Blood Clot in the Legs (cont.)
IN THIS ARTICLE
Deep Vein Thrombosis (DVT) Medications
Warfarin (Coumadin) is an oral medication taken to thin or anticoagulate the blood. It may take a few days for its action to take effect. The dose needs to be individualized for each person, and blood clotting must be monitored routinely since changes in diet, activity, and the administration of other medications may affect the levels of warfarin. Blood tests (usually international normalized ratio [INR]) are done routinely to monitor the blood-thinning effects and help the health care professional select the appropriate warfarin dose. Ideally, the INR should be kept in a range between 2.0 and 3.0. Blood tests are done weekly until the INR stabilizes and then are done every 2 weeks to every month.
Enoxaparin (Lovenox) is a low molecular weight heparin injected beneath the skin to thin the blood. The dose is usually 1 milligram per kilogram of weight injected twice daily or 1.5 milligrams per kilogram injected once daily. Enoxaparin usually is considered a temporary medication to be used to thin the blood while warfarin begins to take effect; however, it may be used over the long term in some patients with cancer.
If a woman develops a DVT/PE while pregnant it is usually treated with heparin only, because warfarin is dangerous to administer during pregnancy.
Rivaroxaban (Xarelto) is a newer medication, which belongs to the selective Factor Xa inhibitor class of drugs, is an oral tablet for the treatment of DVT. It may be used as a treatment and a preventive therapy for blood clots.
Apixaban (Eliquis) and dabigatran (Pradaxa) are also used to prevent blood clots and treat acute DVT.
Deep Vein Thrombosis (DVT) Surgery
Surgery is a rare option in treating large deep venous thrombosis of the leg in patients who cannot take blood thinners or who have developed recurrent blood clots while on anticoagulant medications. The surgery is usually accompanied by placing an IVC (inferior vena cava) filter to prevent future clots from embolizing to the lung.
Phlegmasia cerulea dolens describes a situation in which a blood clot forms in the iliac vein of the pelvis and the femoral vein of the leg, obstructing almost all blood return and compromising blood supply to the leg. In this case surgery may be considered to remove the clot, but the patient will also require anticoagulant medications.
Deep Vein Thrombosis (DVT) Specialists
The initial diagnosis of DVT is usually made by the general practitioner, internist, family practitioner, or an emergency medicine specialist.
Depending on the severity of the DVT/PE, or the need for intervascular or surgical intervention, one may be referred to a vascular surgeon or an interventional radiologist. Other specialists involved in the care may involve a pulmonologist (a physician who specializes in the lungs), or a hematologist (specialist in blood disorders).
Deep Vein Thrombosis (DVT) Follow-up
A person who has had a deep vein thrombosis may be asked to return for follow-up Doppler ultrasounds or other imaging studies may be performed if the leg swelling persists or if the symptoms recur. During anticoagulant treatment, it is often advised to take the following measures:
Medically Reviewed by a Doctor on 9/28/2015
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