Treatment

A number of medicines, mechanical therapies and surgical procedures can be used either to prevent or treat venous thromboembolism (VTE).

Because there is an increased risk of VTE associated with orthopaedic surgery, patients undergoing surgery are offered protection in the form of preventative treatment, known as prophylaxis. Such methods may be used before and/or shortly after surgery to prevent you from developing VTE whilst in hospital.

Treatment of existing deep vein thrombosis (DVT) also aims to prevent the development of a pulmonary embolism (PE) and any long-term effects.

Anticoagulants

• These are medicines that prevent the blood from clotting and can stop existing clots getting bigger.
  
  
• When given as prophylaxis, anticoagulant medicines may need to be continued for some time after the surgery when there is still a risk of a blood clot forming.
  
  
• Treatment of a diagnosed DVT would normally involve an initial course of medicines whilst in hospital, but may then require you to take medicines yourself at home. 
  
  
• It is important to take your medicines correctly, consult your doctor before taking any other medicines and ask him/her about your diet. Certain foods, as well as alcohol, can affect how well your anticoagulant works.

More on medicines…

Graduated compression stockings

• These are worn on the legs from the arch of the foot to just above or below the knee and are used most commonly after surgery.
  
  
• The stockings are tight at the ankle and become looser towards the top, causing gentle pressure within the leg.
  
  
• The pressure increases the speed at which blood flows through the veins in your leg. This improves circulation and reduces the risk of DVT.
  
  
• They can reduce the swelling that may occur in the leg after a blood clot has developed.
  
  
• Although they can be hot and uncomfortable, they have been shown to reduce the risk of a painful long-term effect of DVT known as post-thrombotic syndrome.

Intermittent pneumatic compression (IPC) boots

• These plastic stockings inflate then deflate every few seconds to increase the speed of blood flow within the legs and improve circulation.
  
  
• They have practically no side effects when properly fitted and inflated and are commonly used in combination with anticoagulant medicines.
  
  
• They encourage the breakdown of existing blood clots within the veins.

Leg exercises

• Regular movement of the legs improves the circulation of blood. However, this will not always be possible following orthopaedic surgery.

Surgery

Surgical treatment is very rare and includes:

• Vena caval interruption: some patients are not able to receive anticoagulant medicines. A medical device, or filter, is inserted into a vein in order to trap the clot and prevent it from lodging within the lungs.
  
  
• Pulmonary embolectomy: in cases of severe PE, where medicines are insufficient or unsuitable, the clot will need to be surgically removed (an embolectomy).