International vascular surgeons and specialists are exploring both established and experimental treatments for deep vein thrombosis. Many leaders in the field presented their research at the 29th annual Veith Symposium, in New York from November 21-24. DVT is a blood clot found in a vein that accompanies an artery, or a deep vein. It occurs in approximately 2 out of 1,000 people, most of whom are over 60. Sometimes, the condition resolves itself, but, when necessary, treatment focuses on prescription anticoagulants (like Heparin, Coumadin and Warfarin) or aspirin to prevent thrombogenesis and old clots from traveling to other parts of the body.
Dr. John J. Bergan, an expert on vascular disease for over 40 years from the Vein Institute of La Jolla, in California, said experimental oral heparins, which are currently being tested in joint replacement, may one day become the treatment of choice, over standard injectable heparin treatments.
"They look to be as effective as the standard," Bergan said. "I don't see anything else comparable."
In a double-blind study, Dr. Samuel Money, chief of vascular surgery at the Ochsner Clinic, in New Orleans, found that oral SNAC/heparin (liquid) was just as effective as low-molecular weight heparin in elderly patients who underwent hip surgery. But patients experienced nausea and vomiting. He said that oral heparin may have proven superior to the standard treatment, if it had been given as a pill.
"It's a lot easier to take a pill than it is to take 50 cc of a bitter-tasting liquid," he said.
Like Bergan, Money said he is optimistic that a DVT drug, which is convenient for doctors to administer and easy for patients to take, will become available in the future.
"We're looking for a ideal oral anticoagulant with a large safe range that doesn't need monitoring; doesn't need injections; doesn't need close follow-up," Money said. "Unfortunately, it's not here yet, but, hopefully, at some point it will be here."
Dr. Andrew N. Nicolaides, of the Cyprus Institute of Neurology and Genetics, has been working with a tried and true method to prevent the stagnation of blood--intermittent pneumatic compression. Vascular surgeons have been employing this device to stave off DVT, for the last 25 years. Now it's starting to have applications for people with ischemia, a serious complication of DVT. Nicolaides noted studies that revealed applying IPC to seated patients stimulated arterial venous circulation enough to save ischemic limbs.
"So not only do you prevent DVT, but you also improve the ability for people to walk and [the condition of] people who have bad arterial circulation," he said.
As IPC technology improves, Nicolaides envisions a miniaturized device will replace the current IPC model, which has to be strapped on to the leg at home.
One day, Nicolaides said, "You'll have something in your pocket that massages your leg."
Still the running consensus is that no single treatment offers the magic bullet for DVT, but a combination of modalities, like compression stockings, IPC, and anticoagulants together, are most effective. In addition, experts said, more research into therapies that prevent and manage this painful condition are needed.
"We need to continue studies to find effective therapies for DVT," Bergan said. "Agents change and some are better."
