July 25, 2016
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Deep Vein Thrombosis (cont.)

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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:

  • Heparin
  • 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).

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.

Medically Reviewed by a Doctor on 4/20/2016

Source: MedicineNet.com

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