Ghatkopar (East), Mumbai)
Home > Interventional radiology > Deep Vein Thrombosis
Deep Vein Thrombosis (DVT) Treatment in Mumbai
Deep vein thrombosis , the formation of a blood clot in the deep venous system, most commonly in the leg , is a potentially life-threatening medical emergency. When a deep vein thrombus propagates or breaks off, it can embolise to the pulmonary arteries and cause pulmonary embolism (PE), which kills 10–15% of patients with massive PE before treatment can be given. DVT itself causes chronic post-thrombotic syndrome , swelling, pain, skin changes, and venous ulceration , in 20–50% of patients within 5 years of an acute episode, producing long-term morbidity that often exceeds the acute event in clinical impact.
At Shree Hospitals Ghatkopar East, our Interventional Radiology and vascular medicine team provides complete DVT management: same-day duplex diagnosis, direct-acting oral anticoagulant initiation, IVC filter placement where indicated for pulmonary embolism prevention, and catheter-directed thrombolysis for severe iliofemoral DVT where clot removal rather than clot stabilisation is the appropriate management goal.
(24×7 Emergency Care)
(24×7 Emergency Care)
Our approach in managing Deep Vein Thrombosis
DVT management at Shree Hospitals is structured around five steps: accurate probability-guided diagnosis, anticoagulation initiation, pulmonary embolism risk stratification, interventional management for severe or complicated cases, and long-term follow-up to prevent recurrence and post-thrombotic syndrome.
Step 1 — Pre-Test Probability Assessment and Duplex Diagnosis
Not every swollen, painful leg has DVT and not every DVT presents with classic signs. Structured pre-test probability assessment using the Wells DVT Score guides diagnostic sequencing. Wells score ≤1 (low probability) combined with a negative D-dimer safely excludes DVT without further imaging in the majority of patients. Wells score ≥2 or positive D-dimer requires duplex ultrasound. Duplex ultrasound is the primary diagnostic test for DVT , direct, non-invasive, widely available, and without radiation. DVT on duplex shows non-compressibility of the affected vein (failure of the vein to collapse with probe pressure , the most reliable sign), absent or reduced flow, and visible echogenic thrombus within the vein lumen. At Shree Hospitals, same-day duplex ultrasound is available with results within 30–60 minutes. Proximal DVT , thrombus in the popliteal vein or above (femoral, common femoral, iliac, IVC) , carries substantially higher PE risk than distal DVT (calf veins only) and mandates immediate anticoagulation.
Step 2 — Anticoagulation: Immediate Initiation and Duration
Anticoagulation is the cornerstone of DVT treatment , it prevents thrombus extension, reduces PE risk, and allows the body's natural fibrinolytic system to gradually resolve the thrombus over weeks to months. At Shree Hospitals, direct-acting oral anticoagulants (DOACs) , rivaroxaban (15mg twice daily for 21 days then 20mg once daily) or apixaban (10mg twice daily for 7 days then 5mg twice daily) , are the first-line anticoagulants for DVT of the lower extremity. DOACs require no bridging with LMWH, no INR monitoring, no dietary restrictions, and produce equivalent efficacy and lower major bleeding rates compared with warfarin. LMWH (enoxaparin) is preferred in cancer-associated DVT (where LMWH or DOAC specific to malignancy-related VTE guidelines apply), during pregnancy (heparin class only , warfarin and DOACs are contraindicated), and in patients with severe renal impairment where DOAC dosing is unreliable. Anticoagulation duration: 3 months for provoked DVT (with a temporary risk factor , surgery, immobility, trauma); at least 6 months for unprovoked DVT; indefinite anticoagulation for recurrent unprovoked DVT, antiphospholipid syndrome, or DVT in the context of active malignancy.
Step 3 — Thrombophilia Workup and Provocation Assessment
Identifying whether DVT was provoked (occurred in the context of a clear temporary risk factor , surgery, long-haul flight, prolonged immobility, plaster cast) or unprovoked (no obvious precipitant) determines both anticoagulation duration and the need for thrombophilia testing. Unprovoked DVT in young patients, bilateral DVT, DVT at unusual sites (upper limb, mesenteric, cerebral), recurrent DVT, and strong family history of VTE are indications for thrombophilia workup: Factor V Leiden mutation, prothrombin gene mutation G20210A, protein C and S activity, antithrombin III activity, antiphospholipid antibody panel (lupus anticoagulant, anticardiolipin IgG/IgM, anti-beta2-glycoprotein I). Thrombophilia testing is performed after 3 months of anticoagulation not during acute treatment, as acute thrombosis and anticoagulants artefactually alter clotting factor levels. All patients with unprovoked DVT under age 50 also require age-appropriate cancer screening occult malignancy is present in 3–5% of apparently unprovoked DVT patients.
Step 4 — IVC Filter and Catheter-Directed Thrombolysis
Inferior vena cava (IVC) filter placement is indicated for patients with proximal DVT or PE in whom anticoagulation is absolutely contraindicated (active life-threatening bleeding, very recent haemorrhagic stroke) or has failed despite therapeutic levels (recurrent PE on adequate anticoagulation). At Shree Hospitals, retrievable IVC filters deployed via a 7–8 French right internal jugular or femoral access under fluoroscopy are used preferentially, as they can be retrieved when the contraindication to anticoagulation has resolved, avoiding the long-term filter-related complications of permanent devices (filter thrombosis, IVC occlusion, filter migration, caval perforation). Catheter-directed thrombolysis (CDT) with alteplase is considered for patients with acute massive iliofemoral DVT causing severe limb swelling (phlegmasia cerulea dolens threatened limb from venous occlusion), where rapid clot removal rather than gradual fibrinolysis may prevent venous hypertensive ischaemia. CDT infuses thrombolytic agent directly into the thrombus through a multi-sidehole catheter embedded in the clot, achieving faster and more complete clot lysis than systemic anticoagulation alone.
Step 5 — Post-Thrombotic Syndrome Prevention
Post-thrombotic syndrome (PTS) — occurring in 20–50% of proximal DVT patients is caused by residual venous obstruction and valve damage from the thrombus, causing chronic venous hypertension with symptoms identical to advanced chronic venous insufficiency: swelling, aching, skin discolouration, and in severe cases venous ulceration. Prevention strategies at Shree Hospitals include: adequate therapeutic anticoagulation for the full recommended duration, early ambulation rather than bed rest (which improves venous recanalization rates), and graduated compression stockings (ECS 30–40 mmHg below-knee) for at least 2 years after proximal DVT. May-Thurner syndrome left iliac vein compression by the overlying right common iliac artery is identified in 20–30% of left iliofemoral DVT patients and is treated by iliac vein stenting after catheter-directed thrombolysis to correct the anatomical abnormality predisposing to recurrent DVT.
How to identify Deep Vein Thrombosis?
The classic presentation of DVT is unilateral leg swelling , occurring suddenly or over 24–48 hours , with associated calf pain, warmth, and redness or cyanosis of the affected limb. The swelling characteristically pits on pressure (pitting oedema) and is typically greater below the level of the thrombus. Calf tenderness , particularly on dorsiflexion of the foot (Homan's sign) , was historically considered diagnostic but is neither sensitive nor specific and should not be used as a clinical surrogate for duplex ultrasound. The leg is often warm to touch compared with the contralateral limb. In extensive iliofemoral DVT, the entire leg from foot to groin is swollen, and in the most severe cases, phlegmasia cerulea dolens occurs , massive swelling with cyanosis (purple-blue discolouration) from venous outflow obstruction so severe it compromises arterial inflow, threatening the limb.
A critically important feature of DVT is that 30–50% of cases are clinically silent ,no swelling, no pain, no warmth , and are diagnosed incidentally during imaging for another purpose, or only when pulmonary embolism from the unrecognised DVT presents with chest symptoms. This is particularly true of distal DVT confined to the calf veins, but occurs also with proximal DVT in hospitalised patients with immobility, critical illness, or neurological injury that masks sensory perception of leg symptoms.
Symptoms of Pulmonary Embolism — DVT's Most Dangerous Complication:
Any DVT patient who develops the following requires immediate emergency attendance:
-
- Sudden-onset breathlessness (dyspnoea) — the most common PE symptom
- Sharp pleuritic chest pain (worse with inspiration) — caused by infarction of a peripheral lung segment
- Haemoptysis (coughing blood) — small amounts of blood-stained sputum from pulmonary infarction
- Syncope (fainting) or near-syncope — from acute right heart strain in massive PE
- Rapid heart rate (tachycardia) with worsening breathlessness
- Central cyanosis — blue discolouration of lips and fingers in massive PE
Important FAQs: Deep Vein Thrombosis
How long do I need to take blood thinners after DVT?
Anticoagulation duration depends on the DVT classification: provoked or unprovoked. Provoked DVT occurring in the context of a temporary, reversible risk factor such as surgery, major trauma, long-haul travel above 8 hours, hormonal contraception, or plaster cast immobilisation ,is treated for 3 months. After 3 months with the provoking factor removed, the recurrence risk falls to background levels and anticoagulation can be safely stopped. Unprovoked DVT , with no obvious precipitating cause , has a 30% recurrence risk at 5 years off anticoagulation, and patients are typically treated for 6 months with consideration of indefinite anticoagulation based on bleeding risk, patient preference, and D-dimer result 1 month after stopping anticoagulation (elevated D-dimer predicts higher recurrence risk). Recurrent unprovoked DVT, thrombophilia (Factor V Leiden homozygous, antiphospholipid syndrome), cancer-associated DVT, and bilateral iliofemoral DVT are generally indications for long-term or indefinite anticoagulation.
Can DVT resolve completely, or will my leg always be swollen?
The natural history of DVT treated with adequate anticoagulation shows progressive thrombus resolution , most acute DVT resolves substantially within 3–6 months of anticoagulation through the body's endogenous fibrinolytic system, with residual thrombus persisting in some degree in 30–50% of patients at 3 months but typically not causing ongoing symptoms. However, residual thrombus and valve damage from the acute DVT cause chronic venous insufficiency in 20–50% of patients , post-thrombotic syndrome , which is the primary source of long-term morbidity. PTS produces chronic leg swelling, heaviness, aching, and in severe cases skin pigmentation and venous ulceration. Wearing graduated compression stockings (30–40 mmHg below-knee) for 2 years after proximal DVT significantly reduces PTS development. Patients with iliofemoral DVT , the highest PTS risk subgroup , are assessed for catheter-directed thrombolysis at the time of acute DVT to achieve more complete clot removal and better valve preservation than anticoagulation alone.
Is there a difference between DVT and superficial thrombophlebitis?
Superficial thrombophlebitis (SVT) — thrombosis of a superficial vein, typically a varicose vein , presents as a painful, red, firm cord along the vein surface. Unlike DVT, superficial thrombophlebitis is typically not immediately life-threatening and does not require anticoagulation in most cases , local anti-inflammatory treatment (topical diclofenac gel, systemic NSAIDs, and compression) is appropriate for short-segment SVT confined to the saphenous tributaries. However, SVT extending to within 3 cm of the saphenofemoral junction , where the superficial and deep venous systems communicate , carries significant risk of extension into the deep venous system and requires anticoagulation (fondaparinux is the evidence-based agent for junctional SVT). All cases of SVT should have duplex ultrasound to map thrombus extent and specifically identify saphenofemoral or saphenopopliteal junction involvement before deciding on management.
Can I travel by air after DVT?
Travel by air during active DVT treatment (within 3 months of acute DVT) is permissible with ongoing anticoagulation , blood thinners reduce the recurrence risk during travel-associated immobility. However, every long-haul flight (above 4 hours) independently increases VTE risk, and this is additive to any residual underlying DVT risk. Practical measures for all patients with DVT history travelling by air: wear below-knee class 2 graduated compression stockings during the flight, perform in-seat ankle exercises and walk the aisle every 60–90 minutes, stay well-hydrated, and avoid alcohol and sedative medications that reduce movement during long flights. Patients who complete their anticoagulation course and are off blood thinners but have a personal history of DVT should wear compression stockings and take aspirin (if not contraindicated) during any flight above 4 hours. Discuss travel plans with your treating physician at Shree Hospitals
What is May-Thurner syndrome and how does it relate to DVT?
May-Thurner syndrome (MTS) — also called iliac vein compression syndrome , is an anatomical variant in which the right common iliac artery crosses over and compresses the left common iliac vein against the lumbar spine, creating a chronic fibrotic spur within the vein lumen that significantly reduces venous outflow from the left leg. This compression predisposes to left-sided iliofemoral DVT , explaining why 70–80% of iliofemoral DVTs occur on the left side. MTS is identified in 20–30% of patients with acute left iliofemoral DVT on intravascular ultrasound (IVUS) or venography. Treatment involves catheter-directed thrombolysis to clear the acute clot followed by iliac vein stenting to permanently open the compressed venous segment , correction of the anatomical cause of DVT substantially reduces recurrence risk compared with anticoagulation alone. Any patient under 50 with unprovoked left-sided DVT should be assessed for May-Thurner syndrome.
Treatments for Deep Vein Thrombosis at Shree Hospitals
Duplex Ultrasound DVT Diagnosis & D-Dimer Assessment
Same-day duplex ultrasound at Shree Hospitals confirms or excludes DVT within 60 minutes of presentation. The non-compressibility sign on ultrasound provides definitive DVT diagnosis without radiation or contrast. D-dimer blood test , a fibrin degradation product elevated in the presence of active thrombosis ,is used in conjunction with Wells pre-test probability scoring: a low Wells score combined with negative D-dimer safely excludes DVT without ultrasound in a significant proportion of patients. In patients with positive D-dimer and intermediate or high Wells score, duplex ultrasound is performed urgently. Duplex maps thrombus extent (distal calf vs popliteal vs femoral vs iliofemoral), thrombus echogenicity (acute versus chronic), and vein compressibility , guiding anticoagulation duration decisions and identifying iliofemoral extension that may warrant catheter-directed thrombolysis consideration.
Direct-Acting Oral Anticoagulation (DOAC) Therapy
Anticoagulation initiation at Shree Hospitals uses rivaroxaban or apixaban as first-line therapy , both DOACs are approved for DVT treatment without initial heparin bridging, are taken orally, require no INR monitoring, and have fixed dosing without dietary restrictions. Both produce equivalent efficacy and statistically significantly lower major bleeding rates compared with warfarin in Phase III trials. DOAC prescribing at Shree Hospitals accounts for renal function (creatinine clearance determines DOAC eligibility), drug interactions, and specific patient subgroups: pregnant patients (heparin only), antiphospholipid syndrome (warfarin preferred based on trial data), and cancer-associated DVT (LMWH or apixaban/rivaroxaban per current cancer VTE guidelines). Patient education on anticoagulation , bleeding recognition, drug interactions, duration, and what to do if a dose is missed , is provided at every DVT anticoagulation initiation.
IVC Filter Placement for PE Prevention
Retrievable IVC filter placement at Shree Hospitals is performed in 30–45 minutes under local anaesthesia and fluoroscopic guidance through a right internal jugular or femoral vein access. The filter is deployed in the infrarenal IVC immediately below the renal veins, where it traps thromboemboli from DVT before they can reach the pulmonary arteries. At Shree Hospitals, retrievable filter designs (Boston Scientific Denali, Cook Celect, or equivalent) are used in preference to permanent filters for all patients in whom anticoagulation may be resumed within 3–6 months. Filter retrieval is performed under fluoroscopic guidance via jugular snare technique when the anticoagulation contraindication has resolved , typically within 4–12 weeks of placement. Permanent IVC filters are reserved for patients in whom anticoagulation is permanently contraindicated. Filter position and integrity is confirmed by post-placement fluoroscopy and abdominal X-ray.
Catheter-Directed Thrombolysis for Massive Iliofemoral DVT
Catheter-directed thrombolysis (CDT) at Shree Hospitals delivers alteplase thrombolytic agent directly into acute iliofemoral DVT through a multi-sidehole infusion catheter positioned within the thrombus under fluoroscopic guidance. The catheter is inserted from the popliteal vein (prone position) or through a tibial vein access, and infuses alteplase at 0.5–1mg/hour over 12–24 hours — dissolving the thrombus from within rather than relying on the body's own fibrinolytic system to work from outside. CDT achieves more rapid and complete clot resolution than anticoagulation alone, reduces the development of post-thrombotic syndrome in randomised trials, and in phlegmasia cerulea dolens (limb-threatening massive DVT) can be life and limb-saving. After thrombolysis, the underlying venous anatomy is assessed by venography — May-Thurner compression or residual iliac vein stenosis is treated with iliac vein stenting to prevent recurrent DVT.
Deep Vein Thrombosis Specialists in Mumbai
Now at Shree Hospitals
10+ years of experience
Dr. Swati Narurkar
Interventional Radiology
For Appointment/Query
1800-268-4000
Tele consultation/2nd Opinion
Schedule Consultation
News & Updates
Shree Hospitals Expands Paediatric Surgical Care With Latest Technology
Shree Hospitals Installs a Robotic-Assisted Surgical System for Better Patient Care
