In detail about the treatment of deep vein thrombosis of the lower extremities

Today, the question of the methodology and treatment regimens for patients with established diagnosis - thrombosis of deep veins of the lower extremities - is put with particular severity. This is due to the frequent development of the disease in an active working age.

Special concern of physicians causes disability of a large part of patients after the transfer of the disease and the subsequent development of post-thrombotic syndrome, the progression of chronic venous insufficiency, and most importantly - the high threat of death of patients with acute pulmonary embolism.

Content

  • 1 approach to therapy
  • 2 Conservative therapy
    • 2.1
    • Mode 2.2 drugs and treatment regimens
      • 2.2.1 heparin in the hospital
      • 2.2.2 Rheological therapy
      • 2.2.3 Antibiotics
      • 2.2.4 compression hosiery and bandages
  • 3 What to treat: Essential medicines
    • 3.1 Anticoagulants
    • 3.2 Antiaggregants
    • 3.3 Phlebotonics
  • 4 Operative intervention
  • 5 Should I go to folk medicine?
  • 6 What can not be done?
  • 7 Prevention
  • 8 Useful video

Approach to therapy


The main tasks that are solved by active therapy for deep vein thrombosis are as follows:

  • prevention of pulmonary embolism, ischemic stroke and infarct-pneumonia with the embolus;
  • interrupt the process of formation of pathological blood clots;
  • decreased blood coagulation;
  • restoration of recanalization and vascular patency;
  • elimination of clot formation factors;
  • prophylaxis of postthrombotic syndrome.

Conservative therapy

The main method of treatment of acute thrombotic process is conservative therapy, conducted in the department of surgery, where the patient enters. A patient with bloody thick masses in a venous bed from the moment of admission to a medical institution is considered as a potential patient with a risk of developing pulmonary embolism.

If the diagnosis is established, treatment is started immediately. Depending on the severity of the symptoms, the stage of the disease, is performed either in the hospital( at the first stage) or out-patient( during the stabilization period) .

Mode

Pre-treatment mode:

Before the ultrasound examination and determination of the shape and localization of the thrombus, and before the embolism threat is detected in the first 5 days, the is prescribed strict bed rest.

Simultaneously, compulsory compression of the affected limb with an elastic bandage is required. To normalize the venous outflow , the end of the bed is raised by 20 ° or the leg is fixed in a special conductor for immobilization.

The need for the physical rest of and the state of psychological comfort for the patient during this period are due to:

  • the threat of pulling off a tight clot and rapid transfer with blood flow to any organ;
  • possibility of development of pulmonary thromboembolism with the subsequent lethal outcome.

Post-examination mode:

Patient is allowed to stand up and move if during the ultrasound angioscanning of a thrombosis of the following forms of is diagnosed:

  • , a parietal shape when the thrombus body is snug against the wall of the vessel;
  • is occlusive, when thrombotic masses overlap the lumen of the vein.

This means that the flotation( motion) of the thrombus in the venous bed is absent. However, even under these conditions, if there are pain and swelling of the leg, the bed rest is shown.

As the manifestations of these symptoms decrease, patients are allowed activity with adherence bandage to the groin for up to 10 days of .This time is usually enough that the threat of pulmonary embolism is reduced, and the thrombus is fixed on the vein wall. Patients can get up to stimulate blood flow in the veins, walk a little.

When a flotation form of thrombosis is detected, when the clot does not overlap the vein but floats in it under the influence of blood flow, the patient is not allowed to stand up, and the lower extremity is fixed in an elevated position, since the risk of rupture of the embolus( pulmonary thrombus) and the onset of pulmonary embolism is very great.

Patients can get up and move only after taking active therapy and completely removing the threat to their lives.

Drugs and treatment regimens

Therapy for thrombosis involves, first of all, the use of direct anticoagulants, and primarily - heparin, which quickly reduces blood clotting, deactivating the enzyme thrombin, and inhibits the formation of new pathological clots.

Heparinotherapy in the hospital

First of all, the patient is intravenously administered a one-time dose of heparin - 5 thousand units.

Further for the introduction of the drug per hour, droppers are used( injection rate up to 1200 units per hour).In the next days of treatment, up to 6 times a day, heparin is injected subcutaneously into the abdominal region at a dose of 5,000 units. The use of heparin in pure form is possible only in the hospital, due to possible complications when used in the proper dosage and the need for continuous monitoring.

The effectiveness of heparin therapy is confirmed by the indicator of the duration of blood clotting, which should be 1.5 to 3 times higher than the primary indicator.

In general, adequate therapy with heparin provides for a daily intake of 30,000 - 40,000 units of the drug. With such treatment the risk of repeated thrombus formation is reduced to 2 - 1.5%.

With positive dynamics of for 4-7 days in this treatment scheme, instead of the usual form of heparin, low molecular weight fractiprorin is started in ready-made syringes, which is injected into the abdomen only subcutaneously 1-2 times a day.

The course of heparin therapy using intravenous drippers continues for 10 days simultaneously with anticoagulant, antibacterial, rheological and compression therapy.

Rheological therapy

It is conducted up to 15 days, directed:

  • for the change in the viscosity of blood and plasma;
  • for the correction of hematocrit( the number of red blood cells in the blood that can carry oxygen);
  • to counteract aggregation( clumping) of erythrocytes.

Provides intravenous or dropwise administration of such drugs as:

  • Reopoliglyukin ( drip, in a daily dose of 400-800 ml).Plasma-replacing agent, which normalizes hemodynamics, improves circulation of blood in the vessels, increases the volume of fluid in the circulatory system, prevents the adhesion of platelets and red blood cells.
  • Pentoxifylline is an antiaggregant drug that reduces blood viscosity, activates microcirculation in areas where blood supply is impaired. The drug is injected intravenously or drip with a solution of sodium chloride( 0.9%) and a duration of up to 180 minutes.
  • Nicotinic acid , which is administered intramuscularly 4 to 6 ml per day, and has a vasodilating and weak anticoagulant effect.

Antibiotics

Treatment is indicated for in severe inflammatory symptoms of deep vein thrombosis of the lower limbs, duration is 5 to 7 days. Antibiotics are used: ciprofloxacin - in tablets;cefazolin, lincomycin, cefotaxime - in the form of intramuscular injections.

Compression underwear and bandages

Elastic compression is included as an indispensable element of therapy for thrombosis. For this, elastic bandages are used, covering the aching limb from the fingers to the groin fold. With this type of therapy:

  • improves venous outflow;
  • is actively developing a network of bypass vessels, providing an outflow of venous blood in place of the main occluded vein( the so-called collaterals);
  • prevents the destruction of venous valves;
  • increases the speed of blood flow through deep veins;
  • improves the function of lymphatic drainage.

You can find out about the selection of compression underwear from this article.

Treatment: basic medicines

Anticoagulants

Approximately on the 6th - 10th day after the onset of heparin therapy , the treatment regimen provides for switching to tableted anticoagulants of indirect action and disaggregants - agents that do not allow platelets to clump.

Warfarin is classified as an anticoagulant for long-term use, inhibiting the synthesis of vitamin K, which is a strong coagulant.

It is taken once a day at a certain time. When using warfarin, the control of the INR indicator is mandatory, for the determination of which the blood test is done every 10 days. Warfarin has a lot of contraindications, therefore is used only after the doctor has selected a specific dose and under the strict laboratory control of .

Today there are other drugs of similar action: enoxaparin, clexane, dalteparin or phenindione, fractiparin.

Currently, Western pharmaceutical companies are researching drugs with an even more narrowly focused anticoagulant action, which do not require ongoing testing. This enables to use low molecular weight heparins for therapy on an outpatient basis.

Antiaggregants

Acetylsalicylic acid, taken at 50 mg per day of , helps to keep the blood viscosity low enough to prevent the formation of pathological blood clots. With problems with the gastrointestinal tract, depending on the dynamics of the disease, it is advisable to take coated tablets for 4 to 8 weeks.

It is recommended that take venous drugs , which help to increase the tone of veins, strengthen the walls of blood vessels, improve microcirculation and normalize blood flow: escusan, detralex, phlebodia.

Phlebotonics

The results of compression therapy, which continues on an outpatient basis, are more pronounced if the place of the inflammatory process is lubricated with special phlebotrophic ointments and gels: Troxevasin, Venoruton, Venitane, Escuzan, Lyoton gel, Reparil gel .These agents have excellent venotonic and anti-inflammatory effects.

Surgical intervention

The choice of therapy for thrombosis is directly dependent on the degree of its "embolism," that is, from the possibility of a floating thrombus to break away from the wall and penetrate into the lungs, heart or brain, causing embolism.

Surgical treatment, as a rule, is shown in two cases of :

  • in a flotation thrombus and a patient's life threat;
  • with segmental form of thrombosis and the recent term of clot formation in the absence of severe pathology in the patient.
The aim of the surgical intervention is to remove thrombotic mass and prevent the clot growth up the vascular bed in the direction of important organs.

The type of surgery depends on the location of the clot that blocks the vessel. Applied :

  • Blood clot removal surgery or surgical thrombectomy with the extraction of dense blood masses from the vein through a small incision. The procedure is used only for serious forms of the disease, when the probability of tissue necrosis is ascertained.

    However, experts believe that thrombectomy performed after 10 days of thrombus formation is ineffective due to its tight fusion with the vascular wall and the destruction of the valves. vein ligation.

  • Application of an arteriovenous shunt .Currently, it is used very rarely due to the procedure under general anesthesia, the inability to perform it under pronounced trophic changes in tissues and the difficulty with repeated access due to the development of scar tissue.
  • Installation of self-locking "cava filter" .This device to delay moving blood clots( emboli) on the way to important organs( lung, heart, brain).It is implanted into the vein through the endovascular method( through the vessel).The method is used only if anticoagulants can not be used.
  • Stitching or flushing of the .Applicable in the case of inability to use a cava filter. In this procedure, the wall of the hollow vein is stitched with metal clips.
  • Dissolution of thrombotic masses of , or thrombolysis.

Thrombolysis is an procedure in which the dissolution of blood clots of occurs. The vascular surgeon inserts into a vein, covered with a dense clot into which a special dissolving agent-thrombolytic enters by means of a catheter.

Modern drugs can really dissolve life-threatening flotation emboli. However, this method for deep vein thrombosis is used very rarely due to the large number of limitations and the high threat of bleeding. Therefore, thrombolysis is indicated only in rare and severe cases, or when there is a direct danger to life.

Should I turn to folk medicine?

Treatment of can be supplemented with traditional medicine recipes, but only on the advice of a phlebologist .

  • Fish oil. Fish oil contains glycerides and special fatty acids that have the properties to destroy fibrin, a protein that takes part in the formation of a thrombus. In addition, they contribute to the dilution of blood.

    For the prevention of fish oil, drink 1 tablespoon two to three times a day .But a more rational way is to use fish oil in capsules that do not have an unpleasant odor and are much more convenient to use. Usual dose 1 - 2 capsules up to 3 times a day with meals. Contraindications: allergic reactions, cholelithiasis and urolithiasis, pathology of the thyroid gland.

  • Baths from the infusion of marsh for foot swamp .Dry grass cudweed in an amount of 150 g pour boiling water in a volume of 10 liters. Insist 60 minutes. For half an hour before going to bed, keep your feet warm.
  • Curd or clay compresses .Daily massage of heels using cottage cheese or clay very well affects the venous blood flow. In places of inflammation and painful areas, the feet are not massaged, but simply apply a warm curd or clay in the form of a compress for 2 to 3 hours.

What can not be done?

Do not violate the assigned mode. Early ascent and walking with a flotation thrombus in the vein of the lower limb can lead to its detachment and rapid development of pulmonary embolism.

It is not allowed to take any medicines and herbal infusions without consulting a doctor. Admission of anticoagulants, the ability of the blood to quickly fold and form clots imposes certain restrictions on any procedures and taking medications.

For example, , many drugs reduce the effect of warfarin or vice versa increase , which means a high probability of bleeding, hemorrhagic strokes or vice versa - thickening of blood and re-formation of blood clots. The same applies to any folk remedies. So, a very useful nettle contains a lot of vitamin K, and uncontrolled drinking of broths can promote a strong blood thickening.

Non-compliance with compression therapy with mandatory bandaging of the patient's leg leads to a violation of blood flow and, as a consequence, the formation of new blood clots.

Prevention of

It should be noted that over a long period of , recurrences of thrombosis( from 1 year to 9 years) of are possible. According to statistics, after 3 years 40 - 65% of patients with non-compliance with preventive measures and prescribed treatment come to disability on the background of chronic venous insufficiency.

In this regard, is mandatory :

  • compliance with all medical prescriptions and medications;
  • use of compression jersey;
  • screening for blood clotting against oral contraceptives( for women of reproductive age);
  • regular laboratory tests for blood clotting MNO;
  • quitting;
  • compliance with the correct mode of physical activity , are unacceptable: prolonged sitting on the legs, sitting position, a sharp transition from intense physical activity to prolonged fixation of the limbs( for example, after sports training - a long trip in the car when the legs are practically immobile);
  • the use of certain products of ( onions, apples, green tea, oranges, natural red wine in small doses), in which there are chemicals that help prevent the formation of thrombotic formations.

The main task of modern medicine in the field of treatment and prophylaxis of deep vein thrombosis of the lower extremities( shin, thigh or other vessel) is to prevent or shortly halt the development of this dangerous disease , which occurs in the conditions of prolonged bed resting in bedridden elderly people,in young women taking contraceptives, pregnant women, parturient women and even among students who abuse smoking.

The provoking factors are long flights and crossings, complex births, especially after a caesarean section operation, extensive cavitary operations, serious fractures.

Prevention of the formation and growth of blood clots in the deep veins significantly reduces the risk of heart attack, embolism, stroke, and therefore - preserves the life and health of .

Useful video of


Watch a video on how to recognize the disease and what to do to save life: