Thrombophlebitis Medication

Updated: Aug 31, 2020
  • Author: Padma Chitnavis, MD; Chief Editor: Dirk M Elston, MD  more...
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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.

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Anticoagulants

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)

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)

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)

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)

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)

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.

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