Deep vein thrombosis (DVT) is a condition that occurs when blood clots form in veins deep inside your body. These clots can occur anywhere in the body. However, this condition often affects the lower legs or thighs.
Symptoms of DVT include swelling, pain or tenderness, and skin that may feel warm to the touch.
DVT can happen to anyone. But you have a greater risk of developing DVT after a surgery or trauma. Being overweight and smoking are also risk factors.
A serious condition called pulmonary embolism can occur as a result of DVT if a blood clot travels to the lungs and blocks an artery. Risk for this condition is also higher after a surgery.
Since DVT can lead to serious complications, your doctor may recommend graduated compression stockings or socks to ease pain, reduce swelling, and improve blood flow to your heart and lungs. If you’re not familiar with how these stockings work, here’s what you need to know about them, and about other ways you can treat and prevent DVT.
How to Treat and Avoid DVT at Home
Start With Compression Stockings
If you have had a blood clot in the leg (deep vein thrombosis-DVT) and have leg pain and swelling, your leg will likely feel better with compression stockings. Compression stockings may also prevent post-thrombotic syndrome, a complication of DVT.
Once you have had a DVT in your leg, you are at risk for developing chronic (long-term) pain and swelling, called Post-thrombotic syndrome (PTS). PTS is common, and occurs in approximately 40% of persons with DVT. Use of compression stockings may prevent PTS.
Symptoms of PTS include:
- Chronic swelling
- Chronic pain, pressure, heaviness, tightness or leg tiredness
- Skin hardening or itching
- Dark pigmentation, visible spider veins
- Ulcers (skin breakdown)
Your risk of developing PTS can be reduced by using special graduated compression stockings which are designed to decrease or prevent swelling. They work by keeping fluid from pooling in the ankle and calf.
For maximum effectiveness, compression stockings should be started as soon as possible after being diagnosed with DVT – typically within one week, once the initially more pronounced swelling has decreased after the blood thinners are started.
Compression stockings are like pantyhose or tights, but they’re made from a different material and serve a different purpose. While you may wear an ordinary stocking for style or to protect your legs, compression stockings have an elastic fabric designed to fit tightly around the ankles, legs, and thighs. These stockings are tighter around the ankle and less tight around the calves and thighs.
The pressure created by the stockings pushes fluid up the leg, which allows blood to flow freely from the legs to the heart. Compression stockings not only improve blood flow, they also reduce swelling and pain. They are particularly recommended for DVT because the pressure stops blood from pooling and clotting.
The Science Behind Compression for DVT
Compression stockings are effective for treating DVT. Studies examining the effectiveness of compression stockings have found a link between compression stockings and DVT prevention in hospitalized patients.
One study followed 1,681 people and consisted of 19 trials, including 9 with participants undergoing general surgery and 6 with participants undergoing orthopedic surgery. Among those wearing compression stockings before and after surgery, only 9 percent developed DVT, compared with 21 percent of those who didn’t wear compression stockings.
Similarly, a study comparing 15 trials found that wearing compression stockings could reduce the risk of DVT by as much as 63 percent in surgical cases.
Compression stockings don’t just prevent blood clots in those who’ve had surgery or trauma. Another study concluded that these stockings could also prevent DVT and pulmonary embolism in people on flights of at least four hours. Blood clots in the legs can form after a long flight due to prolonged sitting in a confined space.
Compression Stockings – Not Just for DVT
Symptoms or conditions that benefit from compression therapy:
- varicose or spider veins
- Swelling, pain or blood clots in the lower legs (DVT)
- Poor circulation from sitting for long periods
- Post-surgical and post-sclerotherapy treatment
- pregnancy related swelling and vein problems
- stasis dermatitis (skin changes that occur in the leg as a result of “stasis” or blood pooling from insufficient venous return, also known as varicose eczema)
Choosing the Right Compression Stockings
Compression stockings come in different levels of tightness, so it’s important to find a stocking with the right amount of pressure. Choose between a knee-high, a thigh-high, or a full-length stocking. Your doctor may recommend a knee-high if you have swelling below the knee, and a thigh-high or full-length if you have swelling above the knee.
How Much Compression Do You Need?
Even though your doctor can write a prescription for compression stockings, you don’t need a prescription for stockings up to 20 mmHg (millimeters of mercury). Millimeters of mercury is a measurement of pressure. Stockings with higher numbers have a higher level of compression.
Look for 30-40mmHg compression if you have DVT.
There are 4 main compression levels which are measured in millimeters of mercury (mmHg).
1. 8-15mmHg: mild compression – great for tired, aching legs | makes legs feel energized | very mild swelling
2. 15-20mmHg: moderate compression – travel | standing for long periods | mild swelling | mild varicose veins | pregnancy
3. 20-30mmHg: firm compression – moderate swelling | edema | post-sclerotherapy | moderate varicose veins
4. 30-40mmHg: x-firm compression – severe swelling | edema | venous ulcers | post-sclerotherapy | severe varicose veins|DVT
Class I Medical Compression Stockings
This class includes both the 15-20 mmHg and 20-30 mmHg compression levels. Your doctor may recommend one of these levels in order to relieve strain or ache in your legs or to provide therapy for mild swelling, circulatory problems or varicose veins.
Often the choice between these two compression levels is a matter of individual preference. Either compression level may be effective and the level that affords the most relief and comfort for you will be best determined by trying each level for a couple days.
If your doctor did not specify and you do not know what works best for you we recommend that you begin with the 15-20 mmHg level. You may want to order 1 or 2 pairs of each and see what works best for you. Many people own both 15-20 and 20-30 garments and choose daily what to wear depending on how their legs are feeling.
Class II (Extra Firm Compression) – Recommended for DVT
Class II medical compression stockings are the 30-40mmHg compression level. This is the recommended compression level for DVT, and is usually reserved to treat patients who are prone to blood clotting, poor lymph circulation and more severe leg and foot swelling. It is recommended that you choose this compression level only on the advice of your physician.
Measure for Sizing
The right amount of tightness is also necessary for the treatment and prevention of DVT. Compression stocking sizes vary by brand, so you’ll need to take body measurements and then use the manufacturer’s sizing chart to determine the right size for you.
To find your size for a knee-high stocking, measure the circumference of the narrowest part of your ankle, the widest part of your calf, and your calf length starting from the floor to the bend of your knee.
For a thigh-high or a full-length stocking, you’ll also need to measure the widest part of your thighs, and your leg length starting from the floor to the bottom of your buttocks.
How to Use Compression Stockings
- You should begin wearing compression stockings as soon as possible following a DVT, once the initial more pronounced swelling of a DVT has improved after about 1 week.
- Put your stocking on first thing in the morning, before you are up on your feet.
- Remove stockings at bedtime. There is no need to wear them at night. Do not shower in your compression stockings
- Most stockings are sold in pairs, but you need only to wear a stocking on the leg affected by the DVT.
- You should wear compression stockings every day for as long as they continue to make your leg feel better. The length of time will vary by individual and may be weeks, months or years. For example, if swelling has disappeared a few weeks or months after the acute DVT with the use of the stockings, you may stop wearing the stocking. If swelling recurs, then the stocking should be worn again. If there is no more swelling, then stockings are not needed any more.
- Some research suggests that compression stockings should be worn for 2 years after a DVT, even if there is no swelling, to prevent post-thrombotic syndrome. However, it is not clear whether that is really needed and exactly who benefits form the stockings most. Official recommendations (ACCP 2012) suggest that “compression stockings should be worn for 2 years, and we suggest beyond that if patients have developed PTS and find the stockings helpful”.
Tips for Putting Compression Stockings On
Compression stockings are designed to be tight. They can take some effort to pull on. To make it easier:
- Put compression stockings on first thing in the morning before you start moving around much, when your leg is less swollen.
- Makes sure your skin is dry. If you use lotion, be sure it is completely absorbed before putting on the stocking. Talcum powder can help make the stocking glide on more smoothly.
- Put the stocking first completely over the foot, then over the heel and finally up covering the calf or thigh. Getting the heel in position first will make the process easier.
- Do not pull the stocking by the top. Gently pull the stocking up the leg, smoothing the extra material as you go along.
- For knee-length stockings, once on properly, the top of the stocking should be about one-inch below the bend of the knee.
- Do not fold or roll down the stop of the stocking. If you feel that is needed, then you probably need a shorter stocking. If your stocking keeps falling or sliding down, you may need a different size.
- Use a stocking aid; they make they make the process much easier.
If you need to wear compression socks or stockings regularly, I recommend using the Stockeez PRO to avoid the struggle that’s required to get the extra firm compression stockings on in the morning.
The Stockeez Pro is not just a generic “sock aid” – it is specifically designed for all styles of compression hosiery.
Stockeez PRO Video Guide
Caring for Compression Stockings
Follow the instructions on the label for washing the stockings. In general:
- Wash the stockings after each use. Washing removes oils and dirt and helps fabric keep elasticity.
- Hand or machine wash – check the label for specific recommendation. If machine washing, use of a mesh laundry bag can protect the stockings during the wash cycle.
- Wash in mild soap. Do not use detergent as this can affect the elasticity of the fabric.
- Rinse the fabric completely.
- Pat dry the stocking with a towel. Do not wring and twist.
- Air-dry the stocking. Some stockings can be dried on the delicate cycle of a dryer – check the label.
- Replace compression stockings as needed. Over time, the fabric will lose its elasticity. Stockings last about 4 to 6 months.
Managing Your DVT at Home – Beyond Compression Therapy
Treating your DVT is important because of the risk of a life-threatening complication known as pulmonary embolism.
Once you receive a diagnosis of DVT, you’ll likely be prescribed medications known as anticoagulants, or blood thinners. These work to keep the clot from growing and to prevent further clots. Research shows that taking these medications at home is just as safe and effective as taking them while in the hospital.
You can also help treat your symptoms and prevent another blood clot from forming with a few home remedies and lifestyle changes.
The main focus of DVT treatment at home includes:
- taking your prescribed anticoagulant medicine safely
- relieving symptoms, such as leg pain and swelling
- lifestyle changes to reduce your risk of another blood clot forming
Your doctor may give you the first dose of an anticoagulant medication such as warfarin while you’re still in the hospital. They’ll give you detailed instructions for taking additional doses at home. You may have to take the anticoagulant medication for three to six months, sometimes longer.
Make sure to follow your doctor’s instructions carefully. Taking too much of an anticoagulant this medication can over-thin the blood and lead to bleeding problems.
To avoid bleeding problems, you can follow these steps:
- Prevent injuries or falls, which include avoiding contact sports, wearing protective gear like a helmet, or using a walker or cane.
- Inform your doctors about any other medications, supplements, and vitamins you’re taking.
- Visit your doctor for regular partial thromboplastin time (PTT) tests to make sure you’re receiving the right dose of anticoagulant if your doctor tells you to do so.
- Avoid changing or stopping your medication unless your doctor tells you to.
- Take your medication at the same time each day.
- Call your doctor if you miss a dose.
- Make sure all your doctors and dentists know you’re on anticoagulants.
- Eat a balanced diet.
Seek immediate medical attention if you notice any signs of abnormal bleeding due to your anticoagulant medication, including:
- coughing or vomiting blood
- blood in the stool or urine
- a nosebleed that doesn’t stop
- bruises that form without a known cause
Remember that if you are on anticoagulant medications, certain herbal supplements and vitamins shouldn’t be taken with your them. Check with your doctor or pharmacist to avoid interactions.
DVT Symptom Management
DVT doesn’t always cause symptoms, but it can sometimes result in leg pain or swelling. The pain usually occurs in the calf and feels like an intense cramp.
In addition to wearing compression stockings, do the following at home:
- Take walks. Aim for walks three to five times a day to improve blood flow to your legs.
- Elevate the affected leg. Make sure your foot is higher than your hip.
If you’ve been prescribed anticoagulant medications, don’t take aspirin and medications that contain aspirin. Avoid other nonsteroidal anti-inflammatory drugs (NSAIDs) as well. These include ibuprofen (Advil, Motrin) and naproxen (Aleve).
Preventing DVT Recurrence
Along with managing your symptoms, it’s important to make changes to your lifestyle in order to prevent DVT happening again. Certain people are at a higher risk of developing DVT, including:
- people who are having surgery in the lower extremities
- heavy smokers
- people with a family history of DVT
- pregnant women
Lifestyle Changes to Helpt Prevent DVT:
- Quit smoking.
- Lower your blood pressure with dietary changes, like reducing your salt and sugar intake.
- Lose weight if you’re overweight.
- Avoid sitting for long periods of time. Get up and walk around every so often if you’re driving or on a long flight. Flex your feet to stretch out your calves.
- Exercise, such as walking or swimming, every day.
- Don’t wear tight clothing when traveling long distances.
- Wear your graduated compression stockings, especially after a surgery or if you’re on bed rest.
- Drink lots of fluids.
- Stop taking birth control pills prior to surgery, if directed by a doctor.
Supplements to Prevent DVT
Adding certain herbs to your diet in small amounts is generally safe, but you shouldn’t take any herbal or vitamin supplements or consume large amounts without first consulting your doctor. Certain herbs and vitamins can cause dangerous drug interactions.
Studies have shown that the following herbs and supplements may be effective in preventing blood clots:
Evening Primrose Oil
Evening primrose oil, borage oil, and black currant oil all contain an unsaturated fatty acid called gamma-linolenic acid. Patients taking warfarin are sometimes advised to not take evening primrose oil because it can increase bleeding risk, but this recommendation has been based primarily upon anecdotal case reports rather than the result of clinical studies. There are few studies examining the anticoagulant effect of these oils in humans.
One study found that evening primrose oil has both anticoagulant and antiplatelet effects, and caused an increase in clotting time.
The effect of moderate doses was said by the study authors to be “almost equivalent” to that of warfarin.
We can get Vitamin D from foods, vitamin-fortified foods, supplements and from sunlight. Vitamin D is a nutrient most often linked to the maintenance of strong bones, but it has also been suspected to have an anticoagulant effect by changing certain proteins involved in the clotting mechanism.
One large Swedish study, which looked at the sun exposure habits of 40,000 women over an average of 11 years, found that regular sun exposure reduced DVT/PE risk by one-third. It was hypothesized that vitamin D obtained through sunlight exposure may be the reason behind the protective effect.
Foods high in vitamin E are natural blood thinners. You can find vitamin E in olive, corn, and soybean oils. Other vitamin E-rich foods include greens like spinach and kale, kiwi, almonds, tomato, mango, and broccoli.
Don’t eat very large amounts of leafy green vegetables if you’re taking warfarin. Leafy green vegetables contain vitamin K. Too much vitamin K can lower the effect of warfarin.
In a large-scale, 10 year trial in women (known as the Women’s Health Study) 600 IU of vitamin E taken on alternate days was associated with a significant reduction in DVT/PE, and women with a priory history of clotting or who had a genetic clotting predisposition had a particularly strong benefit. The study authors concluded that:
“vitamin E may be a useful treatment for prevention of a first or recurrent” DVT/PE.
Another prospective study which included a large sample size of 129,420 men and women also found that vitamin E intake was associated with a lower risk of DVT/PE.
Fish Oil, Omega 3 Fatty Acids
Fish oil is an omega-3 polyunsaturated fatty acid that comes from cold water fish, such as wild salmon, tuna, herring, and anchovies. Omega-3 fatty acids affect blood clotting by decreasing platelet aggregation, which modestly prolongs bleeding time. Some evidence suggests that omega 3 fish oil supplementation may also enhance fibrinolysis (the break-up of clots).
Three compounds in garlic (allicin, adenosine, and paraffinic sulfide) are thought to have antiplatelet properties. You can get odorless garlic supplements for a concentrated dose without garlic breath.
DVT can cause pain and swelling. It can be a potentially life-threatening condition if a blood clot travels to your lungs. Learn how to recognize symptoms of this condition, especially if you’ve recently taken a long trip, experienced trauma, or had surgery. Seek treatment if you suspect a blood clot in your legs.
If you have an upcoming surgery or plan on taking a long trip, ask your doctor about wearing compression stocking to help prevent DVT.
If you have already had DVT:
Along with taking the anticoagulant medications prescribed by your doctor, you can manage your DVT risk successfully at home with compression therapy and a few simple lifestyle changes.
DVT is a serious condition. Always follow your doctor’s advice for prevention and treatment, especially if you’re at a higher risk of developing it.
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