The standard of care for treating deep vein blood clots (deep vein thrombosis or DVT) is evolving markedly. Traditional treatment involves the use of oral blood thinners. While this can be effective, many patients may go on to develop post-thrombotic syndrome, which can dramatically affect their quality of life.
Post-thrombotic syndrome can cause chronic leg pain and swelling, and in severe cases, major disability due to venous ulcers and venous claudication (leg and thigh pain and tightness during exercise). Post-thrombotic syndrome can occur in about 40 percent of patients who have had blood clots in the deep veins, which may lead to moderate to severe symptoms. This complication is a lifelong condition and is difficult to treat.
This prompted the ATTRACT Trial, which studied the effects of treating deep vein blood clots with catheter-directed “clot-busting” medication (thrombolysis) rather than just the standard oral blood thinner treatment. Catheter-directed thrombolysis is performed by introducing a catheter directly into the deep vein.
Published in the New England Journal of Medicine in December of 2017, the study showed that while catheter-directed thrombolysis did not reduce the incidence of post-thrombotic syndrome, it significantly reduced its severity and provided better resolution of pain and swelling.
Although catheter-directed thrombolysis is minimally invasive (i.e., needle puncture through the skin but not involving major surgery), it is not recommended for everyone. Additional studies are underway to determine which DVT patients may reap the greatest benefit.
It’s important to understand that deep vein blood clots can be serious and life-threatening. Even with appropriate treatment, they may cause long-term harm. That’s why we urge you to learn more about your risks of developing clots and take steps to reduce them. Seek immediate and expert care from a vascular specialist if you suspect you have one.
DVT is easily diagnosed with a painless ultrasound, with patients referred for treatment if necessary. Fortunately, we can rule out DVT in most cases. The vast majority of sudden leg pain and swelling are not due to DVT, but rather, to another venous condition called venous insufficiency, which responds well to outpatient therapy.
DVT treatment can be a complicated process to explain, but it is an urgent condition that needs immediate care. We advise that you err on the side of caution. If you suspect you have a deep vein blood clot, contact your primary care physician, go to your nearest emergency department, or call our office at 413.732.4242