When you receive a diagnosis of venous thromboembolism (VTE), it can be scary. This condition is a combination of deep vein thrombosis (DVT), the term for a blood clot in your vein, and pulmonary embolism (PE), which is the term for a blood clot that has traveled through the vein to lodge in the lung. Occasionally VTE occurs when a blood clot forms directly in the lungs. Luckily, there are numerous treatment options for VTE. Some are used preventively while others can reduce the acute danger and make VTE a manageable condition.
When you are having surgery that puts you at risk for VTE, your doctor may prescribe preventive medication to reduce the risk of a clot developing. If you've already developed a clot, your doctor will quickly begin tests to get a clear picture of the situation and begin treatment immediately with anticoagulant medications designed to thin the blood and lower the clotting threshold.
Because VTE recurs in 40 percent of all patients, it's considered a chronic condition. This means that in addition to immediate treatment, your doctor will also put in place a long-term treatment plan designed to prevent future blood clot emergencies. If there is concern that your condition can't be fully controlled with medication, your doctor may recommend other therapies, including surgical options.
Here's a rundown of the most common treatments used to treat VTE and what you need to know about them.
Preventive Treatments: Factor Xa Inhibitors
Certain surgeries, particularly hip and knee replacements and abdominal surgery, carry an increased risk of VTE occurring during or after surgery. If your doctor is concerned about VTE risk from surgery, she may prescribe a factor Xa inhibitor. The most commonly used factor Xa inhibitor is the drug fondaparinux (brand name Arixtra), but two new drugs have recently come into use, apixaban and rivaroxaban. Factor Xa inhibitors are usually considered a prophylactic, or preventive, treatment.
A natural anticoagulant manufactured by the human body, heparin is given as a shot or via IV to trigger the blood's natural mechanism for preventing and breaking up clots. It comes in two types: low-molecular-weight heparin and unfractionated heparin; you may hear your doctor refer to these by their initials, UH and LMWH.
Warfarin and Other Blood Thinners
This blood-thinner may be most familiar by its original brand name, Coumadin. Also known as a vitamin K antagonist, warfarin (other brand names are Jantoven and Marevan) is the oldest treatment for VTE and remains the bedrock of treatment for many people. Newer blood-thinners include Xarelto, Eliquis, and Pradaxa. Aspirin, which is also blood-thinner, is sometimes used for long-term treatment.
Your doctor is likely to recommend wearing compression stockings in addition to taking blood thinners. This is because they can help prevent more clots, and they also ease pain and swelling in your legs.
In cases where a clot is considered immediately dangerous or life-threatening, doctors use a clot-busting drug known as a thrombolytic. These are typically administered via catheter to go directly to the clotting site. Another way doctors dissolve clots is using a physical mechanism such as ultrasound or blood filtering, also called a vena cava filter.
In some cases where a blood clot in the lung (PE) is considered life-threatening, doctors may perform a type of surgery called an embolectomy to physically remove the clot.
Knowing your options is important, but don’t be afraid to ask a doctor about which treatment is best for your loved one’s lifestyle and condition.