Is it possible to treat deep vein thrombosis without anticoagulant therapy?

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One of the most dangerous vascular diseases is deep vein thrombosis, mainly due to the risk of such a complication as pulmonary embolism. According to the data of epidemiological studies, the vast majority of patients who had clinically significant thromboembolic complications according to ultrasound in the lower extremities had proximal deep vein thrombosis (spread of thrombosis to the popliteal, femoral vein, or saphenous venous segment). Of course, absolutely all clinical recommendations agree on the need for anticoagulant therapy in such patients.

At the same time, from 30 to 50% of patients with this disease have the so-called isolated distal deep vein thrombosis, which is characterized by spreading only to the veins of the leg. Research data indicate that the risk of pulmonary embolism is about 5%, and the risk of post-traumatic disease (the most severe clinical form, such as venous trophic ulcer) in such patients in the future is only about 2%. Therefore, specialized medical associations develop clinical recommendations, an example of which is ACCP, which was one of the first to have separate recommendations for the treatment of isolated distal deep vein thrombosis. At the same time, one of the latest recommendations is developed by members of the International Union of Phlebology (UIP).

In this document, patients with distal deep vein thrombosis are proposed to be divided into two groups, taking into account the intensity of clinical symptoms, as well as the risk of spreading the thrombotic process to a higher venous segment (popliteal vein or progression in the veins of the lower leg). As a result, it is possible to distinguish a group of patients who will not have pronounced clinical symptoms, as well as risk factors for the spread of venous thrombosis (which include: a high level of D-dimer, proximity to the popliteal vein, an active oncological process, hospitalization in a hospital, the absence of a clear provoking factor , as well as aggravated history of VTE). For patients who do not have the above-mentioned risk factors, as well as clinical symptoms, it is possible to consider conducting a serial ultrasound examination after two weeks and not prescribe anticoagulant therapy. Especially this tactic can be justified in the case of the so-called thrombosis of sural veins (intramuscular), while intermuscular thrombosis is suggested to be either anticoagulated or, according to the above-mentioned criteria, observed at intervals of once every two weeks. Only if an increase in the level of thrombosis or a worsening of the clinical picture is noted, in this case, anticoagulant therapy is prescribed in addition to compression therapy and symptomatic treatment.

You can get acquainted with this document by following the link. Phlebologists of the vascular center Angiolife always use the latest clinical recommendations in the treatment of our patients with vascular pathology.

Author: Machuskyi Serhii MD ©