How can I prevent developing a DVT?
Prevention of DVT is most successful by addressing the preventable risk factors.
Lengthy convalescence from surgery, especially hip, leg, or abdominal surgeries in which postoperative pain discourages movement and ambulation can create the stasis in veins that leads to thrombosis. In such cases, ambulation as soon as is safe, based on criteria related to the particular surgery, is the best preventative. Should ambulation be discouraged to ensure proper healing, passive range-of-motion techniques and physical therapy help protect from DVT.
The same applies for other causes of prolonged bed rest or convalescence, including trauma, bone fractures, cancer, or pregnancy.
Patients with a high risk of DVT, based on an inherited predisposition or a previous history of DVT, should avoid hormonal contraception or menopausal hormone replacement that involves estrogen.
If there is increased risk from cardiovascular interventions such as indwelling venous or implantable cardiac devices, added surveillance is prudent in prevention.
Obesity, especially in those >60 years of age, should be managed via certified dietitian/nutritionist counseling with weight reduction goals that are reasonable.
Although anticoagulation is required for treatment of acute DVT, there are patients as severe risk of recurrence that make an on-going and indefinite anticoagulation treatment protocol prudent:
- Patients with an unprovoked proximal DVT. DVT of the upper leg’s popliteal, femoral, or iliac veins who have no risk factors or precipitating events to explain DVT occurrence.
- Recurrence of DVT. The risk of recurrence after a course of anticoagulation is completed is approximately 10% in the first year and a 5%/year thereafter. At 5 years, the risk will have risen to 30%.
Anticoagulation causes a 90% reduction in the rate of DVT recurrence. This benefit outweighs the risk of bleeding that anticoagulation can cause, unless there is an increased bleeding risk, as there is with diabetes, advanced age, kidney and liver disease, alcohol abuse, thrombocytopenia, anemia, or recent surgery.