Deep Venous Thrombosis: Treatment

Patients with DVT should be initially treated with intravenous heparin in the hospital, or with subcutaneous low–molecular–weight heparin (LMWH) in an outpatient clinic, along with warfarin. Partial thromboplastin time (PTT) should be closely monitored when using IV heparin (this is not done with LMWH). Oral anticoagulation with warfarin should be overlapped with heparin until a therapeutic prothrombin time (PT) or International Normalized Ratio (INR) is reached.

PT and INR are used to monitor the effectiveness of anticoagulant therapy. INR is now the standard warfarin monitoring test, because it includes a mathematical calculation that corrects for the highly variable prothrombin time. Heparin is often administered before warfarin, because warfarin initially reduces protein C and S, thus inducing a hypercoagulable state. Uncomplicated DVT patients are generally treated for 3 to 6 months. Patients with multiple DVT episodes, high recurrence risk, associated PE, cancer, or coagulopathies may require prolonged or even lifetime warfarin anticoagulation.

If anticoagulation therapy is not viable (eg, patient has active hemorrhage), external compression devices are a mechanical alternative for DVT treatment. 

Patients are often admitted to the hospital for acute thrombosis above the groin (ie, suspected PE), presence of concomitant illness, morbid obesity, noncompliance with or poor response to oral anticoagulation, or lack of a caretaker.

Recommended treatment for this condition is elevation of the affected limb and application of warm compresses to the affected area.

Nonsteroidal anti–inflammatory drugs are contraindicated for DVT and PE because they may mask the symptoms of a new thrombus.

Surgical procedures for treatment of extensive DVT or PE include balloon or direct thrombectomy and insertion of inferior vena cava filters. Treatment with inferior vena cava filters is also indicated for patients with contraindications or poor response to anticoagulation, and for prophylaxis in high–risk patients.