Thrombosis: Therapy

General measures

  • Immobilization is not required for venous thrombosis of any localization and morphology! This serves exclusively to relieve the symptoms of severely painful leg swelling (regardless of thrombus localization and morphology). In contrast, mobilization is an important measure. Note: A regularly performed anticoagulation should be present, however.
  • 3 x L and 3 x S rule: “prefer walking and lying” and “sitting and standing is bad”.
  • As early as possible compression bandage or fitted compression stocking to reduce acute clinical symptoms (edema and pain) and the frequency and severity of post-thrombotic syndrome (PTS).
  • Stool regulation to avoid the need for forced abdominal press (prevention of pulmonary embolism).
  • Always wear compression stockings when sitting or lying down for long periods to prevent thrombosis.
  • Frequent movement, even during working hours, especially when working a lot in one and the same body position, serves significantly to prevent thrombosis.
  • Nicotine restriction (refrain from tobacco use).
  • Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
  • Limited caffeine consumption (max 240 mg of caffeine per day; equivalent to 2 to 3 cups of coffee or 4 to 6 cups of green/black tea).
  • Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program.
  • Review of permanent medication due topossible effect on the existing disease.
  • Travel recommendations in case of risk of thrombosis:
    • Before starting a trip participation in a travel medical consultation!
    • Long-haul flights (flight travel time > 6 h; “economy-class syndrome”) and longer longer train and bus rides avoid.
    • Pay attention to sufficient fluid intake!
    • Wearing loose-fitting clothing during the flight.
    • Wearing compression stockings (class 1-2) to below the knee.
    • If necessary, consider a drug thrombosis prophylaxis.

Conventional non-surgical therapy methods

  • Primary recanalizing procedure to reduce the incidence and severity of postthrombotic syndrome (PTS); indication: iliofemoral thrombosis esp. in young patients with low probability of bleeding
  • Anticoagulation with additional catheter treatment (pharmacomechanical, catheter-directed thrombolysis (PCDT)) to remove or crush the thrombus after instillation of tPA
    • In a study with PCDT, as many patients hdeveloped postthrombotic syndrome in the PCDT group as in the control group with anticoagulation alone (47 versus 48%; risk ratio, 0.96; 95 percent confidence interval, 0.82-1.11);major bleeding was more common in the first 10 days after PCDT (1.7 versus 0.3%).

Medical aids

  • Compression stockingsNote: documentation of leg circumference at a minimum of three measurement points at the start of treatment and every four weeks thereafter.

Vaccinations

The following vaccinations are advised, as infection can often lead to worsening of the present disease:

  • Flu vaccination
  • Pneumococcal vaccination

Nutritional medicine

  • Nutritional counseling based on nutritional analysis
  • Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
    • Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruits).
    • Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
    • High-fiber diet (whole grains, vegetables).
  • Observance of the following special dietary recommendations:
    • If necessary, stool regulation so that no forced abdominal press is required (prevention of pulmonary embolism).
    • Diet rich in:
      • Vitamins (vitamin C, E)
      • Trace elements (selenium)
      • Omega-3 fatty acids (marine fish)
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.