The Hip: Preservation, Replacement and Revision

Deep Venous Thrombosis (DVT) - Treatment

Indications for treatment
Treatment modalities (classes of drugs)
  • Anticoagulants
    • Prevent recurrent or ongoing thrombolytic occlusion of the verterobasilar circulation
  • Low molecular weight heparins
    • Prepared by selectively treating UFH to isolate low molecular weight fragments
    • Activity measured in units of factor X inactivation and monitoring of aPTT not required
  • Vitamin K antagonists
    • Class of oral anticoagulant drug that acts as antagonists to vitamin K
    • Interferes with interaction between vitamin K and coagulation factors II, VII, IX, and X
  • Thrombolytics
    • Used to dissolve a pathologic intraluminal thrombus or embolus that has not been dissolved by the endogenous fibrinolytic system
    • Used for prevention of recurrent thrombus formation and rapid restoration of hemodynamic disturbances
Duration of treatment
  • standard recommendations range from 3-6 months
  • in the study by Ridker PM, et al.,: that long-term, low-intensity warfarin therapy is a highly effective method of preventing recurrent VT
    • patients assigned to placebo or low-intensity warfarin (target INR, 1.5 to 2.0) had a risk reduction of 64 percent p < 0.001)
  • in the future, patients with DVT may be tested for thrombophilias (inherited suseptibility), and recommendations for length of treatment are based accordingly
  • patients with DVT need to wear fitted compression stockings for at least two years - will reduce incidence of the post-thrombotic syndrome by 50%
  • in the report by Agnelli G, et al. (2001), the authors sought to determine the optimal duration of treatment
    • patients with a first episode of idiopathic proximal DVT who had completed 3 months of oral anticoagulant therapy were randomly assigned to the discontinuation of oral anticoagulants or to their continuation for 9 additional months
    • analysis showed that of 134 patients assigned to continued oral anticoagulant therapy, 21 had a recurrence of DVT (15.7 %; average follow-up, 37.8 months), as compared with 21 of 133 patients assigned to the discontinuation of oral anticoagulant therapy (15.8 percent; average follow-up, 37.2 months), resulting in a relative risk of 0.99 (95 % CI, 0.57 to 1.73)
    • incidence of recurrence after the discontinuation of treatment was 5.1 % per patient-year in patients in whom oral anticoagulant therapy was discontinued after 3 months and 5.0 percent per patient-year in patients who received an additional 9 months of oral anticoagulant therapy
    • authors concluded that the clinical benefit associated with extending duration of anticoagulant therapy to one year is not maintained after therapy is discontinued
  • references
Use of D-dimer to determine length of treatment
Superficial DVT
Post-thrombotic syndrome
References

Patient-reported treatment satisfaction with oral rivaroxaban versus standard therapy in the treatment of acute symptomatic deep-vein thrombosis.

Oral rivaroxaban for symptomatic venous thromboembolism.

Rivaroxaban (Xarelto) Criteria for Use for Treatment of Venous Thromboembolism (VTE)



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, February 17, 2014 3:12 pm