From the Guidelines
Thrombitis is not a recognized medical term, and the correct term is thrombosis, which refers to the formation of a blood clot inside a blood vessel, obstructing blood flow. Thrombosis can occur in arteries (arterial thrombosis) or veins (venous thrombosis) 1. Common types include deep vein thrombosis (DVT) in leg veins and pulmonary embolism when clots travel to the lungs.
Causes and Risk Factors
Thrombosis occurs due to Virchow's triad: blood stasis, hypercoagulability, and endothelial injury 1. Risk factors include immobility, surgery, cancer, pregnancy, hormonal contraceptives, and inherited clotting disorders.
Treatment
Treatment typically involves anticoagulant medications like heparin (initially) followed by warfarin, direct oral anticoagulants (DOACs) such as apixaban (5mg twice daily), rivaroxaban (15-20mg daily), or dabigatran (150mg twice daily) 1.
Duration of Treatment
Treatment duration ranges from 3-6 months for provoked thrombosis to indefinite therapy for recurrent or unprovoked cases.
Prevention of Complications
Compression stockings may help with symptoms and prevent post-thrombotic syndrome. Prompt treatment is essential to prevent complications like pulmonary embolism, which can be life-threatening 1. Some key points to consider in the management of thrombosis include:
- The use of clinical risk-stratification scores (eg, Wells score) in combination with a blood evaluation for plasma D-dimer to diagnose DVT 1
- The importance of imaging to definitively exclude DVT and properly document the extent of venous thrombosis 1
- The need for serial imaging to exclude proximal DVT extension in patients with distal DVT who do not receive anticoagulation therapy 1
From the Research
Thrombitis Treatment
- Thrombitis, also known as venous thromboembolism, can be treated with anticoagulants such as warfarin, unfractionated heparin (UFH), and low-molecular-weight heparins 2.
- Newer oral anticoagulants like rivaroxaban, dabigatran, and apixaban have also been approved for the treatment of venous thromboembolism 2, 3.
- The primary objective of initial heparin therapy is to prevent recurrent venous thromboembolism, and it is given as an initial intravenous bolus of 5000 units, followed by a maintenance dose of 30,000-40,000 units per 24 h by continuous intravenous infusion 4.
Anticoagulant Therapy Duration
- The duration of anticoagulant therapy for venous thromboembolism is a topic of controversy, with some patients requiring indefinite anticoagulation to decrease the risk of recurrent thrombosis 3.
- The risk of recurrent venous thromboembolism must be balanced against the risk of bleeding, which is a potential adverse effect of anticoagulation therapy 3, 5.
- Factors that affect clinical decisions regarding the duration of anticoagulant therapy include the type of venous thromboembolism, patient population, and individual risk factors 3, 5.
Anticoagulant Medications
- Anticoagulant medications work by exerting their effect on clotting factors to prevent the formation of thrombi or the propagation of an existing clot 6.
- Commonly prescribed anticoagulants include heparins, vitamin K antagonists, and newer agents such as rivaroxaban and dabigatran 6.
- The choice of anticoagulant therapy depends on the patient's predisposing risk factors and risk of event recurrence, as well as the availability of reversal agents in the event of life-threatening bleeding 6, 5.