Deep Vein Thrombosis (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Deep vein thrombosis (DVT) facts
- Introduction to deep vein thrombosis (DVT)
- What are the causes of deep vein thrombosis (DVT)?
- What are the symptoms of deep vein thrombosis (DVT)?
- When should I seek medical care for deep vein thrombosis (DVT)?
- How is deep vein thrombosis diagnosed (DVT)?
- What is the treatment for deep vein thrombosis (DVT)?
- Deep vein thrombosis (DVT) medications
- Surgery for deep vein thrombosis (DVT)
- What are the complications of deep vein thrombosis (DVT)?
- Can deep vein thrombosis (DVT) be prevented?
- Deep Vein Thrombosis - Slideshow
- Deep Vein Thrombosis and Pulmonary Embolism
- Spider & Varicose Veins - Slideshow
- Find a local Cardiologist in your town
What is the treatment for deep vein thrombosis (DVT)?
Superficial thrombophlebitis treatment
Treatment for superficial blood clots is symptomatic with:
- warm compresses,
- leg compression, and
- an anti-inflammatory medications such as ibuprofen.
If the thrombophlebitis occurs near the groin where the superficial and deep systems join together, there is potential that the thrombus could extend into the deep venous system. These patients may require anticoagulation or blood thinning therapy (see below).
Deep venous thrombosis treatment
The recommended length of treatment for an uncomplicated DVT is 3 months. Depending upon the patient's situation, a longer duration of anticoagulation may be required.
- Deep venous thromboses (DVTs) that occur below the knee tend not to embolize (break loose). They may be observed with serial ultrasounds to make certain they are not extending above the knee. At the same time, the cause of the deep vein thrombosis may need to be addressed.
- The treatment for deep venous thrombosis above the knee is anticoagulation, unless a contraindication exists. Contraindications include recent major surgery (since anticoagulation would thin all the blood in the body, not just that in the leg, leading to significant bleeding issues), or abnormal reactions when previously exposed to blood thinner medications.
Deep vein thrombosis (DVT) medications
Anticoagulation prevents further growth of the blood clot and prevents it from forming an embolus that can travel to the lung. The body has a complex mechanism to form blood clots to help repair blood vessel damage. There is a clotting cascade with numerous blood factors that have to be activated for a clot to form.
Warfarin (Coumadin) is one type of anti-coagulation medication that and acts as a Vitamin K antagonist, blocking blood clotting factors II, VII, IX and X. It may be prescribed immediately after diagnosis, but unfortunately it takes a week or more for the blood to be appropriately thinned with warfarin. Therefore, low molecular weight heparin (enoxaparin [Lovenox)] is administered at the same time. It thins the blood via a different mechanism and is used as a bridge therapy until the warfarin has reached its therapeutic level. Enoxaparin injections can be given on an outpatient basis. For those patients who have contraindications to the use of enoxaparin (for example, kidney failure does not allow the drug to be appropriately metabolized), intravenous heparin can be used as the first step in association with warfarin. This requires admission to the hospital. The dosage of warfarin is monitored by blood tests measuring the prothrombin time or INR (international normalized ratio).
Another option is the prescription of medications that inhibit blood clotting factor X. These act almost immediately to thin the blood, and do not need the two step approach described above of warfarin and heparin. These medications do not need blood tests to monitor dosing. The medications that have been approved for deep vein thrombosis treatment include:
- apixaban (Eliquis),
- rivaroxaban (Xarelto),
- dabigatran (Pradaxa) and
- edoxaban (Savaysa).
The decision to prescribe a type of anticoagulation medication (Vitamin K antagonist v. Factor X inhibitor) depends upon the patient's situation. Patients who take these 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. However, there are reversal strategies available for warfarin and heparin.
Some patients may have contraindications to anticoagulation therapy, for example a patient with bleeding in the brain, major trauma, or recent significant surgery. An alternative may be to place a filter in the inferior vena cava (the major vein that collects blood from both legs) to prevent emboli, should they arise, from reaching the heart and lungs. These filters may be effective but also may be the source of new clot formation.
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