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How do you treat chronic DVT?

This question was asked in Desert Hot Springs, California and has 10 answer(s) as of 05/23/2013.
How is chronic deep vein thrombosis (DVT) treated, and is there any difference in treatment between chronic DVT and acute DVT?


Doctors Answers (10)

Treatment for chronic DVT depends entirely on symptoms. If the patient has minimal symptoms then conservative treatment is usually ideal. In some cases even if the patient is very symptomatic there may be no other option but conservative treatment. Conservative treatment usually involves compression garments or compression wraps. Patients who have severe symptoms and have blockages in the veins that lead blood out of their leg can sometimes have something done to open up these veins. This technique involve specialized skills on the part of the physician to cross the blockage with a guide wire and place stents to reopen flow through the block veins.

Acute DVT should be treated with blood thinners. Once it becomes chronic it can cause scarring in the vein, and cause the veins to reflux. (Post Phlebitic Syndrome) Chronic DVT with swelling and skin changes should be treated with compression therapy. If there is an underlying clotting disorder with recurrent clots, then long term blood thinners may be warranted.

Acute deep vein thrombosis (DVT) is the development of a clot within veins and generally is thought of as being no more than a few days old. Chronic deep vein thrombosis is the presence of older clots within veins, usually at least two weeks old. Generally, both acute and chronic DVT have been treated with anticoagulant drugs in order to prevent development of additional thrombus (clot). Anti-coagulation does NOT "thin" the blood or "dissolve" the thrombus. In circumstances when there is a large amount of acute or sub-acute thrombus in large veins, a drug such as tPA is infused into the clot through a small catheter with the assistance of mechanical devices to improve the contact of the drug with the clot. In this case, the goal is to dissolve as much of the clot as possible in order to restore more normal venous flow. Chronic DVT usually cannot be dissolved with the thrombolytic drugs such as tPA so the goal is just to prevent more clot from forming with anticoagulants such as warfarin, one of the new anticoagulants, and/or one of the inject-able anticoagulants. Over time, the body often will break down some of the chronic thrombus. In other locations, the old clot may become a firm, rubber-like material and still other veins will shrink and scar closed. Occasionally, this will leave so much obstruction to venous blood flow that balloon angioplasty and stent techniques are used in the pelvic veins to reopen the flow channel out of the leg and pelvis. Almost all patients who have DVT should be placed in elastic compression hose as soon as the diagnosis is established.

Acute DVT when diagnosed early, and depending on the location and extent of the thrombus, is usually treated with an anticoagulant such as i.v. Heparin in the early stages and then the patient is switched to oral medication known as Coumadin which is a pill. This medication requires frequent blood tests to monitor the blood effectiveness. Depending on the associated complications and which organs have been affected by the DVT, you may remain on this medication for 3-12 months, and sometimes for life. Chronic DVT is referred to as the after effects of acute DVT. The affected vein undergoes a series of anatomical changes which result in partial occlusion and/or re-canalization of the affected vein. The changes seen on the ultrasound and/or other diagnostic modalities (MRI, CT, VENOGRAPHY) are mostly scar, rather than clotted blood. These chronic DVT changes cause some degree of impairment for the blood to return to the heart; as a consequence of this, the lower extremities become swollen, skin discolored and ulcers may develop along the lower third of the leg. It's possible to open up this chronically occluded veins with balloons and stents.

Anti-coagulation (or blood thinners medication) is the mainstay treatment modality for these two conditions. Additionally, a catheter may be placed inside of the chronic DVT to remove/dissolve it either mechanically or through medications. For patients who can't tolerate blood thinners, a filter is placed in the main vein in the abdomen called inferior vena cava.

The treatment of chronic DVT depends on it's age, usually consisting of compression therapy and/or anticoagulants.

Acute DVTs may have a specific cause that is temporary or removable such as following a surgery. Chronic (recurrent) blood clots in deep veins - typically of the legs, would require a detailed search for a formal diagnosis including an evaluation for hypercoagulable conditions (genetic or induced) and a possible screen for pregnancy or any occult (hidden) cancers. Treatment is long term anti-coagulation, and possibly placement of a wire screen device in the main vein returning to the heart (vena cava) to prevent any large clots from being able to travel up from the legs to the lungs.

You need to see your physician for appropriate evaluation of your condition in order to find the right treatment. There are multiple treatments possible. You must know the underlying cause and amount of damage inside the vein.

Yes, Acute DVT is treated for a specified time (usually 6 months) with anti-coagulation (usually injections followed by oral anti-coagulation). Chronic DVT as the name suggests requires chronic, often lifelong, treatment.

Acute deep vein thrombosis (DVT) is a newly formed blood clot and usually is treated with anticoagulation (blood thinners) and compression stockings. The blood thinner treatment can last from a few weeks to many years, although in most cases the anticoagulation treatment time is 3-12 months. Compression stockings should be worn for up to 2 years. Some studies have shown that long term use of aspirin once the anticoagulation medication is stopped helps prevent another DVT from forming. Chronic DVT is a blood clot that has been present for more than 3 months. Treatment depends on the cause of the DVT, prior history of blood clots, appearance of the DVT on ultrasound examination and venogram, presence of leg swelling, and overall health of the patient. Sometimes anticoagulation therapy is recommended, but sometimes anticoagulation is not necessary. Some doctors recommend long term use of aspirin. Long term use of compression stockings is indicated.

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