Which medications in the drug class Anticoagulants, Hematologic are used in the treatment of Superficial Thrombophlebitis?

Updated: Apr 17, 2019
  • Author: Khanjan H Nagarsheth, MD, MBA; Chief Editor: Vincent Lopez Rowe, MD  more...
  • Print
Answer

Anticoagulants, Hematologic

Heparin is essential for patients with superficial thrombophlebitis that is progressive and for those with particular risk factors for progression or recurrence. Heparin should always be used when thrombophlebitis involves the great saphenous vein. Heparin is the mainstay of treatment when deep system involvement is suggested, but anticoagulation alone does not guarantee a successful outcome. The disease may progress despite full and effective heparin anticoagulation.

Heparin works by activating antithrombin III to slow or prevent the progression of venous thrombosis. Heparin does not dissolve existing clots.

Fractionated LMWHs have largely replaced unfractionated heparin in the treatment of superficial phlebitis. LMWHs offer several distinct advantages over unfractionated heparin, including the following:

- They may be used in the outpatient setting

- They do not require measurement of the activated partial thromboplasting time (aPTT)

- They produce more reliable anticoagulation

- They are associated with a lower risk of bleeding

When unfractionated heparin is used, an aPTT of at least 1.5 times the control value is necessary for a therapeutic effect. To achieve this, unfractionated heparin must be given intravenously in adequate doses. Low-dose, subcutaneous unfractionated heparin should not be used, as it is not an effective therapy for thrombophlebitis and does not provide effective prophylaxis against progression of the disease.

Warfarin should not be used in the acute treatment of superficial phlebitis, because the early risk of increased thrombogenesis outweighs any convenience of oral therapy.

Enoxaparin (Lovenox)

Enoxaparin was the first LMWH released in the United States and is the only LMWH now approved by the US Food and Drug Administration (FDA) for both treatment and prophylaxis of deep venous thrombosis (DVT).

It is widely used in pregnancy, although clinical trials are not yet available to demonstrate that it is as safe as unfractionated heparin.

When enoxaparin is used, there is no utility in checking the aPTT (the drug has a wide therapeutic window, and aPTT does not correlate with the anticoagulant effect).

Dalteparin (Fragmin)

Dalteparin is indicated for the prevention of DVT, which may lead to pulmonary embolism (PE). It enhances the inhibition of factor Xa and thrombin by increasing antithrombin III activity. In addition, dalteparin preferentially increases the inhibition of factor Xa. The average duration of treatment is 7-14 days.

Heparin

The initial bolus used for inflammatory or septic thrombosis is lower than that needed for spontaneous DVT and PE, because most patients with inflammatory or septic thrombophlebitis do not have underlying hypercoagulability.

Patients withDVT and PE require more aggressive therapy because DVT is a manifestation of an active hypercoagulable state.

Do not check aPTT until 6 hours after the initial bolus, as an extremely high or low value during this time should not provoke any action.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!