Anticoagulation: Management & Treatment Menu

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

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.

Long-Term Anticoagulation

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.

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This information is provided by Vascular Health Clinics and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.

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