The usual treatment for deep vein thrombosis is to thin the blood using anticoagulants.
This usually entails injections of heparin which act immediately, whilst oral warfarin is started and stabilised. Warfarin combats the vitamin K in the body which is used for blood clotting. It is usually started by giving a loading dose for three days and then using blood tests to stabilise the right dose over the next few days to weeks.
The correct level is obtained by measuring the clotting time by a regular blood test – the “INR” (International Normalised Ratio). For DVT this should be kept about 2.0 – 3.5 x normal clotting – in other words, the time for the blood to clot should be 2.0 – 3.5 times longer than it would normally clot in that person.
The body is able to break down most clots by itself and so the heparin followed by the warfarin is merely there to stop any more clots forming whilst the body breaks down the deep vein thrombosis (DVT) that is already there.
Traditionally doctors have kept the warfarin going for three to six months. However, we now rescan the leg to make sure the blood is flowing before deciding whether the warfarin can be stopped or not.
Very rarely, if there is a massive deep vein thrombosis which is a risk of either blocking the veins completely or breaking off and going up through the system to the lungs (a pulmonary embolism), then either a clot busting injection called thrombolysis can be used to break down the clot, or a filter can be put into the veins to catch the clot if it breaks off.
Clots in the superficial veins are painful and locally inflamed and lumpy. Once the diagnosis has been confirmed, treatment is usually non-steriodal anti-inflammatory drugs such as Aspirin in those who can tolerate them.
Antibiotics are NOT needed as the inflammation is due to the clot in the vein and NOT infection.
In severe cases, the clot can be removed under local anaesthetic, reducing the pain, speeding up the recovery and improving the end cosmetic result.
In the longer term, the underlying cause needs to be treated – usually varicose veins.
Treatment of the post-phlebitic limb can be a very complex and demanding process – often requiring considerable time and expense.
Fortunately, most people who consult us having been told elsewhere that they have “complex veins” or a “post-phlebitic limb” actually turn out to have less severe and more easily treatable conditions once we have performed our specialised scans.
Those rare people who do have complex post-phlebitic limb are given a full diagnosis and explanation, and a full option of possible treatments are discussed. As these are many and varied, they cannot be easily summarised here.