Acute venous thrombosis

Description:

Acute venous thrombosis is a formation of "a blood clot", blood clot, in deep venous system lower, or that is observed much less often, upper extremities.

Reasons of acute venous thrombosis:

Causes of illness are definitely not established. A number of risk factors as, for example, reception by young women of oral contraceptives, volume formations of a small pelvis and retroperitoneal cellulose, a long bed rest, a paraplegia, a puerperal period, oncological diseases, nevertheless, it is difficult to allocate the specific reasons in considerable number of cases is considered.

Pathogeny:

Process of acute venous thrombosis begins at a combination of the following three factors: damage of a vascular wall, стаз blood, disturbance of rheological properties of blood. The pathogeny of this process consists in acute emergence of an obstacle to venous outflow and redistribution of blood on collaterals against the background of an inflammation of a venous wall; then process (period) of a rekanalization of the thrombosed veins and recovery of a pathological blood-groove on them which (пеиод) comes to an end by sixth month begins. But, even in rekanalizovanny veins the blood stream does not gain normal character as the gleam of a vein does not reach initial diameter, and destruction of valves after the postponed thrombosis leads to a retrograde blood flow.

Symptoms of acute venous thrombosis:

Clinically the beginning of a disease is shown by sharp emergence of a pain syndrome, hypostasis of an extremity and cyanosis of integuments. Localization of symptoms depends on height of thrombosis and extensiveness of defeat. If process strikes the lower vena cava, then there is bilateral hypostasis of extremities. So, in case of proximal involvement of an ileal segment unilateral hypostasis of all extremity is noted. Thrombosis of a femoral and subnodal zone is followed by defeat symptoms below a knee joint, as well as occlusion of all veins of a shin. Expressiveness of a pain syndrome and circulatory disturbances considerably is defined by extent of involvement of several segments and a condition of collateral outflow. For an acute venous deep vein thrombosis a characteristic sign is morbidity of muscles, and also morbidity of fabrics on the course of neurovascular bunches. It is necessary to remember a possibility of thrombosis of muscular veins of a shin at which the clinic of a disease is identical described, but in this case there is no disturbance of passability of the main veins. Sometimes the isolated fibrinferments of one of main (or their couples) shin veins meet. In this case the disease is shown only by pains. Extremely seldom at the expressed damage of the main veins and bad ways of collateral outflow at acute venous thrombosis there is venous gangrene, in this case amputation of an extremity is required.

Diagnosis:

Diagnosis of acute venous thrombosis in out-patient and in stationary conditions is based on assessment of clinical symptomatology and results of tool methods of inspection and has to be carried out in the shortest possible time as from speed of definition of the fact of thrombosis, its localization, character of a proximal part of blood clot the clinical forecast depends. In all cases of acute venous thrombosis it is preferable to begin inspection with an ultrasonic angioskanirovaniye and only when visualization is complicated (for example, an ileal and caval segment) or when in the presence of clinic of an iliofemoralny phlebothrombosis it is noninvasively impossible to carry out verification of the diagnosis performance in the emergency order of a X-ray contrast research is shown. The test for D-dimer became a screening diagnostic method of acute venous thrombosis today. Its negative take excludes venous thrombosis with probability of 95-98% at patients with low risk of its emergence.

Treatment of acute venous thrombosis:

Purposes of treatment of venous thrombosis: to stop spread of thrombosis, to prevent a thromboembolism of pulmonary arteries, not to allow progressing of hypostasis and by that to prevent possible venous gangrene and loss of an extremity, to recover passability of veins (prevention of a posttromboflebitichesky disease, to warn a thrombosis recurrence. Remember: suspicion on a deep vein thrombosis of the lower extremities, especially the established diagnosis, are the indication to the emergency hospitalization of the patient, at an opportunity in a specialized angiokhirurgichesky hospital, as a last resort in all-surgical department.

The main objective of surgical treatment is prevention of a pulmonary embolism. For this purpose at detection of the emboloopasny (floating) blood clot depending on a specific clinical situation carry out a direct or catheter thrombectomy, transdermal implantation of kava-filters of various design, bandaging of the main veins or plication of the lower vena cava. In all other cases problems of treatment are solved with the help of conservative therapy. Also conservative therapy without fail has to be carried out after any of the listed surgical interventions.

Anticoagulating therapy is shown to all patients with clinical and laboratory signs of an active thrombogenesis that usually corresponds to the first three weeks of a disease. This most efficient means of the termination of progressing of thrombosis with the proved medical effect. Anticoagulating therapy assumes consecutive use of straight lines (unfractionated or low-molecular (дальтепарин, надропарин, эноксапарин, etc.) heparins) and indirect (antivitamins-K) anticoagulants (coumarin derivatives (warfarin, аценокумарол, ethyl бискумацетат, etc.) and an indandiona (Phenilinum)). The anticoagulating teraiya has to be carried out with the obligatory accounting of contraindications to these drugs.

Active drugs (реополиглюкин, пентоксифиллин, тиклопедин, клопидогрель) and fleboaktivny drugs (Detralex, trokserutina, Escuzanum, a cyclo-3-fort, etc.) use Gemorealogicheski for the purpose of improvement of microcirculation, decrease in viscosity of blood and reduction of adhesive and aggregation potential of uniform elements.

Anti-inflammatory drugs (NPVS) apply owing to the fact that there is an inflammation from a venous wall and perivazalny fabrics, and also painful a syndrome, complicating activation of the patient. Besides, NPVS suppress A2 thromboxane synthesis what decrease aggregation of thrombocytes and moderately expressed hypocoagulation is result of. Use of derivatives of arylalkane acid (diclofenac and ketoprofen) is preferable.

Therapy by antibiotics is carried out at patients with the inflammatory centers, infarctive pneumonia, "entrance gate" for an infection (open fractures, an operational injury, etc.), pustulous damages of skin, and also at patients with high risk of septic complications (a diabetes mellitus, AIDS, etc.). Thrombolytic therapy on which were laid great hopes in the today's look did not acquit them.

Topical treatment includes a local hypothermia in projections of vascular bundles, and also use of ointments which main effective agent are heparin and NPVS. It is not necessary to apply the warming spirit and ointment compresses which are only capable to strengthen blood inflow, to support the phenomena of phlebitis and to promote progressing of thrombosis.

Non-drug methods of treatment: observance of a certain motive mode and elastic compression. The more carefully the patient observes the motive mode and the mode of compression therapy in an acute stage of a disease and during rehabilitation and the longer time it is spent, the it is better results of treatment of venous thrombosis, and also the phenomena of chronic venous insufficiency in the remote posttrombotichesky period are less expressed.