[Initial treatment of venous thromboembolic events].
Initial treatment of venous thromboembolic events is currently based on antithrombotics. This treatment is validated and identical for deep vein thrombosis (DVT) and pulmonary embolism. For distal DVT, this treatment has still to be validated. This reference therapeutic strategy is firstly parenteral and based on low-molecular-weight heparins (LMWH) or fondaparinux, subcutaneously prescribed at fixed dosage based on body weight without any systematic dose adjustment on hemostasis tests. Unfractionated heparin is steel the reference treatment in case of severe renal insufficiency. This parenteral treatment has to be relieved by vitamin K antagonists (VKA). VKA has to be co-administrated for at least 3 days, without any loading dose and can be early initiated. VKA dose needs to be adjusted in order to maintain INR between 2 and 3. However, in case of cancer, LMWH have to be carried on for 6 months. A part this antithrombotic treatment, thrombolytics are recommended in case of massive PE and vena cava filter should be used in case of recurrence despite adequate antithrombotic treatment or in case of contraindication to antithrombotic.
Mismetti
Patrick
P
Service de médecine interne et thérapeutique, unité de pharmacologie clinique, Groupe de recherche sur la thrombose EA 3065 CIE3, CHU de Saint-etienne, 42055 Saint-Etienne. patrick.mismetti@chu-st-etienne.fr
Decousus
Hervé
H
Moulin
Nathalie
N
D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000037:antagonists & inhibitors; D005170:Factor X / Q000008:administration & dosage / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D000077425:Fondaparinux; D006493:Heparin / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D007279:Injections, Subcutaneous; D019934:International Normalized Ratio; D011134:Polysaccharides / Q000008:administration & dosage / Q000627:therapeutic use; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000628:therapy; D051437:Renal Insufficiency / Q000150:complications; D013923:Thromboembolism / Q000188:drug therapy / Q000628:therapy; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000628:therapy; D014812:Vitamin K / Q000037:antagonists & inhibitors
D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D011134:Polysaccharides; D014812:Vitamin K; D005170:Factor X; D006493:Heparin; D000077425:Fondaparinux