September 2, 2015

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Blood Clots

Blood Clots

What is the treatment for blood clots?

Depending upon their location, blood clots may be aggressively treated or may need nothing more than symptomatic care.

Blood clots in the veins (venous blood clots)

What is the treatment for blood clots?Depending upon their location, blood clots may be aggressively treated or may need nothing more than symptomatic care.

Blood clots in the veins (venous blood clots)

Clots may develop in the superficial or deep veins of the leg. Treatment for a superficial blood clot is directed at managing pain and decreasing inflammation with medication (for example, acetaminophen [Tylenol and others] or ibuprofen [Advil, Motrin, etc.]). The risk of these clots lodging and obstructing (embolizing) in the vein is low because of the anatomy of the leg. Specialized veins (perforator veins) connect the superficial veins to the deep veins, and have valves that act like strainers to prevent clots from travelling to the lung.

Blood thinners

Clots located above the knee in the deep vein system may need to have the blood "thinned" with anticoagulation medications.

Warfarin (Coumadin)

Warfarin (Coumadin) is one type of anticoagulation medication that has been used for many years to treat blood clots. It blocks clotting factors II, VII, IX and X, those that depend upon Vitamin K, and is usually prescribed as soon as DVT (deep venous thrombosis) or blood clot is diagnosed. Because if take a few days to effectively thin the blood, low molecular weight heparin (enoxaparin) or regular heparin is used to immediately cause anticoagulation.

Heparin is injected subcutaneously under the skin and can be administered in an outpatient setting.

Regular heparin is given intravenously, and the patient will need to be admitted to the hospital to receive this drug. Once the warfarin effectively thins the blood, the heparin is discontinued. Warfarin effectiveness is measure by a blood test and the INR needs to have a value between 2.0 and 3.0.

Newer anticoagulation drugs

Newer anticoagulation medications have been approved that inhibit blood factor X. These act almost immediately to thin the blood and include:

  • apixaban (Eliquis),
  • rivaroxaban (Xarelto),
  • dabigatran (Pradaxa) and
  • edoxaban (Savaysa).

These drugs are taken orally and become effective in thinning the blood within a couple of hours. They also do not need blood tests to monitor dosage.

The decision to prescribe a type of anticoagulation medication (Vitamin K antagonist v. Factor X/thrombin inhibitor) depends upon the patient's situation. All patients who take anticoagulation medications are at risk for bleeding. At present there is no antidote approved in the United States to reverse the effects of the Factor X inhibitors, should the need arise. There are reversal strategies available for warfarin and heparin.

Pulmonary emboli are treated similarly to deep venous thrombosis, but depending on the severity of the symptoms, amount of clot formation, and the underlying health of the patient, admission to the hospital for treatment and observation may be needed. This is especially the case if lung function is compromised and the patient is short of breath or is experiencing hypoxia, (low oxygen levels in the blood). Patients who are critically ill and display symptoms of heart strain or shock may be candidates for thrombolytic therapy using drugs known as tissue plasminogen activators (TPAs). TPAs may be injected into a peripheral vein in the arm to immediately thin the blood and act as a clot busting drug.

Arterial blood clots

Arterial blood clots are often managed more aggressively. Surgery may be attempted to remove the clot, or medication may be administered directly into the clot to try to dissolve it. Alteplase (Activase, TPA) or tenecteplase (TNKase) are examples of tissue plasminogen activator (see above) medications that may be used in peripheral arteries to try to restore blood supply.This is the same approach that is used for heart attack. If possible, cardiac catheterization is performed to locate the blocked blood vessel and a balloon is used to open the occluded area, restore blood flow, and place a stent to keep it open. This is a time-sensitive procedure and if a hospital is not available to do the procedure emergently, TPA or TNK is used intravenously to try to dissolve the thrombus and minimize heart damage. Eventually, the patent, when stable, will be transferred for potential heart catheterization to evaluate the heart anatomy and decide whether stents may be needed to keep an artery open or whether bypass surgery might be needed to restore blood supply to the heart.

Stroke is also treated with TPA if the patient is an appropriate candidate for this therapy. Continue Reading

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Reviewed on 2/27/2015
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