Treatment of Venous Thromboembolism (2024)

FAQs

What is the treatment for venous thromboembolism? ›

Management and Treatment

Some DVTs may be managed with oral medications, while some PEs may need to be urgently removed. Your healthcare provider might remove a life-threatening PE through a catheter in your vein, or they might inject a medication called a thrombolytic that dissolves the clot quickly.

First-line therapy for non-high risk venous thromboembolism (VTE) or pulmonary embolism (PE) consists of direct oral anticoagulants (dabigatran, rivaroxaban, apixaban, or edoxaban) over vitamin K antagonists (VKAs).

The cornerstone of DVT/PE treatment is anticoagulant therapy. Currently, the most frequently used options include DOACs (mainly apixaban or rivaroxaban), warfarin, LMWH, and intravenous unfractionated (IV) heparin.

DVT thrombolysis involves inserting a small catheter into the leg using ultrasound and x-ray guidance. Clot-dissolving medications as well mechanical devices may be inserted into the catheter and used to remove or reduce the clot.

Treatments include medications called anticoagulants (blood thinners), compression stockings and elevating your affected leg(s) at different times throughout the day. In a minority of cases, when the DVT is extensive, invasive treatments (catheter-based procedures) may be required.

All patients with an acute episode of VTE require at least 3 months of therapeutic anticoagulation.

Elevation: Elevating the legs can help to instantly relieve pain. A doctor may also instruct a patient to elevate the legs above the heart three or four time a day for about 15 minutes at a time. This can help to reduce swelling.

Use of direct oral anticoagulants (DOACs) are recommended as first-line treatment of acute DVT or PE. DOAC therapy is preferred over vitamin K antagonists (VKAs) for most patients without severe renal insufficiency (creatinine clearance <30 ml/min), moderate-severe liver disease, or antiphospholipid antibody syndrome.

The first line of treatment for chronic venous insufficiency is to try non-surgical strategies. The goal is to promote normal flow of blood through the veins and reduce the pooling of blood in your legs. These conservative strategies may include: wearing compression stockings.

Apixaban was as effective as the conventional treatment in terms of VTE recurrence (2.3% vs. 2.7%; p < 0.001 for non-inferiority). Apixaban had a better safety profile, with a rate of major bleeding of 0.6%, compared with 1.8% for the conventional treatment (RR = 0.31; 95% CI: 0.17-0.55; p < 0.001).

What is the best medicine for blood clots in the legs? ›

Anticoagulants, such as heparin, warfarin, dabigatran, apixaban, and rivaroxaban, are medications that thin the blood and help to dissolve blood clots.

Depending on the blood thinner, you may be given an injection (shot), take a pill, or have an intravenous tube (IV) inserted. You may need to take blood thinners for several months or for a lifetime.

Anticoagulant and thrombolytic therapy options are available for the treatment of venous thromboembolism (VTE). Anticoagulant therapy prevents further clot deposition and allows the patient's natural fibrinolytic mechanisms to lyse the existing clot.

The risk of developing VTE is highest after major surgery, major injury, or during periods of infection and inflammation. This is because blood clots can develop in veins damaged by surgery or injury. Lack of movement after surgery or while traveling long distances can raise the likelihood of blood clotting.

DON'T stand or sit in one spot for a long time. DON'T wear clothing that restricts blood flow in your legs. DON'T smoke. DON'T participate in contact sports when taking blood thinners because you're at risk of bleeding from trauma.

Unfractionated heparin, administered by continuous infusion or subcutaneous injections adjusted to achieve activated partial thromboplastin time (APTT) greater than 1.5, is effective as initial treatment of venous thromboembolism.

Medication Summary

Apixaban, dabigatran, rivaroxaban, edoxaban, and betrixaban are alternatives to warfarin for prophylaxis or treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE). Apixaban, edoxaban, rivaroxaban, and betrixaban inhibit factor Xa, whereas dabigatran is a direct thrombin inhibitor.