How are blood clots treated?

Depending upon their location, blood clots may be aggressively treated or may need nothing more than symptomatic care.

Venous blood clots

Venous thrombosis in the leg may occur in the superficial or deep systems of veins.

Clots in the superficial system are often treated symptomatically with warm compresses and acetaminophen or ibuprofen since there is no risk for clots in the superficial veins to embolize to the lung. They are connected to the deep system by perforator veins that have valves that act like a sieve to strain and prevent any clots form getting to the lung.

Deep venous thrombosis usually requires anticoagulation to prevent the clot from growing and causing a pulmonary embolus. Initial therapy with injectable enoxaparin (Lovenox) is used to immediately "thin" the blood. Meanwhile, warfarin (Coumadin) is prescribed as an anti-coagulation pill. It takes a few days for warfarin to reach therapeutic levels and in this time frame, both the injectable and oral medications are used.

Blood clots below the knee are at lower risk for embolization to the lung, and an alternative to anti-coagulation treatment is serial ultrasound examinations to monitor the clot to see if it is growing or being resorbed by the body.

Pulmonary emboli are treated similarly to deep venous thrombosis, but often the patient is admitted to hospital for observation. This is especially true if lung function is compromised and the patient is short of breath or is experiencing hypoxia, or low oxygen levels in the blood.

Arterial blood clots

Arterial blood clots are often managed more aggressively. Surgery may be attempted to remove the clot, or medication may be administered directly into the clot to try to dissolve it. Alteplase (Activase, TPA) or tenecteplase (TNKase) are examples of medications that may be used in peripheral arteries to try to restore blood supply.

This is the same approach that is used for heart attack. If possible, cardiac catheterization is performed to locate the blocked blood vessel and a balloon is used to open the occluded area, restore blood flow, and place a stent to keep it open. This is a time-sensitive procedure and if a hospital is not available to do the procedure emergently, TPA or TNK is used intravenously to try to dissolve the thrombus and minimize heart damage.

Stroke is also treated with TPA if the patient is an appropriate candidate for this therapy.