Latest Care for Thrombosis
DVT remains a common problem, asymptomatic in at least 50% of patients. It is poorly understood with a large proportion of cases being classified as "idiopathic" cause not known.
These "causeless" clots are responsible for the highest recurrence rate 20-30% within two years.
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This is an example of a FLOATING Femoral DVT often arising from Popliteal Vein Compression. These are Silent and Deadly
Warfarin medication is being substituted with oral anti Xa inhibitors but there has been no functional advantage shown with the dosage currently recommended.
Warfarin shows only a 10% recanalisation of major central thrombus and 40% show extension on treatment. The trials have shown the NOACs the new agents only as equivalent in efficacy to Warfarin, a little safer in regard to bleeding. These agents all are satisfactory at prevention but poor in treatment of DVT especially in regard to life threatening central DVT.
Full dose Unfractionated heparin administered in the Gusto style with weight adjusted dosing is more effective, clot extension 12% or less. Clexane with full weight adjusted dosing shows extension in 4-6%. I have found extended therapy with Clexane the most effective means to manage DVT and it can be administered for months with Duplex assessments to assess progressive results.
The Company organised trials purporting to do a comparison with Clexane have all generally only used Clexane for a few days as a bridge to Warfarin treatment