Which therapy for blood clots in the legs is best suited for you?

A Disease Management post on 8/22/2014.   Topics: 

Every year in the U.S., between 300,000 and 600,000 people are diagnosed with deep vein thrombosis (DVT), or blood clots in their legs, which can be fatal. Although there are several treatments available, you may be unclear as to which one is best suited for you.

Currently, doctors usually treat blood clots with one of two approaches. Anticoagulation therapy uses blood-thinning medication to break down the clot, and catheter-directed thrombolysis (CDT) delivers clot-busting drugs directly to the blockage through a catheter device during a minimally invasive operation. Each treatment comes with its own risks and benefits, and new research published in JAMA Internal Medicine may help both doctors and individuals with DVT make more informed decisions about which direction to take.

Quick and effective treatment can save your life
What makes a DVT so dangerous is the possibility that a portion of it can dislodge and travel to the lungs. A clot in the lungs is called a pulmonary embolism and can become life threatening. Experts estimate that up to 30 percent of people diagnosed with DVT die within a month of receiving the diagnosis. Among those who develop a pulmonary embolism, sudden death is the first sign of a problem 25 percent of the time.

Risk factors for DVT include advanced age, injury to a vein from fractures or major surgery, mobility issues, certain chronic health conditions including heart, lung and inflammatory bowel disease, cancer and cancer treatment, increased estrogen levels and obesity.

While anticoagulation and compression stockings can treat DVT, between 20 and 50 percent of those who had a clot above the knee will still experience post-thrombotic syndrome (PTS). Symptoms of this condition in the leg include pain, swelling and discoloration or ulceration of the skin. As an alternative treatment, CDT significantly reduces the odds of PTS, but until recently, not much has been known about how safe CDT was compared to anticoagulation therapy. The research in JAMA Internal Medicine gives us new insight.

Death rates from treatments not that different
To gain a better understanding of whether anticoagulation or CDT was a better treatment for DVT, a team of researchers from the Temple University Health System conducted a study in which they reviewed more than 90,000 cases of blood clots. They focused on two groups of nearly 3,600 individuals. Members in each group underwent either CDT or anticoagulation alone.

Results showed that:

  • The in-hospital mortality rate between these two groups was not significantly different.
  • Those who underwent CDT were more likely than those who received anticoagulation drugs to require a blood transfusion, which is an indicator of abnormal bleeding.
  • Rates of pulmonary embolisms between those who had CDT or anticoagulation were 17.9 percent and 11.4 percent, respectively.
  • Hospital stays following CDT were an average of 7 days, compared to 5.1 days for the anticoagulation group.
  • Medical expenses for CDT totaled an average of more than $85,000. For anticoagulation, the average was more than $29,000.

The study authors also noted that, during the research period, the mortality rate associated with CDT decreased as use increased, which may be an indicator of provider expertise. Still, rates of abnormal bleeding remained high.

Overall, CDT and anticoagulation had similar mortality rates, but though CDT may be associated with a lower risk of PTS than anticoagulation, it may also be linked to other health complications.

Ultimately, each available treatment comes with its own pros and cons. If you are still confused as to which treatment would work best for you or your loved one, talk to a health advisor, who can help direct you to the most appropriate resources to answer your question. This may involve consulting with various specialists or seeking a second opinion.


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