Blood Clots (cont.)
How are blood clots treated?
Depending upon their location, blood clots may be
aggressively treated or may need nothing more than symptomatic care.
Venous blood clots
Venous thrombosis in the leg may occur in the
superficial or deep systems of
veins.
Clots in the superficial system are often treated
symptomatically with warm compresses and acetaminophen or ibuprofen since there
is no risk for clots in the superficial veins to embolize to the lung. They are
connected to the deep system by perforator veins that have valves that act like
a sieve to strain and
prevent any clots form getting to the lung.
Deep venous thrombosis usually requires anticoagulation
to prevent the clot from growing and causing a pulmonary embolus. Initial
therapy with injectable enoxaparin (Lovenox) is used to immediately
"thin" the
blood. Meanwhile, warfarin (Coumadin) is prescribed as an anti-coagulation pill. It takes a few
days for warfarin to reach therapeutic levels and in this time frame, both the
injectable and oral medications are used.
Blood clots below the knee are at lower risk for embolization to the lung,
and an alternative to anti-coagulation treatment is serial ultrasound
examinations to monitor the clot to see if it is growing or being resorbed by
the body.
Pulmonary emboli are treated similarly to deep venous thrombosis, but often
the patient is admitted to hospital for observation. This is especially true if
lung function is compromised and the patient is short of breath or is
experiencing hypoxia, or low oxygen levels in the blood.
Arterial blood clots
Arterial blood clots are often managed more aggressively. Surgery may be
attempted to remove the clot, or medication may be administered directly into
the clot to try to dissolve it.
Alteplase (Activase, TPA) or tenecteplase (TNKase) are examples of medications that may
be used in peripheral arteries to try to restore blood supply.
This is the same approach that is used for heart attack. If possible, cardiac catheterization is performed to
locate the blocked blood vessel and a balloon is used to open the occluded area, restore blood
flow, and place a stent
to keep it open. This is a time-sensitive procedure and if a hospital is not
available to do the procedure emergently, TPA or TNK is used intravenously to
try to dissolve the thrombus and minimize heart damage.
Stroke is also treated with TPA if the patient is an appropriate candidate
for this therapy.
Next: What are the complications of blood clots? »
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