[Current trends in the treatment of deep venous thrombosis].
The therapeutic procedure in established deep venous thrombosis (DVT) is summarized. Proximal (2 to 4 levels), symptomatic, recent DVT of less than three weeks duration is still treated in the clinic. The patient receives heparin intravenously, 5000 IU as initial bolus and subsequently 25,000-30,000 IU (approximately 400 IU per kilo bodyweight)/24 hours as continuous infusion or, in particular cases, 15,000 to 20,000 IU subcutaneously two times in 24 hours). Oral anticoagulation is started on the 1st day. Mobilisation takes place when symptoms regress, usually after 2-3 days. If further studies with low molecular weight heparins (LMH) confirm the good efficacy and tolerance, these compounds could replace heparin-schemes by a single daily subcutaneous injection. Also admitted to the hospital institution are patients with DVT and suspicion of pulmonary embolism and patients in whom fibrinolysis or thrombectomy are considered. The less expensive induction of anticoagulation on an outpatient basis and the subsequent follow-up treatment is in our opinion justified in patients with distal DVT (1-2 levels), older proximal DVT (and superficial venous thrombosis reaching the deep vein) and in patients with a thrombosed subclavian vein.) These patients are mobilized immediately under 12,500 to 15,000 IU heparin b.i.d. administered subcutaneously or alternatively injection of LMH's s.c. once per day (200 anti Xa-units/kg), changing over rapidly to p.o. vitamin K antagonists. For ambulatory patients LMH's may replace heparin for a single daily application if further studies confirm efficacy, this for mostly practical reasons. Long term anticoagulation by LMH could be ideal as for instance in pregnant patients.
Eichlisberger
R
R
Abteilung Angiologie, Universitätskliniken, Kantonsspital Basel.
Frauchiger
B
B
Jäger
K
K
D000925:Anticoagulants / Q000008:administration & dosage; D004434:Early Ambulation; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D013927:Thrombosis / Q000188:drug therapy / Q000628:therapy*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin
Neue Trends in der Behandlung der tiefen Venenthrombose.