Trombosi venosa profonda, diagnosi e terapia

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La trombosi venosa profonda (TVP) è una patologia che vede la formazione di un trombo (coagulo di sangue) all’interno di una delle vene profonde, solitamente delle gambe, potenzialmente pericoloso. La trombosi può provocare dolore, gonfiore, o anche essere asintomatica. Quanto prima va diagnosticata e trattata. Ecco come.

cure trombosi venosa profonda

Come si fa la diagnosi di trombosi venosa profonda?

Per diagnosticare la trombosi venosa profonda, il medico richiederà la sintomatologia (se presente) e sottoporrà il paziente ad un esame fisico, obiettivo, in grado di fargli identificare eventuali aree anomale sulla pelle o nelle vene. A seconda del sospetto o meno di trombo e dell’area interessata suggerirà poi a conferma delle indagini diagnostiche. La più comune è l’ecografia, con gli ultrasuoni, perfettamente in grado d individuare uno o più coaguli di sangue. Può essere ripetuta anche per più volte per monitorare l’eventuale aumento di volume o spostamento. Possono altresì essere usate una TAC o una Risonanza Magnetica. A queste può essere abbinato un esame del sangue che valuti i valori (alti) di una sostanza chiamata D dimero. In alcuni casi si effettua anche la cosiddetta Venografia, ovvero una procedura con raggi X dopo l’iniezione di un mezzo di contrasto per valutare a fondo le vene, soprattutto delle gambe e dei piedi.

 

Quali terapie per la Trombosi Venosa Profonda?

La cura per la trombosi venosa profonda ha lo scopo di impedire che il coagulo di sangue aumenti di volume, si rompa o si sposti provocando un’embolia. Ecco le terapie più comuni:

Anticoagulanti

Sono farmaci che aiutano, quando possibile a fluidificare il sangue, impedendone la capacità di coagulare: non dissolvono i trombi esistenti, ma impediscono che questi aumentino di volume o se ne creino altri. Solitamente ed in prima battuta si somministra eparina tramite iniezioni, per almeno un paio di giorni. Poi si può passare ad altre soluzioni iniettabili come l’enoxaparina (Lovenox), la dalteparina (Fragmin) o il fondaparinux (Arixtra) o a farmaci per bocca, in pillole, come il warfarin (Coumadin, Jantoven) o il rivaroxaban (Xarelto). I nuovi anticoagulanti possono anche offrire ulteriori opzioni nel prossimo futuro. Potrebbe essere necessario prendere fluidificanti del sangue per tre mesi o più. Importante è attenersi rigorosamente alla prescrizione del medico perché questi farmaci possono avere seri effetti collaterali se utilizzati in modo improprio. Per tale motivo sono necessarie anche continue analisi del sangue per valutare il tempo di coagulazione.

Trombolitici

Se si ha un tipo più grave di trombosi venosa profonda o un’embolia polmonare, o se altri farmaci non funzionano, il medico può prescrivere farmaci diversi come i trombolitici (o TPA attivatore plasminogeno tissutale). Sono in grado di distruggere un coagulo ed in genere si somministrano con un catetere: si utilizzano solo in caso di grave rischio per la vita ed in reparti ospedalieri di terapia intensiva.

Filtri

Se non è possibile prendere farmaci per diluire il sangue, un filtro può essere inserito in una grossa vena – vena cava – nell’ addome. Un filtro nella vena cava impedisce che eventuali coaguli arrivino ai polmoni.

Calze a compressione

Aiutano a prevenire il gonfiore associato a trombosi venosa profonda. La loro pressione aiuta a ridurre le probabilità che il sangue coaguli. Si consiglia di indossare queste calze durante il giorno per almeno due o tre anni, se possibile. Calze a compressione possono aiutare a prevenire anche la sindrome postflebitica.

 

Stile di vita e rimedi casalinghi

Una volta ricevuto il trattamento per la trombosi venosa profonda è necessario cambiare il proprio stile di vita e probabilmente anche la dieta al fine prevenire un altro trombo o incappare, dato l’uso di anticoagulanti in emorragie. Cosa fare?

Intanto visite regolari dal medico curante con le dovute indagini diagnostiche. Evitare cibi ricchi di Vitamina K se si stanno assumendo farmaci come il warfarin, perché possono interferire ed anche sport ed attività di contatto o tagli.

Fare un minimo di attività motoria ogni giorno, evitare di stare seduti a lungo, indossare calze a compressione graduata se prescritte, anche d’estate.

Leggi anche:

Trombosi venosa profonda: cause, sintomi e cure

Prevenire le vene varicose

 

Foto: Thinkstock

 

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