Zona has taught Nursing and has a master's degree in Nursing Education and Maternal-Infant Nursing from University of Maryland Baltimore.
A deep vein thrombosis (DVT) is an unwanted and unneeded blood clot that occurs in the body, usually in the legs.
Medications Used to Treat DVT
Treatment of DVT includes medicine to prevent new clots from forming and to stop the current clot from growing larger.
Anticoagulants, or 'blood thinners,' do not actually thin the blood. Instead, they make it harder for the body to form blood clots. The idea that these medications thin the blood comes from the fact that the person taking anticoagulants bleeds more easily and takes longer to stop bleeding from an accidental cut.
Heparin is the medication of choice when first treating DVT. There are two forms of heparin. The older of the two is called unfractionated heparin and is given by injection or intravenously. The other type of heparin is known as low molecular weight heparin (LMWH) or Lovenox. It is given by injection.
Both forms of heparin work right away to interfere with clot formation.
Once the heparin has started working, a second medication may be added to the treatment. This medicine is a pill that is taken by mouth. The oldest of the pills is warfarin, or Coumadin. It has been in use for many decades and is quite effective as a blood thinner. The good thing about Coumadin is that it is inexpensive. The downside is that there are many foods and other medications that interfere with the action of Coumadin as a blood thinner. So the patient has to have frequent blood tests, especially at first, to establish the dose that is most effective without thinning the blood too much. This dose is different for each patient.
Newer pills that are sometimes used for DVT include rivaroxaban, or Xaralto, and apixaban, or Eliquis. These also decrease clotting, but in a different way from warfarin. Because the interaction with food is less of a problem, there is no need for frequent blood testing to establish dosage. Like warfarin, rivaroxaban and apixaban both interact with certain other medicines.
No matter which anticoagulant medication the patient is taking, the patient must remember to tell every health care provider about being on an anticoagulant and the name of blood thinner as well. This is especially important for surgery, dental procedures, and epidural or spinal anesthetics due to the increased risk for bleeding.
The shortest recommended treatment with anticoagulants for DVT is three months. How long medications will be continued after that will depend on a number of factors including:
- What risk factors led to this DVT
- Whether this DVT was a first or subsequent episode
- Risk of bleeding from anticoagulants vs. risk of clotting without
The decision of which anticoagulant is the right one for a given patient is based on a number of factors including the following:
- Other health conditions present in the patient
- Availability of the medicine
- Out of pocket costs for the patient
- How easily a patient can obtain follow-up blood draws for lab work
Recovery and Complications
The main goal of treatment of DVT is prevention of complications. About 60% of patients with DVT recover with no complications at all. The other 40% will experience one or more complications ranging from annoying to deadly.
The most deadly complication of DVT is pulmonary embolism, or PE. A PE is most likely to occur when a part of the blood clot forming the DVT breaks off and travels through the veins to the heart and into the circulation in the lungs. Depending on how much of the circulation in the lungs is affected, the person may die instantly, experience shortness of breath or a drop in oxygen saturation, turn blue around the lips, and/or experience non-specific anxiety. The first symptom in approximately 25% of patients who develop PE will be sudden death with no prior symptoms.
The other (more common) complication, which is less immediate and not as deadly, is post-thrombic syndrome, or PTS. This occurs when the DVT damages valves or otherwise blocks blood flow through the veins. About one-third of patients who develop DVT will go on to develop PTS, which causes pain, swelling, and other symptoms. There is no reliable way to know whether a given patient will or will not develop PTS. Therefore, preventive measures are generally put in place for every DVT patient. If a patient goes more than two years without developing PTS, the odds are greatly reduced and some of the following preventive measures can be stopped. However, if PTS does develop, most, if not all, of these measures may be lifelong.
- Pressure stocking beginning within one month of DVT diagnosis
- Long-term anticoagulant medicine
- Smoking cessation
- Weight loss if needed
- Frequent walking, swimming, or arm and leg exercises to keep the blood flowing freely
- Elevating legs when sitting if possible
- Instructions to report bleeding that won't stop
- Instructions to tell every healthcare provider about the previous blood clot(s), especially if another blood clot is suspected
Treatment and recovery following deep vein thrombosis (DVT), or an unwanted blood clot, will depend on the condition's underlying cause(s). Most DVTs will go away and leave no lingering problems. However, post-thrombic syndrome, or PTS, occurs in approximately 40% of cases of DVT. Pulmonary embolism, or PE, is a severe, potentially fatal, complication of DVT in which part of the blood clot breaks off and travels to the patient's lung.
Anticoagulant medications are used to treat DVT. Follow-up care will likely include efforts to prevent another DVT and PTS, including oral anticoagulants, compression stockings, and regular exercise.
DVT alone is not a big deal, but it can easily turn into PE and/or PTS if untreated. PE is an emergency, and PTS can have long-term, possibly disabling effects. The best action is to prevent DVT, PTS and PE.
Medical Disclaimer: The information on this site is for your information only and is not a substitute for professional medical advice.
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