Local Heparin, Superficial Vein Thrombosis

Abstract

Local, topical effects of heparins on the skin still need deeper investigations. The lack of evidence is mainly due to the lack of large investments in this field. Three main local actions of heparin on the skin can be defined: (1) the anticoagulant action, (2) the microcirculatory-modulatory action determining important control of the microcirculation in case of excessive vasoconstriction or vasodilatation, and (3) the "facilitatory action" on skin permeability, allowing other drugs to diffuse better and faster into the skin (producing a therapeutic effect). These aspects have to be evaluated more extensively both in experimental and in clinical conditions as they may be clinically very important. Recent experimental studies indicate these effects of locally applied heparin. Therefore, key questions on local heparin administration such as skin penetration and the action on the local thrombi have a promising answer. These observations suggest important clinical applications for local liposomal heparin. Both the potentials of local applications of heparin, particularly with new formulations, and some new aspects in the management of superficial vein thrombosis can focus on locally applied heparin. Superficial vein thrombosis is an important clinical condition considering its frequency and the potentially large use of local heparin in this clinical problem. Results from new studies and observations presented in this issue of Angiology could be a window for suggesting new significant clinical applications and therapeutic solutions.

Topically applied heparin in venous thrombosis, why not using it: A review of literature

“…It may also decrease local thrombogenecity and hence the recurrence, and in addition it may improve the spontaneous lysis of the local thrombosis. It was found that reduction in thrombus size in patients with locally applied heparin occurred 3 times faster than other patients after two weeks.the heparin used in the research was, liposomal spraygel heparin [5]. Another RCT study published showed that the use of Essavin Gel (contains aescin, heparin and essential phospholipids); on a skin with venous hypertensive microangiopathy improves the local microcirculation.…”

Superficial thrombophlebitis (Mondor's Disease) after breast augmentation surgery

“…[1–37] Locally acting anticoagulants/antithrombotics have a positive effect on both pain as well as reduction of the size of the thrombus and systemic oral anticoagulation is rarely requested. [79]…”

“…[7910] Following this guideline, the authors considered prescribing in this case, both low molecular weight heparin (Enoxaparin 20 mg/day for five days) and topically applied anticoagulants/antithrombotics in the acute phase while complete laboratory and radiological investigations were conducted. These drugs appear effective in terms of reducing local pain, swelling and redness, increasing the patient's mobility, and in preventing local thrombus growth.…”

“…These drugs appear effective in terms of reducing local pain, swelling and redness, increasing the patient's mobility, and in preventing local thrombus growth. [79]…”

Superficial thrombophlebitis (Mondor′s Disease) after breast augmentation surgery

“…[1][2][3]7] Locally acting anticoagulants/antithrombotics have a positive effect on both pain as well as reduction of the size of the thrombus and systemic oral anticoagulation is rarely requested. [7,9] Nevertheless, the American College of Chest Physicians and several other consensus documents suggest using low molecular weight heparin (LMWH) to prevent thrombosis in subjects at higher risk, mainly in patients with primary superficial thrombosis, which may be associated with other more severe underlying diseases. [7,9,10] Following this guideline, the authors considered prescribing in this case, both low molecular weight heparin (Enoxaparin 20 mg/day for five days) and topically applied anticoagulants/antithrombotics in the acute phase while complete laboratory and radiological investigations were conducted.…”