What medicine is best and most effective for treating deep vein embolisms?

Answer 1

The choice of drugs for the treatment of deep vein embolisms depended on many factors. There was no absolute "best and most effective" single drug. The following are the common drugs used to treat deep vein embolisms:

** 1. Anticoagulated drugs **
1. ** Normal Heparin **
- The initial dosage was 80 - 100 U/kg, followed by 10 - 20 U/kg·h. After that, the dosage was adjusted according to the activated partial coagulin time every 4 - 6 hours to prolong it to 1.5 - 2.5 times the normal control value. However, during the use of Heparin, Heparin-induced Platelessness (HIT) will occur, which usually occurs after 5 days. On the 3rd to 10th day, the Platelet Count should be checked. If the decrease is greater than 30% - 50%, or if the Platelet Count gradually drops to (8 - 10)x10/L after 5 days of Heparin use, HIT should be highly suspected and stopped immediately. In serious cases, protamine should be used to neutralize it (protamine injection 1 - 1.5 ml neutralizing 1 ml of Heparin).
2. ** Low-molecular Heparin **
- Bleeding adverse reactions were less, and the medicine was given according to body weight, 100 U/kg each time, once every 12 hours. However, it should be used with caution in patients with kidney failure due to kidney metabolism.
3. ** Waradin **
- This was a type of oral contraceptive that was a type of vitamin K antagonist. It required regular monitoring of the International Normalized ratio (INR) of blood clot function. The treatment dose range was narrow, the individual difference was large, and the efficacy was affected by many foods and drugs. Initially, it should be combined with low-molecular-weight Heparin at a dose of 2.5 - 6.0 milligrams per day. After 3 days, the INR should be measured. The INR should be stabilized between 2 - 3 and maintained for 24 hours before the low-molecular-weight Heparin was stopped. Pregnant women are prohibited, but breast-feeding women are allowed. During the use, if there is severe bleeding, immediately stop and slowly inject the patient with intravenous injection of Vitamin K1 (10 milligrams). If necessary, transfuse the blood clot factor, and monitor the INR at any time.
4. ** New oral coagulator **
- There was no need to monitor the strength of the coagulated blood (unless there were special circumstances, such as kidney incompetence, old age, low body weight, etc.). There was no need to adjust the dosage. The oral absorption was fast, the drug concentration reached its peak, and the half-life was short. After stopping the drug, the coagulated blood disappeared quickly, and it was not affected by food.
- ** Rivaroxaban **: A factor Xa antagonist, recommended to be taken at 15 milligrams twice a day for 21 days, followed by 20 milligrams once a day for maintenance. If a dose is missed during the 15-milligram twice daily treatment period (Days 1 - 21), the patient should take rivaroxaban immediately to ensure that the 30-milligram rivaroxaban is taken daily. After that, he should continue to receive the usual 15-milligram twice a day administration according to the medication recommendations. It is recommended to use 20 milligrams once a day to reduce the risk of stroke and systematic embolisms in patients with non-prosthetic AF.(This dosage is also the maximum recommended dosage. For patients with low body weight and elderly age (>75 years old), 15 milligrams once a day can be used as appropriate.) If a dose is missed, rivaroxaban should be taken immediately and continued to be given once a day the next day. The dose cannot be doubled within a day to make up for the missed dose. For the prevention of venous chemotherapy in adult patients undergoing elective hip or knee replacement surgery, oral rivaroxaban 10 milligrams once a day is recommended. If the wound has stopped bleeding, the first medication should be used between 6 - 10 hours after the surgery. The recommended course of treatment for major hip surgery was 35 days, and the recommended course of treatment for major knee surgery was 12 days. If you miss a dose, you should take rivaroxaban immediately and continue taking it once a day the next day. Rivaroxaban 10-milligram tablets can be taken with food or alone. 15-milligram or 20-milligram tablets should be taken with food.
- ** dabigatrin **: direct hemostatic agent, recommended 150 milligrams, twice a day.

5. ** Elements to consider when choosing an hemostatic drug **
- For non-tumor-associated venous troboembolisms (VTE): New anticoagulators (such as rivaroxaban) can be taken directly by mouth, or low-molecular-weight Heparin combined with a vitamin K antagonist. The low-molecular-weight Heparin can be stopped after the INR reaches the standard and is stable for 24 hours.
- For VTE with tumors: For patients with non-digestive system tumors, direct oral anticoagulators can be used; for patients with digestive system tumors, low-molecular-weight hemostatic therapy is the first choice, followed by the use of vitamin K antagonist.
- For patients with kidney failure, uncoagulated Heparin is the first choice. For mild to moderate kidney failure, rivaroxaban or low-molecular-weight Heparin can be used in a reduced amount.
- Patients with hepatic incompetence: no dosage adjustment is needed for mild liver damage. Anticoagulated drugs are contraindicated for patients with coagulated blood disorder and high risk of bleeding due to liver disease. Those who have abnormal liver zymes during the medication should be monitored in time and given liver protection treatment until they return to normal. If the transferment continues to rise to more than three times the normal value and is accompanied by an increase in bile, it is recommended to take a low dose or stop using it.
- Patients with low blood clot count: For patients with a blood clot count of 50x10/L or lower, it is not recommended to use anticoagulate drugs; for patients with a blood clot count of 50x10 - 100x10/L, it should be used with caution.
- Anticoagulation therapy for pregnant women: Pregnant women are recommended to use low-molecular-weight heparin to treat and prevent VTE. Low-molecular-weight heparin should be stopped 24 hours before delivery, and the previous hemostatic protocol can be resumed after delivery. Lactation women can use low-molecular-weight heparin or Waradin for hemostatic therapy.

** 2. Bronzing drugs **
1. ** Inject venous Fibrinogen **
- These included ungraded Heparin, Urokinase, Lumbrokinase, Alteplase, etc. These drugs can be used to prevent serious consequences from the embolus falling off when the patient suddenly has uneven swelling of both lower limbs accompanied by pain (when deep vein embolus is highly suspected). However, there were certain risks in using a dissolving drug, such as bleeding and other complications.

** 3. Swelling medicine **
1. ** Common anti-swelling medicine **
- Horse chestnut seed extract, calcium dobesilate capsules, diosmin tablets, etc. These drugs were mainly used to reduce swelling to improve limb symptoms and assist in the treatment of deep vein embolisms.
Read more exciting novels for free