Blood Clot in the Legs (cont.)
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Deep Vein Thrombosis Medical Treatment
The treatment of blood clots depends upon their location in the body. Most commonly, anticoagulation or blood-thinning medication is prescribed to prevent further clot formation and to minimize the risk that part of the blood clot will break off and travel to the lung and cause pulmonary embolism.
Treatment of deep venous thrombosis in the leg is often individualized for each patient depending upon the clinical situation and other medical conditions that may be present.
Anticoagulation is the treatment of choice and is a two stage process. Low molecular weight heparin (enoxaparin [Lovenox], dalteparin [Fragmin]) injections are started to begin immediate blood thinning. At the same time, warfarin (Coumadin) is prescribed (an oral anticoagulation medication that takes a few days to become effective and adequately anticoagulate the blood). Blood tests (prothrombin time or international normalized ratio [INR]) are used to measure the effectiveness of the warfarin therapy. When the INR reaches the appropriate level, the heparin injections are discontinued.
Rivaroxaban (Xarelto) is a medication called a selective Factor Xa inhibitor that is an oral tablet indicated for the treatment of DVT. It may be used as a treatment and a preventative prophylaxis for blood clots instead of warfarin.
Apixaban (Eliquis) and dabigatran (Pradaxa) are new drugs used to prevent blood clots that may soon be approved to treat acute DVT.
If possible, the treatment of uncomplicated deep venous thrombosis in an individual is accomplished as an outpatient. Education is provided to the patient and family to teach them how to administer the injection, and the patient is instructed to return to their family physician or the hospital for appropriate monitoring (blood tests). Some patients will need to be admitted to the hospital if they have significant underlying medical illnesses, are pregnant, or are unable to administer the heparin injections.
The duration of anticoagulation therapy depends upon the circumstances that led to the development of the blood clot. If there were temporary risk factors, for example a long trip or recent immobility because of injury or illness, treatment may last 3 to 6 months. However, if the cause is unknown or if there is the risk for recurrent clot formation, medication may be required for more than 12 months.
Not all DVTs require anticoagulation. Because small clots located in veins below the knee have a low risk of embolizing to the lung, it is possible to observe the patient without giving medications. Using serial ultrasound tests of the veins, the clot can be monitored to see whether it is extending and growing or whether it is stable and needs no further treatment.
Blood clots located in the femoral vein near the groin that extend into the iliac vein in the abdomen may require more aggressive treatment with thrombolytic (thrombo=clot + lysis=breakdown) therapy. Clot-busting drugs (alteplase [Activase], streptokinase [Streptase]) may be injected directly into the clot itself. This usually requires a specialist (a vascular surgeon or an interventional radiologist) who can use fluoroscopy or real time X-rays to position a catheter or tube into the affected vein where the clot resides and drip the medication in over a period of time to dissolve the clot and prevent it from traveling to the lung.
Similar situations can exist in the arm. DVTs above the elbow are usually treated with blood-thinner medications as described above, while clots in the subclavian vein, located just below the collarbone, may be considered for thrombolytic therapy.
Because of underlying medical conditions, some people may not be able to take anticoagulation medications and may require an alternative treatment instead of medication. Those who have gastrointestinal bleeding (bleeding from the stomach or bowel), intracranial bleeding (bleeding in the brain), or who have had recent major trauma potentially could bleed to death if anticoagulation medications are prescribed. The alternative for leg DVT treatment in these situations may be an inferior vena cava filter. The vena cava is the large vein that collects blood from the lower body just before it enters the heart. A filter can be placed into the vena cava to trap any clots that might break off and prevent them from traveling to the heart and then to the lungs.
Compression stockings or socks are useful in preventing a complication of a leg blood clot called post-thrombotic syndrome or postphlebitis syndrome, in which the affected leg swells and becomes chronically painful. These stockings may be purchased over-the-counter or can be custom fitted. It is recommended they be worn for at least a year after the diagnosis of deep venous thrombosis.
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