What is Heparin: description of the drug
The drug is a direct-acting anticoagulant. Its active ingredient is sodium heparin. The pharmacological properties of the drug are primarily aimed at reducing the intense production of fibrin, which is involved in the formation of blood clots.
Heparin also stimulates the removal of toxins by increasing the speed of blood circulation in the vessels, reduces the permeability of the vascular wall, thereby reducing swelling and relieving spasms. All this prevents thrombus formation.
Possible complications and consequences
Subcutaneous injections may be accompanied by some complications: the penetration of various infections when using non-sterile syringes, nerve damage if the rules of the procedure are not followed. Some patients may break the needle and leave it in the skin. Often, lumps, bruises, and hematomas occur in the area where the injection was given.
The patient should consult a doctor if allergy symptoms, fever, rash, itching, or severe swelling are observed after the injection. Consultation with specialists is also necessary when bruises or lumps on the skin do not disappear for a long time. To avoid such negative consequences, injections should be trusted to professionals, and you should undertake it yourself only after carefully studying all the nuances.
The advantage of subcutaneous injections is that you can do them yourself. The main thing is to study the technique of the procedure. Manipulations are practically not accompanied by painful sensations. If you follow all the recommendations of doctors, injections in the stomach are rarely accompanied by complications. The disadvantages of the procedure include the need to use special syringes with a thin needle.
Composition of the drug
Most often in everyday life you can find Heparin in the form of a product for external use - an ointment or gel. In clinical practice, it is used in the form of a solution for intravenous, intramuscular or subcutaneous administration.
One milliliter of solution contains 5000 IU of active substance. In addition to sodium heparin, it contains excipients: benzyl alcohol, sodium chloride and water for injection.
When administered intravenously, blood clotting decreases almost instantly. With intramuscular injection, the effect of the drug begins after 15-30 minutes, and with subcutaneous injection - after 20-60.
Area of application of injections in the abdomen
For diabetes, the most suitable place for injections is the subcutaneous tissue on the abdomen.
A subcutaneous injection is a method of introducing medications into the layer located between the skin and muscles. This procedure has a limited scope of application. An injection into the navel is performed using the following drugs:
- Anticoagulants. The drugs thin the blood and prevent the formation of blood clots.
- For the treatment of rabies. In this case, a series of injections is given. When administered intramuscularly, they can cause muscle paralysis. If injections are given using an intradermal technique, such side effects are not observed, since the drug is distributed throughout the body gradually.
- Triggers of ovulation. Used to stimulate the process of egg maturation. Carrying out such manipulation is necessary when performing an IVF procedure or for a controlled pregnancy.
- For the treatment of diabetes mellitus. Insulin into the abdomen is the best way to administer this medication.
- Products for burning subcutaneous fat for weight loss.
The subcutaneous injection method is used in cardiology, phlebology, endocrinology, gynecology and other areas of medicine. The procedures are actively used in cosmetology.
Injections can have therapeutic and preventive purposes, but only a doctor can prescribe them based on the diagnosis performed and the observed clinical picture.
Heparin for coronavirus: instructions for use
COVID-19 infection causes increased stress on the cardiovascular system. This is due to the fact that with a lack of oxygen caused by damage to lung tissue, blood flow worsens. The antigen also has a negative effect on the level of blood clotting. Its increase can lead to the following consequences:
- exacerbation of existing chronic diseases, such as angina pectoris, coronary heart disease, heart failure;
- development of thrombosis, the occurrence of thromboembolism.
In mild cases of the disease, patients are prescribed anticoagulants to thin the blood orally, and in moderate and severe cases, injections are used. In this case, the active substance enters the blood directly, bypassing physiological barriers.
If there are no acute indications, when seconds count, subcutaneous injections are chosen. With them, the medicine begins to act quickly, but is absorbed gradually, without significantly changing the composition of the blood.
Intravenous injections are given for already formed blood clots, for example, with the development of aortic thrombosis. Then it is necessary that the effect of the drug begins immediately.
Sclerotherapy: questions and answers
This article is compiled from questions that my patients asked me when I advised them, or vice versa, did not recommend using sclerotherapy to treat dilated veins.
To begin with, I will repeat the definitions again so that in the future it will be clear what I am talking about. Telangiectasia (spider veins, vascular network) - veins with a diameter of up to 0.5 mm, reticular veins with a diameter of 0.6 to 2 mm, varicose veins with a diameter of more than 2 mm. The first and second in the modern classification of chronic venous diseases are displayed as C1, the third C2. With visible dilatation of veins in the form of capillaries (C1), modern phlebology does not interpret them as varicose veins and, in general, as a manifestation of varicose veins. Sclerotherapy is otherwise called sclerotherapy of veins, phleboscleroobliteration.
Is it worth treating spider veins in order to prevent varicose veins?
I have to deal with this often erroneous opinion often. Advertising in the media is to blame, as well as just rumors from relatives and friends. Unfortunately, what is in the genes cannot be prevented. Having 2-3 stars and sclerosing them, there is no guarantee that they will not arise again, nearby or in the distance. Essentially, starlet treatment is used almost always for beauty reasons. And only in rare cases of bleeding from them do medical indications occur.
Is it true that after sclerotherapy, surgery on veins is much more difficult?
This rarely happens. Usually doctors who practice this view of this problem motivate it as follows. They say that after inflammation of the vein wall, it fuses with the skin, and during the operation it is very difficult and traumatic to separate it. In addition, wall thrombi also interfere with the advancement of the probe. The second position is usually not supported by anything. The probe usually always passes if there is blood flow. In the first case, this is justified only when sclerotherapy of the vein trunks - the great and small saphenous veins - was carried out, or sclerotherapy was complicated by phlebitis of these veins. But nevertheless, everything is not so scary. Any veins, as a rule, can be removed without loss of quality and cosmetics, if this inflammation does not recur several times.
Are there cases when sclerotherapy does not help at all? So the drug doesn't work?
Yes, this can happen. Assuming that instead of medicine there is water in the ampoule. But I have not seen any proven cases of falsification. The reasons for the lack of effect may be different. This includes an unreasonable selection of the drug concentration by the doctor performing sclerotherapy, underestimation of the local structural features of the venous segment being treated, and non-compliance with compression conditions by the patient. Sometimes you want to blame the insufficient concentration of the medicine. If the concentration of the drug increases, it should still work. It is especially unpleasant when this happens during microsclerotherapy of telangiectasia, when when the drug is administered it displaces the blood and then fills it again, but there is no reaction from the vein. The problem is likely that the blood inactivates the drug, which reduces its therapeutic effect. It happens that even with a strong immediate reaction to the medicine in the form of edema along the course of telangiectasias, after a week, when the edema passes and then only uncoagulated blood is present in the veins, and sclerosis does not occur. Probably the fact is that it is impossible to fully compress some vessels, which reduces the effect of the method. Usually the problem is the incorrect selection of the percentage or dose of sclerotherapy and inadequate compression. It doesn’t matter whether the medicine has any effect on the vein. Another thing is that there is no expected effect. I myself still wonder why this happens when the same veins and the same drug are used, but the reaction in rare patients is sometimes inadequate.
Is it true that sclerosis of large veins is dangerous?
If we consider the main saphenous veins (large and small saphenous veins) to be large veins, then this view is justified. There is a danger of thrombosis of these veins. And there are hemodynamic reasons for this. Existing varicose veins lead to dilation of the veins, spreading of the valve flaps along the walls and their functional inferiority. When introducing a sclerosant into a section of such a venous tube and expecting an effect in this area, we cannot in any way prevent the stagnation of blood above and below this place. And given the non-functioning valve apparatus, blood stagnation can lead to the formation of a blood clot in an untreated vein. Therefore, if you undertake sclerosis of the main saphenous vein, then you need to treat it along its entire length. This is possible, but the effectiveness of such treatment still seems doubtful to me in terms of long-term results. Relapses are frequent. Sclerotherapy itself is a rather complex procedure, since it must be performed under ultrasound guidance.
Is it possible to do sclerotherapy for thrombophilia?
No, in case of identified thrombophilias. The option when the patient had thrombophlebitis should alert the doctor in terms of examination.
Can sclerotherapy be performed by a non-phlebologist?
It is reasonable to leave the treatment of large veins (from 3 mm in diameter) to a phlebologist. Vascular mesh can be entrusted to an experienced dermatologist and doctors of other specialties. In different countries, this is done by doctors of different specialties.
What time of year is best to do sclerotherapy?
Can be done at any time of the year. However, you need to be aware that compression is necessary after injections. It will be difficult to maintain compression mode in the hot season. The smaller the vein, the shorter the compression time.
Bandages or knitwear for sclerotherapy?
For large veins it is better to use bandages. FLEBO ROLLERS are often used in this case to enhance compression in some places that are difficult to leave under knitwear. Compression hosiery can and should be used in the treatment of spider veins. In this case, the patient must learn to put them on himself in advance.
Is sclerotherapy done during pregnancy?
Recommendations for sclerosants very limit these possibilities. In addition, it is difficult to imagine a situation where sclerotherapy during pregnancy is justified as a therapeutic agent. It is better to treat varicose veins either before or after childbirth.
Is there a difference in the drugs used in sclerotherapy?
Today, ONE drug is used in the Republic of Belarus: aethoxysclerol. He
Does foam sclerosant have any advantages over liquid sclerosant?
It does when we treat non-small veins. The gain in concentration, quantity of the drug, and efficiency is obvious. When it comes to the vascular network, the obvious inconvenience of its introduction into such small vessels offsets the advantages. Therefore, all small vessels are sclerosed by the liquid medicine.
Are side effects common after injections?
Yes, unfortunately, they do exist. Pigmentation is more common. Either when the concentration of the drug is exceeded, or when it gets under the skin, or in the case of developing thrombophlebitis. Along the vein or near it, the skin becomes brownish in color. Can exist for a long time. To one degree or another, 15-20% of injections are accompanied by pigmentation. It is rare, but there is such a complication as skin necrosis. Occurs when treating a capillary network, when the medicine enters the arterial segment of the vessels. After a few days, a blister forms at the injection site; when opened, a superficial ulcer remains, which subsequently heals. Another side effect of treatment can develop from the application of an elastic bandage. I have observed the development of burn-like skin blisters in an area where there is little or no subcutaneous tissue and no cushion between the bandage and the bone or ligaments. Moreover, the injection sites were located quite far away. It is treatable and healable.
Do sclerosant injections hurt?
Large veins tolerate the administration of the drug painlessly. The patient only feels the injection itself. When treating spider veins, there is often a burning sensation, but it is short-lived.
Do you experience pain after injections?
Occurs with the development of phlebitis. This is relevant in the treatment of varicose veins.
Is it necessary and possible to treat spider veins on the face and torso?
The question of necessity, as a rule, is decided by the patient himself, because this is only a cosmetic drawback. The vascular network on the nose, dilated veins on the temples, and the paraorbital zone can be sclerosed. When it comes to veins on the body, it is important to find out the cause of their occurrence if there are many of them. Asterisks, as a rule, are not treated with sclerosis.
What place does ultrasound have in the sclerosis of veins?
Ultrasound is used when it is necessary to sclerose the main varicose veins, or to treat perforating veins. At the same time, it is possible to control the introduction and distribution of foam sclerosant through the vein. The method is called echophleboscleroobliteration.
If we take into account the chronic course of varicose veins, doesn’t it turn out that a patient who decides to undergo sclerotherapy becomes a permanent patient attached to this method of treatment?
Here it is necessary to observe the golden mean. Of course, not all veins can be cured. It is better to selectively deal with only those that are most important and visible and not chase the illusory temporary effect of cleansing the veins. It seems to me that this approach is wrong when visits to the doctor become regular. Probably the wrong treatment method was chosen, or the patient's demands are too high. It makes more sense to think that it is impossible to deceive nature; it can only be improved and alleviated, but not completely cured. However, many people understand this at the stage of explaining the method. And the doctor who doesn’t talk about all the pitfalls is wrong.
Is sclerotherapy best used before or after surgery?
Ideal after surgery. During the operation, all “large” veins are removed. The rest is obtained by injections. In addition, even after surgery, the formation of new stars is possible. This often happens on the thigh. In this case, this is also more of a cosmetic method than a therapeutic one.
Are veins subject to sclerotherapy in children and the elderly?
For children, you need to wait until they are at least 16 years old and not rush. The upper age limit has not been determined. The possibility of sclerotherapy exists if the patient is mobile, can walk at least 1 km without stopping, understands the essence of the sclerotherapy process and follows the prescribed regimen.
Why do you need to puncture veins after injections to extract blood?
The effectiveness of this benefit has not been proven. But purely empirically, standing blood in a vein that has undergone a sclerotherapy session is no longer needed there at all. Removing it from the vein by squeezing will shorten the treatment time and reduce the likelihood of thrombophlebitis. In our language, such “standing blood” in a vein is called “coagula”.
It is up to you to determine whether or not it is worth doing vein sclerosis based on the advice of a phlebologist and determining the expected effect and the risk of side effects.
WITH RESPECT, YOUR DOCTOR!
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Side effects and contraindications
Heparin, like other drugs used to thin the blood, can also cause negative consequences. Among them:
- allergic reactions to components;
- the development of hemorrhoids and its transition to the chronic stage, the appearance of rectal fissures;
- disruption of the gastrointestinal tract and pancreatic functions;
- increased blood pressure;
- decreased platelet levels in the blood;
- internal and external bleeding;
- development of hemorrhagic strokes;
- the occurrence of liver and kidney pathologies;
- growth of neoplasms in the digestive tract;
- bacterial endocarditis;
- aortic and cerebral aneurysm.
Men are at risk of developing hemolytic anemia. Pregnant women may be at risk of miscarriage.
Attention!
If a woman is taking oral contraceptives, when prescribing treatment with Heparin, it is imperative to notify the attending physician. Concomitant use of drugs may cause venous thromboembolism.
Such an impressive list of side effects makes many doctors doubt the advisability of using Heparin as an anticoagulant for coronavirus. For example, Chinese doctors working in hospitals in Wuhan associate the worsening condition of patients and even deaths with the negative effects of Heparin.
Principles of treatment for covid-19
For most people, coronavirus goes away without complications and only causes cold symptoms. In this case, the use of serious medications is not required. If a large number of negative symptoms develop, the condition worsens greatly, complex treatment is prescribed:
- antiviral agents (no specific medicine has been developed; drugs are used against other viral microorganisms);
- antibiotics for the development of infection;
- blood thinning medicine to prevent blood clots;
- drinking regimen to replenish the missing fluid released from the skin due to severe fever;
- bed rest, lack of physical activity;
- antipyretic drugs (NSAIDs are prohibited; they suppress the immune system);
- complex vitamins, especially group D, C.
In mild to moderate severity, treatment of the disease is carried out on an outpatient basis, that is, at home. If the condition worsens, bilateral interstitial pneumonia develops, hospital treatment is indicated. In order to receive high-quality treatment methods from a doctor, they first undergo a laboratory test to detect covid-19, since the symptoms are nonspecific.
During the period of coronavirus infection in the human body, it is prohibited to contact any person in order to eliminate the risk of spreading the disease. Read more in the article: “how to find out that you have recovered from coronavirus.”
Analogues of the drug
The choice of medications that are most effective in preventing blood clots during coronavirus should be made by a doctor. He also decides in what form to prescribe the medicine.
If injections are necessary, in addition to Heparin, other direct anticoagulants can be used:
- Elivix;
- Fraxiparine;
- Warfarin;
- Nadroparin sodium;
- Bemiparin;
- Parnaparin sodium;
- Fondaparinux sodium.
Tablets are prescribed for oral administration:
- Phenilin;
- Sinkumar;
- Neodicoumarin;
- Warfarex;
- Acenocoumarol.
Preparation for the procedure
To avoid hematomas, it is necessary to alternate injection sites.
Preparation for performing a subcutaneous injection involves careful selection of the injection site. Doctors recommend that all manipulations be carried out in an area located in close proximity to the navel (about 2 cm from it). The procedure is best performed at the same time, in a calm environment and a secluded place.
For injections into the abdomen, special syringes with a thin needle are used. The dosage of the drug is selected by the doctor individually for each patient. Medical alcohol is used to treat the skin before giving the injection. Before the procedure, hands must be washed using running water and any soap. It is also recommended to wear sterile gloves, especially if the person will not be injecting themselves.
