Thoracic Outlet Syndrome Medication

Updated: Jan 10, 2019
  • Author: Daryl A Rosenbaum, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Medication

Medication Summary

Acute findings of ischemia or thrombosis require immediate evaluation and anticoagulation.

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Anticoagulants

Class Summary

Anticoagulants are used to treat acute arterial or venous occlusion.

Heparin

Potentiates antithrombin III and prevents conversion of fibrinogen to fibrin. Inhibits thrombogenesis.

Warfarin (Coumadin)

Interferes with hepatic synthesis of vitamin K–dependent coagulation factors. Tailor dose to maintain an INR in the range of 2-3.

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Analgesics

Class Summary

The use of analgesics may aid in relieving the discomfort of an acute occlusion of the vascular structures or nervous impingement.

Acetaminophen (Tylenol, Feverall, Aspirin Free Anacin)

DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, those with upper GI disease, and those who are taking oral anticoagulants.

Ibuprofen (Motrin, Ibuprin)

DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Acetaminophen and codeine (Tylenol #3)

Oral analgesic indicated for treatment of moderate pain.

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Fibrinolytic Agent

Class Summary

Thrombolytics are used to promote fibrinolysis of intraluminal thrombus or embolus in occluded vessels.

Urokinase (Activase)

Direct plasminogen activator that acts on endogenous fibrinolytic system and converts plasminogen to the enzyme plasmin, which, in turn, degrades fibrin clots, fibrinogen, and other plasma proteins. The advantage is that the agent is nonantigenic.

Most often used for local fibrinolysis of thrombosed catheters and superficial vessels. When used for local fibrinolysis, urokinase is given as local infusion directly into the area of thrombus and with no bolus given.

The dose should be adjusted to achieve clot lysis or patency of the affected vessel.

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