Management for Hemostasis and Thrombosis
Once a thrombus is identified, attempts at dissolving it as well as preventing more should be made. Treatment aimed at these two goals is primarily in the medical use of anticoagulant therapy (“blood thinners”).
Initial anticoagulation is instituted upon diagnosis, and any delay in the initial anticoagulation increases the risk of life-threatening embolization. After initial treatment, therapeutic long-term (maintenance) anticoagulation is used. The duration of treatment depends on risk factors for recurrence.
Initial anticoagulation is done for up to 10 days. Medication can be from a variety of anticoagulants, among them:
- Subcutaneous heparin
- Subcutaneous fondaparinux
The conversion from initial to long-term anticoagulation should be smooth, with no drops or interruptions, as the highest risk of recurrence in in the first three months of anticoagulation.
- Monotherapy (one agent): via oral rivaroxaban and apixaban for those who begin long-term therapy without the need for an initial coagulation period.
- Edoxaban and dabigatran orally: are used after a five-day course of initial anticoagulation.
- Warfarin: An anti-vitamin K agent is for patients who are not pregnant and for those with kidney disease. It is used in the conversion from the heparin used in initial therapy to oral long-term therapy. Warfarin is also easily reversed, in cases of the need for surgery. It is contraindicated in pregnancy (Category “X”).