Therapy

If deep vein thrombosis of the leg has been diagnosed, the doctor will initiate a so-called acute therapy. Here, the aim is to prevent pulmonary embolism, to prevent the spread of the thrombosis and to make the vessel pass through again (recanalization) and to avert secondary diseases such as postthrombotic syndrome. Compression treatment is started for this purpose.

First, an elastic wrap bandage is applied, since the leg is still swollen and a compression stocking adapted to the patient would not be appropriate. Once the swelling has subsided, a compression stocking is fitted, which must be worn during the day for at least 3 months. In addition, the patient should make sure that he or she gets enough exercise.

If there is too much pain or a pulmonary embolism, bed rest is usually ordered. In addition to these general measures, a drug therapy is carried out. Blood-thinning medication is given for at least 5 days.

The blood is thinned in the vein by means of low-molecular-weight heparin (NMH) such as Clexane®, so that a new clot formation is prevented. Factor Xa inhibitors such as Fondaparinux can also be given. Clexane® must not be given if the kidney is weak.

In this case, so-called unfractionated heparins (UFH) are used. Xarelto® represents another alternative. This drug contains the active ingredient rivaroxaban and inhibits coagulation factor X, which is very important for the formation of clots.

In contrast to heparins, Xarelto is administered orally as a tablet and not into the vein. The third goal, recanalization, is achieved by means of so-called thrombolysis or fibrinolysis. This is intended to dissolve the clot that has formed.

Various drugs can be used to dissolve the thrombus, such as streptokinase or urokinase. A surgical method to remove the thrombus is thrombectomy. In this procedure, the thrombus is removed from the vessel using a catheter.

This procedure is mainly used to remove clots in the pelvic veins in young patients or to prevent a limb amputation. Emergency measures are followed by maintenance therapy with coumarins (vitamin K antagonists). How long therapy is necessary depends on the circumstances and risks of developing a new thrombosis.

Thus, a therapy can last at least 3 months up to 1 year. Compression stockings are an important part of the treatment of deep vein thrombosis. For this purpose, a class II compression stocking is fitted to the patient, which exerts a mean pressure of approximately 25-30 mmHg on the leg.

The external pressure is intended to accelerate the blood flow in the direction of the heart. This is also important to prevent secondary damage such as postthrombotic syndrome.It is important that compression stockings can either be put on by the patient himself/herself or that a nurse or assistant takes over this work, as the compression stocking cannot fulfil its task or cannot do so sufficiently without correct application. Compression stockings are reimbursed by the statutory health insurance.