial for people who are at risk of developing
deep vein thrombosis.
You must wear the stockings from the first month of the diagnosis of deep
vein thrombosis and must continue wearing for a minimum of one year for
best results.
Exercise
Exercise is another factor in reducing your risk of D.V.T..
As you grow older, you may tend to become less active, but the more active
you are, the better the chances of not developing D.V.T..
You need to keep your weight and your blood pressure under control.
Exercise is a great way to moderate both.
Walking: The more you walk, the more your leg muscles remain firm and fit.
There is less chance of developing clots in legs that are always active.
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Non-prescription Treatments for Deep Vein Thrombosis
The focus with any non-prescription treatment for deep vein thrombosis is
safety and they should never be considered without prior consultation with
your medical professional and only as a companion to your continuing use of
the anticoagulants because of the high risk of bleeding with this condition.
The first important point of deep vein thrombosis treatment is awareness. If
you are prone to deep vein thrombosis; have a genetic disorder or family
history, then you must be very cautious. However, knowing about the
disease itself is taking the first step of prevention.
If you have deep vein thrombosis, you must manage your diet properly. Do
not suddenly change your eating habits or include food in your diet that is
vitamin K rich. Those foods may interfere with the anticoagulant’s action and
make your blood clot too easily.
Check the components of your current diet.
Here are some non-prescription treatments that some people claim may be
beneficial for you:
Nattokinase:
Nattokinase is an enzyme that is derived from natto, a Japanese preparation
made of boiled and fermented soybeans.
Natto is claimed to enhance cardiovascular health. Many Japanese have
made it a part of their diet over many centuries.
They claim that some studies show nattokinase dissolves or even prevents
blood clots. It is also claimed to prevent heart attack, senility, hardened
arteries, stroke and angina.
They take nattokinase with or without having other food at the same time
but, if you are taking blood-thinning drugs, it is strongly recommended that
you