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How to manage deep vein thrombosis (DVT)?

Q: My brother aged 31 is having deep vein thrombosis (DVT) from May 2002. At that time he had heavy swelling on his left leg, was hospitalised for 11 days and given heparin shots. Since then he is on warfarin tabs. The dosage varies depending on the INR but presently he is taking 11mg. On 11/01 the INR was 2.77 and last week it was 1.87 (keeps fluctuating). Two weeks earlier he complained of pain in the same leg and on checking another clot was detected in the calf region. The previous clot was in the upper part of the thigh. There is no family history of the same. My brother is an engineer by profession with odd working conditions. Please enlighten us about the disease.

A:Deep Vein Thrombosis (DVT) is a term used to describe clotting of blood in the legs, and usually develops after injuries or prolonged lying down (as during an illness). Treatment is directed towards preventing further clotting. The clots dissolve spontaneously, and rarely need to be removed. The initial treatment is by heparin, which is given by injections. Treatment at home is given by tablets of warfarin or other anticoagulant drugs (eg acitrom). The dose of anticoagulant drug depends on the prothrombin time and is measured by INR. The INR usually needs to be maintained at about twice normal. Once the clots have fully dissolved, the anticoagulant can be discontinued. This may take months. Anticoagulant drugs interact with several other medicines, and any concomitant medication should be closely checked for drug interaction: you should refer to the product literature, and also consult your physician for this. It is also important to know why DVT occurred. Did this follow trauma? A long term sequel of DVT is varicose veins of the leg. If recurrent clotting is a problem, he may need to maintain his INR slightly higher, under close medical supervision. He may also need to wear special compression stockings.

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