Treatment of thrombosis occurs when you have a diagnosed deep-vein thrombosis (DVT) or pulmonary embolism (PE) that needs to be treated. One of the most important aims of treatment is to prevent the blood clot from breaking into smaller pieces called emboli and travelling to other parts of the body (such as the lungs).

If you are at high risk of thrombosis (e.g. you need to undergo orthopedic surgery), you will be given medication in order to prevent the development of thrombosis.

There are a variety of options, in terms of medications and devices, available to prevent or treat thrombosis. The therapies used to prevent thrombosis may differ (e.g. in dose) from the therapies used to treat thrombosis.

The risks associated with a particular treatment option, the most common of which is bleeding, will depend on the type, dose and regimen (schedule) of the therapy. Your physician will only recommend those treatment options that he/she believes are appropriate for you and will provide you with most benefit while keeping your risk of deep-vein thrombosis (DVT) or pulmonary embolism (PE) as low as possible.

If you have any concerns about the treatment that you have been prescribed, or the effects it has, you must consult your physician.

Mechanical devices

Mechanical devices that have been shown to be effective in the prevention of deep-vein thrombosis (DVT) in patients at risk of DVT include elastic graduated compression stockings and intermittent pneumatic compression. They are most often used after a surgical operation. Elastic graduated compression stockings increase the rate of blood flow through the veins in your legs. Pneumatic compression is achieved by wearing a plastic stocking that intermittently fills with air and squeezes your leg. This compression enhances blood flow in the deep veins and stimulates your body to produce factors that help to dissolve small blood clots. These methods are particularly useful in patients with a high risk of serious bleeding.

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Side effects UFH is associated with a risk of bleeding, heparin-induced thrombocytopenia (low platelet count in the blood) and local reactions in the skin around the site of infusion. Long-term use of UFH may also be associated with an increased risk of osteoporosis (loss of bone tissue leading to brittle bones). If you experience any side effects, you must consult your physician. Potential drug interactions before you start taking UFH, you may be asked to stop taking any other treatments that may increase your risk of bleeding (e.g. other anticoagulants and platelet inhibitors, such as aspirin or nonsteroidal anti-inflammatory drugs). If your physician considers it is necessary for you to continue taking these treatments while you are taking UFH, he/she is likely to ensure that you are monitored very carefully. Monitoring of therapy if you are receiving treatment with UFH, the dose you receive has to be regularly monitored and adjusted to ensure that you are sufficiently protected from thromboses forming in your veins. Your physician will conduct a blood test (the activated partial thromboplastin time, or aPTT, test) 6 hours after the first dose and at least once a day thereafter to ensure that you are receiving the correct dose of UFH.

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Low-dose aspirin

Aspirin (acetylsalicylic acid) can prevent blood clots forming in the arteries and is therefore used in preventing problems such as heart attack and stroke. However, the usefulness of aspirin in the prevention of deep-vein thrombosis (DVT) or pulmonary embolism (PE) is not clear. Aspirin is inexpensive, easy to use and is effective very soon after it is administered. Aspirin is not used for the treatment of DVT or PE.

Side effects Aspirin may irritate the lining of your stomach, which can occasionally lead to nausea, vomiting, pain and bleeding in the gut. It may also cause an allergic or asthmatic reaction. If you experience any side effects, you should consult your physician. Potential drug interactions Before you start taking aspirin, you may be asked to stop taking other treatments that could increase your risk of bleeding (e.g. other anticoagulants). Some of the medications that aspirin interacts with include the following: coumarin anticoagulants, hypoglycemic agents (diabetes drugs, particularly sulfonylureas), certain anti-inflammatory agents, corticosteroids and certain antacids. You should inform your physician if you are aware that you are taking any of these drugs and you are prescribed aspirin. Monitoring of therapy Aspirin therapy is not usually monitored with any tests.

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Oral anticoagulants

The oral anticoagulant warfarin has been used successfully for over 50 years in the prevention of thrombosis. Warfarin is not recommended for the prevention of thrombosis in patients who are undergoing general surgery. Warfarin, dose-adjusted according to the results of a blood clotting test, is generally safe and effective in the prevention of thrombosis in patients who are undergoing major orthopedic operations (e.g. hip or knee replacement surgery). Treatment of thrombosis using warfarin is usually started while you are in hospital and can be continued after you are discharged. Warfarin is generally safe; however, it is not effective until at least 3 days after you have taken it and it is only effective within a narrow range of doses (called a therapeutic window). For this reason, when you are first diagnosed with a deep-vein thrombosis (DVT) or pulmonary embolism (PE), you will be given either unfractionated heparin or low-molecular-weight heparin together with warfarin for the first few days (up to 1 week) until your blood test shows that the warfarin dosage is effective.

Side effects Warfarin is associated with a risk of bleeding complications. It may also cause rash, nausea and diarrhea. If you experience any side effects, you must consult your physician. Warfarin should be avoided during pregnancy. Potential drug interactions Drug interactions with warfarin can increase the anticogaulant effect which can result in bleeding, or decrease the anticoagulant effect which can lead to an increased risk of DVT. The following are some of the most important drugs with which warfarin interacts:

• nonsteroidal anti-inflammatory drugs
• oral hypoglycemics (diabetes drugs)
• sulfonamides
• antibiotics
• drugs affecting liver enzymes (e.g. some cholesterol-lowering drugs, such as carbamazepine)
• corticosteroids
• imidazole antifungals (e.g. Amfotericin B, Fluconazole)
• vitamin K in food (foods that contain high levels of vitamin K include spinach, avocado and cabbage), and dietary supplements (vitamin K helps produce some important blood-clotting factors and decreases the effects of warfarin).
• Hormonal contraceptives in general

You should inform your physician if you are taking any of these drugs or dietary supplements and you are prescribed warfarin. You should also consult your physician for more complete advice on the drugs likely to interact with warfarin, and whether it is necessary to adjust your diet in order to avoid foods high in vitamin K.
Monitoring of therapy
if you are prescribed warfarin, you will usually be monitored frequently and closely to minimize the risk of serious bleeding complications. Your physician may also periodically conduct a blood test (the PT test) to ensure that you are receiving the correct dose of warfarin. The standardized method for reporting the results of this test is called the international normalized ratio (INR). The aim of your treatment will be to keep your INR within a certain range.

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• bleeding in your eye
• more bleeding than normal from your gums when brushing your teeth
• blood in your bowel movements (or stools; be aware of your stools becoming black and tarry or pitchy)
• blood in your urine
• blood in your vomit
• coughing up of blood
• nosebleeds
• pinpoint red spots on your skin
• unusual bleeding or bruising
• unusually heavy bleeding or oozing from cuts or wounds
• unusually heavy or unexpected menstrual bleeding

• abdominal or stomach pain or swelling
• back pain or backaches
• blurred vision
• chest pain
• confusion
• diarrhea (sudden and severe)
• dizziness or fainting
• headache (continuing or severe)
• joint pain, stiffness or swelling
• loss of appetite
• nausea and vomiting (severe)
• nervousness
• numbness or tingling of hands, feet or face
• paralysis
• shortness of breath
• weakness (sudden)

• incomplete understanding of any of your physician's orders about your anticoagulant therapy or not following his/her orders exactly
  • you must follow your physician's orders exactly to ensure the anticoagulant is effective without causing serious bleeding
  • you must ask your physician about anything you are unsure or concerned about regarding your treatment.

• other medical problems
  • make sure you inform your physician if you have any other medical problems, or if you have recently had any medical conditions or procedures
  • it is important that you tell your physician if you are currently being treated by any other medical physician or dentist.

• certain combinations of medication
  • make sure you tell your physician about all prescribed and over-the-counter drugs that you are taking, including any herbal medications
  • make sure you tell your physician about any changes in other prescribed and over-the-counter drugs that you are taking
  • if you are prescribed a new drug and you notice any new or unusual bleeding or symptoms, you must alert your physician.

• alcohol
  • you should limit your intake of alcohol to 1 or 2 drinks a day and you should try to have a few alcohol-free days each week. Discuss this with your physician for the advice most relevant to you, or if you are uncertain about any previous advice concerning alcohol.

• diet
  • you should eat a normal, balanced diet
  • you must not make any significant changes to your diet (including dietary supplements) unless you have first informed your physician and received his/her approval. If you do change your diet, it may be necessary to monitor your anticoagulant therapy (e.g. warfarin) more frequently than before.

• vitamin K in your diet (particularly important if you are taking warfarin)
  • keep foods containing high levels of vitamin K to a minimum in your diet
  • if you are not sure which foods contain vitamin K, check with your physician.

• stomach upset, diarrhea, fever or loss of appetite
  • inform your physician if you notice a significant change in your usual appetite over the course of several days because this could affect the amount of vitamin K that gets into your body.