Sections

Medication

Medication Summary

Anticoagulation is necessary only in cases of extensive thrombophlebitis or propagation into the deep venous system. For additional drugs, see the Medication section in Thromboembolism.

Class Summary

These agents inhibit thrombin, which prevents the formation and/or extension of thrombus and allows recanalization of the blood vessel over time. Oral anticoagulants are the mainstay of long-term outpatient management. Oral anticoagulants competitively interfere with vitamin K metabolism, decreasing plasma concentrations of the active forms of factors II, VII, IX, and X (also proteins C and S). Infants and children tend to require higher maintenance doses and more frequent dosage adjustments than adults.

Heparin (Hep-Lock, Liquaemin)

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Heparin is usually started as part of the initial treatment of thromboembolism. The dose is titrated to maintain the aPTT at 60-85 seconds. Monitor the CBC count, PT, and aPTT daily once the aPTT is at therapeutic value. Stopping the infusion is usually sufficient for reversal. If rapid reversal is needed, administer protamine (dose based on amount of heparin received in previous 2 h); if more than 30 minutes have elapsed since the last heparin dose, administer 1 mg/100 mg heparin received to a maximum of 50 mg per dose IV over 5 mg/min.

Enoxaparin (Lovenox)

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Enoxaparin prevents DVT, which may lead to PE in patients undergoing surgery who are at risk for thromboembolic complications.

Enoxaparin enhances the inhibition of factor Xa and thrombin by increasing antithrombin III activity. In addition, it preferentially increases the inhibition of factor Xa. The average duration of treatment is 7-14 days. It has greater bioavailability and a longer half-life after subcutaneous injection than unfractionated heparin. With enoxaparin, monitor the CBC count, including platelet count, and monitor its effect with anti–factor Xa levels.

Dalteparin (Fragmin)

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Dalteparin enhances the inhibition of factor Xa and thrombin by increasing antithrombin III activity. In addition, it preferentially increases the inhibition of factor Xa. The average duration of treatment is 7-14 days.

Tinzaparin (Innohep)

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Tinzaparin enhances the inhibition of factor Xa and thrombin by increasing antithrombin III activity. In addition, it preferentially increases the inhibition of factor Xa. The average duration of treatment is 7-14 days.

Warfarin (Coumadin)

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Warfarin is used for long-term anticoagulation. Warfarin has a half-life of 36-42 hours. It is more difficult to monitor the PT and INR in children because of variability in dietary vitamin K intake, effects of other medications, and age; monitor the CBC and platelet counts and INR.

Questions

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Superficial thrombophlebitis. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/vascular/thrombophlebitis.jpg).
Deep venous thrombosis.

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Author

Padma Chitnavis, MD Resident Physician, Department of Dermatology, Howard University Hospital and Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Mary Piazza Maiberger, MD Assistant Professor of Dermatology, Howard University College of Medicine; Assistant Clinical Professor of Dermatology, George Washington University School of Medicine and Health Sciences; Chief of Dermatology and Residency Program Site Director, Washington DC VA Medical Center

Mary Piazza Maiberger, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Washington DC Dermatological Society, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Julia R Nunley, MD Professor, Department of Dermatology, Virginia Commonwealth University Medical Center

Julia R Nunley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Nephrology, International Society of Nephrology, Medical Dermatology Society, Medical Society of Virginia, National Kidney Foundation, Phi Beta Kappa, Women's Dermatologic Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Board of Dermatology<br/>Author for: Up-to-date.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Zoltan Trizna, MD, PhD Private Practice

Zoltan Trizna, MD, PhD is a member of the following medical societies: Texas Medical Association

Disclosure: Nothing to disclose.

Mitchel P Goldman, MD Voluntary Clinical Professor of Dermatology, University of California, San Diego, Medical Center; Dermatologist, West Dermatology and Cosmetic Laser Dermatology

Mitchel P Goldman, MD is a member of the following medical societies: Aerospace Medical Association, American Academy of Cosmetic Surgery, American Academy of Dermatology, American College of Phlebology, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, American Society of Lipo-Suction Surgery, California Medical Association, Dermatology Foundation, Phi Beta Kappa, San Diego County Medical Society

Disclosure: Nothing to disclose.

Carrie L Kovarik, MD Assistant Professor of Dermatology, Dermatopathology, and Infectious Diseases, University of Pennsylvania School of Medicine

Carrie L Kovarik, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Melanie D Palm, MD, MBA, FAAD Director, Art of Skin MD; Assistant Volunteer Clinical Professor, University of California, San Diego, School of Medicine; Affiliate Physician, Scripps Encinitas Memorial Hospital

Melanie D Palm, MD, MBA, FAAD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Thrombophlebitis Medication

Medication Summary

Anticoagulants

Class Summary

Heparin (Hep-Lock, Liquaemin)

Heparin (Hep-Lock, Liquaemin)

Enoxaparin (Lovenox)

Enoxaparin (Lovenox)

Dalteparin (Fragmin)

Dalteparin (Fragmin)

Tinzaparin (Innohep)

Tinzaparin (Innohep)

Warfarin (Coumadin)

Warfarin (Coumadin)

Thrombophlebitis Medication

Medication Summary

Anticoagulants

Class Summary

Heparin (Hep-Lock, Liquaemin)

Heparin (Hep-Lock, Liquaemin)

Enoxaparin (Lovenox)

Enoxaparin (Lovenox)

Dalteparin (Fragmin)

Dalteparin (Fragmin)

Tinzaparin (Innohep)

Tinzaparin (Innohep)

Warfarin (Coumadin)

Warfarin (Coumadin)

References

Tables

Contributor Information and Disclosures

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