The most common and effective treatment is to administer anticoagulants (clotting prevention agents). These drugs block the formation of new clots. Over time the body's natural processes will begin to dissolve the clots that have already formed. Initially, injections of heparin or low-molecular weight heparin are used because they act within hours. For the longer term, the most common medication is warfarin, often sold under the brand name Coumadin, and taken orally. Unlike, heparin or low-molecular weight heparin, 3-5 days is needed before Coumadin reaches full therapeutic effect. There are also novel oral anticoagulants that have been recently approved by the FDA. View the chart below to understand the differences between these drugs.
The safest way to dissolve a clot is to let the body's own clot-dissolving processes take effect. This can take anywhere from weeks to years. In the case of massive or life-threatening clotting, thrombolytic or clot dissolving drugs can be administered via catheter directly into the blocked blood vessels to dissolve recently formed clots. Thrombolytic drugs do have a risk of bleeding. In certain emergency situations clots can be removed surgically, but this increases the risk of further clotting.
The chances of a recurrent VTE is dependent on the circumstances leading up to the first VTE. For example, if the blood clot occurred as a result of surgery or trauma, then the chances of reoccurrence is relatively low. On the other hand, for people who developed spontaneous VTE and have terminated warfarin treatment after 6 months, the chance of recurrence is approximately 20% in the first 4 years and roughly 30% after 10 years. These figures emphasize the importance of continued warfarin treatment; the rate of recurrent DVT is less than 1% for patients who stay on warfarin.
Warfarin has been in use for over 50 years and there are no known long-term side effects. There is an increased risk of bleeding, which is reduced by avoiding contact sports, or sports that can result in head trauma such as downhill skiing or bicycling. A small percentage of patients are not helped by Warfarin and use other anticoagulants.
Despite the alarming statistics, fortunately for most people, there are simple, inexpensive and effective treatments and preventions to manage this prevalent disease. In many ways, management is akin to the blood sugar management of a diabetic. What is often unrecognized about patients who have experienced a thrombosis is the anxiety and fear that they experience. This is that the most challenging experience for many of them.