A doctor at Department of Haematology, Singapore General Hospital (SGH) explains how they decide between treatment options when one is diagnosed with deep vein thrombosis (DVT).
How is deep vein thrombosis (DVT) diagnosed?
When someone goes to the A&E (the accident and emergency department of hospitals) or his general practitioner with deep vein thrombosis (DVT) symptoms, he will be put through tests such as validated scoring algorithms and the D-dimer, or CT and MRI scans.
Treatment of deep vein thrombosis (DVT)
Anticoagulant drug versus thrombolytic drug
If the condition is confirmed, the first thing to do is “prevent more clots from forming, while giving the body a chance to melt the (initial) clot,” says
Associate Professor Lee Lai Heng, Senior Consultant,
Department of Haematology,
Singapore General Hospital (SGH), a member of the
SingHealth group. Thus, anticoagulant drugs are the mainstay of treatment.
If there is a large limb- or life-threatening clot, a strong dose of a thrombolytic drug might have to be given to try and dissolve it, but that would put the patient at risk of bleeding.
“A thrombolytic drug is used to dissolve blood clots in stroke or heart attack situations. In such instances, the blood clots are very small but situated in strategic positions where they can cause massive damage,” explained Prof Lee.
So the usefulness of using drugs to dissolve a large blood clot has to be weighed against the risks, especially in situations where the clot has to be dissolved quickly instead of waiting for the body to do its work.
Administering thrombolytic drugs, a procedure performed by an interventional radiologist or surgeon, is not commonly done.
Other treatment methods: Surgery and inferior vena cava (IVC) filter
If a patient diagnosed with DVT is also at high risk of developing a pulmonary embolism, but cannot use anticoagulant drugs because he is at risk of bleeding, an inferior vena cava filter may be used to prevent the blood clot from travelling towards the lungs.
Such filters can be removed later, and anticoagulant drugs started as soon as the risk of bleeding subsides.
In extreme cases, surgery can be performed to remove clots, in particular life-threatening clots in the lungs.
Preventing deep vein thrombosis (DVT): Another reason to drink more water
People who are at greater risk of developing DVT should:
- Drink enough water to prevent dehydration
- Do leg exercises on long-haul flights
- Get up to walk and stretch, or at least move the legs, when sitting for long periods of time
- Wear compression stockings to promote blood circulation
To find out if you are at risk of DVT and its symptoms, see previous page.