Venous thromboembolism (VTE) is the medical term for blood clots that form in veins. VTE includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). When a blood clot forms in the lungs, it is called a pulmonary embolism.  Deep vein thrombosis (DVT) occurs when a blood clot forms in the deep veins of the thigh, lower leg, and pelvis. 

The CDC estimates that 900,000 Americans are affected by venous thromboembolism each year. The condition is responsible for up to 100,000 deaths. But effective medications and treatments are available to treat DVT (blood clots in the legs). 

Please continue reading to learn more about medications and treatments for deep vein thrombosis.

What causes deep vein thrombosis?

Anyone can develop deep vein thrombosis, but some people are at higher risk. Some of the risk factors for DVT are listed below. 

• Lack of mobilization: A blood clot can form in your leg if you don’t move for long periods, such as during long-distance travel on a plane or in a car. The risk for blood clot is also higher with bedrest over an extended recovery period after an accident, illness, or surgery. 
• Surgery: veins can be damaged during surgery, leading to a higher risk of blood clots.
• Inherited blood clotting disorders: Factor V Leiden, Protein C, and Protein S deficiency are some examples of inherited conditions that put a person at higher risk of blood clotting.
• Certain chronic health problems: Blood clots can form in people who have certain medical conditions that affect blood clotting or blood flow, such as heart failure, inflammatory bowel disease, and certain cancers. 
• History of DVT: People who have had DVT before are at risk of developing further blood clots. A family history of DVT also puts you at a higher risk for blood clots.
• Being overweight or obese: Obesity puts pressure on the leg veins and pelvis and increases your risk of deep vein thrombosis. Pregnant women are at high risk for the same reason, especially those with a genetic blood clotting disorder.
• Hormonal therapy: Medications such as oral contraceptives and hormone replacement therapy can increase your risk of DVT because they make your blood more likely to clot. 
• Smoking: Smoking changes the surface of blood platelets, making it easier for platelets to stick together, thus, increasing the risk of blood clots.  
• Age: Though blood clots can occur at any age, older adults (age 60 plus) are at a higher risk. 

What are the symptoms of a blood clot forming in the legs?

Deep vein thrombosis (DVT) symptoms include leg swelling, leg pain, cramps and soreness in the calf, a warm feeling on the affected leg, and changes in skin color on the affected leg (red or purple).

Pulmonary embolism is a medical emergency. You should seek emergency medical care without delay, as it can be life-threatening. Without any warning signs of a DVT, PE can present with sudden shortness of breath, rapid breathing, chest pain (worsened with cough or deep breath), rapid pulse, dizziness, fainting, or coughing up blood.

Keep in mind that if you have symptoms of a DVT, you should contact your doctor immediately. At the first sign of a PE, you should go to the nearest emergency room to be treated as soon as possible. 

What are the complications of deep vein thrombosis?

Deep vein thrombosis is a serious condition. If left untreated, there is a risk of a blood clot breaking loose. Blood clots that break loose can travel through the blood vessels to vital organs such as the heart, lungs, and brain, causing life-threatening blockages in blood supply and potentially shutting them down. 

Also, one-third to one-half of all patients with deep vein thrombosis (DVT) experience long-term complications called post-thrombotic syndrome with pain, swelling, skin discoloration, and skin sores on the affected limb.

How do doctors diagnose DVT?

Healthcare providers diagnose DVT based on your symptoms, medical history, physical examination, laboratory tests, and imaging studies.  

• Blood work: Standard lab tests for all components of your blood in addition to lab tests to measure kidney function and electrolyte blood levels are standard laboratory orders when you go to the emergency room. However, D-dimer is the specific blood test if you have DVT symptoms. D-Dimer is a protein that is elevated in people with DVT. A high level of D-Dimer is considered a marker for severe DVT.  
• Imaging tests: Most of the time, imaging studies are ordered along with blood tests to diagnose DVT. Duplex ultrasound, venography (using X-ray and dye), or magnetic resonance imaging (MRI) are imaging tests to diagnose DVT.

Is DVT curable by medicine?

Yes, deep vein thrombosis (DVT) can be treated with injectable or oral blood thinning medications. There are different options with older anticoagulants like warfarin, heparin, and newer agents such as rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa).

The duration of DVT treatment is at least 3 months. There are different options for blood-thinning medication; your doctor will help you choose one that is a good fit for you. It’s important to take these medications exactly as directed. However, taking warfarin will require more frequent monitoring compared to other medicines. Regardless of the type of blood thinner, you should take your medication regularly and follow your doctor’s recommendations. Compliance with blood thinning treatment is vital to prevent complications down the road.     

What is the most common treatment of deep venous thrombosis?

The goal of DVT treatment is to prevent an existing clot from getting bigger, prevent new clots from forming, and prevent a clot from breaking loose and traveling to a vital organ. Treatment options for DVT include the following:

Blood thinners

Blood thinning medications, also referred to as anticoagulants, prevent an existing blood clot from getting bigger and prevent blood clots from forming in the future. There are blood thinner pills as well as injections that go into a vein or inject under the skin. 

Thrombolytics

Also called clot busters, thrombolytics are used to treat large clots of DVT or PE. They may also be given when other medications do not work. These drugs can dissolve an existing clot quickly. They are injected directly into the vein of an arm or leg. However, like anticoagulants, thrombolytics carry a risk of excessive bleeding. Examples of these clot busters include streptokinase, urokinase, and alteplase.

IVC filters

If you cannot take blood thinners, your doctor may recommend putting an IVC filter in your inferior vena cava, which is a large vein in your abdomen. If more blood clots form, inferior vena cava filters catch the clots before they move to the heart and lungs.

Compression stockings

Special socks called compression stockings or support stockings can help prevent the pooling of blood in the legs. They can provide relief from DVT symptoms like discomfort and swelling. Compression stockings may also reduce the risk of more clots developing. 

Which type of drug is a first-line medication treatment for deep vein thrombosis?

Direct oral anticoagulants (DOAC) are the newer class of blood thinners. DOACs are recommended as first-line treatment for acute PE or DVT. In addition to Savaysa (edoxaban), Xarelto (rivaroxaban) and Eliquis (apixaban) are two commonly-prescribed DOACs. These anticoagulants are preferred over warfarin, a vitamin K antagonist.

Direct oral anticoagulants offer flexibility in daily life since you don’t have to have a strict diet compared to warfarin. Patients on warfarin have to be careful with the type of food and the amount being consumed, as dietary fluctuation can affect the amount of warfarin in the blood. DOACs also do not have as many drug interactions as warfarin.

Above are some of the reasons why blood thinners like Xarelto and Eliquis are the preferred therapy for most people. DOACs may not be safe if you have severe kidney disease, moderate to severe liver disease, or if you have an autoimmune disease called antiphospholipid antibody syndrome. DOACs are not recommended for pregnant women as they can be harmful to unborn babies.

How can I prevent DVT?

Lifestyle changes such as quitting smoking and maintaining a healthy weight can lower your risk of blood clots and help prevent DVT. It’s also important to be active and try not to have a long period of immobilization. For example, during a long plane or car ride, you should stretch, stand, and walk periodically. Avoid crossing your legs while sitting, as this can block blood flow.

References:

1. https://www.cdc.gov/ncbddd/dvt/data.html
2. https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/symptoms-causes/syc-20352557
3. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2020/10/08/15/01/american-society-of-hematology-2020-guidelines#:~:text=Use%20of%20direct%20oral%20anticoagulants,disease%2C%20or%20antiphospholipid%20antibody%20syndrome.