Deep vein thrombosis (DVT) not only causes a venous blockage in the legs, but the thrombus can partially or completely dislodge and travel to the lungs, resulting in a pulmonary embolism. Depending on the extent of the occluded pulmonary vessels, the heart must work harder against the resistance of the blocked vessels to maintain adequate lung perfusion and, consequently, oxygen supply to the body. This can lead to cardiac arrhythmias or acute heart failure.
To prevent further growth of the thrombus and promote its dissolution, anticoagulant medications are used. Available options include so-called NOACs (non-vitamin K antagonist oral anticoagulants) such as Apixaban and Rivaroxaban, low-molecular-weight heparin in injectable form, and the well-established Marcumar. Current guidelines favor NOACs due to their fixed dosing, lack of need for blood level monitoring, and availability in tablet form.
Apixaban and Rivaroxaban require an initial high-dose therapy for 7 to 21 days before transitioning to a maintenance dose. Dabigatran, Edoxaban, and Marcumar require at least 5 days of heparin bridging to achieve full efficacy.
The duration of treatment depends on the cause of the thrombosis. If the cause is identifiable and temporary, such as postoperative thrombosis, anticoagulation is typically prescribed for three to six months. Recurrent thromboses, active cancer, or genetically determined coagulation disorders, however, may necessitate lifelong treatment.
Bed rest for thrombosis, as practiced in the past, is no longer required. Compression stockings help alleviate symptoms (leg pain, tightness) and improve quality of life.