[Alternative therapy of deep venous thrombosis in patients at hemorrhagic risk].
The authors report on the pharmacological employment of defibrotide in the treatment of a case of deep vein thrombosis (DVT) of the left iliac-femoral veins in a patient with a high-risk of hemorrhage (haematuria from kidney neoplasm, rupture of basilar artery aneurysm, urethral bleeding from catheter trauma). Alternatively to the traditional thrombolytic and anticoagulants, not indicated here for their haemorrhagic risk potential, defibrotide promptly resolved the DVT without any major effect on blood coagulation parameters. Initially, 1 gr of defibrotide in 250 ml of glucose-1-phosphate solution was administered twice-daily for the first two days when improvement had been observed. An additional 5 days of therapy was continued under the same regimen, then 400 mg intravenously every 2 hours for 14 days, and 400 mg intramuscularly every 24 hours until the 30th day. The patient was dismissed from the hospital on therapy with indobufen 200 mg orally, and elastic support stocking. After 6 months the patient is well. An echo color Doppler evaluation showed a normal venous blood flow through the femoral, iliac and caval veins, and venous blood reflux in the iliac-femoral and femoral saphenous veins due to valvular insufficiency. Caval filters, although recognized by many institutions as a preferred method of protection against pulmonary thromboembolism especially in patients with a contraindication to anticoagulation therapy or recurrent pulmonary embolism, was not used in this case, since the patient was critically ill. From this case report and the review of the literature it seems that defibrotide may represent a valid alternative therapy in the treatment of DVT, especially in high risk haemorrhagic patients.
Palombi
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Divisione Chirurgia Generale, USL RM n. 6, Ospedale CTO, Roma.
Bochicchio
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O
Gargiulo
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M
Sammarco
M
M
D000368:Aged; D001458:Bandages; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006470:Hemorrhage / Q000517:prevention & control*; D006801:Humans; D054833:Isoindoles; D008297:Male; D010654:Phenylbutyrates / Q000627:therapeutic use; D011089:Polydeoxyribonucleotides / Q000008:administration & dosage / Q000627:therapeutic use; D012307:Risk Factors; D013924:Thrombophlebitis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014463:Ultrasonography
D005343:Fibrinolytic Agents; D054833:Isoindoles; D010654:Phenylbutyrates; D011089:Polydeoxyribonucleotides; C036901:defibrotide; C020371:indobufen
Terapia alternativa della trombosi venosa profonda nel paziente a rischio emorragico.