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Blood Clot in the Legs (cont.)

Medications That Treat DVT

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. Fondaparinux (Arixtra) is another injectable chemically related to low molecular weight heparin, used for DVT prevention and treatment.

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), dabigatran (Pradaxa), and Edoxaban (Savaysa, Lixiana) are also used to prevent blood clots and treat acute DVT.

What about 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.

What about Follow Up Care with My Doctor?

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:

  • Take the prescribed amount of medication as directed by a physician. Do not miss or add doses.
  • Follow the doctor's instructions closely about when to get lab tests for blood coagulation.
  • Ask the doctor before starting or stopping any medication or supplement, including over-the-counter (OTC) medications. Many medicines and supplements increase or otherwise interfere with the effect of anticoagulants.
  • Ask what foods should be avoided, because some foods may change the effectiveness of blood-thinning drugs.
  • Wearing a MedicAlert bracelet with information about any anticoagulants one is taking is advised.
  • People on anticoagulant therapy should inform any other medical professionals including dentists or podiatrists before undergoing any procedure.
Medically Reviewed by a Doctor on 9/11/2017

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Deep Venous Thrombosis »

Deep venous thrombosis (DVT) most commonly involves the deep veins of the leg or arm, often resulting in potentially life-threatening emboli to the lungs or debilitating venous alular dysfunction and chronic leg swelling.

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