Definition
Otherwise known as phlebothrombosis coma, deep vein thrombosis reflects a serious pathological condition, in which there is obstruction of a vein due to a thrombus, regardless of the presence of an inflammatory process. If the blood clot breaks, the risk of death increases, as deep vein thrombosis can degenerate into pulmonary embolism (the blood clot reaches the lungs).
Causes
Deep venous thrombosis is the most immediate expression of the formation of a blood clot in a vein, a consequence of a blood coagulation abnormality. The thrombus can slow down or even block the circulation of the blood, causing serious damage. Deep vein thrombosis occurs mainly in the arms and legs.
- Risk factors: clothing that is too tight, old age, maintaining a static position for long periods, obesity, birth control pills, genetic predisposition, sedentary lifestyle, smoking
Symptoms
It is estimated that half of patients with deep vein thrombosis do not complain of any particular symptoms; in general, the disease can begin with weight and leg fatigue, muscle cramps, pain, edema, swelling of the limbs and ankles.
Each organism reacts differently, so the disease does not necessarily occur with the same symptomatology in all patients
Information on Deep Venous Thrombosis - Drugs for the Treatment of Deep Venous Thrombosis is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Deep Venous Thrombosis - Drugs for the treatment of Deep Venous Thrombosis.
drugs
Before proceeding with the administration of drugs for the treatment of deep vein thrombosis, diagnostic assessment is indispensable: in fact, the symptoms that accompany the disease are common to many others (eg hematomas, fractures, osteomyelitis, strains, tears, traumas, etc.). .). In general, the probabilities that it is actually a deep vein thrombosis increase when the characteristic symptoms involve only one limb; in any case, from the first signs it is indispensable to run for cover for a medical consultation: not surprisingly, it is observed that the probability of a good prognosis increases when the pathology is diagnosed early.
The goals of therapy for deep vein thrombosis can be summarized in three very important points:
- Stop the growth of the clot in a vein
- Prevent clot rupture (hence the risk of pulmonary embolism)
- Reduce the likelihood of recurrence of deep vein thrombosis
In addition to the administration of fluidifying, antithrombotic and vitamin K antagonists (specifically analyzed below), it is possible to proceed with other mechanical measures (wear elastic compression stockings, indicated to favor the return of blood to the heart and prevent the formation of thrombus ) and surgical (thrombectomy). In some patients it is preferred to proceed with the caval filters: these are real filters that, through a surgical intervention, are placed inside a large-caliber vein, in order to prevent the transport of clot fragments in the lungs; this practice is indicated for the prevention of complications of deep vein thrombosis, especially for those patients presenting previous relapses.
Heparins (anticoagulants or blood thinners): the administration of these drugs is particularly indicated to prevent the formation of blood clots in the veins (thrombi). Although they are not able to break the pre-existing clots, these drugs can still prevent their development, thus avoiding the blockage of the blood circulation. Generally, therapy with anticoagulants for the treatment of deep vein thrombosis must be continued for at least three months, except for further indications from the doctor.
- Heparin (eg. Heparin Cal Acv, Heparin Sod.Ath, Ateroclar, Trombolisin): in general, therapy with fluidizers to treat deep vein thrombosis begins with an intravenous administration of heparin. After a few days of therapy, it is possible to replace heparin with another anticoagulant drug (eg Warfarin); for the treatment of deep vein thrombosis, it is recommended to start therapy with a dose of heparin equal to 5000 units, to be taken by continuous intravenous bolus infusion, followed by 1300 units of medication per hour, again by continuous infusion. Alternatively, 80 units / kg (initial dose) should be administered as a bolus infusion, followed by 18 units / kg per hour (continuous infusion). In some patients, however, the subcutaneous injection of heparin at a dose of 17, 500 units, every 12 hours, appears to be more effective. For the prophylaxis of deep vein thrombosis, it is recommended instead to take 5000 units of active principle by subcutaneous route every 8-12 hours; to underline that the precise dosage must always be established by the doctor on the basis of the severity of the condition and the general health of the patient.
- Enoxaparin (eg. Clexane): for the treatment of deep vein thrombosis, it is recommended to take 1 mg / kg of drug subcutaneously every 12 hours; alternatively, 1.5 mg / kg can be administered subcutaneously once a day, approximately always at the same time. It is also recommended to start therapy with warfarin on the same day that enoxepeparin is taken. The therapy can be continued for 5-17 days. For the prophylaxis of venous thrombosis in the context of the anti-phospholipid antibody syndrome, it is recommended to take an active dose of 40 mg, subcutaneously, once a day. The duration of therapy varies from 6 to 14 days. If the patient is obese, in addition to reducing his weight by at least 30%, it is recommended to follow a low-calorie, healthy and balanced diet, and to practice constant physical activity. The drug can also be taken during pregnancy.
- Tinzaparin (eg Innohep): it is a low molecular weight heparin, indicated for the treatment of adults suffering from deep vein thrombosis. The drug should be taken at a dose of 175 units / kg once a day for at least 6 days. Second choice drug for the treatment of the disease. Consult your doctor.
- Dalteparin (eg Fragmin): the drug is taken subcutaneously, and requires a reduced frequency of administration compared to heparin (common): the drug is available in doses ranging from 2500 IU / 0.2 ml, up to 18000 IU / 0.72 ml. The dosage for the treatment and prophylaxis of deep vein thrombosis is exclusively medical.
- Bemiparin (eg Ivor): another low molecular weight heparin, used in therapy both for the treatment and for the prevention of phlebothrombosis. For treatment: take 115 units / kg of drug per day (to be taken approximately always at the same time for 5-9 days). This dosage is also indicated to prevent pulmonary embolism. For the prophylaxis of deep vein thrombosis, especially for the medium-moderate post-surgical risk, it is recommended to take the drug subcutaneously at a dose of 2500 units 2 hours before or 6 hours after the operation; proceed with this dose for 7-10 days, taking the drug at the same time every day. Due to the high risk of post-surgery clot formation, it is recommended instead to increase the dosage to 3500 units, proceeding according to the same frequency scheme just described.
What to do in case of heparin overdose
It is not uncommon, unfortunately, that patients treated with heparin for the treatment of deep vein thrombosis take a dose (or more) of heparin (common) or low molecular weight heparin: in this case, a protamine dose (eg Protamine MEP 50mg / 5ml), administered by intravenous infusion (lasting no more than 5 mg / min). For the dosage: it is estimated that one gram of drug is able to neutralize 80-100 units of heparin, to be administered within 15 minutes of the intake of excess heparin.
- Possible side effects: asthenia, bradycardia, dyspnoea, pulmonary edema, hypo / hypertension, back pain, nausea, bleeding
Oral anticoagulants: useful for stopping / inhibiting the formation of blood clots in the context of deep vein thrombosis
- Warfarin (eg. Coumadin): first-line oral anticoagulant for the treatment of the disease. The administration of this drug is useful to antagonize the effect of vitamin K, therefore it is indicated in the treatment of deep vein thrombosis. It is important to remember that an overdose of this drug increases the chance of bleeding. Do not take during pregnancy: the drug is a teratogen. In general, warfarin requires 48-72 hours to fully develop its therapeutic effect. Take together with heparin. The dosage of this powerful drug will not be described, given the serious side effects that could occur following a wrong dosage (bleeding, necrosis, tissue gangrene). The dosage of this oral anticoagulant must be accurately established by the doctor, according to the prothrombin time expressed according to the international normalized ratio. Warfarin, at high doses, can seriously endanger the patient's life, as well as completely cancel the therapeutic purposes.
- Acenocumarol (eg. Sintrom): the drug is particularly indicated for prophylaxis for deep vein thrombosis following cardiac operations (implants of cardiac valve prostheses), as well as for the prevention of pulmonary embolism. Indicatively, take 4-12 mg of active ingredient on the first day of therapy, followed by 4-8 mg the next day. The maintenance dose is expected to take 1-8 mg of the drug a day.
Thrombolytics : active ingredients used in therapy to harm the thrombus created in the vein. It should be pointed out that these drugs can cause bleeding, therefore they are prescribed only in patients who are unstable from a haemodynamic point of view.
- Urokinase (eg Urochinase Crinos, Urokinasi HSP): the drug belongs to the class of thrombolytics, indicated for the treatment of deep vein thrombosis and for the prophylaxis of pulmonary embolism. Start the therapy with 4400 units per kilo, given as a bolus infusion, in 10 minutes. Continue with 4, 400 units / kg every hour, administered intravenously continuously for 72 hours. The duration of therapy varies from 10 to 14 days.
Selective factor Xa inhibitors
- Fondaparinux (eg Arixtra): indicated for the treatment of deep venous thrombosis and for the prevention of its complications (pulmonary embolism). The drug is used in therapy for the anticoagulant properties, capable of inhibiting one of the factors involved in the mechanism of blood coagulation (factor Xa). By blocking the Xa factor, the synthesis of thrombin is denied, which reflexively prevents the formation of thrombi. To treat episodes of deep vein thrombosis, the drug is administered by intravenous injection at a dose of 5-7 / 5-10 mg, based on the patient's weight (generally, the dose of 5 mg is used for patients who they weigh less than 50 kilos, 7.5 mg for those weighing 50-100 kilos and 10 mg if the subject weighs over 100 kilos). Lower doses are generally used for the control of angina pectoris and myocardial infarction. Normally, the drug is administered concomitantly with warfarin (no later than 72 hours after the administration of factor Xa inhibitor); in the context of deep vein thrombosis, it is recommended to continue this therapy for 5-9 days, following the treatment scheme described above.
