Deep Vein Thrombosis

A deep vein thrombosis (DVT), if left untreated, may lead to a fatal complication called a pulmonary embolism (PE). Pulmonary embolism is a blood clot that detaches from the lower limb and travels to the lungs. Symptoms of a PE are usually nonspecific, which may include difficulty in breathing and chest pain. In fact, about 30% of patients with a DVT develop a PE without symptoms.

The primary objective of treating a DVT is to prevent this type of embolism. Therefore, treatment should be started when a patient is highly suspected of having an embolism or is at risk of developing one. Two main classes of medications 'blood thinners' and 'clot-busters' are commonly used.

Blood thinners are the first recommended treatment of DVTs with or without a lung embolism. Heparin is the preferred medication because of its fast action on blood clotting. Traditionally, heparin was given to patients in the vein. Today, newer heparin drugs that can be given under the skin are more often used. Patients can have a shorter hospital stay due to the drug's ease of administration.

Anticoagulants or blood thinners that are taken by mouth, such as warfarin, are often used when a longer duration is required. Warfarin is usually overlapped with the heparin therapy for four to five days to ensure that the blood thins adequately. The most common side effect of warfarin is bleeding, so it usually must be monitored. Regular visits to the physician to monitor are important in warfarin therapy. Most patients will continue to use it for three to six months.

The purpose of clot-busting drugs is to dissolve the blood clots. Examples include streptokinase, urokinase and alteplase (t-PA). similar to anticoagulant therapy, the major side effect of clot-busters is bleeding. Therefore, lab monitoring of blood work has to be performed at the completion of therapy.

Although newer agents, such as direct thrombin inhibitors, are being developed, the current standard of treating DVTs remains anticoagulation medications.