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Deep Vein Thrombosis (cont.)

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What are the treatment guidelines for DVT?

The treatment for deep venous thrombosis is anticoagulation or "thinning the blood" with medications.

The recommended length of treatment for an uncomplicated DVT is three months. Depending upon the patient's situation, underlying medical conditions and the reason for developing a blood clot, a longer duration of anticoagulation may be required. At three months, the doctor or other health care professional should evaluate the patient in regard to the potential for future blood clot formation. If the decision is made to continue anticoagulation over the long term, the risk/reward decision of preventing clots versus bleeding risk should occur every year to decide if anticoagulation is still a reasonable treatment.

There are times when anticoagulation may have increased bleeding risk, for example, if the patient has had recent major surgery (anticoagulation thins all of the blood in the body not just the DVT). Other bleeding risks occur in patients with liver disease and those who take medications that can interact with the anticoagulation medicines.

What is the treatment of superficial blood clots?

Treatment for superficial thrombophlebitis treating the symptoms with:

  • Warm compresses
  • Leg compression
  • Anti-inflammatory medications such as ibuprofen (Mortin) or naproxen (Naprocen).

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.

Medications to treat blood clots in the leg

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:

  1. Unfractionated heparin
  2. Low molecular weight heparin: enoxaparin (Lovenox)
  3. Novel oral anticoagulatants (NOACs) also known as direct oral anticoagulants (DOACs)
  4. Warfarin (Coumadin, Jantoven)

The American College of Chest Physicians has guidelines that give direction as to what medications might best be used in different situations. For example, a patient with a DVT, and no active cancer, treatment with a NOAC would be recommended. If active cancer exists, the treatment of DVT would be with enoxaparin as the drug of first choice.

NOACs work almost immediately to thin the blood and anticoagulate the patient. There is no need for blood tests to monitor dosing. The NOAC medications presently approved for deep vein thrombosis treatment include:

  • apixaban (Eliquis)
  • rivaroxaban (Xarelto)
  • edoxaban (Savaysa)
  • dabigatran (Pradaxa)

All four are also indicated to treat pulmonary embolism. They also may be prescribed to patients anticoagulated with nonvalvular atrial fibrillation to prevent stroke and systemic embolus.

Warfarin (Coumadin, Jantoven)

Warfarin (Coumadin, Janotven) is an anti-coagulation medication that acts as a Vitamin K antagonist, blocking blood clotting factors II, VII, IX and X. Historically, it was a first-line medication for treating blood clots, but its role has been diminished because of the availability of newer drugs. While warfarin may be prescribed immediately after the diagnosis of DVT, it takes up to a week or more for it to reach therapeutic levels in the blood so that the blood is appropriately thinned. Therefore, low molecular weight heparin (enoxaparin [Lovenox)] is administered at the same time. Enoxaparin thins the blood almost immediately 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).

Side effects and risks of anticoagulation therapy

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 strategies available to reverse the anticoagulation effects.

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 have the potential risk of being the source of new clot formation. An IVC filter is NOT recommended for patients who are also taking anticoagulation medications.

Medically Reviewed by a Doctor on 7/3/2017

Source: MedicineNet.com
https://www.medicinenet.com/deep_vein_thrombosis/article.htm

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