Acute DVT treatment encompasses interventional procedures to dissolve newly formed clots in leg deep veins and prevent complications.
What is Acute DVT?#
Deep Vein Thrombosis (DVT) is the formation of blood clots, usually in the deep veins of the legs. Acute DVT refers to thrombosis within the first 14 days from symptom onset.
Thrombosis Locations:
| Location | Frequency | Risk |
|---|---|---|
| Iliofemoral | 25% | Highest PE risk |
| Femoral | 35% | High |
| Popliteal | 25% | Moderate |
| Distal (Calf) | 15% | Low |
Acute DVT Risk Factors#
Virchow’s Triad#
Three fundamental factors for DVT development:
- Stasis: Prolonged immobility
- Endothelial damage: Vessel wall injury
- Hypercoagulability: Increased clotting tendency
Specific Risk Factors#
Transient:
- Surgery (especially orthopedic)
- Long plane/car travel
- Immobilization
- Pregnancy/postpartum
- Oral contraceptive use
Persistent:
- Cancer
- Thrombophilia (Factor V Leiden, etc.)
- Antiphospholipid syndrome
- Previous DVT history
Acute DVT Symptoms#
Clinical Findings#
- Swelling: Unilateral leg edema
- Pain: Especially in calf
- Warmth: In affected leg
- Redness: Erythema
- Homan’s sign: Calf pain with dorsiflexion
Phlegmasia Syndromes#
Severe DVT forms:
Phlegmasia Alba Dolens:
- Massive iliofemoral DVT
- Pale, painful leg
- Arterial circulation preserved
Phlegmasia Cerulea Dolens:
- Complete venous occlusion
- Cyanotic, severely painful leg
- Risk of arterial compromise
- Requires emergency intervention
Acute DVT Diagnosis#
Clinical Scoring#
Wells Score:
| Criterion | Points |
|---|---|
| Active cancer | +1 |
| Paralysis or immobilization | +1 |
| >3 days bed rest or surgery | +1 |
| Deep vein tenderness | +1 |
| Entire leg swelling | +1 |
| Calf swelling >3 cm difference | +1 |
| Pitting edema | +1 |
| Collateral superficial veins | +1 |
| Alternative diagnosis more likely | -2 |
Interpretation: ≥2 points = DVT likely
Laboratory#
- D-dimer: Negative value excludes DVT
- Coagulation panel
- Thrombophilia screening (selected cases)
Imaging#
Compression Ultrasound:
- First-choice diagnostic method
- Sensitivity >95%
- Evaluates vein compressibility
CT Venography:
- Iliocaval involvement suspicion
- Pelvic pathology
MR Venography:
- Alternative method
- Non-contrast option available
Acute DVT Treatment Options#
Anticoagulation (Primary Treatment)#
In all patients:
Initial:
- LMWH (Low molecular weight heparin)
- UFH (Unfractionated heparin)
- Fondaparinux
- Rivaroxaban/Apixaban (direct)
Maintenance:
- Warfarin (INR 2-3)
- DOAC (Rivaroxaban, Apixaban, Edoxaban)
Duration:
- Provoked DVT: 3 months
- Unprovoked DVT: ≥6 months or lifelong
- Cancer-related: LMWH preferred
Interventional Treatment Indications#
Consider catheter-directed treatment:
- Iliofemoral DVT: Proximal involvement
- Young patients: <65 years
- Low bleeding risk
- Symptom duration <14 days
- Good functional status
- Life expectancy >1 year
Absolute Indication:
- Phlegmasia cerulea dolens
- Venous gangrene risk
Interventional Treatment Methods#
Catheter-Directed Thrombolysis (CDT)#
Standard interventional approach:
Technique:
- Popliteal or jugular access
- Catheter placement within clot
- tPA (Alteplase) infusion
- 12-24 hour infusion
- Control venography
- If residual stenosis: Balloon/Stent
Dosage:
- tPA: 0.5-1 mg/hour
- Concurrent heparin infusion
Pharmacomechanical Thrombolysis (PMT)#
Mechanical + Pharmacological:
Devices:
- EKOS: Ultrasound-assisted thrombolysis
- AngioJet: Rheolytic thrombectomy
- Trellis: Isolated segment thrombolysis
Advantages:
- Shorter procedure time
- Lower lytic agent dose
- Reduced bleeding risk
Percutaneous Mechanical Thrombectomy (PMT)#
Mechanical only:
- AngioJet
- Aspiration thrombectomy
- ClotTriever
Advantage: No lytic agent used (in high bleeding risk patients)
Venous Stenting#
Indications:
- Residual stenosis >50%
- May-Thurner syndrome
- Post-thrombotic stenosis
Stent Types:
- Self-expanding venous stents
- Wallstent
- Veniti Vici
IVC Filter#
Indications#
Absolute:
- Anticoagulation contraindicated
- Recurrent PE despite anticoagulation
- Protection during thrombectomy
Relative:
- Massive iliofemoral DVT
- Free-floating thrombus
Filter Types#
- Permanent: Lifelong
- Retrievable: Temporary protection
Treatment Outcomes#
CDT/PMT Outcomes#
| Parameter | Result |
|---|---|
| Complete/Partial lysis | 80-90% |
| Iliofemoral patency (1 year) | 70-80% |
| PTS reduction | 40-50% |
| Major bleeding | 5-10% |
ATTRACT Trial#
- Pharmacomechanical treatment vs Anticoagulation alone
- Significant PTS reduction (especially iliofemoral)
- Moderate/severe PTS: 18% vs 24%
Complications#
Early#
| Complication | Frequency | Management |
|---|---|---|
| Bleeding (minor) | 5-10% | Compression |
| Bleeding (major) | 2-5% | Transfusion, reversal |
| PE | <1% | IVC filter |
| Access site hematoma | 3-5% | Compression |
Late#
- Restenosis: Re-intervention
- Post-thrombotic syndrome: Reduced but possible
Post-Procedure Management#
Anticoagulation#
- Continue immediately
- Minimum 3-6 months
- If stented: Long-term
Compression Stockings#
- Below-knee 30-40 mmHg
- Recommended for 2 years
- PTS prevention
Follow-up#
- 1 week: Clinical check
- 1 month: Doppler US
- 6 months: Doppler US
- Annual: Assessment
Frequently Asked Questions#
What is acute DVT?
What are the symptoms of acute DVT?
Is acute DVT dangerous?
How is acute DVT treated?
Does the leg return to normal after DVT treatment?
Appointment and Contact#
To schedule an appointment for acute DVT evaluation and interventional treatment:
📍 Eurasia Hospital - Beştelsiz Mah. 101. Sokak No:107, Zeytinburnu, Istanbul
📞 Phone: +90 212 665 50 50 (Ext: 4012)
This content has been prepared by Assoc. Prof. Habib Çil for general informational purposes. Please consult a cardiology specialist for definitive diagnosis and treatment.
Related Venous Interventions#
Other services related to acute DVT treatment:
- Chronic DVT Treatment - Post-thrombotic syndrome
- May-Thurner Syndrome - Iliac vein compression
- Pulmonary Embolism - Lung clot treatment
- Iliac Artery Treatment - Pelvic vessel treatment