What are the limitations of anticoagulation therapy for deep venous thrombosis (DVT)?

Updated: Oct 30, 2020
  • Author: Donald Schreiber, MD, CM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Anticoagulation does have its limitations. Although it inhibits propagation, it does not remove the thrombus, and a variable risk of clinically significant bleeding is observed. In 2-4% of patients, deep venous thrombosis (DVT) progresses to symptomatic pulmonary embolism (PE) despite anticoagulation. In the setting of a PE, 8% of patients have recurrences despite anticoagulation, 30-45% of which are fatal. Although anticoagulation markedly reduces the risk of PE and extension of the DVT, it does not reduce the incidence of postthrombotic syndrome (PTS), which requires expedited removal of the existing thrombus without damaging the underlying venous valves.

The main adverse effects of heparin therapy include bleeding and thrombocytopenia. Approximately 2% of patients experience major bleeding within the first 3 months of therapy and 1-3% thereafter per year. [33] The estimated fatality rate for each episode of major bleeding is 13%. [33] The development of thrombocytopenia must alert clinicians to the diagnosis of heparin-induced thrombocytopenia (HIT), which can occur in up to 3% of patients treated with heparin for more than 4 days. Two types exist: the most common form is a self-limiting nonimmune mediated thrombocytopenia that resolves with cessation of therapy; the less common immune-mediated thrombocytopenia has potentially catastrophic thromboembolic complications.

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