Deep Vein Thrombosis (DVT)

Anticoagulants are often referred to as "blood thinners," although they don't actually thin the blood. While these drugs do not dissolve the clot, they can stabilize it by allowing the clot to stick to the vein wall, thereby avoiding pulmonary embolism and allowing the body to eliminate or partially dissolve the clot over time.

Patients take anticoagulants like heparin (administered through IV) and enoxaparin (injected directly into the tissues under the skin of the abdomen or leg) on a short-term basis. They also take a longer-term oral anticoagulant, warfarin, in conjunction. Once the warfarin adequately thins the blood, patients can usually stop taking heparin or enoxaparin.

Warfarin treatment requires careful blood monitoring to ensure that the patient is taking the proper dose since severe bleeding from anticoagulants can occur. Treatment can last 3 to 6 months, and in certain situations, for life.

Rarely, the symptoms of deep vein thrombosis or pulmonary embolism are so severe that more aggressive treatment is needed. Medications that rapidly dissolve blood clots, called thrombolytics, are used selectively in individual patients in severe cases of DVT or PE. Thrombolytics are used to treat DVT when a severe blood clot causes painful leg swelling or compromises blood flow from the leg. They are also used in patients with severe cases of pulmonary embolism when extensive blood clots in the lung result in acute heart failure or acute lung failure. Thrombolytics are given by endovascular specialists in the hospital and require close observation throughout the time they are delivered due to an infrequent, but potentially serious risk of bleeding.

IVC Filters are mechanical devices placed by an endovascular specialist in the large vein of the abdomen, commonly called the IVC or inferior vena cava. They are used when a patient needs additional protection from DVT clots released from the leg or pelvis traveling toward the lungs, where they would cause a pulmonary embolism, or when patients aren't responding to or can't tolerate the anticoagulation medication.

Endovascular specialists advance a small tube containing the filter into a vein in the groin, neck, or arm to the intended site in the inferior vena cava (IVC), which receives the blood from both legs returning to the heart and lungs. Once the filter is in place, it opens fully and attaches to the walls of the IVC where it can trap clots escaping from either leg or the pelvis veins.

Some types of IVC filters are permanent, while others can be removed when the risk of pulmonary embolism has passed.