How are severe cases of deep vein thrombosis or blood clots treated?

In severe cases of deep vein thrombosis (DVT) and blood clotting, more aggressive treatment may be required. Thrombolytics, an inferior vena cava (IVC) filter, or surgery may be indicated.

Thrombolytics or "clot busters" can help to break up a large blood clot that needs immediate treatment. These medications are delivered directly to the clot site using catheters advanced to the area through the veins. Use of thrombolytics is associated with significant risks, however, including bleeding and stroke, so it's reserved for treating severe cases of DVT or very large blood clots. Examples of thrombolytic therapy include streptokinase, urokinase, and tissue plasminogen activator (t-PA).

An inferior vena cava (IVC) filter is a device that can be placed in the large blood vessel (inferior vena cava) that brings deoxygenated blood back to the heart and lungs. This filter then traps blood clots before they can reach the lungs and cause a dangerous pulmonary embolism. IVC filters are typically used on people who can't take anticoagulant medication for some reason, or people who keep developing blood clots despite anticoagulant therapy.

Venous thrombectomy is the surgical removal of a blood clot from a vein. This is an invasive emergency surgical procedure reserved for severe cases when the clogged vein threatens critical blood flow to the limb or when the blood clot may cause severe vascular damage.

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