Update of the management of venous thromboembolism.
Venous thromboembolism is the third most common cardiovascular disease. Its treatment is based in unfractionated heparin (UFH), but the advance of low molecular weight heparins, with clinical efficacy at least similar to UFH and better safety profile, have changed the therapeutic consensus. The highly relevant physiopathologic information has contributed to understand the paradoxical thrombotic mechanisms associated with heparin induced thrombocytopenia. New drugs, such as danaparoid sodium, lepirudin and argatroban, are an alternative to anticoagulation by heparin when this adverse reaction occurs. Another relevant progress was the determination of optimal duration of oral anticoagulation in order to prevent thromboembolic recurrences. In the meantime, other pharmacological approaches (thrombolytics and antiplatelet agents) have been assessed in several trials of limited value outcomes. Prophylactic measures like graduated compression stockings/intermittent external pneumatic compression and inferior vena cava filters have shown efficacy in primary and secondary prevention in patients with different risks of thromboembolic recurrence.
Rodrigues
H Luz
HL
Instituto de Farmacologia e Terapêutica, Faculdade de Medicina, Lisboa.
Brandão
E Serra
ES
Lima
B Silva
BS
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006493:Heparin / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D006493:Heparin