Deep vein thrombosis and its treatment in questions and answers.


Authors: M. Berková;  Z. Berka;  E. Topinková
Published in: Geriatrie a Gerontologie 2016, 5, č. 1: 19-27
Category: Review Article

Overview

Deep vein thrombosis (DVT) affects 1–2 people out of 1000 per year. It is 10x more common among elderly people than among people under the age of 30. Deep vein thrombosis most commonly affects distal parts of the deep vein system (calves and under the knee). The diagnostic method of choice is ultrasound examination. Pharmacological therapy of DVT is based on anticoagulation therapy: heparin, low molecular weight heparin, pentasaccharides (currently unavailable in the Czech Republic), for long term therapy, warfarin is available, along with new peroral anticoagulants. Hirudin-based drugs and argatroban remain reserved for certain specific conditions – for example for heparin-induced type II thrombocytopenia. In indicated cases of DVT, intervention treatment is used (local thrombolysis, endovascular procedures with special catheters for fragmentation and aspiration of thrombi or stent implantations). When treating DVT, non-pharmacological measures are essential – in haemodynamically stable patients, an early mobilisation is possible, as soon as pain passes, using bandages, compression garments or in bed-ridden patients, plantar flexion. For patients treated with warfarin, we do not recommend the “warfarin diet”, but a diet with a constant supply of nutrients. The length of pharmacotherapy depends on the aetiology of the disease – secondary DVT is treated for a minimum of 3 months, idiopathic for at least 6 months and patients with persisting pro-thrombotic condition and repeated DVTs are treated perpetually. Even in spite of efficient anticoagulation therapy, chronic post-thrombotic syndrome develops in up to 50 % of patients, especially in cases of proximal DVT. HIT II represents a specific issues, caused by antibodies against heparin with platelet factor 4, which form roughly since the 4th day of heparin therapy and lead to serious intravascular thromboses. It occurs in 1–3 % patients treated with non-fractioned heparin and in less than 0.1% people treated with low molecular weight heparin. A 30 % or higher decrease of thrombocytes is typical for this condition. This is why examinations of the level of thrombocytes are necessary while patients are on heparin, every other day, between the 4th and 14th day of the treatment. Idiopathic phlebothrombosis can be a symptom of a hidden malignancy in almost 10 % of elderly patients. When looking for a malignancy in cases of seemingly idiopathic DVT, we focus on diligently examining the patient’s medical history, physical examinations, basic haematological and biological examinations and x-rays of the chest. Further examinations of the urogenital system and colonoscopies are recommended in patients over a certain age, in case the patient has not undergone these examinations as a part of routine preventive examination or if a malignancy is suspected based on the basis of the prior examinations. The most common malignancies discovered this way include leukaemia, urogenital and gastrointestinal tumours.

KEYWORDS:
deep vein thrombosis – diagnostics – treatment – advanced age


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Labels
Geriatrics General practitioner for adults Orthopaedic prosthetics
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