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
- What is 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)?
- What kind of doctor treats DVT?
- How is deep vein thrombosis diagnosed (DVT)?
- What is the treatment for deep vein thrombosis (DVT)?
- What medications treat deep vein thrombosis (DVT)?
- Surgery for deep vein thrombosis (DVT)
- What are the complications of deep vein thrombosis (DVT)?
- Can deep vein thrombosis (DVT) be prevented?
- Find a local Cardiologist in your town
What medications treat deep vein thrombosis (DVT)?
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. There are difference types of medications that can be used for anticoagulation to treat DVT:
- Low molecular weight heparin: enoxaparin (Lovenox)
- Warfarin (Coumadin)
- Novel oral anticoagulatants (NOACs) also known as direct oral anticoagulants (DOACs).
The American College of Chest Physicians recommends different medications based upon the clinical situation. For patients with a DVT and no active cancer, NOACs are the drug of choice. For patients with a DVT and active cancer, enoxaparin is the drug of choice.
NOACs may be used to almost immediately thin the blood and anticoagulate the patient. There is no need for blood tests to monitor dosing as there is with warfarin. The NOAC medications that have been approved for deep vein thrombosis treatment include:
- apixaban (Eliquis)
- rivaroxaban (Xarelto)
- edoxaban (Savaysa)
- dabigatran (Pradaxa)
All four are also indicated to treat pulmonary embolism.
Warfarin (Coumadin) is an anti-coagulation medication that 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 up to 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 taken effect. 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 (PT), or INR (international normalized ratio).
Learn more about: heparin
Patients who take anticoagulation medications are at risk for bleeding. The decision to use these medications must balance the risk and rewards of the treatment. Should bleeding occur, there are reversal medications available for only some of these drugs, but all have a reversal strategy should it be needed.
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. AN IVC filter is not recommended for patients who are taking anticoagulation medications.
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