During this time, it is important to handle the affected extremity with care. Avoid grasping the soft tissue of the leg when moving the extremity, and advise the patient not to rub the extremity. 10 Invasive management Antithrombotic therapy with heparin or warfarin prophylactically interrupts the thrombotic process, but does not actively dissolve blood clots. However, the thrombus may resolve over time. The use of thrombolytic agents in the treatment of VTE must be highly individualized.
All thrombolytic agents act systemically, increasing the risk of bleeding.
Because of this risk, thrombolytic therapy is generally reserved for patients with acute VTE in whom heparin is contraindicated and who are not at risk for bleeding. 8 One recent study addressed the potential for thrombolytic therapy to reduce the chance of acute DVT recurring because of venous valve damage. There is some evidence that rapid thrombolysis preserves venous valve function more effectively than if the thrombus is allowed to reabsorb slowly during the course of anticoagulant therapy. A vena cava filter is a cone-shaped device inserted into the inferior vena cava to keep thrombi from migrating upward. A vena cava filter may be used when there is a contraindication to or complication of anticoagulant therapy in a patient with or at high risk for proximal vein thrombosis and PE, and for patients who have recurrent VTE despite adequate anticoagulation.