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

Abstract

Superficial vein thrombosis (SVT) is a condition of clotting of superficial veins associated with minimal inflammatory components, while superficial thrombophlebitis (STP) is defined as a condition of minimal thrombosis of superficial veins associated with inflammation or infection. In UK it is estimated to have 400 cases of SVT in every 100 000 person per year in comparison to 125 000 case annually in the United States. SVT and STP tend to occur more in old ages because of increased incidence of varicose veins, with a tendency toward working population. Women are affected more in the UK, but the San-Valantino study showed a similar rate. Obese low mobility people, pregnant ladies, females on contraceptives and hormone replacement therapy (HRT) are more affected by the two conditions. Conventional treatment of both conditions is conservative and usually includes pain killers, compression, anti-inflammatory creams and elevation. Anticoagulation is indicated in some cases, whether systemic or topical. SVT and STP are better prevented than treated, and some simple steps help to achieve that goal. Removal of intravenous (IV) catheters after maximum 48 hours of usage and avoidance of small veins while puncturing are some but not all. Low molecular weight heparin (LMWH) and nitroglycerin patches distal to peripheral lines can also prevent SVT and STP. Exercise is recommended while total bed rest is not in such cases. Antibiotics are usually conserved for cases with proved source of infection. Our main concern in this paper is to review the literature regarding the use of topical heparins in SVT and STP. Although it was mentioned in many trials and expert opinions, the use of topical heparin is not yet standardized and its use is limited to some centers only. It still lacks the enough evidence because of deficiency in large pharmaceutical investments in this field, yet it has shown many beneficial effects in clinical practice. Scientifically speaking, three main effects of heparin on skin can be observed; a)the anti-coagulation effect, b)modulatory effect on microcirculation, c)the effect on skin permeability allowing increased diffusion of drugs [1][2][3].

The Efficacy of Topical Heparin Preparations for the Management of Pain and Superficial Vascular Disorders in Orthopaedic Surgery and Musculoskeletal Trauma

“…These symptoms are often associated with the use of low molecular weight heparin for thromboembolic complications prophylaxis, an essential component of trauma treatment in orthopaedic pathology. However, topical heparin preparations are also frequently added because they have shown many beneficial effects in clinical practice [1][2][3]. The use of topical heparin is not yet standardized and its efficacy is often questionable because of contradictory reported information related to heparin absorption.…”