Anticoagulation
The mainstay of DVT and PE treatment is blood thinners (anticoagulation). Currently, the American Academy of Family Physicians recommends that anticoagulation should be maintained for 3 to 6 months for DVT or PE that has been attributed to transient risk factors, such as a long car ride, recent surgery or trauma. Anticoagulation for DVT of unknown cause or recurrent DVT continue for more than 12 months but the appropriate duration of anticoagulation beyond 12 months is not definitively known. However, there is evidence of substantial benefit for extended-duration therapy. Your doctor should weigh the benefits, harms, and patient preferences in deciding on the duration of anticoagulation. In addition to anticoagulation, compression stockings should be used routinely to prevent postthrombotic syndrome, beginning within 1 month of diagnosis of proximal DVT and continuing for a minimum of 1 year after diagnosis.
Catheter Directed Thrombolysis (Clot-Busting) Treatment
Catheter-directed thrombolysis is performed under imaging guidance by interventional radiologists. This procedure, performed in a hospital's interventional radiology suite, is designed to rapidly break up the clot, restore blood flow within the vein, and potentially preserve valve function to minimize the risk of post-thrombotic syndrome. The interventional radiologist inserts a catheter into the popliteal (located behind the knee) or other leg vein and threads it into the vein containing the clot using imaging guidance. The catheter tip is placed into the clot and a "clot busting" drug is infused directly to the thrombus (clot). The fresher the clot, the faster it dissolves - one to two days. Any narrowing in the vein that might lead to future clot formation can be identified by venography, an imaging study of the veins, and treated by the interventional radiologist with a balloon angioplasty or stent placement. Clinical resolution of pain and swelling and restoration of blood flow in the vein is greater than 85 percent with the catheter-directed technique.
In patients in whom this is not appropriate and blood thinners are not medically appropriate, an interventional radiologist can insert a vena cava filter, a small device that functions like a catcher's mitt to capture blood clots but allow normal liquid blood to pass.
