Does lovenox dissolve blood clots

Getting a Pulmonary Embolism Under Control

A pulmonary embolism is a sudden blockage of an artery in your lung due to a blood clot, and it’s usually caused when a clot formed in a deep vein in the lower extremities — a condition called DVT, or deep vein thrombosis — breaks away and travels to a lung. If left untreated, a pulmonary embolism can damage your lungs, resulting in low blood oxygen levels that can injure other organs, and may even be fatal.

Symptoms of pulmonary embolism include shortness of breath, coughing up blood, and chest pain. However, half of all people who experience a pulmonary embolism do not have symptoms at all.

Treatment for pulmonary embolism is aimed at breaking up the clot and preventing more blood clots from forming. Treatment for a pulmonary embolism is basically the same as it is for DVT — it starts with medications to thin your blood, reducing the blood’s capability to clot. But if your condition is life-threatening, you may also receive drugs to dissolve the clot immediately. In rare cases, a doctor may choose to remove the clot surgically.

Medications for Pulmonary Embolism

The medications used to treat a pulmonary embolism are called anticoagulants. They prevent more blood clots from forming and stop the one in your lungs from growing larger. Although these drugs don’t break up the existing clot, the body often dissolves it naturally over time.

Medications used to treat pulmonary embolism include:

  • Heparin, which is given intravenously
  • Lovenox (enoxaparin) or Arixtra (fondapinux), which is injected under the skin
  • Warfarin (Coumadin and others), which is given orally

After a pulmonary embolism, heparin, Lovenox, or Arixtra is usually started immediately, and then gradually switched to warfarin for long-term treatment. The length of treatment depends on the cause of the blood clot. If the clot developed due to a temporary risk factor, such as immobility after surgery, the treatment may only last three to six months. If the risk factor is persistent, such as having a blood clotting disorder, or if you have had blood clots before, then treatment will last longer.

When taking these drugs, you will need to be monitored regularly by your doctor. Blood tests will be given to make sure your blood level stays at an appropriate range. Your doctor will regularly measure your blood’s ability to clot, and will check to make sure your blood is not being thinned too much or too little while you’re on medication.

Pulmonary Embolism: When It’s Life Threatening

If the blood clot in your lung is immediately life-threatening, your doctor may opt to break it up or remove it. To dissolve a clot, a thrombolytic drug is injected directly into it. Alternatively, the doctor can use a catheter — a small tube — to reach in and break up the blood clot or deliver medications directly. During the procedure, a catheter is placed in a vein, usually in the groin or arm. A small wire is then threaded through the vein to break up the clot. In very rare cases, surgery is needed to remove the blood clot from the lungs.

Pulmonary Embolism: Other Treatment Options

Some people with DVT or pulmonary embolism are unable to tolerate standard treatments. In these cases, a device called a vena cava filter may be used. This small umbrella-like filter is placed in the large vein (vena cava) which carries blood from your legs to your heart. The filter acts as a physical barrier to prevent DVT clots from traveling to the lungs. However, the filter cannot prevent clots from forming, nor will it help to dissolve existing clots.

Pulmonary Embolism: What’s Next?

After initial treatment for a pulmonary embolism, you’ll likely stay on anticoagulants for a while. The most important thing you can do during this period is to watch for signs of excessive bleeding — when bleeding won’t stop after 10 minutes — and report it immediately to your doctor.

The most dangerous type of bleeding to occur after pulmonary embolism treatment is bleeding that affects your gastrointestinal system or your head. If you have any of the following signs, seek emergency medical care right away:

  • Red vomit or vomit that resembles coffee grounds
  • Red blood in your stool or black, tarry stools
  • Severe pain in your abdomen or head
  • Sudden vision changes
  • Sudden inability to move your legs or arms
  • Confusion or memory loss

Pulmonary Embolism: Preventing Complications

Other things you can do to prevent any future complications after pulmonary embolism treatment include:

  • Taking your medications exactly as prescribed.
  • Not skipping any of your follow-up blood tests.
  • Discussing any other medications you’re taking, including aspirin or other over-the-counter drugs, with your doctor. Some medications can increase your bleeding risk.
  • Talking to your doctor about any dietary changes you need to make. You may need to alter your diet because food containing Vitamin K can affect how well warfarin works.
  • Asking your doctor if it’s safe for you to drink alcohol while taking anticoagulant medication.

Additionally, if you have DVT, your doctor may advise you to wear compression stockings. These stockings can prevent chronic swelling associated with DVT and may also help to prevent a pulmonary embolism.

For Patients

“When will my clot and pain go away?” is a question commonly asked following diagnosis of deep vein thrombosis (DVT) or pulmonary embolism (PE).

Blood-thinners themselves do not dissolve the clot. The body naturally absorbs a blood clot over the course of several weeks to months and the symptoms which accompanied the blood clot gradually improve and often eventually disappear.

Most patients with DVT or PE recover within several weeks to months without significant complications or long-term effects.

In some patients, the clot never goes away completely: about half of the patients with DVT will have left-over (residual) clot if a follow-up Doppler ultrasound is done 6 months after the acute clot. This is not a clot that can break off, but rather scar tissue within the blood vessel. Because other blood vessels take over and bypass the narrowed or damaged veins, patients are often without symptoms, even if they do have left-over damage at the area where the DVT was.

The risk of clot breaking off and forming a PE is mostly present in the first few days, up to approximately 4 weeks, while the clot is still fresh and fragile and not scarred. Some people have chronic (long-term) problems after a clot due to damage done when the clot formed and partly due to the chronic obstruction from left-over clot, i.e. scar tissue.

Post-thrombotic syndrome is one complication from a blood clot in the leg which results in long-term swelling and pain. PTS occurs in approximately 40% of persons with DVT and varies from person-to-person in its severity. Post-thrombotic syndrome is discussed in detail, here.

Blood clots in the lung can sometimes cause left-over symptoms of shortness of breath, decreased exercise ability, or chest discomfort, but most people recover completely. However, in a few patients, clots do not completely dissolve and significant chronic damage to the lung results, called pulmonary hypertension. Pulmonary hypertension is discussed in detail, here.

It is not helpful to obtain regular follow-up Doppler ultrasounds of the legs to see whether the clot is gone or still there. Finding left-over clot or scar tissue does not change management. The only time a follow-up Doppler ultrasound is really helpful is once a patient comes off blood thinners. A new ultrasound at that time provides a new baseline, so that it is easier to tell in the future, if new symptoms occur, whether a new clot is present or whether the changes seen are old. Follow-up CT scans are also typically not helpful. Because of the radiation exposure, even though relatively low, a routine CT of the chest is typically not obtained as a new baseline when a patient stops the blood thinner.

Anticoagulants are medications used by doctors as blood thinners that treat blood cots. These medications prevent new clots from forming as well as current clots from growing any larger. However, they do not break up or dissolve existing blood clots.
Warfarin (Coumadin) and Heparin are the two most common anticoagulants, but newer anticoagulant medications like Xarelto, Pradaxa, and Eliquis are also widely prescribed by doctors.
Heparin is an anticoagulant medication that is given by injection and comes in two forms.
One form of Heparin is LMWH, which stands for Low-molecular-weight Heparin. It can be found under the names Dalteparin(Fragmin) and Enoxaparin (Lovenox).
LMWH is given by injection(shot) and can be given at home.
Advantages of Low Molecular Weight Heparin
* Blood tests are generally not needed
* Given as a shot rather than by IV
* Home treatment
Disadvantages:
*Expensive
The next form is (UF) Unfractionated Heparin. Some doctors refer to it as IV Heparin, because generally you receive it only in a hospital from an IV.
Advantages of UF Heparin:
* UF Heparin works very quickly to prevent blood clots
* It is inexpensive
Disadvantages:
* Daily blood tests to ensure heparin is working to prevent blood clots.
* Hospitilization is required when taking UF Heparin by IV. It will be administered by medical professionals during the hospitilization, which typically averages 5 to 8 days.
* UF Heparin can cause internal bleeding, but that is watched for in the hospital.
Warfarin
Warfarin(Coumadin) is an oral anti-coagulant that serves as the foundation for long-term treatment of DVT and PE.
It helps to prevent new blood clots from forming, and helps to keep existing blood clots from getting worse.
Warfarin is also prescribed to prevent stroke in people with atrial fibrillation.
Advantages of Warfarin(Coumadin):
* Warfarin comes in a pill form.
* Inexpensive
* Prescribed for more than 50 years
Disadvantages of Warfarin:
* Must be taken on time every day
* Requires regular monitoring with blood tests(INR)
* Most serious side effect is bleeding
Rivaroxaban (Xarelto)
Xarelto is an oral anticoagulant(pill) that is prescribed to serve as the foundation for the long-term treatment of DVT and PE. It is also prescribed to reduce the formation of blood clots and prevent stroke in people with atrial fibrillation that is not caused by a heart valve problem.
Advantages:
* Routine monitoring is not required
* It is a pill, not a shot.
* Home treatment
Disadvantages:
* Most serious side effect is bleeding
* Expensive
* Taken twice daily for DVT and PE
Dabigatran (Pradaxa)
Pradaxa is an oral anticoagulant(pill) that is prescribed to to reduce the formation of blood clots and prevent stroke in people with atrial fibrillation that is not caused by a heart valve problem.
It is also prescribed to treat blood clots in your legs (DVT) and lungs (PE) and to reduce the risk of them occurring again.
Advantages:
* Routine monitoring is not required
* It is a pill, not a shot.
* Home treatment
Disadvantages:
* Most serious side effect is bleeding
* Expensive
* Taken twice daily
Apixaban (Eliquis)
Eliquis is an oral anticoagulant (pill) that is prescribed to reduce the risk of stroke and blood clots in people who have atrial fibrillation that is not caused by a heart valve problem.
It is also prescribed as a long-term foundation to treat DVT and PE, while reducing the risk of blood clots from occurring again.
Advantages:
* Routine monitoring is not required
* It is a pill, not a shot.
* Home treatment
Disadvantages:
* Most serious side effect is bleeding
* Expensive
* Taken twice daily
Please consult your physician to determine which medication is correct for you. Follow the prescription directions provided by your physician.

Pulmonary Embolism

What is a pulmonary embolism (PE)?

A pulmonary embolism (PE) is a sudden blockage in a lung artery. It usually happens when a when a blood clot breaks loose and travels through the bloodstream to the lungs. PE is a serious condition that can cause

  • Permanent damage to the lungs
  • Low oxygen levels in your blood
  • Damage to other organs in your body from not getting enough oxygen

PE can be life-threatening, especially if a clot is large, or if there are many clots.

What causes a pulmonary embolism (PE)?

The cause is usually a blood clot in the leg called a deep vein thrombosis that breaks loose and travels through the bloodstream to the lung.

Who is at risk for a pulmonary embolism (PE)?

Anyone can get a pulmonary embolism (PE), but certain things can raise your risk of PE:

  • Having surgery, especially joint replacement surgery
  • Certain medical conditions, including
    • Cancers
    • Heart diseases
    • Lung diseases
    • A broken hip or leg bone or other trauma
  • Hormone-based medicines, such as birth control pills or hormone replacement therapy
  • Pregnancy and childbirth. The risk is highest for about six weeks after childbirth.
  • Not moving for long periods, such as being on bed rest, having a cast, or taking a long plane flight
  • Age. Your risk increases as you get older, especially after age 40.
  • Family history and genetics. Certain genetic changes that can increase your risk of blood clots and PE.
  • Obesity

What are the symptoms of a pulmonary embolism (PE)?

Half the people who have pulmonary embolism have no symptoms. If you do have symptoms, they can include shortness of breath, chest pain or coughing up blood. Symptoms of a blood clot include warmth, swelling, pain, tenderness and redness of the leg.

How is a pulmonary embolism (PE) diagnosed?

It can be difficult to diagnose PE. To make a diagnosis, your health care provider will

  • Take your medical history, including asking about your symptoms and risk factors for PE
  • Do a physical exam
  • Run some tests, including various imaging tests and possibly some blood tests

What are the treatments for a pulmonary embolism (PE)?

If you have PE, you need medical treatment right away. The goal of treatment is to break up clots and help keep other clots from forming. Treatment options include medicines and procedures.

Medicines

  • Anticoagulants, or blood thinners, keep blood clots from getting larger and stop new clots from forming. You might get them as an injection, a pill, or through an I.V. (intravenous). They can cause bleeding, especially if you are taking other medicines that also thin your blood, such as aspirin.
  • Thrombolytics are medicines to dissolve blood clots. You may get them if you have large clots that cause severe symptoms or other serious complications. Thrombolytics can cause sudden bleeding, so they are used if your PE is serious and may be life-threatening.

Procedures

  • Catheter-assisted thrombus removal uses a flexible tube to reach a blood clot in your lung. Your health care provider can insert a tool in the tube to break up the clot or to deliver medicine through the tube. Usually you will get medicine to put you to sleep for this procedure.
  • A vena cava filter may be used in some people who cannot take blood thinners. Your health care provider inserts a filter inside a large vein called the vena cava. The filter catches blood clots before they travel to the lungs, which prevents pulmonary embolism. But the filter does not stop new blood clots from forming.

Can pulmonary embolism (PE) be prevented?

Preventing new blood clots can prevent PE. Prevention may include

  • Continuing to take blood thinners. It’s also important to get regular checkups with your provider, to make sure that the dosage of your medicines is working to prevent blood clots but not causing bleeding.
  • Heart-healthy lifestyle changes, such as heart-healthy eating, exercise, and, if you smoke, quitting smoking
  • Using compression stockings to prevent deep vein thrombosis (DVT)

  • Moving your legs when sitting for long periods of time (such as on long trips)
  • Moving around as soon as possible after surgery or being confined to a bed

NIH: National Heart, Lung, and Blood Institute

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