Editing Thrombosis (section)

== Treatment ==
The treatment for thrombosis depends on whether it is in a vein or an artery, the impact on the person, and the risk of complications from treatment.{{citation needed|date=July 2024}}

===Anticoagulation===
{{main|Anticoagulant}}
[[Warfarin]] and [[vitamin K antagonists]] are [[anticoagulant]]s that can be taken orally to reduce thromboembolic occurrence. Where a more effective response is required, heparin can be given (by injection) concomitantly. As a side effect of any anticoagulant, the risk of bleeding is increased, so the [[international normalized ratio]] of blood is monitored. Self-monitoring and self-management are safe options for competent patients, though their practice varies. In Germany, about 20% of patients were self-managed while only 1% of U.S. patients did home self-testing (according to one 2012 study).<ref name="Heneghan">{{cite journal |vauthors=Heneghan C, Ward A, Perera R |year=2012 |title=Self-monitoring of oral anticoagulation: systematic review and meta-analysis of individual patient data |journal=The Lancet |volume=379 |issue=9813 |pages=322–334 |doi=10.1016/S0140-6736(11)61294-4 |pmid= 22137798|url=http://discovery.ucl.ac.uk/1468252/1/Gardiner_28.%20Heneghan%20Lancet%202011.pdf |doi-access=free}}</ref> Other medications such as [[direct thrombin inhibitor]]s and [[direct Xa inhibitor]]s are increasingly being used instead of warfarin.{{citation needed|date=December 2016}}

===Thrombolysis===
[[Thrombolysis]] is the pharmacological destruction of blood clots by administering [[thrombolytic drug]]s including [[tissue plasminogen activator|recombinant tissue plasminogen activator]], which enhances the normal destruction of blood clots by the body's enzymes. This carries an increased risk of bleeding so is generally only used for specific situations (such as severe stroke or a massive pulmonary embolism).<ref>{{cite journal | vauthors = Tran HA, Gibbs H, Merriman E, Curnow JL, Young L, Bennett A, Tan C, Chunilal SD, Ward CM, Baker R, Nandurkar H | title = New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous [[thromboembolism]] | journal = The Medical Journal of Australia | volume = 210 | issue = 5 | pages = 227–235 | date = March 2019 | pmid = 30739331 | doi = 10.5694/mja2.50004 | hdl = 11343/285435 | s2cid = 73433650 | hdl-access = free }}</ref>

===Surgery===
Arterial thrombosis may require surgery if it causes [[acute limb ischemia]].{{citation needed|date=July 2021}}

===Endovascular treatment===
Mechanical clot retrieval and catheter-guided thrombolysis are used in certain situations.<ref>{{cite journal |last1=Berkhemer |first1=Olvert A. |last2=Fransen |first2=Puck S.S. |last3=Beumer |first3=Debbie |last4=van den Berg |first4=Lucie A. |last5=Lingsma |first5=Hester F. |last6=Yoo |first6=Albert J. |last7=Schonewille |first7=Wouter J. |last8=Vos |first8=Jan Albert |last9=Nederkoorn |first9=Paul J. |last10=Wermer |first10=Marieke J.H. |last11=van Walderveen |first11=Marianne A.A. |last12=Staals |first12=Julie |last13=Hofmeijer |first13=Jeannette |last14=van Oostayen |first14=Jacques A. |last15=Lycklama à Nijeholt |first15=Geert J. |last16=Boiten |first16=Jelis |last17=Brouwer |first17=Patrick A. |last18=Emmer |first18=Bart J. |last19=de Bruijn |first19=Sebastiaan F. |last20=van Dijk |first20=Lukas C. |last21=Kappelle |first21=L. Jaap |last22=Lo |first22=Rob H. |last23=van Dijk |first23=Ewoud J. |last24=de Vries |first24=Joost |last25=de Kort |first25=Paul L.M. |last26=van Rooij |first26=Willem Jan J. |last27=van den Berg |first27=Jan S.P. |last28=van Hasselt |first28=Boudewijn A.A.M. |last29=Aerden |first29=Leo A.M. |last30=Dallinga |first30=René J. |last31=Visser |first31=Marieke C. |last32=Bot |first32=Joseph C.J. |last33=Vroomen |first33=Patrick C. |last34=Eshghi |first34=Omid |last35=Schreuder |first35=Tobien H.C.M.L. |last36=Heijboer |first36=Roel J.J. |last37=Keizer |first37=Koos |last38=Tielbeek |first38=Alexander V. |last39=den Hertog |first39=Heleen M. |last40=Gerrits |first40=Dick G. |last41=van den Berg-Vos |first41=Renske M. |last42=Karas |first42=Giorgos B. |last43=Steyerberg |first43=Ewout W. |last44=Flach |first44=H. Zwenneke |last45=Marquering |first45=Henk A. |last46=Sprengers |first46=Marieke E.S. |last47=Jenniskens |first47=Sjoerd F.M. |last48=Beenen |first48=Ludo F.M. |last49=van den Berg |first49=René |last50=Koudstaal |first50=Peter J. |last51=van Zwam |first51=Wim H. |last52=Roos |first52=Yvo B.W.E.M. |last53=van der Lugt |first53=Aad |last54=van Oostenbrugge |first54=Robert J. |last55=Majoie |first55=Charles B.L.M. |last56=Dippel |first56=Diederik W.J. |title=A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke |journal=New England Journal of Medicine |date=January 1, 2015 |volume=372 |issue=1 |pages=11–20 |doi=10.1056/NEJMoa1411587 |pmid=25517348 |display-authors=etal|hdl=2066/153000 |s2cid=9499117 |url=https://research.utwente.nl/en/publications/a-randomized-trial-of-intraarterial-treatment-for-acute-ischemic-stroke(ec0aa0f7-d007-4590-8ea1-a610e648f3a3).html |hdl-access=free }}</ref>

===Antiplatelet agents===
Arterial thrombosis is platelet-rich, and inhibition of platelet aggregation with [[antiplatelet drug]]s such as [[aspirin]] may reduce the risk of recurrence or progression.<ref>{{Cite web|title=Aspirin Monograph for Professionals|url=https://www.drugs.com/monograph/aspirin.html|access-date=June 9, 2020|website=Drugs.com|language=en}}</ref>

=== Targeting ischemia/reperfusion injury ===
{{Main|Reperfusion injury}}
With reperfusion comes ischemia/reperfusion (IR) injury (IRI), which paradoxically causes cell death in reperfused tissue<ref name="Grace 637–647">{{Cite journal|last=Grace|first=P. A.|date=May 1994|title=Ischaemia-reperfusion injury|journal=The British Journal of Surgery|volume=81|issue=5|pages=637–647|issn=0007-1323|pmid=8044536|doi=10.1002/bjs.1800810504|s2cid=34608929}}</ref> and contributes significantly to post-reperfusion mortality and morbidity.<ref>{{Cite journal|last1=Yellon|first1=Derek M.|author1-link=Derek M. Yellon|last2=Hausenloy|first2=Derek J.|date=September 13, 2007|title=Myocardial Reperfusion Injury|journal=New England Journal of Medicine|volume=357|issue=11|pages=1121–1135|doi=10.1056/nejmra071667|pmid=17855673|issn=0028-4793}}</ref><ref>{{Cite journal|last1=Bai|first1=Jilin|last2=Lyden|first2=Patrick D.|date=January 19, 2015|title=Revisiting Cerebral Postischemic Reperfusion Injury: New Insights in Understanding Reperfusion Failure, Hemorrhage, and Edema|journal=International Journal of Stroke|volume=10|issue=2|pages=143–152|doi=10.1111/ijs.12434|pmid=25598025|s2cid=25953179|issn=1747-4930}}</ref> For example, in a feline model of intestinal ischemia, four hours of ischemia resulted in less injury than three hours of ischemia followed by one hour of reperfusion.<ref name="Grace 637–647"/> In ST-elevation myocardial infarction (STEMI), IRI contributes up to 50% of final infarct size despite timely primary percutaneous coronary intervention. This is a key reason for the continued high mortality and morbidity in these conditions, despite endovascular reperfusion treatments and continuous efforts to improve timeliness and access to these treatments. Hence, protective therapies are required to attenuate IRI alongside reperfusion in acute ischemic conditions to improve clinical outcomes.<ref name="Ho 1">{{Cite journal|last1=Ho|first1=Andrew Fu Wah|last2=Jun|first2=Chong|last3=Ong|first3=Marcus Eng Hock|last4=Hausenloy|first4=Derek J.|date=April 2019|title=Remote Ischemic Conditioning in Emergency Medicine—Clinical Frontiers and Research Opportunities|journal=SHOCK|volume=53|issue=3|pages=269–276|doi=10.1097/SHK.0000000000001362|pmid=32045394|s2cid=149537443|issn=1073-2322|url=https://discovery.ucl.ac.uk/id/eprint/10093574/1/Hausenloy_Manuscript%2023%20Mar%202019%20accepted%20version.pdf}}</ref> Therapeutic strategies that have potential to improve clinical outcomes in reperfused STEMI patients include [[remote ischemic conditioning]] (RIC), exenatide, and metoprolol. These have emerged amongst a multitude of cardioprotective interventions investigated with largely neutral clinical data.<ref>{{Cite journal|last1=Hausenloy|first1=Derek J.|last2=Botker|first2=Hans Erik|last3=Engstrom|first3=Thomas|last4=Erlinge|first4=David|last5=Heusch|first5=Gerd|last6=Ibanez|first6=Borja|last7=Kloner|first7=Robert A.|last8=Ovize|first8=Michel|last9=Yellon|first9=Derek M.|date=April 26, 2016|title=Targeting reperfusion injury in patients with ST-segment elevation myocardial infarction: trials and tribulations|journal=European Heart Journal|volume=38|issue=13|pages=935–941|doi=10.1093/eurheartj/ehw145|pmid=27118196|issn=0195-668X|pmc=5381598}}</ref> Of these, RIC has the most robust clinical evidence, especially in the context of STEMI, but also emerging for other indications such as acute ischemic stroke and aneurysmal subarachnoid hemorrhage.<ref name="Ho 1"/>

=== Neonatal thrombosis ===
Treatment options for full-term and preterm babies who develop thromboembolism include expectant management (with careful observation), nitroglycerin ointment, [[pharmacological therapy]] (thrombolytics and/or anticoagulants), and surgery.<ref name=":1" /> The evidence supporting these treatment approaches is weak. For anticoagulant treatment, it is not clear if unfractionated and/or low molecular weight heparin treatment is effective at decreasing mortality and serious adverse events in this population.<ref name=":1" />  There is also insufficient evidence to understand the risk of adverse effects associated with these treatment approaches in term or preterm infants.<ref name=":1" />