Management of Thrombus Disease
When thrombus disease is diagnosed, any delay in anticoagulation increases the risk of life-threatening embolization. Treatment, primarily via the use of anticoagulants (“blood thinners”), has two goals:
- Dissolve any clots that are present and inhibit a current thrombotic tendency with initial anticoagulation
- Preventing clots in the future, with long-term (maintenance) anticoagulation
Initial anticoagulation is done for up to 10 days. Medication can be from a variety of anticoagulants, among them:
- Subcutaneous heparin: Heparin increases the activity of antithrombin III, which interferes with the clotting factor, thrombin, it its role; heparin also inhibits several other clotting factors.
- Subcutaneous fondaparinux: This inhibits Factor Xa, one of the clotting factors.
After initial anticoagulation, therapeutic long-term (maintenance) anticoagulation is used. The duration of treatment depends on a patient’s risk factors for recurrence.
Since the highest risk of thrombus recurrence is in the first three months of anticoagulation, a time span which includes the transition from initial to maintenance anticoagulation, the conversion should be smooth with uninterrupted effective 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 (Category “X”) and for those with kidney disease. It is used for conversion from initial therapy (subcutaneous heparin) to oral long-term therapy. Warfarin is also easily reversed, in cases of a need for surgery.