Deep Vein Thrombosis (cont.)
What is the treatment for deep vein thrombosis?
Superficial Thrombophlebitis
Treatment for superficial blood clots is symptomatic with:
- warm compresses,
- leg compression, and
- an anti-inflammatory medications like
ibuprofen.
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 (see below).
Deep venous thromboses
Deep venous thromboses that occur below the knee tend not to embolize (break
loose). They
may be observed with serial ultrasounds to make certain they are not extending
above the knee. At the same time, the cause of the deep vein thrombosis may need to be addressed.
The treatment for deep venous thrombosis above the knee is anticoagulation,
unless a contraindication exists. Contraindications include recent major surgery
(since anticoagulation would thin all the blood in the body, not just that in
the leg, leading to significant bleeding issues), or abnormal reactions when
previously exposed to blood thinner medications.
Anticoagulation prevents further growth of the blood clot and prevents it
from forming an embolus that can travel to the lung.
Anticoagulation is a two step process.
Warfarin (Coumadin) is the
drug of choice for anti-coagulation. It is begun immediately, but unfortunately
it may take a week or more for the blood to be appropriately thinned. 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 reached its therapeutic level. 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 metabolized), intravenous
heparin can be used as the first step. This requires admission to the hospital.
The dosage of warfarin is monitored by blood tests measuring the prothrombin
time or INR (international normalized ratio). For an uncomplicated deep vein
thrombosis, the
recommended length of therapy with warfarin is three to six months.
Some patients may have contraindications for warfarin 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 from reaching the
heart and lungs. These filters may be effective but also may be the source of
new clot formation.
Next: What are the complications of deep vein thrombosis? »
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