Diseases

Deep Vein Thrombosis (DVT)

The aim of treatment is to prevent
  • death from pulmonary thromboembolism
  • recurrence of DVT
  • the post-thrombotic syndrome.
In most cases, this is achieved with anticoagulants, like Heparin and Warfarin (or Sintrom). We initially administer some form of Heparin in subcutaneous injections for 5-7 days and then it is decided whether the injection therapy will continue for several months or whether it will be replaced by Warfarin tablets. In recent years, new anticoagulants have emerged. Rivaroxaban (Xarelto), a direct inhibitor of activated factor X (factor Xa), has been licensed for the treatment of DVT and prevention of recurrent DVT in the United Kingdom (www.nice.org.uk/TA261) since 2012, and more recently in Greece. It is given orally and does not require routine anticoagulant monitoring, but is more expensive than Warfarin. Thrombolytic agents, i.e. drugs injected directly into the clot of the vein with a fine catheter may dissolve even large clots. However, the risk of bleeding (particularly in the brain) is higher than that of anticoagulants, and, therefore, thrombolysis is usually reserved for young people and in special cases, such as quite extensive DVT of the iliac or ilio-femoral venous axis causing significant leg swelling. For safer thrombolysis for DVT in a lower limb, a temporary filter in the inferior vena cava may be inserted prior to the lysis. Permanent inferior vena cava filter insertion has certain indications. Surgical removal of a vein clot is rarely performed today and only in very serious cases of DVT, when the leg viability is threatened. Following an episode of DVT, the use of a graduated compression stocking (of suitable size and class) is highly recommended mainly with the goal to prevent the post-thrombotic syndrome, i.e. chronic venous insufficiency; this may occur as a result of reflux of blood in the veins which have undergone damage in their valves because of the thrombosis. Generally speaking, the risk of developing post-thrombotic syndrome is reduced if anticoagulation is commenced early after an episode of DVT, and if a compression stocking is properly used for a period of at least two years. Your vascular surgeon will advise you regarding the type of stocking which is best for you and how it should be used.

You should avoid standing for long periods of time and having a sedentary life. If you need to remain seated, don’t sit with the legs bent for hours, but stretch your legs out from time to time, and move your feet up and down at the ankles or stand up and stretch your legs. Some data (

If you are planning to have surgery – Appropriate measures of prophylaxis will be taken by your surgeon depending upon your risk for DVT. These may include anticoagulation, antithromboembolism stockings, early ambulation etc.

If you are planning to travel – Do not wear tight clothes. Move your feet up and down at the ankles, stretch your legs and go for a walk up and down the aisle. Do not get dehydrated: drink plenty of water and avoid alcohol drinks. If you are a person at high risk for DVT, ask your doctor if you need to use compression stockings during your travel or even have Heparin injections.

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