Is it necessary to treat DVT as soon as it is detected? The answer is yes. However, some people think that the swelling is uncomfortable, so they can tolerate it or just move around, so they don’t need to treat it, which is not true. Because once DVT occurs, the disease progresses faster, plus the acute stage is likely to occur serious pulmonary embolism, so it is not recommended to endure without treatment. And moving around not only will not be good, but on the contrary, increase the chance of thrombus dislodgement. I feel that it usually does not affect my life too much, so can I leave it untreated for a while and then treat it when I have symptoms? If the patient thinks so, it is very dangerous. As the thrombus grows bigger and bigger, it is more and more likely to be dislodged; it will also block the blood vessel. By the time there are symptoms, it is likely to be more serious. Therefore, when DVT is detected in the lower limbs, it should be treated as soon as possible, regardless of whether the symptoms are serious or not. What can I do if I have just detected a DVT in my lower limbs? The greatest danger in the acute phase is pulmonary embolism caused by dislodgment of the thrombus, so it is important to stabilize the thrombus and prevent it from growing and dislodging. The internationally recognized standard treatment in the acute phase is anticoagulation. As you know, many patients with cardiac stents have to take aspirin and other antiplatelet drugs for a long time after surgery to prevent arterial thrombosis. In the case of venous thrombosis, it is more likely that clotting factors are at play, so drugs that antagonize clotting factors are used to treat DVT. There are several types of oral anticoagulants: the classic one is warfarin, a vitamin K antagonist; newer oral anticoagulants such as rivaroxaban and dabigatran etexilate. There are also subcutaneous drugs – low molecular heparin. In the acute phase, anticoagulants with a rapid onset of action are usually chosen, as warfarin usually takes 3 to 5 days to take effect and is suitable for use in the chronic phase, and the effect of anticoagulation (INR value) must be monitored, with an INR value of between 2 and 3 for optimal warfarin action. If warfarin is too much, it will easily lead to bleeding; if warfarin is too little, it will not be able to achieve the anticoagulant effect. Therefore, in the acute stage, low molecular heparin is generally used as a fast-acting anticoagulant. Of course, with the development of medicine, the new anticoagulant drug – rivaroxaban has a rapid onset of action compared to warfarin and does not need to monitor the NIR value, but the price is more expensive. Regardless of which type of anticoagulant you choose, there are three things to keep in mind: early, adequate dosage, and adequate treatment. Early means that once a clot is detected, it should be treated aggressively. Adequate dosage means that only a standard dose of anticoagulant can have a therapeutic effect without causing side effects such as bleeding. For example, rivaroxaban needs to be taken 1 tablet per day to prevent blood clots, but in the acute stage, it should be taken three tablets per day, and after about 21 days, it should be changed to 2 tablets per day for more than three months. A full course of treatment means not stopping or reducing the medication without authorization. The treatment of DVT in the lower limbs should be continued for more than three months in order to completely dissolve the thrombus and not to recur. Why should I stay in bed during the acute phase? The calf is the “second heart” of human body, when the thrombus is not stabilized in the acute stage, if you go down to the ground hastily, the calf muscle may squeeze the blood vessel, resulting in dislodging of thrombus and triggering pulmonary embolism. Therefore, in the acute stage, we should be absolutely bedridden for 7 to 10 days, when the thrombus is stabilized, then we can try to get out of bed. Subsequently, you can follow the treatment of the chronic phase. After acute treatment, will there be no leg swelling and pain? After acute phase treatment, leg swelling and pain will not disappear immediately. Anticoagulant medication only stabilizes the thrombus and reduces the risk of dislodgement, but venous thrombosis in the lower limbs still exists, and the problem of poor blood return in the deep veins still exists. And because of the blockage of the deep veins, the superficial veins will replace part of the function of the deep veins to promote the return of venous blood to the lower limbs. This compensatory function is then secondary to the development of varicose veins. Therefore, the symptoms of swollen and painful legs do not disappear immediately. Some patients with swollen and painful legs are found to have lower extremity DVT only after several days, is this the acute or chronic phase? Does it affect the treatment? Many people are confused as to which day the acute and chronic phases are counted. Clinically, it is generally considered to start from the day of swelling and pain. In fact, there is another indicator – D-dimer, which can reflect the activity of blood clots. If the thrombus is stable, this indicator will decrease, and with the gradual dissolution of the thrombus disappeared, this word gradually close to 0, then counted as the chronic period. If the thrombus is unstable and the embolus is large, the D-dimer value will be higher and it is considered to be in the acute phase. What should I treat if my symptoms worsen? Should I treat it if the symptoms decrease? Worsening of symptoms indicates that the thrombus is not well controlled. While standardizing the treatment, it is also necessary to investigate whether the patient has congenital hypercoagulability, which leads to insensitivity to heparin, and at this time, it is necessary to switch to drugs such as rivaroxaban and dabigatran etexilate. There is also a possibility that the patient may be combined with other diseases, such as nephrotic syndrome, hypoproteinemia, etc. Although anticoagulant drugs can control the thrombus, but these comorbidities will affect the effect of thrombolysis. At this point, it is time to investigate whether there are other comorbidities. If the symptoms are reduced, after the transition from the acute phase to the chronic phase, the treatment has to be continued for at least three months or more.