From the Guidelines
If you suspect a blood clot, seek immediate medical attention, especially if you experience symptoms like swelling, pain, warmth, and redness in a limb or sudden shortness of breath, chest pain, or rapid heartbeat.
Treatment of Blood Clots
Treatment typically involves anticoagulant medications, with the most recent guidelines recommending low molecular weight heparin (LMWH) for at least 6 months for cancer patients with venous thromboembolism (VTE) 1.
- LMWH is preferred over unfractionated heparin (UFH) for the initial 5 to 10 days of anticoagulation for cancer patients with newly diagnosed VTE who do not have severe renal impairment 1.
- For long-term anticoagulation, LMWH is preferred due to improved efficacy over Vitamin K antagonists, such as warfarin 1.
- Anticoagulation with LMWH or Vitamin K antagonist beyond the initial 6 months may be considered for select patients with active cancer, such as those with metastatic disease or those receiving chemotherapy 1.
Prevention Strategies
Prevention strategies include staying active, maintaining a healthy weight, avoiding prolonged immobility, staying hydrated, and avoiding smoking.
- It is also recommended to consider the use of anticoagulant therapy with LMWH and vitamin K antagonist for patients with catheter-induced thrombosis 1.
Important Considerations
- The insertion of a vena cava filter is only indicated for patients with contraindications to anticoagulant therapy, and may be considered as an adjunct to anticoagulation in patients with progression of thrombosis despite maximal therapy with LMWH 1.
- The use of novel oral anticoagulants for either prevention or treatment of VTE in cancer patients is not recommended at this time 1.
- Incidental pulmonary embolism (PE) and deep vein thrombosis (DVT) should be treated in the same manner as symptomatic VTE 1.
From the FDA Drug Label
People with atrial fibrillation (a type of irregular heart beat) that is not caused by a heart valve problem (non-valvular) are at an increased risk of forming a blood clot in the heart, which can travel to the brain, causing a stroke, or to other parts of the body. If you stop taking XARELTO, you may have increased risk of forming a clot in your blood.
Blood Clot Risk: The risk of forming a blood clot is increased in people with atrial fibrillation, and stopping XARELTO can further increase this risk.
- Atrial Fibrillation: A type of irregular heart beat that can increase the risk of forming a blood clot.
- Blood Clot Formation: Can occur in the heart and travel to the brain, causing a stroke, or to other parts of the body.
- XARELTO: A prescription medicine used to reduce the risk of stroke and blood clots in adults with atrial fibrillation. 2
From the Research
Blood Clot Treatment
- Anticoagulation therapy is recommended for preventing, treating, and reducing the recurrence of venous thromboembolism, and preventing stroke in persons with atrial fibrillation 3.
- Direct oral anticoagulants are first-line agents for eligible patients for treating venous thromboembolism and preventing stroke in those with nonvalvular atrial fibrillation 3, 4.
- Vitamin K antagonists are recommended for patients with mechanical valves and valvular atrial fibrillation, and require a minimum of five days overlap with parenteral anticoagulants 3.
Reversal of Anticoagulation
- Idarucizumab has been effective for reversing the anticoagulant effects of dabigatran, and andexanet alfa has been effective for reversing the effects of rivaroxaban and apixaban 3, 4.
- Urgent reversal of anticoagulation may be advantageous in patients with serious or life-threatening bleeding or in those requiring urgent surgery or procedures 4.
- Validated bleeding risk assessments such as HAS-BLED should be performed at each visit and modifiable factors should be addressed 3.
Anticoagulant Complications
- Hemorrhage is the main concerning adverse event with all anticoagulants 5.
- Major bleeding should be treated with vitamin K and 4-factor prothrombin complex concentrate for patients already being treated with a vitamin K antagonist 3.
- The risk of bleeding complications can be attributed to the anticoagulant itself, or other issues such as acute trauma, invasive procedures, or underlying comorbidities 4.