March 16, 2015 | by The Polyclinic

DVT stands for deep vein thrombosis and occurs when a thrombosis or clot develops in one of the deep veins in your body.  DVT is a major public health problem and becomes more common with age. By age 80, 5 in 1,000 people will experience DVT.  DVT can occur either spontaneously or as a complication of surgery, cancer, or prolonged immobility such as airline travel.

DVT can become life-threatening if not promptly diagnosed and treated.  DVT often develops in veins in the legs and presents as swelling and pain. But the clot may not remain in the legs. In about 1/3 of patients, the clot travels to the lungs where it can quickly lead to complications or death.

In addition to the acute problem of DVT, incompletely treated DVT can become a source of chronic problems in the leg such as swelling, inflammation, varicose veins, infections, pain, and ulcerations or sores that may persist for months or years.

If DVT is suspected, it is important to get prompt medical attention for diagnosis and treatment.  The diagnosis is generally made with a blood test and an ultrasound of the legs.  If your physician suspects that the clots may have travelled to the lungs, then a CT scan may also be recommended.

When DVT is found or strongly suspected, your physician will begin treatment with a blood thinner or anti-coagulant. The goal of this treatment is to stabilize the blood clots while the body’s own clot-clearing mechanism goes to work.  The treatment with traditional blood thinners has involved a quick-acting drug such as heparin or low molecular weight heparin (LMWH) that stabilizes the acute clot and then warfarin that is taken as a tablet for several months.

Although treatment with heparin and warfarin has been effective, the traditional approach involves either hospitalization or self-administered injections and an overlapping administration of warfarin tablets. The warfarin takes several days to become effective and requires careful dose adjustment.

To safely and effectively give warfarin, your doctor will require frequent monitoring with a blood test.  Although warfarin has proven to be effective, it has been notoriously difficult to adjust.  Many patients either receive too much or too little and it is difficult for the doctor to predict the dose for each individual.

Fortunately, there is a new class of drugs called NOAC’s or New Oral Anti-Coagulants that are becoming available that may make the treatment of DVT and other clotting disorders easier.  The NOAC medication is given as a pill rather than as an injection or infusion.  NOACs also can be given without frequent laboratory tests or customized dose adjustments.  They work quickly and may be at least as safe to take as the traditional blood-thinning medications.

There are currently four NOAC’s available for your doctor to consider prescribing:  Dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa).  Medical researchers are actively working to determine which of these new medications will be best for each situation where blood thinning is needed. 

For now, we don’t have the complete picture.  If you have DVT and need to receive a blood thinner, you may wish to discuss with your doctor whether a NOAC may be right for you.