DEEP VEIN THROMBOSIS - DRUGS FOR THE TREATMENT OF DEEP VEIN THROMBOSIS - MEDICATIONS

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Drugs to Treat Deep Vein Thrombosis

Definition

Otherwise known as phlebothrombosis, 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 vein 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 blood circulation, causing even serious damage. Deep vein thrombosis. it 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 weighting and tiredness of the legs, muscle cramps, pain, edema, swelling of the limbs and ankles.

Each organism reacts differently, so it is not certain that the disease manifests itself with the same symptom picture in all patients

The information on Deep Vein Thrombosis - Drugs for the Treatment of Deep Vein Thrombosis is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Deep Vein Thrombosis - Drugs for the Treatment of Deep Vein Thrombosis.

Medicines

Before proceeding with the administration of drugs for the treatment of deep vein thrombosis, a diagnostic assessment is essential: in fact, the symptoms accompanying the disease are common to many others (eg. Hematomas, fractures, osteomyelitis, strains, tears, trauma, etc. In general, the chances 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 essential to take cover for a medical consultation: not surprisingly, it is observed that the chances of good prognosis increase when the disease is diagnosed early.
The goals of therapy for deep vein thrombosis can be summarized in three very important points:

Stopping the growth of the undermined clot in a vein
Prevent the breakdown of the clot (hence the risk of pulmonary embolism)
To reduce the chances of the recurrence of deep vein thrombosis

In addition to the administration of fluidifying drugs, antithrombotics and vitamin K antagonists (specifically analyzed below), it is possible to proceed with other mechanical measures (wear elastic compression stockings, indicated to promote 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 caval filters: these are real filters which, through a surgical intervention, are placed inside a large caliber vein, in order to prevent the transport of clot fragments into the lungs; this practice is indicated for the prevention of complications of deep vein thrombosis, especially for those patients with previous history of relapses.

The following are the classes of drugs most used in therapy against deep vein thrombosis, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the state of health of the patient and his response to treatment:

Heparin (Anticoagulants or blood thinners): the administration of these drugs is particularly indicated to prevent the formation of blood clots in the veins (thrombi). While not able to break pre-existing clots, these drugs can still prevent their development, thus avoiding the blockage of the bloodstream. In general, the therapy with anticoagulants for the treatment of deep vein thrombosis must be continued for at least three months, unless otherwise indicated by the doctor.

Heparin (eg Heparin Cal Acv, Heparin Sod.Ath, Ateroclar, Trombolisin): generally, therapy with fluidifiers 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 for continuous intravenous bolus infusion, followed by 1300 units of drug per hour, again by continuous infusion. Alternatively, administer as a bolus infusion of 80 units / kg (starting dose), followed by 18 units / kg per hour (continuous infusion). of 17500 units, every 12 hours. For prophylaxis of deep vein thrombosis, it is recommended instead to take 5000 units of active substance subcutaneously every 8-12 hours; It should be emphasized 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 Cure of deep vein thrombosis, it is recommended to take 1 mg / kg of the drug subcutaneously every 12 hours; alternatively, it is possible to administer 1.5 mg / kg subcutaneously once a day, always at approximately the same time. It is also recommended to start warfarin therapy on the same day that enoxeparin is taken. Therapy can be continued for 5-17 days. For prophylaxis of venous thrombosis in the context of 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 their 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 dosage 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 a medical competence.
Bemiparin (eg Ivor): another low molecular weight heparin, used in therapy both for the treatment and for the prevention of phlebothrombosis. For the Cure: take 115 units / kg of drug per day (to be taken at approximately the same time for 5-9 days). This posology is also indicated to prevent pulmonary embolism. For prophylaxis of deep vein thrombosis, especially for the medium-moderate risk after surgery, 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 clot formation after surgery, it is advisable to increase the dosage to 3500 units, proceeding according to the same frequency scheme just described.

What to do in case of heparin overdose

Unfortunately, it is not uncommon for patients treated with heparin for the treatment of deep vein thrombosis to take one dose (or more) of heparin (common) or low molecular weight heparin in excess: in this case, a dose is required. dose of protamine (eg Protamine MEP 50mg / 5ml), administered by intravenous infusion (lasting no more than 5mg / min). For the dosage: it is calculated that one gram of drug is able to neutralize 80-100 units of heparin, to be administered within 15 minutes of taking excess heparin.

Possible side effects: asthenia, bradycardia, dyspnoea, pulmonary edema, hypo / hypertension, back pain, nausea, bleeding

Oral anticoagulants: useful for arresting / 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, for this reason it is indicated in the treatment of deep vein thrombosis. It must be remembered that an excessive dose of this drug increases the chances of bleeding. Do not take during pregnancy: the drug it is a teratogen.Generally, warfarin requires 48-72 hours to fully develop its therapeutic effect. Take together with heparin. The dosage of this potent drug will not be described, given the serious side effects that could occur following an incorrect dosage (haemorrhages, necrosis, tissue gangrene). The dosage of this oral anticoagulant must be accurately established by the physician, according to the prothrombin time expressed according to the international normalized ratio. Warfarin, in high doses, can seriously endanger the patient's life, in addition to completely canceling the aims. therapeutic.
Acenocoumarol (eg. Sintrom): the drug is particularly indicated for the prophylaxis of deep vein thrombosis following cardiac operations (implantation of heart 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 involves taking 1-8 mg of the drug per day.

Thrombolytics: active ingredients used in therapy to damage the thrombus created in the vein. It should be pointed out that these drugs can cause bleeding, therefore they are only prescribed in hemodynamically unstable patients.

Urokinase (eg. Urokinase 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 therapy with 4400 units per kilo, administered by 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 vein thrombosis and for the prevention of its complications (pulmonary embolism). The drug is used in therapy for its anticoagulant properties, capable of inhibiting one of the factors involved in the mechanism of blood clotting (factor Xa). By blocking factor Xa, thrombin synthesis is denied, which reflexively prevents thrombus formation. 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 (typically, the 5 mg dose is used for patients who weigh less than 50 kilos, 7.5 mg for those weighing 50-100 kilos and 10 mg if the subject weighs over 100 kilos). The lower doses are generally used for the control of angina pectoris and myocardial infarction. Normally, the drug should be administered concomitantly with warfarin (no later than 72 hours after the administration of the factor Xa inhibitor); in the context of deep vein thrombosis, it is recommended to continue this therapy for 5-9 days, following the schedule therapeutic just described.