For a long time, treatment of deep venous thrombosis centered on anti-coagulation alone. Depending on various factors (provoked or unprovoked, location, and whether new or recurrent episode, chances of causing a fatal pulmonary embolism or previous episodes of pulmonary embolism), the treating physician could decide the duration of the treatment from three months to lifelong.
Recently newer modalities (catheter-directed TPA-tissue plasminogen activator thrombolysis and mechanical thrombectomy) are available to treat acute (ideally less than 2-3 weeks old) DVT. This helps to reduce chances of post phlebitis or thrombotic syndrome (PTS) and reduce chances of venous hypertension long term. This may help in reducing chances of developing a wound in the leg. Based on available research it is less clear if a recurrent DVT episode is avoided by utilizing these procedures.
Catheter-directed TPA thrombolysis: A fine plastic tube (catheter) is placed at the site of the blood clot and strong clot-busting medication (TPA) is dripped through the catheter for 12 hours continuously. The patient is brought back the next day, and balloon angioplasty is performed to get rid of the remaining clot. Some of it may be suctioned out or macerated. The obvious disadvantage is the chances of major bleeding occurring in the brain or elsewhere as a side effect due to the prolonged administration.
Mechanical thrombectomy (INARI): This is a wide-bore catheter that is introduced in the vein of the leg, and the clot is pulled out from an umbrella filter deployed on the other side. The advantage is the avoidance of clot-busting medication and the need for multiple visits to achieve the result.