Therapy of venous thrombosis

Deep vein thrombosis - treatment at a glance

A deep vein thrombosis in the lower leg can usually be treated on an outpatient basis, whereas thigh and pelvic vein thromboses are usually treated in hospital. The following treatment options are used:

• Heparin is a medication used to thin the blood and is administered as an infusion. The medication reduces blood clotting and prevents the thrombus from growing further, being carried away or forming new blood clots.
• Low-molecular-weight heparins (LMWH) are similar drugs to heparin and are administered as an injection.
• Blood thinners (anticoagulants) in tablet form in the coming months: New oral anticoagulants (NOACs) such as dabigatran, rivaroxaban, apixaban and edoxaban. Vitamin K antagonists (coumarins) are also used, such as the active ingredients phenprocoumon or warfarin.
• Metal filter (vena cava filter): this is used if the patient must not be given any anticoagulant medication (e.g. due to a life-threatening risk of bleeding). This small metal filter is inserted via a catheter into the large vena cava in the abdominal cavity above the kidneys. It intercepts any blood clots that could migrate from the leg to the lungs.
• Compression bandage and compression stockings: reduce the risk of post-thrombotic syndrome
• Lysis therapy: In the case of severe thromboses, especially pelvic or inguinal vein thromboses, an attempt is made to dissolve the blood clot with medication as a venous infusion or via a catheter directly in the thrombus. One example of a lysis drug is recombinant tissue plasminogen activator (rtPA). Lysis drugs are very effective, but can rarely cause severe bleeding, which is why special monitoring is necessary.
• Surgically removing blood clots – surgical thrombectomy is the technical term for this. Thanks to minimally invasive options with special catheters, open surgery is rarely performed nowadays.

Deep vein thrombosis - Minimally invasive catheter therapy

For selected patients with severe thrombosis of the pelvic and leg vessels, minimally invasive catheter therapy represents a treatment option to reduce the risk of post-thrombotic syndrome. This involves either infusing a clot-dissolving medication into the immediate vicinity of the thrombus for several hours via a special catheter or suctioning the thrombus directly out of the vein using a special suction catheter. The advantage of direct thrombus removal using a suction catheter is that significantly smaller amounts of dissolving medication are administered, thus minimizing the risk of bleeding. Chronic narrowing of the pelvic vein is often found after thrombus removal, which is suspected to be the cause of the thrombus formation. These constrictions are then treated with the help of a vascular support (stent).