Treatment of venous thrombosis

1. Bed rest and elevated affected limb

Leg elevation and initial bed rest can relieve pain in patients with deep vein thrombosis accompanied by acute leg swelling. The traditional approach of recommending strict bed rest for 1 to 2 weeks to prevent pulmonary embolism has been questioned. Lung scans show that bed rest is associated with There was no reduction in the incidence of pulmonary embolism. Additionally, patients' pain and swelling improve more quickly with early ambulation than with bed rest.

Wearing compression stockings in patients with deep vein thrombosis can improve pain and swelling. Long-term wear may inhibit the growth of thrombus and reduce post-thrombotic syndrome.

2. Anticoagulant therapy

This is one of the most important modern treatments for deep vein thrombosis. Correct use of anticoagulants can reduce the complications of pulmonary embolism and the sequelae of deep vein thrombosis. Its function is to prevent the existing thrombus from continuing to grow and the formation of new thrombus in other parts, and to promote the rapid recanalization of the thrombosed vein. Generally, heparin or low-molecular-weight heparin is used in the acute phase, and then transitioned to oral anticoagulant drugs, such as warfarin. Due to the complex effects of warfarin on drugs or food, individual dosage differences are large, and there is a risk of bleeding, which requires monitoring. In recent years, research and development Many new oral anticoagulants have been released, such as rivaroxaban. Rivaroxaban is rarely affected by drugs or food, generally does not require testing, and is easy to use.

3. Thrombolytic treatment

Including systemic thrombolysis and catheter contact thrombolysis, most of the drugs used are urokinase and so on. Systemic thrombolysis Transvenous systemic thrombolysis: systemic administration through superficial veins, so that the drug is evenly distributed in the body along with blood circulation to achieve the purpose of thrombolysis. Interventional thrombolysis mostly refers to catheter-retaining contact thrombolysis: also known as CDT. The proximal deep vein catheter is retrogradely inserted into the distal deep vein of the limb. First, a guidewire and catheter are used to physically open the part of the vascular cavity to relieve the outflow obstruction. Then, a thrombolytic catheter is inserted to bring the drug into direct contact with the thrombus, and the In the acute stage, the loose and fresh thrombi are dissolved, and the main veins are restored to patency in time. Some scholars believe that catheter thrombolysis in the treatment of iliofemoral venous thrombosis can improve quality of life than anticoagulation alone.

4. Long-term treatment of deep vein thrombosis

The duration of anticoagulation treatment for deep vein thrombosis remains controversial. Long-term anticoagulation can help reduce the recurrence of deep vein thrombosis and post-thrombotic syndrome. For deep vein thrombosis caused by simple factors such as surgery or rest, the anticoagulation time needs to last for 3 months. For idiopathic deep vein thrombosis, it is recommended that the anticoagulation time needs to last for 6 to 12 months. For patients with malignant tumors, low Molecular heparin is due to warfarin, and the medication time is 3 to 6 months. For the first episode of deep vein thrombosis, but with anticoagulant lipid antibodies or two or more thrombosis risk factors, it is recommended that the anticoagulation time should be continued for at least 12 months, while for patients with a history of two deep vein thrombosis, lifelong anticoagulation Anticoagulation therapy.