[Evolution in the pharmacological treatment of venous thrombosis according to evidence-based medicine].
Today therapeutic protocols must be in accordance with Recommendations derived by Randomized Controlled Trials (RCT) Evidences. Deep Venous Thrombosis (DVT), post-thrombotic syndrome and pulmonary embolism (PE) are different forms of the thromboembolic venous disease. The Authors, according with Evidence-Based Medicine, review the most significant RCT about Low-Molecular-Weight Heparin (LMWH). It has been proved that LMWH is more efficacious, easier to administrate and with less significant side effects than Unfractioned Heparin (UH) in DVT treatment. Its higher anti-Xa than anti-IIa activity provides higher anti-thrombotic properties and lower haemorrhagic risk. LMWH does not require anticoagulant monitoring and allows outpatient--ambulatory care. RCT also showed lower PE ratio and lower haemorrhagic risk with LMWH outpatient care than with UH in-hospital care for DVT. RCT showed also a long-term lower DVT relapse and PE incidence with LMWH than with oral anticoagulants. The Authors report their own experience with LMWH and early ambulation for the treatment of DVT versus standard UH therapy. Their retrospective analysis confirms lower incidence of complications: growth of the thrombus, severe haemorrhages, PE.
Manganaro
A
A
Scuola di Specializzazione in Cardiologia Malattie dell'Apparato Cardiovascolare Cattedra di Angiologia, Università degli Studi, Messina.
Giannino
D
D
Lembo
D
D
Bruni
F
F
Consolo
F
F
D000208:Acute Disease; D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D017985:Dalteparin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D017984:Enoxaparin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005268:Femoral Vein / Q000000981:diagnostic imaging; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D017762:Nadroparin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D018615:Ultrasonography, Doppler, Color; D020246:Venous Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*
D000925:Anticoagulants; D017984:Enoxaparin; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D017762:Nadroparin; D017985:Dalteparin