Deep vein thrombosis (DVT) is one of the most serious vascular problems, causing blockages in the deep veins and leading to severe swelling and pain. The clot can also travel to the lungs, causing a life-threatening pulmonary embolism.
At Dr Mohamed Rafeek Saafan's clinic, we offer a precise and phased treatment plan tailored to the type and stage of the clot to ensure its dissolution and prevent complications.
Treatment Methods for Deep Vein Clots
1) Drug Therapy
When Used: The first line of treatment for most cases of deep vein thrombosis, provided there are no contraindications to anticoagulants.
How It Works: Anticoagulants (such as heparin, Novarin/low molecular weight heparin, or modern oral anticoagulants — DOACs) are started quickly to prevent the clot from growing larger and to prevent new clots from forming, giving the patient's body a chance to gradually break down part of the clot. The initial treatment duration is usually at least 3 months and is extended depending on the cause of the clot and risk factors. Benefit: Reduces the risk of pulmonary embolism (PE) and prevents recurrent clots.
Risks/Follow-up: Risk of bleeding (monitoring kidney function, neutrophil count, and bleeding tests is important when needed). In some cases, dose adjustment or alternative medication may be required. Regular follow-up is important to determine the duration of treatment.
2) Medical Compression Stockings
When to Use: Used as supportive therapy after a DVT to help reduce swelling and pain and improve blood return from the leg. They are sometimes prescribed to reduce the risk of post-thrombotic syndrome (PTS), but the evidence is not entirely conclusive, and guidelines for routine prophylactic use vary.
How It Works: Graduated compression stockings apply progressive compression from the ankle to the upper leg, improving venous drainage and reducing congestion. Different compression levels and sizes are prescribed depending on the condition.
Benefit: Improves symptoms (swelling, pain) in many patients; may reduce the likelihood of PTS in some patients. Risks/Limitations: Not suitable if there are severe arterial problems in the limb (requires examination and blood pressure readings before use), or in the presence of severely damaged skin. Some studies have indicated low quality of evidence regarding the absolute prevention of PTS; therefore, the decision is made on a patient-centred basis.
3) Local Thrombolysis
When to Use: Considered when there is a large, extensive clot, especially in the iliofemoral vein (iliofemoral DVT), causing severe pain, risk of limb loss or limb-threatening injury, or when the goal is to reduce the risk of post-thrombotic syndrome in selected patients. It is used when the benefits outweigh the risks of bleeding.
How it's done: Under fluoroscopic guidance, a catheter is inserted into the site of the clot, and clot-dissolving drugs (such as alteplase) are injected directly into the clot in low, continuous doses—this increases the effectiveness of dissolution and reduces systemic drug exposure. The team may complement the procedure with angioplasty or residual clot surgery. Benefits: Faster thrombus resolution, improved restoration of venous permeability, and potentially reduced risk of PTS in selected cases.
Risks: The most significant risk is bleeding (internal or acute). Therefore, indications and contraindications (active bleeding, recent surgery, uncontrolled hypertension, history of hemorrhagic stroke) are assessed prior to the procedure. The decision is made after individual evaluation.
4) Interventional Catheterisation and Mechanical Thrombolysis
When to Use: An increasing option for large acute thrombotic thrombosis (especially iliofemoral) or when drug dissolution is insufficient or contraindicated due to bleeding risks, or as a complement to local dissolution to accelerate thrombus removal. Also useful when the team wants to minimise exposure time to thrombolytic therapy.
How the Procedure Works: A special catheter carrying mechanical instruments (such as suction devices, clippers, rotators, ClotTriever/AngioJet, etc.) is inserted into the thrombus, and it is mechanically removed or broken up and aspirated via the device. The procedure is performed under fluoroscopy and is less invasive than open surgery.
Benefits: Rapid restoration of venous flow, reduced length of stay, good results in restoring venous permeability and reducing acute symptoms; in some analytical series, acceptable success rates and complications have been demonstrated.
Risks: Vascular injury, localised bleeding, residual partial occlusion. The choice of device and approach still depends on the team's experience and the patient's condition.
5) Intravenous Filter
When to use: Not recommended for routine use. It is considered an option when there is a high risk of pulmonary embolism and drug therapy is not possible or there are direct contraindications to anticoagulants (e.g., severe bleeding, surgery close to the vena cava that prevents anticoagulation), or when drug therapy has failed and thrombosis continues. Some filters can be removed later when the patient improves.
How it works: The filter is inserted via a catheter into the inferior vena cava to collect clots before they reach the lungs. The procedure is short and usually performed under local anaesthesia and fluoroscopy. Benefit: Reduces the risk of pulmonary embolism in patients who cannot receive optimal treatment.
Risks/Limitations: Risks associated with filter placement (displacement, infiltration, periventricular thrombosis), and an increased likelihood of subsequent DVT if the filter is left in place for an extended period. Current guidelines recommend against routine use and encourage removal when no longer necessary. The decision should be personalised and based on expert guidance.
💡 Why choose Dr Mohamed Rafeek Saafan's clinic?
Extensive experience in vascular surgery and diabetic foot treatment.
Utilisation of the latest interventional catheterisation and microsurgical techniques.
An individualised treatment plan for each patient to ensure optimal results and maximum safety.