Deep Vein Thrombosis

The Problem

Anticoagulation (blood thinners): ESSENTIAL and life-saving for acute DVT (prevents pulmonary embolism 50-90%—can be fatal) BUT: Warfarin challenges: narrow therapeutic window (need frequent INR monitoring, dose adjustments), many drug and food interactions (vitamin K foods, antibiotics, NSAIDs, others), bleeding risk (major bleeding 1-3%/year), inconvenient, DOACs (rivaroxaban, apixaban, edoxaban, dabigatran): easier than warfarin (no monitoring, fewer interactions, fixed dose) but expensive ($400-600/month without insurance—warfarin $10/month), bleeding risk similar to warfarin, can't easily reverse (though reversal agents now available for some), not for severe kidney disease, All anticoagulants: bleeding risk (major bleeding 1-3%/year, intracranial hemorrhage most feared—can be fatal or disabling, risk vs benefit decision—balance clot risk vs bleeding risk), lifelong anticoagulation for recurrent/unprovoked DVT (chronic bleeding risk), IVC filter: complications (filter migration, IVC perforation, thrombosis on filter 10-20%, difficult to remove if temporary—often become 'permanent', use only if anticoagulation truly contraindicated), Conventional doesn't emphasize: prevention in general population (most DVTs occur in hospital or post-surgery—focus on high-risk, but compression stockings, hydration, movement during long flights could prevent many community-acquired DVTs), natural fibrinolytics (nattokinase, lumbrokinase, serrapeptase—enhance clot dissolution, may reduce post-thrombotic syndrome, safe as adjunct to anticoagulation or for prevention, rarely discussed), omega-3 (reduces thrombosis risk, safe with anticoagulants, anti-inflammatory), compression stockings for post-thrombotic syndrome prevention (proven to reduce by 50% but many patients not prescribed or don't comply—2 years of daily use needed), Post-thrombotic syndrome (chronic leg swelling, pain, skin changes in 20-50% after DVT): compression stockings reduce risk 50% but compliance poor (uncomfortable, difficult to put on, expensive—need high-quality medical-grade stockings, not just 'support hose'), no other proven prevention, Many DVTs provoked by temporary risk factors (surgery, hospitalization, pregnancy, long flight): 3 months anticoagulation sufficient (low recurrence risk once risk factor removed), but conventional sometimes continues longer than necessary (bleeding risk), Unprovoked DVT: higher recurrence risk (30% within 10 years), extended or lifelong anticoagulation reduces recurrence 80-90% but increases cumulative bleeding risk—individualized decision, Thrombophilia testing: often done but rarely changes management (Factor V Leiden, prothrombin mutation common—don't strongly predict recurrence, anticoagulation decision based on whether provoked vs unprovoked, not genetic test results), expensive testing, Gabriel's integrative approach: acute DVT—conventional anticoagulation ESSENTIAL (life-saving, no alternative), supportive: omega-3 (safe with anticoagulants, anti-inflammatory), nattokinase or serrapeptase (fibrinolytic, as adjunct—WITH doctor approval, not instead of anticoagulation), compression stockings, early mobilization, prevention: high-risk patients (long flights, family history, previous DVT, cancer, surgery)—compression stockings, movement, hydration, consider nattokinase, omega-3, pycnogenol (proven to reduce DVT risk in long flights).