Deep vein thrombosis — what to take?

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Risk factors

Prolonged immobilisation (hospitalisation, long flights, plaster cast), surgery, pregnancy, contraceptives, cancer, hereditary thrombophilia, obesity, age, personal/family history, COVID-19.

DVT symptoms

Unilateral limb oedema, calf pain (worsened by dorsiflexion — Homans' sign), erythema, local warmth. 50% of DVTs are asymptomatic.

Pulmonary embolism symptoms

Sudden shortness of breath, pleuritic chest pain, cough (possibly haemoptysis), tachycardia, syncope — EMERGENCY.

Diagnosis

D-dimers, venous Doppler ultrasound of the limbs, CT pulmonary angiography when embolism is suspected. Clinical scores (Wells).

Treatment (Rx)

• Anticoagulants: DOACs (rivaroxaban, apixaban, edoxaban, dabigatran), heparins, vitamin K antagonists (warfarin, acenocoumarol).
• Duration: 3-6 months for a primary episode, longer with persistent risk factors.
• Thrombolysis/thrombectomy — in selected severe cases.
• Vena cava filter — when anticoagulation is contraindicated.

OTC and supplements

Strictly adjuvant:

• Omega-3 — mildly antithrombotic (beware dosing if anticoagulated).
• Vitamin D3 — frequent deficiency.
• Magnesium.
• Compression stockings after DVT to prevent post-thrombotic syndrome.

AVOID high-dose aspirin, ginkgo biloba, high-dose vitamin E — cumulative antiplatelet effect with anticoagulants.

Prevention

• Move legs during long flights, breaks every 2-3 hours.
• Preventive compression stockings.
• Prophylactic anticoagulation post-surgery.
• Hydration.
• Weight loss.

Medical disclaimer: the information in this guide is for informational purposes only and does not replace advice from a doctor or pharmacist. For diagnosis and treatment, consult a healthcare professional.