Internal Jugular Vein Thrombosis Medication

Updated: May 15, 2017
  • Author: Dale K Mueller, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

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Anticoagulants, Hematologic

Class Summary

Anticoagulant medications prevent further clot deposition. They allow the natural fibrinolytic mechanisms to lyse the existing clot.

Heparin

Heparin augments the activity of antithrombin III and prevents conversion of fibrinogen to fibrin. It does not actively lyse but is able to inhibit further thrombogenesis. The drug prevents the reaccumulation of clot after spontaneous fibrinolysis.

Warfarin (Coumadin, Jantoven)

Warfarin interferes with the hepatic synthesis of vitamin K–dependent coagulation factors. It is used for prophylaxis and treatment of venous thrombosis, pulmonary embolism (PE), and thromboembolic disorders. Tailor the dose to maintain an international normalized ratio (INR) in the range of 2.0-3.0.

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Thrombolytic Agents

Class Summary

As advanced by the American College of Chest Physicians in their fourth consensus conference on antithrombotic therapy, thrombolytic treatment is indicated for acute, massive PE with hemodynamic instability in patients who do not seem prone to bleeding. These agents dissolve recent clots promptly by activating a plasma proenzyme, plasminogen, to its active form, plasmin. Plasmin degrades fibrin to soluble peptides.

Thrombolytic therapy speeds pulmonary tissue reperfusion and rapidly reverses right-sided heart failure. It improves pulmonary capillary blood flow and more rapidly improves hemodynamic parameters.

Reteplase

Reteplase is used in the management of PE in hemodynamically unstable patients. Its safety and efficacy with concomitant administration of heparin or aspirin during the first 24 hours after symptom onset have not been investigated.

Tenecteplase (TNKase)

Tenecteplase is a modified version of alteplase that is made by substituting three amino acids. It has a longer half-life than alteplase and thus can be given as a single bolus infused over 5 seconds (as opposed to the 90 minutes required for alteplase). It appears to cause less nonintracranial bleeding than alteplase but carries a comparable risk of intracranial bleeding and stroke.

Base the dose on the patient's weight. Initiate treatment as soon as possible after the onset of acute myocardial infarction symptoms. Because tenecteplase contains no antibacterial preservatives, it must be reconstituted immediately before use.

Alteplase (Activase)

Alteplase, or tissue plasminogen activator (tPA), exerts an effect on the fibrinolytic system to convert plasminogen to plasmin. Plasmin degrades fibrin, fibrinogen, and procoagulant factors V and VIII. The serum half-life of alteplase is 4-6 minutes but is lengthened when the drug is bound to fibrin in clot.

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. For all cases of thrombophlebitis, therapy should be continued for 4-6 weeks.

Nafcillin (Nallpen in Dextrose)

Nafcillin is used in the initial therapy for suspected penicillin G–resistant streptococcal or staphylococcal infections. Parenteral therapy should be used initially in severe infections, with a change made to oral treatment as the condition warrants.

Because of thrombophlebitis, particularly in elderly persons, nafcillin should be administered parenterally only for a short term (1-2 days); change to an oral antibiotic should be made as clinically indicated.

Vancomycin

Vancomycin is a potent antibiotic directed against gram-positive organisms and active against Enterococcus species. To avoid toxicity, the current recommendation is to assay vancomycin trough levels after the third dose, drawn 0.5 hour prior to the next dosing. Use creatinine clearance to adjust the dose in patients diagnosed with renal impairment.

Vancomycin is used in conjunction with gentamicin for prophylaxis in penicillin-allergic patients undergoing gastrointestinal or genitourinary procedures.

Daptomycin (Cubicin)

Daptomycin binds to bacterial membranes and causes rapid membrane potential depolarization, thereby inhibiting protein, DNA, and RNA synthesis, ultimately causing cell death. It is indicated for complicated skin and skin-structure infections caused by Staphylococcus aureus (including methicillin-resistant strains), Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus dysgalactiae, and Enterococcus faecalis (vancomycin-susceptible strains only).

Ampicillin and sulbactam (Unasyn)

This agent features ampicillin combined with a beta-lactamase inhibitor. It interferes with bacterial cell-wall synthesis during active replication, causing bactericidal activity against susceptible organisms.

Chloramphenicol

Chloramphenicol binds to 50 S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. It is effective against gram-negative and gram-positive bacteria. The oral form is not available in the United States.

Clindamycin (Cleocin)

This agent is a semisynthetic antibiotic produced by 7(S)-chloro-substitution of the 7(R)-hydroxyl group of the parent compound, lincomycin. Clindamycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl transfer ribonucleic acid (tRNA) from ribosomes, causing RNA-dependent protein synthesis to arrest. The drug is widely distributed in the body without penetration of the central nervous system (CNS). It is protein-bound and excreted by the liver and kidneys.

Penicillin G aqueous (Pfizerpen)

Penicillin G interferes with the synthesis of cell-wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.

Metronidazole (Flagyl)

Metronidazole is an imidazole ring–based antibiotic active against various anaerobic bacteria and protozoa. It is used in combination with other antimicrobial agents.

Ticarcillin and clavulanate potassium (Timentin)

This drug combination inhibits the biosynthesis of cell-wall mucopeptide and is effective during the stage of active growth. It consists of an antipseudomonal penicillin plus a beta-lactamase inhibitor and provides coverage against most gram-positives, most gram-negatives, and most anaerobes.

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