Deep vein thrombosis, anticoagulation

Evaluate the patient for adverse effects, including peripheral neuropathy and deep vein thrombosis. Prophylactic anticoagulation therapy should be considered in thalidomide or lenalidomide based therapy. 

Anticoagulant drugs include heparin and warfarin (Coumadin ) —agents used to prevent deep vein thrombosis. They are also used to prevent formation of emboli due to atrial fibrillation, valvular heart disease, and other cardiac disorders. Heparin, which is not absorbed by the gastrointestinal tract, is available only by injection its effect is immediate. 

Sarasin, F.P. and H. Bounameaux, "Decision Analysis Model of Prolonged Oral Anticoagulant Treatment in Factor V Leiden Carriers with First Episode of Deep Vein Thrombosis," BMJ, 316, 95-99 (1998). 

Venous thrombi (red thrombi) are formed mainly from fibrin in simations where vascular stasis exists or in hypercoagulability states. Here the symptoms consist of deep vein thrombosis with the risks of pulmonary embolism and the mainstay of therapy is anti-coagulation with heparin and oral anticoagulants. 

Harper P, Monahan K, Baker B. Warfarin induction at 5 mg daily is safe with a low risk of anticoagulant overdose results of an audit of patients with deep vein thrombosis commencing warfarin. Intern Med J 2005 35 717-20. 

A 23-year old pregnant woman who has been administered IV heparin for treatment of deep vein thrombosis has developed heparin-induced thrombocytopenia. Altering therapy by removing heparin and adding warfarin is not a viable option, because warfarin can cross the placenta and exert an anticoagulant effect in the fetus. Suggest a treatment approach. 

A major focus of drug development has been to develop orally active anticoagulants that do not require monitoring. Rivaroxiban is the first oral factor Xa inhibitor to reach phase III clinical trials. The safety and efficacy of rivaroxiban appears to be at least equivalent, and possibly superior, to LMW heparins for prevention of deep vein thrombosis no routine monitoring is required. This drug is also in clinical trials for treatment of deep vein thrombosis and prevention of stroke in atrial fibrillation. 

The adverse effect profile of thalidomide is extensive. The most important toxicity is teratogenesis. Because of this effect, thalidomide prescription and use is closely regulated by the manufacturer. Other adverse effects of thalidomide include peripheral neuropathy, constipation, rash, fatigue, hypothyroidism, and increased risk of deep vein thrombosis. Thrombosis is sufficiently frequent, particularly in the hematologic malignancy population, that most patients are placed on some type of anticoagulant when thalidomide treatment is initiated. 

Finally, aspirin has also been used to prevent thrombus formation in peripheral veins (deep vein thrombosis [DVT]), and aspirin is sometimes used as an adjunct or alternative to anticoagulants (heparin, warfarin) that are routinely used to treat DVTs.8 Aspirin can likewise be administered to prevent thromboembolism following surgical procedures such as coronary artery bypass, arterial grafts, endarterectomy, and valve replacement 45,78 By preventing platelet-induced thrombogenesis, aspirin helps maintain patency and prevent reocclusion of vessels following these procedures. 

Dennis MS (2004). Effective prophylaxis for deep vein thrombosis after stroke low-dose anticoagulation rather than stockings alone. Stroke 35 2912-2913... 

Heparinoids. Danaparinoid sodium is a mixture of several types of non-heparin glycosaminoglycans extracted from pig intestinal mucosa (84% heparan sulphate). It is an effective anticoagulant for the treatment of deep vein thrombosis (DVT) prophylaxis in high-risk patients and treatment of patients with heparin-associated thrombocytopenia. 

Rev-Eyes daplprazole. reviparin sodium [ban, inn] is a (parenteral) ANTICOAGULANT that is chemically a low-molecular weight form of heparin. It can be used therapeutically in the treatment of deep vein thrombosis, rexostatine (proteinase inhibitor E 64 E-64) is a microbial product isolated from AspergillusJaponicus. It is a (thiol) PROTEASE INHIBITOR, and can be used to sensitize lung and colon carcinomas to ANTICANCER chemotherapy. 

Indications Prophylaxis of deep vein thrombosis Category Anticoagulant Heparinoid Half-life 17-21 hours... 

---