If the suspicion of thrombosis is confirmed, treatment must be given as soon as possible. This is because if the blood clot detaches from the vessel wall (embolism), it can travel with the bloodstream to the right side of the heart and from there into the pulmonary circulation. If it clogs a pulmonary artery there, a pulmonary embolism occurs, which in the worst case can be fatal. In addition, thrombosis can cause venous weakness as a late consequence.
Thrombosis therapy: anticoagulation and thrombolysis.
Most commonly, thrombosis is treated with anticoagulant medications. Most commonly, heparin is used, which is injected either under the skin or into a vein. This prevents the growth and spread of the blood clot and significantly reduces the risk of pulmonary embolism.
Less commonly, a procedure called thrombolysis is performed. In this case, the blood clot is dissolved with the help of active substances such as streptokinase or urokinase, thereby reopening the vein. However, the risk of internal bleeding is higher with this method than with treatment with anticoagulant drugs.
Therefore, risk and benefit are weighed particularly carefully before thrombolysis. It is mainly used when a pelvic vein or several veins are affected at the same time (multi-vein thrombosis) and the thrombosis is not older than seven days.
With both methods, longer-term anticoagulation with so-called vitamin K antagonists such as Marcumar is also started after a few days to reduce the risk of a new thrombosis (recurrence).
Surgery rarely necessary for thrombosis
Surgical removal of the blood clot using a catheter is very rarely necessary. Surgery is performed only if a thrombosis has formed in the vena cava or if the thrombosis has narrowed the arteries of the affected arm or leg.
Surgery may also be considered if thrombolysis would be necessary but cannot be performed because of contraindications such as previous injury or bleeding.
Exercise as an adjunctive measure
Contrary to earlier prevailing opinion, bed rest is not necessary during treatment of thrombosis. According to recent findings, exercise does not increase the risk of pulmonary embolism and is even recommended to support therapy.
However, it is important to avoid heat applications in the area of the thrombosis, since heat dilates the vessels and can thus lead to detachment of the clot. Heavy straining during bowel movements can also increase the risk of embolism. Therefore, the use of stool-regulating agents may be appropriate.
Supplement treatment with compression
In most cases, compression treatment with elastic bandages or thrombosis stockings is given in addition to drug therapy. On the one hand, this improves the return flow of blood and lymph, and on the other hand, it reduces the risk of detachment of the clot. To prevent recurrence, compression should be continued consistently for several months to years.
