Anticoagulation DVT Treatment
The goal of anticoagulation is to prevent clots from propagation and decrease the chance of death from pulmonary embolism. Anticoagulation initially consists of IV unfractionated heparin (UH) or subcutaneous (SC) low-molecular weight heparin (LMWH). Patients with renal failure are better treated with unfractionated heparin since LMWH is excreted primarily via the kidneys. Long-term treatment with anticoagulation is subsequently carried out by administration of oral vitamin K antagonist such as Coumadin. It is important to notice that anticoagulation does not dissolve a clot. It lessens the chance of clot propagation and the chance of fatal pulmonary embolism.
The fate of a clot in DVT depends on the fibrinolytic mechanisms and factors that are secreted by the veins. A patient with a large clot burden such as clots in the central veins, i.e. iliac and femoral vein DVT, can overwhelm these mechanisms. Subsequently, the clot lysing mechanisms will not work properly. This can cause residual thrombus causing postphlebitic syndrome. Mechanical thrombectomy and pharmacological thrombolysis with drugs such as tPA thrombus and significantly decrease the chance of postphlebitic syndrome.
Duration of Anticoagulation
The duration of anticoagulant treatment is stratified based on the extent and the location of the clot and the other risk factors such as the presence of cancer, recent hip or knee surgeries, immobility, recurrence of DVT, and the presence of hypercoagulability.
For patients for the first episode of idiopathic DVT, the treatment in general should continue for 6-12 months of anticoagulation.
DVT TREAMENT OPTIONS
ABOUT DR. MALEKMEHR
Dr. Farshad Malekmehr is a board-certified cardiovascular surgeon. He has a special interest in treating patients with DVT and pulmonary embolism. His education included an undergraduate study at UCLA and CSUN with honors degree. He subsequently received his medical degree from the George Washington University School of Medicine in Washington DC.