How do doctors first treat a patient who arrives at the hospital experiencing symptoms of DVT?

Answer 1

1. Diagnosis

• Ask patient for medical history
• Physical examine (look for swelling, warmth and redness)
• D-dimer test (reference: <250ng/mL)
• Ultrasound
• If ultrasound was inconclusive then venography
• If venography isn't possible MRI

2. Treatment

Drug administration:

• Unfractionated heparin
• Low molecular weight heparin (enoxaparin/Lovenox, dalteparin/Fragmin, or tinzaparin/Innohep)
• Fondaparinux (Arixtra)

Walking/movement

Answer 2

In addition to the excellent answer given below (see Ally U.), family medical history is very important. Some blood (platelet) abnormalities are genetic and can guide treatment protocols. In addition to family medical history, the person's medical history is also important. But onset of the current symptoms is a critical piece in guiding the physician's thinking and patient assessment. Assessment of heart and lungs is crucial at the beginning to set a baseline AND to rule out embolism from a clot breaking off and traveling to heart and lungs. During the first 72 hours up to 7 days, the person is typically put on mandatory bedrest except bathroom needs. Heparin or Lovenox (ONE NOT BOTH) are given during that first week. Heparin is only given to patients in the hospital--most patients with new DVT are automatically admitted to the hospital. However, some patients may be permitted to be home on bedrest--they receive Lovenox, an injection into the abdomen, once a day from a visiting nurse. Once the initial heparin OR lovenox is completed (7days), the person is switched to oral Warfarin. Warfarin requires adjustment based on bloodwork. So the patient must be seen at the doctor's office about every 3 days. After about 2 weeks, Warfarin dosage becomes more stabilized and dr visits decrease to once a week. Bleeding times need constant monitoring, however, so these dr visits (as directed by bloodwork) continue as long as you're on Warfarin. While in the past, people stayed on Warfarin for many years, Warfarin can cause internal bleeds. So doctors try to reduce the Warfarin and stop it around 2-years post DVT if there have been no other problems.

While on Warfarin, patients must avoid eating certain foods and drugs that can increase bleeding. The nurse will provide a booklet with a list of these.

It is important if taking Warfarin to take it exactly as prescribed. If you forget a dose, do NOT double up doses. Call your doctor for instructions.

Also, from Day One of diagnosis, the patient is fitted with compression stockings, either knee high or thigh high. (In hospital, they are typically white; at home, you can buy flesh-colored compression hose. Flesh-colored ones can be ordered with more precise compression requirements, ordered by your doctor. ) These hose are worn in bed and when up. They help compress smaller blood vessels in the lower legs and help venous blood flow to return to the heart. Patients must adhere to wearing these stockings to prevent swelling from blood "pooling" in the lower legs, ankles, and feet. By about 2 years post-diagnosis, the hose can slowly be discontinued, or they can continue being used.

DVTs can cause heaviness in the legs and pain due to swelling. Ask your doctor about meds for the pain.