The basis of treatment are three therapies consisting of:
- stop the progress of venous thrombosis with anticoagulants.
- dissolution of intravenous thrombus with fibrinolytic (thrombolytic) drugs.
- surgical removal of thrombus from deep veins
Stopping the progression of thrombosis with anticoagulants
In case-sensitive cases, especially after the diagnosis of deep vein thrombosis, as well as after leg surgery - the surgeon will prescribe medications that counteract thrombosis. These are:
- low molecular weight heparin
- unfractionated heparin
- oral anticoagulants
Treatment consisting in dissolving thrombus in deep veins
The rule is a treatment aimed at the restoration of veins covered by thrombus:
- streptokinase
- plasminogen activators (urokinase, tissue plasminogen activator)
Unfortunately, there is a significant risk of bleeding complications in this treatment, especially when using streptokinase. This type of treatment is used in patients with massive, extensive deep vein thrombosis, eg in patients with painful cyanotic thrombosis of the lower limb veins (phlegmasia coerulea dolens).
Surgical removal of thrombus from deep veins
The indication for deep vein restoration surgery (venous thrombectomy) is:
- painful cyanotic swelling of the limb,
- each thrombosis lived in the femor-iliac section with the duration of clinical symptoms shorter than 5 days,
- deep vein thrombosis in patients with contraindications to the use of thrombolytics or heparin.
- recent venous thrombosis, in patients who have experienced massive bleeding or allergic shock during thrombolytic therapy or anticoagulants, forcing treatment discontinuation.
The effectiveness of treatment of venous thrombosis
The effectiveness of treatment with anticoagulants is not yet satisfactory. Complete cure is obtained in about 20% of patients. In the remaining cases the thrombus becomes fibrotic and a complication called thrombotic syndrome occurs. However, such a low percentage of healings does not apply to thrombolytic or surgical treatment. In the case of thrombolytic treatment, the percentage of healing is much higher, however, hemorrhagic complications and recurrences often occur.
Thrombotic syndrome - a complication of venous thrombosis
We have a post-thrombotic syndrome when the veins become more resected after venous thrombosis (as a result of treatment or spontaneously) and when the so-called musculoskeletal pump calf. Because even though the vein is reapplied, as a result of the disease in many patients it loses its elasticity and becomes a "stiff tube" with inefficient damaged valves. Then complications appear in the form of symptoms called post-thrombotic syndrome. The most important of these are swelling and leg pain as well as troublesome ulcers.
Treatment of deep vein thrombosis
THE RISK OF THE ZAKRZEPICA INITIATION AND ITS COMPLAINTS
Risk factors for deep vein thrombosis:
- venous circulation disorders and blood stasis in venous vessels caused by, for example, varicose veins
- chronic phlebitis, especially deep,
- broken leg bones, serious injuries, rehabilitation with immobilization of the leg
- female gender
- Pregnancy is conducive to blood stagnation in pelvic venous vessels,
- hormonal contraception, menopause, hormone replacement therapy increases blood clotting
- old age, when you crossed 60 years of age
- high overweight, obesity causes disturbance of venous circulation
- smoking
- sedentary lifestyle, long journeys by plane
Traveling by plane threatens thrombosis
The risk of venous thrombosis and pulmonary embolism
When the blood becomes excessively sticky and clots too quickly, we are afraid of venous thrombi and pulmonary embolism. This applies especially to older people, over 60 years of age, obese people, people suffering from varicose veins and phlebitis, women using hormonal contraception and hormone replacement therapy, people with congenital excessive blood viscosity and diseases or disabilities that force them to stay still for a long time. Remember that a heart-wound clot can cause a serious pulmonary embolism and death!
It is difficult to assess what the overall incidence of a life-threatening pulmonary embolism now looks like, because it is a rarely diagnosed disease. It is estimated, however, that the mortality rate for untreated pulmonary embolism is approx. 30%, while in the case of the treated one - 8%. / 8 /
ed. Edward Ozga Michalski, MA
drug consultation med. Michał Wojtyczka
Literature:
1.Chronic venous insufficiency. From the symptom and diagnosis to treatment dr med. Tomasz Zubilewicz, dr med. Jacek Wroński, prof. zw. dr hab. med. Jerzy Michalak from the Chair and Clinic of Vascular Surgery, Medical University of Lublin Head of the Department and Clinic: prof. dr hab. Jerzy Michalak; Family Medicine - notebook 18 (2/2002)
2. Treatment of deep vein thrombosis; Professor dr hab. med. Maciej Szczepański - Department of Biochemistry of the Clinical Medical Center for Postgraduate Education in Warsaw; Therapy APRIL 2002
3. Preventive cardiology; editorship of prof. dr hab. med Marek Naruszewicz; Szczecin 2003, publisher of Verso s.c.
4. Troublesome varicose veins; bow. med. Marek Durakiewicz from the Department of Vessel Surgery SPSW im. Pope John Paul II in Zamość Branch Office: dr n. Med. Zbigniew Waga; Family Medicine, issue 10 (2/2000)
5. Surgical treatment of deep veins thrombosis of the lower limbs; Professor dr hab. med. Alfred Jerzy Meissner Surgery Clinic of the Institute of Hematology and Transfusiology in Warsaw; Therapy - April 2002
6. How to read and understand the results of medical examinations? bow. med Izabella Barcińska, publ. Literka, 2004
7. A vademecum of diagnosis and therapy; 1993 PZWL
8. Pulmonary embolism - a challenge for doctors
conversation of Alicja Paciorek-Kolbus with prof. dr. hab. med. Zbigniew Gaciong and doc. dr. n. med. Piotr Pruszczyk from the Chair and Clinic of Internal Diseases and Arterial Hypertension of the Medical University in Warsaw "Żyjmy longer" 11 (November) 2000
