How is venous thromboembolism (VTE) treated?

Updated: Nov 05, 2020
  • Author: Vera A De Palo, MD, MBA, FCCP; Chief Editor: Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS  more...
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Anticoagulant and thrombolytic therapy options are available for the treatment of venous thromboembolism (VTE). Anticoagulant therapy prevents further clot deposition and allows the patient’s natural fibrinolytic mechanisms to lyse the existing clot. [27] Guidelines have been developed for optimal management of anticoagulation therapy in patients with VTE. [28, 89] (See Guidelines.)

Anticoagulant inpatient medications should include heparin or a low-molecular-weight heparin (LMWH), followed by the initiation of an oral coumarin derivative. The predominant coumarin derivative in clinical use in North America is warfarin sodium.

The anticoagulant properties of unfractionated heparin (UFH), LMWH, and warfarin sodium stem from their effects on the factors and cofactors of the coagulation cascade.

Patients with acute, massive pulmonary embolism (PE) causing hemodynamic instability may be treated initially with a thrombolytic agent (eg, tissue plasminogen activator [t-PA]). t-PA has increasingly been used as the first-choice thrombolytic agent.

Surgical interventions for VTE include thrombectomy and venous interruption.

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