Venous disorders are diseases affecting the veins, which are the blood vessels that return blood that is low in oxygen from the body back to the heart. This blood then goes to the lungs to gain oxygen and delivers oxygen to the body’s organs and tissues via arteries before returning to the heart via veins. The walls of veins are thinner than artery walls, because they do not have as much pressure. This sometimes makes them more likely to be damaged. Inside many veins are flaps called valves that keep the blood moving in one direction toward the heart. The act of breathing and skeletal muscle movement, especially in the legs, pumps blood back toward the heart through veins. Venous disorders occur when a part of the vein’s structure is damaged and/or veins no longer function like they are supposed to. Venous disorders can range from minor, cosmetic issues to severe and life-threatening issues. Examples of venous disorders are superficial thrombophlebitis (blood clot in small, superficial veins), deep vein thrombosis/DVT (blood clot in larger, deep veins), pulmonary embolism (blood clot in lung from DVT), chronic venous insufficiency, varicose veins (“spider veins”), venous stasis ulcers (ulcers in the skin, usually legs and feet, due to poor blood flow), varicocele (enlarged veins in scrotum/testicles), oesophageal varices (enlarged veins in the oesophagus), haemorrhoids (enlarged veins in the anus), and vasculitis/phlebitis (inflammation of blood vessels/veins). Treatment for venous disorders involves many non-medication interventions such as a healthy diet and exercise, quitting smoking and decreasing alcohol intake, compression stockings or bandages to help move blood from the lower extremities back towards the heart, and surgical procedures to repair damaged veins, remove large clots, and prevent serious blood clot complications. There are several medication treatments available for various venous disorders.
Anticoagulants work on chemicals involved in the clotting cascade (the process of clot formation) to decrease the blood’s ability to clot. These can help to treat a clot that has formed, and/or to decrease the likelihood of other clots forming. Oral anticoagulants include warfarin, dabigatran, rivaroxaban, and edoxaban. Warfarin requires careful monitoring with regular bloodwork. Injectable anticoagulants include heparin, enoxaparin, dalteparin, and fondaparinux.
Thrombolytics (or Fibrinolytics) are called “clot-busting drugs.” They help to break up and dissolve clots that may be blocking critical blood flow. They are often used in emergency situations such as heart attack, stroke, or pulmonary embolus. Examples are alteplase (t-PA), tenecteplase, and streptokinase.
Antiplatelet drugs prevent blood clots by acting on platelets and can help increase blood flow in veins. Examples include aspirin, clopidogrel, and cilostazol.
Pentoxifylline is used to help increase blood flow in venous insufficiency and venous stasis ulcers.
Sclerotherapy involves the injection of a salt solution into varicose veins, which causes scar tissue that closes/collapses the veins and re-routes blood to other, healthy veins.
Anti-hemorrhoidal treatments decrease pain, inflammation, and discomfort associated with haemorrhoids, which are enlarged veins in the anus. Most are topical agents (creams, wipes, or suppositories) that contain lidocaine (a numbing agent), hydrocortisone (a corticosteroid), and/or witch hazel (a natural local anaesthetic). Stool softeners and over-the-counter pain relievers such as acetaminophen, ibuprofen, or naproxen may be used to ease discomfort. In severe cases, a pharmacist may be able to make a cream or ointment containing a vasoconstrictor, which makes enlarged veins smaller, to treat haemorrhoids.
Corticosteroids suppress the immune system to decrease inflammation in the body. They may be used topically to treat haemorrhoids, or systemically (inside the body- orally or by injection) to treat inflammation associated with vasculitis/phlebitis.
Antibiotics may be needed for cellulitis/skin infection caused by chronic venous insufficiency or venous stasis ulcers. They work by killing bacteria or limiting their growth. Topical antibiotics may include mupirocin, bacitracin, and triple antibiotic ointment. Oral or IV medications commonly used to treat these infections include penicillin, cephalexin, amoxicillin/clavulanate, levofloxacin, vancomycin, sulfamethoxazole/trimethoprim, clindamycin, doxycycline, vancomycin, piperacillin/tazobactam, gentamicin, and tobramycin.
Common side effects with many of these medications include nausea/vomiting, diarrhoea, constipation, dizziness, headache, rash, or skin irritation. More serious side effects are discussed below.
Bleeding is a possible side effect of anticoagulants, antiplatelet drugs, and thrombolytics because of how the medications work. If you experience unexplained bruising, excessive nosebleeds, coughing up blood, blood in your urine, stool, or vomit (can be pink, bright red, brown, dark, tarry stools, or coffee-ground appearance of vomit) you should seek medical attention immediately.
Drug Interactions can be significant and require changes in therapy or affect bleeding or clotting risk with some of these medications. It is important that your doctor and/or pharmacist are aware of every medication you are taking, including over-the-counter medications and supplements so that they can monitor for drug interactions.
Complications from venous disorders can be deadly or life-altering, including stroke, heart attack, pulmonary embolism, bone infection, and limb amputation due to infection and poor blood flow, which can kill healthy tissue. There are several steps you can take to prevent venous disease and its complications. It is important to keep other health conditions such as high cholesterol, high blood pressure, and diabetes under control with appropriate medical treatment. A healthy diet, regular exercise, and maintaining a healthy weight are very important. There are some conditions that can increase your risk of venous disorders. These include pregnancy, obesity, a family history of venous disease, female sex at birth, taking hormone therapy or birth control pills, alcoholism, using tobacco products, and sitting or standing for long periods of time. It is recommended that you get up and walk around approximately every hour, especially if you are at high risk for venous disease. If you have venous insufficiency, elevating your feet while at rest may help. It is important that you take your medications exactly as prescribed and report any changes in your condition to your healthcare provider. If you experience a cough and shortness of breath, chest pain, bluish skin, severe pain and warmth in an arm or leg, or fast/irregular heartbeat, you should seek medical attention right away.