Deep vein thrombosis prevention

Kamphuisen PW, Agnelli G. What is the optimal pharmacological prophylaxis for the prevention of deep-vein thrombosis and pulmonary embolism in patients with acute ischemic stroke Thromb Res 2007 119(3) 265-274. 

Formulate an appropriate prevention strategy for a patient at risk for deep vein thrombosis. 

Lenalidomide was approved recently for the indication of myelodysplastic syndrome where the 5q deletion is present. Since lenalidomide is an analog of thalidomide, all the same precautions must be taken to prevent phocomelia. The time to maximum lenalidomide concentrations occurs 0.5 to 4 hours after the dose. The terminal half-life ranges from 3 to 9 hours. Approximately 65% of lenalidomide is eliminated unchanged in the urine, with clearance exceeding the glomerular filtration rate. To date, no pharmacokinetic studies have been done in patients with renal dysfunction. Lenalidomide is used in the treatment of myelodysplastic syndrome and multiple myeloma. Other side effects are neutropenia, thrombocytopenia, deep vein thrombosis, and pulmonary embolus. 

Direct thrombin inhibitors such as hirudin, Hirulog, the peptide aldehyde efegatran, and peptidomimetic compound argatroban have undergone clinical trials. Their application in the prevention and treatment of deep vein thrombosis contin-... 

Eriksson B. I., Kalebo P Anthmyr B. A., et al. Prevention of deep-vein thrombosis and pulmonary embolism after total hip replacement. Comparison of low molecular weight heparin and unfractionated heparin. J Bone Joint Surg [Am] 1991 73A, 484-93. 

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. 

Either low-dose unfractionated heparin or low-molecular weight heparin are effective A in preventing deep vein thrombosis Stress ulcer prophylaxis... 

Goldhaber SZ (2005) Tamoxifen, preventing breast cancer and placing the risk of deep vein thrombosis in perspective. Circulation 111 539-541... 

Reviparin - low MW heparin Prevention of deep vein thrombosis and pulmonary embolism following surgery... 

Unstable angina, non -wave MI Subcutaneous 120 international units/kg ql2h (maximum 10,000 international units/dose) given with aspirin until clinically stable. Prevention of deep vein thrombosis (DVT) or pulmonary edema in the acutely ill patient Subcutaneous 5000 international units once a day. 

Prevention of deep vein thrombosis (DVT) after hip and knee surgery Subcutaneous 30 mg twice a day, generally for 7-10 days. 

Unlabeled Uses Prevention of postoperative deep vein thrombosis (DVT), protection of aortocoronary bypass grafts, reduction of graft loss after renal transplant, treatment of intermittent claudication, sickle cell disease, subarachnoid hemorrhage, diabetic microangiopathy, ischemic heart disease... 

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. 

Estrogens with or without progestins should not be used for the prevention of cardiovascular disease. The Women s Health Initiative (WHI) study reported increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women (50 to 19 years of age) during 5 years of treatment with oral conjugated estrogens (0.625 mg) combined with medroxyprogesterone acetate (2.5 mg) relative to placebo.62... 

Most drug discovery efforts focus on thrombin inhibition as a means to prevent the serious consequences of thrombus formation in myocardial infarction and stroke. Thrombin inhibitors may also prevent clot formation in patients prone to deep vein thrombosis or repeat heart attack. In combination with thrombus dissolution therapies, thrombin inhibitors may decrease the incidence of reocclusion due, in part, to the release of active clot-bound thrombin. 

Thrombus Formation. The thromboxanes, especially TXA2, cause platelet aggregations that result in blood clot formation.73 It is unclear whether excessive thrombus formation (as in deep vein thrombosis or coronary artery occlusion) is initiated by abnormal thromboxane production. Certainly, inhibition of thromboxane synthesis will help prevent platelet-induced thrombus formation in individuals who are prone to specific types of excessive blood clotting.84... 

The use of traditional (unffactionated) heparin has therefore been replaced by LMWHs to a large extent.18,100 LMWHs are clearly safer and more convenient to their unfractionated counterparts, and these drugs have become the primary method of treating acute venous thrombosis.47,100 LMWHs are now used routinely to prevent or treat deep vein thrombosis (DVT) following various types of surgery or medical conditions (ischemic stroke, cancer).70,127 It has also been suggested that LMWHs will produce optimal effects if they are administered for more than a few days, and some patients who are at high risk for thrombosis may receive LMWHs via subcutaneous injection for several weeks or months.80 Future research will help determine the best way to use LMWHs to prevent or treat venous thrombosis in specific clinical situations. 

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. 

Bara L, Planes A, Samama M-M Occurrence of thrombosis and haemorrhage, relationship with anti-Xa, anti-I la activities, and D-dimer plasma levels in patients receiving low molecular weight heparin, en-oxaparin or tinzaparin, to prevent deep vein thrombosis after hip surgery. Br. J. Haematol. (1999) 304 230-240. 

Kaye JA. A trial to evaluate the relative roles of dipyridamole and aspirin in the prevention of deep vein thrombosis in stroke patients. Bracknell, Boehringer Ingelheim (Internal Report), 1990. 

Mrs RP is currently taking warfarin to prevent recurrent thromboembolism after having a deep vein thrombosis a month ago. As Mrs RP is likely to require warfarin treatment for at least another two months, it will be necessary to take the following steps ... 

Bonis LCHau(hO,JbigensaiLN, Lassen MR Enoxaparin versus dextran 70 in the prevention of postoperative deep vein thrombosis after total hip replacement. A Danish multicenter shkdy. Proceeding of the Danish Enoxaparin Symposium, Feb 3,1990... 

Caen JP A randomized double-blind study between a low molecular weight heparin Kabi 2165 and standard heparin in the prevention of deep vein thrombosis in general surgery. A French multicenter trial. IhrombHaemost (19SS) 59(2) 216-220. 

INR 2.0-3.0 Treatment of deep vein thrombosis pulmonary embolism systemic embolism prevention of venous thromboembolism in myocardial infarction mitral stenosis with embolism transient ischaemic attacks atrial fibrillation. 

The main use of the coumarins is in the treatment and prevention of thromboembolic disease, including deep vein thrombosis, pulmonary embolism, and cerebral embolism from cardiac and other sources. 

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