Managing Blood Clots in the 21st Century
Much has changed for the better over the years in the diagnosis and treatment of deep vein thrombosis (DVT), a blood clot in a deep vein, usually in the legs. Despite the advances in DVT management, we still see blood clots at an epidemic rate, with an estimated over 600 thousand cases per year in the United States alone. This might be an undercount due to those blood clots that may go undiagnosed and claim lives as the blood clot passes from the legs to the heart and lungs.
The following shares current evidence-based guidance and leads our current management principles as we evaluate patients with deep vein thrombosis.
Principle 1: Anticoagulation (Blood thinners) – yet how do they work?
Features of anticoagulation involve the drug, the duration of use, and understanding what the drug is supposed to do. In the past twenty years alone, blood clot management has moved from bed rest and IV drips of heparin in the hospital to management at home due to the quick therapeutic activity of the newer drugs and knowledge that patients do far better and have less complications.
Newer agents provide the intensity of anticoagulation a reliable dosing with a safety profile that surpasses traditional treatment. So many believe that blood thinners break up or dissolve blood clots. The reality is that the blood thinners quickly STOP the clotting activity. The development of a blood clot may occur quickly, yet it is an ongoing process until anticoagulation is started. Oral agents like Xarelto and Eliquis become therapeutic in less or same time as injectable blood thinners and have been proven to be more cost effective.
Principle 2 & 3: Walking and Compression therapy – yet won’t the blood clot travel?
One of the foremost experts in compression therapy is Dr. Hugo Partsch. Dr. Partsch and Blattner studied patients with fresh blood clots and compared bed rest without compression to walking and use of compression. What they found is that those who walked with compression had far greater reduction in pain and swelling and had no difference in major complications like a pulmonary embolism. Bed rest is a recipe for clot extension as it promotes ‘stasis’ or less flow in the venous system and is no longer recommended. Clots may travel, yet in this randomized trial patients who walked fared better than those at bedrest.
Compression therapy has received some bad press through the SOX trial where the use of compression did not change the incidence of patients developing post thrombotic syndrome, a long-term complication of blood clots. The SOX trial is viewed by many in the field as flawed. The use of compression to help reduce pain and swelling is clear and should be considered as a script is being written for the specific anticoagulation agent.
Principle 4: The use of statins to help prevent blood clots and to help reduce risk of post thrombotic syndrome.
Do not be surprised if you or a loved one diagnosed with a blood clot (deep vein thrombosis) and the doctor is prescribing a statin (cholesterol lowering class of drugs). Statins have been shown to stabilize the lining of the vessel walls and are felt to help reduce the incidence of deep vein thrombosis. Much is still being learned, yet during our recent online educational event Vision2021, a session on post-thrombotic syndrome brought forth the use of statins in the discussion period. Dr. Tony Comerota is an international expert in managing blood clots and a strong advocate for initiating statin drugs as we prescribe anticoagulation therapy and compression stockings.
Take Home Points
Current management of deep vein thrombosis has moved from the hospital to the home;
The newer classes of anticoagulation are safe, offer quick effect, and are shown to be cost effective vs. traditional therapy;
Compression is an important step in early blood clot management and proven to help reduce pain and swelling associated with the event;
Walking is safe and helps to keep blood moving in the legs and should be encouraged over bedrest;
Statins have a role in managing blood clots and in 2021 is becoming a part of acute management of fresh blood clots we are seeing in Dothan.
Schedule Your Consultation Today!
The diagnosis of a blood clot is where this all starts. If you have undiagnosed leg pain, swelling, skin discoloration, you may have a blood clot. Do not wait. Call us at 1-800=FIX-LEGS to schedule your appointment. We can help!