Deep vein thrombosis medical therapy: Difference between revisions
(New page: '''Editors-in-Chief:''' C. Michael Gibson, M.S., M.D. '''Associate Editor-In-Chief''': Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org] {{Deep vein thrombos...) |
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==Therapy== | ==Therapy== | ||
===Hospitalization=== | ===Hospitalization=== | ||
Treatment at home is an option according to a [[meta-analysis]] by the [[Cochrane Collaboration]]. | Treatment at home is an option according to a [[meta-analysis]] by the [[Cochrane Collaboration]].[www.ncbi.nlm.nih.gov/pubmed/17636714] Hospitalization should be considered in patients with more than two of the following risk factors as these patients may have more risk of complications during treatment<ref name="pmid16926081">{{cite journal |author=Trujillo-Santos J, Herrera S, Page MA, ''et al'' |title=Predicting adverse outcome in outpatients with acute deep vein thrombosis. findings from the RIETE Registry |journal=J. Vasc. Surg. |volume=44 |issue=4 |pages=789-93 |year=2006 |pmid=16926081 |doi=10.1016/j.jvs.2006.06.032}}</ref>: | ||
* bilateral DVT, renal insufficiency, body weight <70 kg, recent immobility, chronic heart failure, and cancer | * bilateral DVT, renal insufficiency, body weight <70 kg, recent immobility, chronic heart failure, and cancer | ||
Revision as of 02:39, 24 August 2011
Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [1]
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Medical Therapy
Therapy
Hospitalization
Treatment at home is an option according to a meta-analysis by the Cochrane Collaboration.[www.ncbi.nlm.nih.gov/pubmed/17636714] Hospitalization should be considered in patients with more than two of the following risk factors as these patients may have more risk of complications during treatment[1]:
- bilateral DVT, renal insufficiency, body weight <70 kg, recent immobility, chronic heart failure, and cancer
Anticoagulation
Anticoagulation is the usual treatment for DVT. In general, patients are initiated on a brief course (i.e., less than a week) of heparin treatment while they start on a 3- to 6-month course of warfarin (or related vitamin K inhibitors). Low molecular weight heparin (LMWH) is preferred,[2] though unfractionated heparin is given in patients who have a contraindication to LMWH (e.g., renal failure or imminent need for invasive procedure). In patients who have had recurrent DVTs (two or more), anticoagulation is generally "life-long." The Cochrane Collaboration has meta-analyzed the risk and benefits of prolonged anti-coagulation.[3]
An abnormal D-dimer level at the end of treatment might signal the need for continued treatment among patients with a first unprovoked proximal deep-vein thrombosis.[4]
Thrombolysis
Thrombolysis is generally reserved for extensive clot, e.g. an iliofemoral thrombosis. Although a meta-analysis of randomized controlled trials by the Cochrane Collaboration shows improved outcomes with thrombolysis,[5] there may be an increase in serious bleeding complications.
Compression stockings
Elastic compression stockings should be routinely applied "beginning within 1 month of diagnosis of proximal DVT and continuing for a minimum of 1 year after diagnosis".[2] Starting within one week may be more effective.[6] The stockings in almost all trials were stronger than routine anti-embolism stockings and created either 20-30 mm Hg or 30-40 mm Hg. Most trials used knee-high stockings. A meta-analysis of randomized controlled trials by the Cochrane Collaboration showed reduced incidence of post-phlebitic syndrome.[7] The number needed to treat is quite potent at 4 to 5 patients need to prevent one case of post-phlebitic syndrome.[8]
- ↑ Trujillo-Santos J, Herrera S, Page MA; et al. (2006). "Predicting adverse outcome in outpatients with acute deep vein thrombosis. findings from the RIETE Registry". J. Vasc. Surg. 44 (4): 789–93. doi:10.1016/j.jvs.2006.06.032. PMID 16926081.
- ↑ 2.0 2.1 Snow V, Qaseem A, Barry P; et al. (2007). "Management of venous thromboembolism: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians". Ann. Intern. Med. 146 (3): 204–10. PMID 17261857.
- ↑ Hutten BA, Prins MH (2006). "Duration of treatment with vitamin K antagonists in symptomatic venous thromboembolism". Cochrane database of systematic reviews (Online) (1): CD001367. doi:10.1002/14651858.CD001367.pub2. PMID 16437432.
- ↑ Palareti G, Cosmi B, Legnani C; et al. (2006). "D-dimer testing to determine the duration of anticoagulation therapy". N. Engl. J. Med. 355 (17): 1780–9. doi:10.1056/NEJMoa054444. PMID 17065639.
- ↑ Watson L, Armon M. "Thrombolysis for acute deep vein thrombosis". Cochrane Database Syst Rev: CD002783. PMID 15495034.
- ↑ Prandoni P, Lensing AW, Prins MH; et al. (2004). "Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial". Ann. Intern. Med. 141 (4): 249–56. PMID 15313740.
- ↑ Kolbach D, Sandbrink M, Hamulyak K, Neumann H, Prins M. "Non-pharmaceutical measures for prevention of post-thrombotic syndrome". Cochrane Database Syst Rev: CD004174. doi:10.1002/14651858.CD004174.pub2. PMID 14974060.
- ↑ Kakkos S, Daskalopoulou S, Daskalopoulos M, Nicolaides A, Geroulakos G (2006). "Review on the value of graduated elastic compression stockings after deep vein thrombosis". Thromb Haemost. 96 (4): 441–5. PMID 17003920.