Pulmonary embolism prevention

Venous thromboembolism (VTE) is a complicating condition responsible for high morbidity and mortality in North America and Europe. This disease commonly is linked to advanced age but has both hereditary and acquired risk factors, such as surgery, any form of trauma, and childbirth, associated with it. It encompasses the conditions of deep vein thrombosis (DVT) and pulmonary embolism. In excess of 60,000 deaths annually are attributed to pulmonary embolism. Preventative therapy consists of the use of two different classes of antithrombotic agents, namely anticoagulants and antiplatelet drugs (1,2). 

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. 

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. 

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

Hull RD, Hirsh J, Sackett DL, et al. Cost-effectiveness of primary and secondary prevention of fatal pulmonary embolism in high-risk surgical patients. CMAf 1982 127 990-5. 

Warfarin is used as an anticoagulant for preventing and treating deep venous thromboses and pulmonary embolism. Synonyms of this drug are cumadin, panwarfm, sofrain, wamerin, and others. 

It is used for the same indications for preventing and treating thrombosis and pulmonary embolism. A synonym of this drug is sintrom. 

Prevention of venous thrombosis, pulmonary embolism, peripheral arterial embolism, atrial fibrillation with embolism Subcutaneous 5000 units q8-12h. 

In present times, because of early mobilization and shorter stays in hospital, venous thrombosis in the legs and resulting pulmonary embolism has declined to a large degree. In persons with acute myocardial infarction, prophylactic low-dose heparin has reduced the incidence of venous thrombosis in the legs. It is considered as a reasonable alternative to warfarin in selected patients. Preventive anlicoagulalion may be indicated in some cases to prevent strokes due to left ventricular mitral thrombi embolizing in tire brain. 

The goal in the treatment of deep venous thrombosis and pulmonary embolism is the prevention of recurrent, fatal embolism. 

UFH anticoagulation is routinely used during vascular and cardiac surgery, for the prophylaxis and treatment of DVT for the prevention of pulmonary embolism in surgical patients, and in patients with atrial fibrillation and recent embolization (6). 

When these patients are discharged from hospital, prophylactic treatment with an oral anticoagulant is recommended to prevent recurrence of the thrombosis. Warfarin sodium, which antagonizes the effects of vitamin K, is used in prophylaxis and treatment of DVT and pulmonary embolism. It is usual to start with an induction dose of 10 mg daily for two days the dose can then be reduced. Patients need to be monitored as there is a risk of haemorrhage with oral anticoagulant drugs. 

Andre C, de Freitas GR, Fukujima MM (2007). Prevention of deep venous thrombosis and pulmonary embolism following stroke a systematic review of published articles. European Journal of Neurology 14 21-32... 

Of the many drugs used as prophylactic antithrombotic agents, heparin has a long history as therapy for both DVT and pulmonary embolism (PE). Many studies have shown that in moderate and high risk patients, heparin can prevent postoperative DVT and PE (4,19-21). Now, with the introduction of LMWHs, these benefits can be had together with easier dosing and potentially less risk of bleeding. 

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. 

Besides its usual indications, topical glyceryl trinitrate has been used to prevent intravenous infusion failure because of phlebitis and extravasation, which occur in 30-60% of patients and can cause discomfort and harm, such as pulmonary embolism, septicemia, and increased mortality. Local application of glyceryl trinitrate patches was efficacious in several studies (11) the mechanism is probably vasodilatation and increased capillary flow. Glyceryl trinitrate is safe, since it causes only skin rashes and transient headache. 

Retardation of clotting is important in blood transfusions, to avoid thrombosis after surgery or from other causes, to prevent recurrent thrombosis in phlebitis and pulmonary embolism. and to lessen the propagation of clots in the coronary aitcries. This retardation may be accomplished by agents that inactivate thrombin (heparin) or substances that prevent the fotmation of prothrombin in the liver (the coumarin derivatives and the phenylindanedione derivatives). 

Mini-dose or subcutaneous heparin was reported on briefly in previous reviews.13 14 In 1975-76 more clinical evaluations have been reported.89-71 These smaller doses with lower and more sustained effect are efficacious i n vivo for use before surgery and other thrombotic conditions to prevent venous thrombosis and pulmonary embolism. This new form of dosing was advanced by the development of new understanding of mechanism and development of new methods for measuring activity. Such therapy eliminates the necessity of laboratory monitoring and the danger of bleeding. 

---