Thrombosis, anticoagulation

In the case of partial venous thrombosis, anticoagulants administration is usually sufficient. However, when confronted with early complete thrombosis, rapid surgical revascularization is required... 

The two most widely used coumarins are warfarin (US, Canada, and UK) and phenprocoumon (continental Europe). The long half-life (60 h) of prothrombin means that coumarin cannot achieve therapeutic anticoagulation for at least 5 days following initiation. Thus, for patients with acute thrombosis, oral anticoagulants are usually started only when the patient is receiving a rapidly active agent, usually UFH or LMWH. 

Anticoagulants Antiplatelet Drugs Coagulation/Thrombosis Fibrinolytics Purinergic System... 

Acute anticoagulation is widely used in the acute setting of arterial dissection. Once again, the rationale is to prevent propagation of local thrombosis and formation of new thrombus at the site of the injured arterial wall, which is beheved to reduce the likelihood of early stroke recurrence. This practice, while rational, is based on anecdotal evidence and case series, as randomized controlled trials have... 

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. 

In the case of thrombosis-related SVCS, anticoagulation is controversial because there is a lack of survival benefit. However, thrombolytics (e.g., alteplase) and anti coagulation with heparin and warfarin may be beneficial in patients with thrombosis owing to indwelling catheters if it is used within 7 days of onset of symptoms, although catheter removal maybe required. 

Whereas (32 glycoprotein 1 ((J2-GPI) is the target of anticardiolipin antibodies, prothrombin is the antigen for most lupus anticoagulants. Both these antibodies are risk factors for both venous and arterial thrombosis. In addition, complications such as thrombocytopenia and recurrent miscarriages are manifestations of the so-called antiphospholipid syndrome (97). 

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. 

Argatroban has two indications (1) prevention or treatment of thrombosis in patients with HIT and (2) as an anticoagulant in patients with HIT, or at risk of HIT, who are undergoing PCI. The recommended dose for the treatment of HIT is 2 mcg/kg/min by continuous IV infusion. The first aPTT should be obtained 2 hours after initiation. The dose can be adjusted as clinically indicated (maximum 10 mcg/kg/min) until the aPTT is 1.5 to 3 times control. 

Venous thrombectomy may be performed to remove a massive obstructive thrombus in a patient with significant iliofemoral venous thrombosis, particularly if the patient is either not a candidate for or has not responded to thrombolysis. Full-dose anticoagulation therapy is essential during the entire operative and postoperative period. These patients need indefinite oral anticoagulation therapy targeted to an INR of 2.5 (range 2.0 to 3.0). 

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