RE: lovenox

[Guest guest]

I thoguht to do what you do LYnn but lookhere is up to dat e.com:

TREATMENT — Appropriate

treatment of superficial phlebitis is related to the site and etiology

of the venous inflammation. General points to consider include:Removal of the cannula is recommended when thrombophlebitis occurs in the setting of an intravenous catheter.Cellulitis should be considered if erythema extends significantly beyond the vein.

Biopsy should be obtained if the diagnosis is not clear, or for some cases of recurrence.

SP excluding the lower extremity — No standardized treatment for SP has been defined. In one randomized study of patients with infusion-related SP, topical diclofenac gel was as effective as oral diclofenac and both were more effective than placebo in relieving symptoms at 48 hours [29]

.. Consensus recommendations from the American College of Chest

Physicians (ACCP) suggest topical diclofenac gel for infusion-related

SP [30]

..

SVT in the lower extremity — Treatment

of phlebitis affecting the lower extremity takes into consideration the

increased risk of DVT and pulmonary embolus. There is no consensus on

the optimal treatment. Usual suggested treatments include compression

stockings combined with one of several options: low-dose subcutaneous heparin, low molecular weight heparin (LMWH), oral anticoagulation, ligation surgery, or venous stripping.

A

2007 systematic review included 24 studies involving almost 2500 cases

of SVT of the legs and concluded that treatment with LMWH should be

considered to prevent thromboembolic events and the extension and/or

recurrence of SVT [31]

.. Symptomatic improvement was achieved with other therapies, such as topical heparin, piroxicam

gel, and NSAIDs, but most studies did not report venous thromboembolic

events or SVT progression, and many studies had methodologic weaknesses.Topical heparin,

commonly available in Europe, applied three times daily for up to seven

days, was more effective than placebo in one randomized trial [32]

.. A smaller study, however, found no benefit for topical heparin or piroxicam gel compared to placebo [33]

.. Several oral nonsteroidal anti-inflammatory agents have been compared

with each other and have been found equally effective [34]

..hmmm

I could be way way out of the loop, but did anyone ever hear of using lovenox to treat a superficial thrombophlebitis? Saw a patient a few days ago with clearly a superficial thrombophlebitis in the popliteal fossa , maybe 5 cm in a superficial vein after an airplane flight. Superficial, tender no clinical involvement of calf or thigh. Recommended compression, motrin, elevation, heat. She wanted a referral to a vascular person for varicose veins, I gave her the name of a a vascular surgeon. He was out of town, so she looked up another vascular surgeon. He saw her yesterday, she says it was somewhat worse, he did an office LE ultrasound, negative for DVT, started her on lovenox. Does this sound nutty to anyone besides me, is there ANY indication to use this at all? Price tag $1000.

Thanks, just reality checking a little, maybe I am too isolated in my IMP. LynnSee what people are saying about Windows Live. Check out featured posts. Check It Out!

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

[Guest guest]

Thank you Dr. Ant.Why didn't I think to use up to date for this?Really! though if doing this as an off label use, why didn't he just use SQ heparin - really!LynnTo: From: jnantonucci@...Date: Fri, 29 Aug 2008 14:54:26 -0400Subject: Re: lovenox

I thoguht to do what you do LYnn but lookhere is up to dat e.com:

TREATMENT — Appropriate

treatment of superficial phlebitis is related to the site and etiology

of the venous inflammation. General points to consider include:Removal of the cannula is recommended when thrombophlebitis occurs in the setting of an intravenous catheter.Cellulitis should be considered if erythema extends significantly beyond the vein.

Biopsy should be obtained if the diagnosis is not clear, or for some cases of recurrence.

SP excluding the lower extremity — No standardized treatment for SP has been defined. In one randomized study of patients with infusion-related SP, topical diclofenac gel was as effective as oral diclofenac and both were more effective than placebo in relieving symptoms at 48 hours [29]

.. Consensus recommendations from the American College of Chest

Physicians (ACCP) suggest topical diclofenac gel for infusion-related

SP [30]

..

SVT in the lower extremity — Treatment

of phlebitis affecting the lower extremity takes into consideration the

increased risk of DVT and pulmonary embolus. There is no consensus on

the optimal treatment. Usual suggested treatments include compression

stockings combined with one of several options: low-dose subcutaneous heparin, low molecular weight heparin (LMWH), oral anticoagulation, ligation surgery, or venous stripping.

A

2007 systematic review included 24 studies involving almost 2500 cases

of SVT of the legs and concluded that treatment with LMWH should be

considered to prevent thromboembolic events and the extension and/or

recurrence of SVT [31]

.. Symptomatic improvement was achieved with other therapies, such as topical heparin, piroxicam

gel, and NSAIDs, but most studies did not report venous thromboembolic

events or SVT progression, and many studies had methodologic weaknesses.Topical heparin,

commonly available in Europe, applied three times daily for up to seven

days, was more effective than placebo in one randomized trial [32]

.. A smaller study, however, found no benefit for topical heparin or piroxicam gel compared to placebo [33]

.. Several oral nonsteroidal anti-inflammatory agents have been compared

with each other and have been found equally effective [34]

..hmmmOn Fri, Aug 29, 2008 at 2:48 PM, Lynn Ho <lynnhrihotmail> wrote:

I could be way way out of the loop, but did anyone ever hear of using lovenox to treat a superficial thrombophlebitis? Saw a patient a few days ago with clearly a superficial thrombophlebitis in the popliteal fossa , maybe 5 cm in a superficial vein after an airplane flight. Superficial, tender no clinical involvement of calf or thigh. Recommended compression, motrin, elevation, heat. She wanted a referral to a vascular person for varicose veins, I gave her the name of a a vascular surgeon. He was out of town, so she looked up another vascular surgeon. He saw her yesterday, she says it was somewhat worse, he did an office LE ultrasound, negative for DVT, started her on lovenox. Does this sound nutty to anyone besides me, is there ANY indication to use this at all? Price tag $1000.

Thanks, just reality checking a little, maybe I am too isolated in my IMP. LynnSee what people are saying about Windows Live. Check out featured posts. Check It Out!

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

Be the filmmaker you always wanted to be—learn how to burn a DVD with Windows®. Make your smash hit

[Guest guest]

Because he's not paying the bill and most of the people he sees are going to pay out of pocket to have their varicose veins fixed, so he doesn't consider cost. IMHO

Thank you Dr. Ant.Why didn't I think to use up to date for this?Really! though if doing this as an off label use, why didn't he just use SQ heparin - really!Lynn

To: From: jnantonucci@...

Date: Fri, 29 Aug 2008 14:54:26 -0400Subject: Re: lovenox

I thoguht to do what you do LYnn but lookhere is up to dat e.com:

TREATMENT — Appropriate treatment of superficial phlebitis is related to the site and etiology of the venous inflammation. General points to consider include:

Removal of the cannula is recommended when thrombophlebitis occurs in the setting of an intravenous catheter.

Cellulitis should be considered if erythema extends significantly beyond the vein.

Biopsy should be obtained if the diagnosis is not clear, or for some cases of recurrence.SP excluding the lower extremity — No standardized treatment for SP has been defined. In one randomized study of patients with infusion-related SP, topical diclofenac gel was as effective as oral diclofenac and both were more effective than placebo in relieving symptoms at 48 hours [29] . Consensus recommendations from the American College of Chest Physicians (ACCP) suggest topical diclofenac gel for infusion-related SP [30] .

SVT in the lower extremity — Treatment of phlebitis affecting the lower extremity takes into consideration the increased risk of DVT and pulmonary embolus. There is no consensus on the optimal treatment. Usual suggested treatments include compression stockings combined with one of several options: low-dose subcutaneous heparin, low molecular weight heparin (LMWH), oral anticoagulation, ligation surgery, or venous stripping.

A 2007 systematic review included 24 studies involving almost 2500 cases of SVT of the legs and concluded that treatment with LMWH should be considered to prevent thromboembolic events and the extension and/or recurrence of SVT [31] . Symptomatic improvement was achieved with other therapies, such as topical heparin, piroxicam gel, and NSAIDs, but most studies did not report venous thromboembolic events or SVT progression, and many studies had methodologic weaknesses.

Topical heparin, commonly available in Europe, applied three times daily for up to seven days, was more effective than placebo in one randomized trial [32] . A smaller study, however, found no benefit for topical heparin or piroxicam gel compared to placebo [33] . Several oral nonsteroidal anti-inflammatory agents have been compared with each other and have been found equally effective [34] .

hmmm

I could be way way out of the loop, but did anyone ever hear of using lovenox to treat a superficial thrombophlebitis? Saw a patient a few days ago with clearly a superficial thrombophlebitis in the popliteal fossa , maybe 5 cm in a superficial vein after an airplane flight. Superficial, tender no clinical involvement of calf or thigh. Recommended compression, motrin, elevation, heat. She wanted a referral to a vascular person for varicose veins, I gave her the name of a a vascular surgeon. He was out of town, so she looked up another vascular surgeon. He saw her yesterday, she says it was somewhat worse, he did an office LE ultrasound, negative for DVT, started her on lovenox. Does this sound nutty to anyone besides me, is there ANY indication to use this at all? Price tag $1000.

Thanks, just reality checking a little, maybe I am too isolated in my IMP. Lynn

See what people are saying about Windows Live. Check out featured posts. Check It Out!

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/

MD ph fax

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-- Lynette I Iles MD

301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

[Guest guest]

Seems nutty to me

________________________________

From: on behalf of Lynn Ho

Sent: Fri 8/29/2008 12:48 PM

To: practiceimprovement1

Subject: lovenox

I could be way way out of the loop, but did anyone ever hear of using lovenox to

treat a superficial thrombophlebitis? Saw a patient a few days ago with clearly

a superficial thrombophlebitis in the popliteal fossa , maybe 5 cm in a

superficial vein after an airplane flight. Superficial, tender no clinical

involvement of calf or thigh. Recommended compression, motrin, elevation, heat.

She wanted a referral to a vascular person for varicose veins, I gave her the

name of a a vascular surgeon. He was out of town, so she looked up another

vascular surgeon. He saw her yesterday, she says it was somewhat worse, he did

an office LE ultrasound, negative for DVT, started her on lovenox. Does this

sound nutty to anyone besides me, is there ANY indication to use this at all?

Price tag $1000.

Thanks, just reality checking a little, maybe I am too isolated in my IMP.

Lynn

________________________________

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