When a blood clot forms in the veins of the body
it is called VTE, or venous thromboembolism.
Let’s break down the meaning of these long words:
venous means vein,
thrombus means clot,
and an embolism is where the clot moves through the bloodstream
to another part of the body.
There are three types of VTE:
(1) a clot in veins just under the skin is called superficial vein thrombosis,
(2) a clot deep in the body is called deep vein thrombosis (DVT)
and (3) a clot that moves to the vessels of the lungs
is called pulmonary embolism (PE).
DVT and PE are the most dangerous types of VTE.
VTE is common, very serious and can cause death.
It is important to take steps to keep VTE from happening
and to get the right care if you have VTE.
Some risk factors make having a dangerous blood clot more likely to happen.
These risk factors include:
not moving for a long time
such as on a long trip
or when staying in bed because you are sick or hurt;
staying in the hospital or having surgery;
having a baby;
taking birth control pills;
smoking;
having cancer;
and/or having some genetic abnormalities.
There are a number of ways to reduce the risk of a dangerous blood clot from forming.
Sometimes special compression stockings
can keep clots from forming in the legs.
Some medicines can also help prevent dangerous blood clots
These drugs are called blood thinners (anticoagulants).
Blood thinners are given to some patients who need surgery
and to people who are likely to experience blood clots.
There are two main types of medications used to treat VTE:
blood thinners (also called anticoagulants);
and clot busters (also called thrombolytic therapy).
Blood thinners make it more difficult for the blood to clot.
These blood thinners make it less likely for a clot to get started
and they also stop clots from growing larger.
Blood thinners include:
warfarin,
heparin,
low molecular weight heparin (LMWH),
and fondaparinux.
There are also blood thinners called direct oral anticoagulants (or DOACs for short).
These include:
apixaban,
dabigatran,
edoxaban,
and rivaroxaban.
DOACs work very fast
and do not need to be regularly monitored by your doctor.
They do not affect other medications
or food you may have taken.
Warfarin does not work as quickly
and can cause problems with other medications,
and limit what you can eat.
Warfarin needs to be monitored regularly with blood tests.
Heparin and low molecular weight heparin are short-acting medicines
that have to be given through an IV or in the form of shots.
Heparin needs to be monitored with blood tests.
Low molecular weight heparin does not require regular monitoring.
DOACs are the first choice for treatment of VTE in people
who may have blood clots, but who do not have cancer.
The second choice is warfarin.
Low molecular weight heparin is preferred in patients with cancer;
however it is the third choice for most patients with VTE
since it requires daily injections.
Fondaparinux is used on occasion as well.
If you need to take blood thinners because you have dangerous blood clots,
you will usually take them for at least 3 months.
Therapy may need to be longer as well depending on several different factors.
People with blood clots and cancer need to take blood thinners
until the cancer is gone.
People with previous blood clots may need to be treated for their entire life.
You and your doctor should talk about
how long you should take the blood thinner based on your risk factors.
If you have blood clots in the vessels of the lungs
and your doctor feels that something must be done
to get rid of the clots faster than your body can get rid of them,
medicines (called thrombolytic therapy), can be given through an IV
or they can be delivered to the clot in the vessels of the lungs
with plastic tubes called catheters.
These catheters can deliver the medicines to bust up the clot
and sometimes even suck the clot out of the blood vessels of the lungs.
The decision to use this type of therapy depends on
what is available at your hospital
and also on your doctor's judgment about
what is the best thing to do for you.
Usually, these thrombolytic medicines are only used for patients
who are at high risk of dying from these dangerous blood clots.
Sometimes patients cannot be treated with a blood thinner because of bleeding
or because they are at high risk of bleeding
while taking one of these blood thinners.
When a blood thinner cannot be used in a patient with a VTE blood clot,
a wire basket, which is called a “filter” can be placed to catch any clots
that may break off and go to the lungs.
This filter is placed in the large vein (called the vena cava)
that drains the vessels of the legs and body parts within the belly
to bring blood back to the heart.
Although these filters have some risks over time,
they lower the chances of getting a new blood clot in the lung for a short period of time.
Because taking a blood thinner is the best way to treat VTE blood clots,
a blood thinner should be started as soon as it is safe.
Sometimes, these vena cava filters can be removed
if they are no longer needed.
You should discuss with your doctor if your filter can be, or should be, removed.
Treatment for blood clots has several goals.
Doctors treat blood clots to:
keep new clots from forming;
stop existing clots from enlarging in size;
stop pieces of a clot from moving
and limiting blood flow in other parts of the body;
avoid complications caused by blood clots;
and keep clots from traveling to the lungs,
brain, or heart where they can be fatal.
VTE blood clots can cause life-long health problems and may cause death.
If you have risk factors for VTE, or have had a VTE in the past,
be sure to talk to your doctor about ways you can prevent VTE
and reduce your risk of life-threatening complications.