The Role of Anticoagulant Therapy with Heparine in Treatment of Acute Hand Ischemia

Abstract

Hand ischaemia has multiple causes. The Methadone (C21H27NO) - opioid family of drugs and Alprazolam (C17H13Cl1N4) microcrystals, available under the trade name Xanax - benzodiazepine anxiolytic, when using in case of drugs abuser, are very powerful embolic agents which can cause thrombosis of small vessels. Microvascular embolization caused by microcrystals of the injectable powder has contributed to the process of ischaemia. This paper brings into discussions a case of acute ischaemia of the right hand due to intra-arterial injection of suspended tablets of Methadone and Alprazolam microcrystals into the right radial artery, in the distal 1/3 of the forearm.The therapeutic management consisted of restoring the arterial circulation at the ischaemic segment to prevent the propagation of thromboembolic complications by using of i.v. heparine and to preserve the function of the hand by preventing delayed ischaemia and compartment syndrome followed by necrosis. Heparin is a drug widely used in the treatment and prevention of arterial and venous thrombosis. The main effect of heparins lies in their anticoagulant activity. Heparins are involved in different pathways of the coagulation cascade with anticoagulant, antithrombotic, profibrinolytic, anti-aggregative, as well as anti-inflammatory effects.This paper aims to discuss a severe case of ischaemia which demonstrates that intra-arterial injection of oral drugs can lead to limb loss with currently accepted therapy.