Thrombus Treatment: Anticoagulation, Thrombolysis, and Surgical Options
Treatment depends on location (arterial vs. venous), acuity, severity, and patient factors.
Medical Management
- Anticoagulants: Heparin (UFH/LMWH) → warfarin/DOAC (apixaban, rivaroxaban). Prevent extension/embolism; do not dissolve existing clot.
- Thrombolytics: Alteplase, tenecteplase, streptokinase. Lyses clot. High bleeding risk. Reserved for massive PE, acute limb ischemia, stroke (<4.5 hrs), STEMI.
- Antiplatelets: Aspirin, clopidogrel. Arterial thrombosis prevention.
Interventional / Surgical
- Catheter-directed thrombolysis/thrombectomy: Local lysis + mechanical removal (DVT, PE, arterial)
- Surgical thrombectomy/embolectomy: Open removal (acute limb ischemia, massive PE)
- IVC filter: If anticoagulation contraindicated (PE prevention)
- Bypass/endarterectomy/angioplasty-stent: Chronic arterial occlusion
Key Principle
Time is tissue. Arterial occlusion = minutes-hours. Venous = days-weeks. Multidisciplinary decision-making optimizes outcomes.
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