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Your doctor should discuss with you the predisposing conditions which contributed to the blood clot formation and then determine your risk of recurrent blood clots. You will then need to work with your doctor to determine if there is a need for long term therapy to attempt to reduce the risk of recurrent blood clots.
Treatment options for blood clots may involve a combination of injections (heparin, low-molecular weight heparin), tablets (Warfarin, Rivaroxaban, Apixaban, Dabigatran) and compression stockings. There is often an overlapping period between injections of heparin and other forms of treatment. Some of these anticoagulant medicines require ongoing testing in the laboratory to make sure that the level of anticoagulation is appropriate – not so high as to cause bleeding and not too low to allow adequate blood clot resolution.
In general blood clots are treated for a period of time ranging from a few weeks for minor clots to a minimum of 12 months therapy in patients who have a large blood clot and a high risk of recurrent blood clot formation. For patients deemed at high risk of recurrent blood clot, the patient may be recommended to stay on anticoagulation or other medications (Aspirin) life-long.
Other risk factors for recurrent blood clots should also be addressed with the patient including: stopping smoking, changing oral contraceptive preparations and the use of low dose anticoagulants in high-risk situations (prophylaxis).
Those who are on continued anticoagulant therapy will have to plan ahead, with the help of their doctor, when they require procedures and surgeries. These usually involve taking the patient off of their anticoagulant for a short period of time prior to their surgery. However, current recommendations suggest that warfarin does not need to be withheld for dental procedures. Following surgery, most patients, including those who do not have known hypercoagulable disorders, will receive a course of preventative anticoagulation. This is especially true after procedures such as hip or knee replacement surgery that may increase a patient’s risk of clotting, either because of the nature of the surgery itself or because of immobilisation and an extended recovery after the surgery.
Patients who are pregnant and have a blood clot will usually receive subcutaneous anticoagulation with low-molecular weight heparin. Patients who have antithrombin deficiencies may benefit from antithrombin factor replacement when they cannot take anticoagulant therapy (for example, around the time of surgery). Protein C concentrates can be used to temporarily replenish protein C deficiencies, and aspirin therapy (which affects platelet function) may be useful in some instances.
Last Review Date: November 1, 2019