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PubMed1995

Oral contraceptives, pregnancy and the risk of cerebral thromboembolism: the influence of diabetes, hypertension, migraine and previous thrombotic disease.

OBJECTIVE: To assess the risk of developing cerebral thromboembolism among pregnant women and among fertile women with hypertension, migraine, diabetes, and previous thrombotic disease, and to investigate the interaction of these risk factors with the use of oral contraceptives. DESIGN: A retrospective case-control study. SETTING: All gynaecological, medical, neurological, and neurosurgical departments in Danish hospitals. SUBJECTS: Seven hundred and ninety-four women in Denmark aged 15 to 44 who suffered a cerebral thromboembolic attack during the period 1985 to 1989 and 1588 age-matched, randomly selected controls. RESPONSE: Of the 692 case and 1584 control questionnaires sent out, 590 (85.1%) and 1396 (88.1%), respectively, were returned. Of the 590 cases, nine had had cerebral thrombosis before 1980, 15 refused to participate, 44 had a revised diagnosis (primarily multiple sclerosis) and 25 had an unreliable diagnosis, leaving 497 with a reliable cerebral thromboembolic diagnosis. Among the 1396 controls, 26 either refused to participate, were mentally handicapped, lived abroad or returned an uncompleted questionnaire, leaving 1370 controls included in the study. RESULTS: After multivariate analysis, pregnancy implied an odds ratio (OR) for a cerebral thromboembolic attack of 1.3 (nonsignificant), diabetes an OR of 5.4 (P < 0.001), hypertension an OR of 3.1 (P < 0.001) and migraine an OR of 2.8 (P < 0.01). Women with previous non-cerebral thrombotic disease had an OR for cerebral thrombo-embolism of 5.3 (P < 0.001). Women with other predisposing medical diseases had an OR of 8.3 (P < 0.001). These ORs were identical among users and non-users of combined oral contraceptives. CONCLUSION: In this study pregnancy implied a non-significant elevated odds ratio of 1.3 for cerebral thromboembolism whereas diabetes, hypertension, migraine and past thromboembolic events increased the risk of cerebral thromboembolism significantly. Women with these increased thrombotic risks should use oestrogen-containing oral contraceptives only after careful considerations of the risks, if at all.

Adolescent↗
PubMed1984

Current status of pulmonary thromboembolism--incidence, diagnosis, classification, pathogenesis, and treatment.

The incidence of pulmonary thromboembolism in the total autopsied cases and the actual reported cases of pulmonary thromboembolism in Japan has gradually increased. Since there is no part of the history, physical examination or noninvasive laboratory findings that is specific, a tentative criteria for diagnosis of pulmonary thromboembolism is proposed based a scoring system. Pulmonary thromboembolism can be classified into 5 different types: (1) massive pulmonary thromboembolism, (2) recurrent or occult pulmonary thromboembolism, (3) diffuse pulmonary microthromboembolism, (4) submassive pulmonary thromboembolism, (5) pulmonary infarction. We have carried out a series of model experiments in order to clarify the mechanism of the development of pulmonary microthromboembolism and the production of pulmonary infarction. On the basis of this data, we suspect that hyperfibrinolysis, endothelial damages and activated permeability factors lead to the interstitial and alveolar edema in pulmonary microthromboembolism or severe hemorrhage in pulmonary infarction. The combination therapy of UK (480,000 units) and DS (3,000 mg) had two advantages: (1) inhibition of shortening of APTT, (2) economy of UK dosage. Laboratory monitoring for effective UK therapy showed a markedly reduced alpha 2PI to under 50% of normal levels and fibrinolysis associated with fibrinogenolysis. The therapeutic effects of heparin were assessed by prolonged APTT (45-250 sec) and elevated Anti-FXa activity (0.2-1.2 u/ml of plasma heparin concentration) as an indicator for the evaluation of anticoagulation activity and by normalized FPA, Fbg, FDP, Plg and AT III as an indicator for evaluation of antithrombolic activity.

Adult↗
PubMed2002

Pulmonary thromboembolism: retrospective study of necropsies performed over 24 years in a university hospital in Brazil.

CONTEXT: Pulmonary thromboembolism is the third most frequent cause of morbidity and mortality among acute cardiovascular diseases. The incidence of pulmonary embolism in necropsies has remained unchanged over the last few decades. Cardiac diseases, neoplasia, trauma, recent surgery and systemic diseases are important predisposing clinical conditions. The relationship between male and female sexes is estimated at 1.24. Various studies have shown an increase in morbidity in spring and autumn. There is great difficulty in precise anatomopathological diagnosis in relation to the localization of the emboli in the pulmonary vessels, although they are preferentially located in the right lung and lower lobes. OBJECTIVE: To study the incidence of lethal and non-lethal pulmonary thromboembolism in relation to epidemiological and anatomical variables. DESIGN: Retrospective study performed via reports on the necropsy findings. SETTING: University hospital providing tertiary-level attendance. SAMPLE: 16,466 consecutive necropsies performed from January 1972 to December 1995. MAIN MEASUREMENTS: Frequency of lethal and non-lethal pulmonary thromboembolism, predisposing diseases, occurrence in relation to the seasons of the year, and location where the embolus is lodged. RESULTS: Pulmonary thromboembolism was found in 4.7% of all the necropsies performed. There was a predominance of lethal cases (68.2%). There was no difference in relation to sex or seasons of the year for the occurrence of this disease. Cardiovascular diseases were more frequently associated with thromboembolic phenomena. With regard to the location where the embolus was lodged, various lung segments showed greater incidence of being bilaterally compromised. CONCLUSION: Over the period of this study, it was observed that there was a reduction in the incidence of pulmonary thromboembolism, which was probably due to the increase in prophylactic measures over the last few decades. Nonetheless, lethal thromboembolism predominated in frequency, probably because of the abrupt onset of a condition of attack across a large area of the lung, lack of clinical suspicions and consequently a lack of early diagnosis, and delay in instituting fibrinolytic therapy in the cases with hemodynamic repercussions or a large number of lung segments affected.

Aged↗
PubMed2005

[Low-molecular-weight heparin for the treatment of acute pulmonary thromboembolism. Comparison with unfractionated intravenous heparin].

BACKGROUND AND OBJECTIVES: Low-molecular-weight heparins have been demonstrated at least as useful as unfractionated heparin (UFH) in the treatment of venous thromboembolic disease. Our aim was to know the effectivity and security of subcutaneous enoxaparin in the treatment of acute pulmonary embolism. METHODS: We compared the effectivity and security of two doses daily, subcutaneous injected enoxaparin adjusted to body weight, and standard treatment with continuous intravenous UFH, determining the rate of major bleeding, in-hospital death and recurrent venous thromboembolic disease in long-term follow up. Massive pulmonary thromboembolism was defined as thrombotic material seen in main pulmonary arteries. RESULTS: Thirty eight patients were treated with UFH (Mean age 72 SD 9 years, male 58%, massive pulmonary thromboembolism 24%) and 65 patients were treated with subcutaneous enoxaparin (Mean age 71 SD 12 years, male 52%, massive pulmonary thromboembolism 49%). Major bleeding rate was 8% in UHF group and 3% in enoxaparin group (Difference 37%, 95% Confidence interval -0.16 to 0.06, p=0.21). In-hospital death rate was 8% in UHF group and 1.5% in enoxaparin group (Difference 25%, 95% Confidence interval -0.17 to 0.04, p=0.11). Recurrent thromboembolism rate was 44% in UFH group and 13% in enoxaparin group (Difference 30%, 95% Confidence interval -0.60 to -0.02, p=0.01). CONCLUSION: Our findings demonstrate that treatment of acute pulmonary thromboembolism with low-molecular-heparin is effective and safe, even in massive pulmonary embolism.

Aged↗
PubMed2000

[Plasma total homocysteine and pulmonary thromboembolism].

OBJECTIVE: To investigate whether the elevated plasma homocysteine increases the risk of pulmonary thromboembolism in the Chinese population. METHODS: Sixty-nine patients with pulmonary thromboembolism and 90 sex- and age-matched healthy controls were recruited, and the patients were diagnosed using lung ventilation/perfusion scan and/or ultrafast CT as well as medical history. The concentration of plasma total homocysteine (tHcy) was measured with high performance liquid chromatography and environmental factors were collected. RESULTS: No significant difference was seen in family history of pulmonary thromboembolism and cardiovascular diseases, cigarette smoking, alcoholic drinking, oral contraceptive and body mass index between cases and healthy controls. The concentration of plasma tHcy in cases was significantly higher than that in healthy controls (16.60 mumol/L +/- 1.75 mumol/L vs 12.48 mumol/L +/- 1.47 mumol/L; t = 3.821, P < 0.05), and adjusting for environmental factors did not change the significance. The plasma tHcy in the isolated pulmonary thromboembolism patients was lower than that in the patients who had lower limb deep venous thrombosis, but no significant difference was found. Compared with normal plasma tHcy, hyperhomocysteinemia was associated with a 4.99-fold risk of pulmonary thromboembolism. CONCLUSION: Our results show that the elevated plasma tHcy increases the risk of pulmonary thromboembolism, and hyperhomocysteinemia is an independent risk factor of pulmonary thromboembolism in the Chinese population.

Adult↗
PubMed2002

Co-segregation of thrombophilic disorders in factor V Leiden carriers; the contributions of factor VIII, factor XI, thrombin activatable fibrinolysis inhibitor and lipoprotein(a) to the absolute risk of venous thromboembolism.

BACKGROUND AND OBJECTIVES: The clinical expression of factor V Leiden varies widely within and between families and only a minority of carriers will ever develop venous thromboembolism. Co-segregation of thrombophilic disorders is a possible explanation. Our aim was to assess the contributions of high levels of factor VIII:C, factor XI:C, thrombin activatable fibrinolysis inhibitor (TAFI) and lipoprotein (a) (Lp(a)) to the risk of venous thromboembolism in factor V Leiden carriers. DESIGN AND METHODS: Levels of the four proteins were measured, in addition to tests of deficiencies for antithrombin, protein C and protein S, and the prothrombin G20210A mutation, in 153 factor V Leiden carriers, derived from a family cohort study. The (adjusted) relative risk and absolute risk of venous thromboembolism for high levels of each protein were calculated. RESULTS: Of carriers, 60% had one or more concomitant thrombophilic disorders. Crude odds ratios (95% CI) of venous thromboembolism for high protein levels were: 3.2 (1.1-9.3) (factor VIII:C); 1.7 (0.6-4.9) (factor XI:C); 3.0 (1.1-8.2) (TAFI); and 1.9 (0.7-5.7) (Lp(a)). Adjusted for age, sex, other concomitant thrombophilic disorders and exogenous risk factors, the odds ratio for venous thromboembolism were 2.7 (0.8-8.7) for high factor VIII:C levels and 1.8 (0.6-5.3) for high TAFI levels. Annual incidences in subgroups of carriers were 0.35% (0.09-0.89), 0.44% (0.05-1.57) and 0.94% (0.35-2.05) for concomitance of high levels of factor VIII:C, TAFI and both, respectively, as compared to 0.09% (0.00-0.48) in single factor V Leiden carriers and 1.11% (0.30-2.82) for other concomitant disorders. INTERPRETATION AND CONCLUSIONS: High levels of factor VIII:C and TAFI, in contrast with factor XI:C and Lp(a), are mild risk factors for venous thromboembolism, and substantially contribute to the risk of venous thromboembolism in factor V Leiden carriers. Our data support the hypothesis that the clinical expression of factor V Leiden depends on co-segregation of thrombophilic disorders.

Adult↗
PubMed2002

Venous thromboembolism in the Chinese population--experience in a regional hospital in Hong Kong.

OBJECTIVE: To estimate the incidence and determine the characteristic features of venous thromboembolism in the Hong Kong Chinese population. DESIGN: Retrospective study. SETTING: Regional hospital, Hong Kong. SUBJECTS AND METHODS: Data were collected during a period of four years (1997-2000). Patients with duplex doppler ultrasonography or venography-documented venous thromboembolism and new episodes of deep vein thrombosis were identified from Department of Diagnostic Radiology records. Patients with high-probability ventilation-perfusion scans were identified from Department of Nuclear Medicine records and these scans were taken as evidence of pulmonary embolism. Patients with intermediate-probability ventilation-perfusion scans, with pulmonary embolism documented by either pulmonary angiography or spiral computed tomography scan, were also included in the study. Patients with autopsy-verified fatal pulmonary embolism were identified from Department of Pathology records. Patients with deep vein thrombosis at other sites were sought from patient discharge diagnostic coding data. Medical records were reviewed for patient characteristics and conditions associated with the development of venous thromboembolism. RESULTS: Three hundred and seventy-six Chinese patients had venous thromboembolism during the study period. Of these, 352 had peripheral deep vein thrombosis, five had deep vein thrombosis at other sites (cerebral sinus and portal vein thrombosis), 40 had pulmonary embolism (26 had concomitant deep vein thrombosis), and six had fatal pulmonary embolism shown at autopsy. CONCLUSION: The calculated annual incidence of venous thromboembolism in Hong Kong Chinese people was estimated at 16.6 events per 100,000 population, which is lower than incidence rates reported in Caucasians. The four conditions most commonly associated with venous thromboembolism were medical illness, malignancy, orthopaedic surgery, and intravenous drug use. Conditions associated with venous thromboembolism in patients younger than 45 years included intravenous drug use, thrombophilia, pregnancy, and the use of oral contraceptives.

Adult↗
PubMed2002

[Acute pulmonary thromboembolism complicating lung lobectomy; report of a case].

Acute pulmonary thromboembolism is fatal if the diagnosis and treatments are delayed. Here we present a case of acute thromboembolism to the right and left pulmonary arteries after right lung lobar resection. A 52-year-old woman who admitted to our hospital with lung cancer was performed right upper lobectomy with mediastinal lymph node dissection (pT1N0M0, well differentiated adenocarcinoma). Two days after surgery, she complained sudden chest discomfort and dyspnea. The blood pressure and oxygen saturation were rapidly decreased. Because there was no lung edema or atelectasis in the chest portable roentgenogram and no ischemic change in the electrocardiogram, pulmonary thromboembolism was suspected and emergency chest computed tomography (CT) was performed. The CT showed left and right pulmonary arterial thromboembolism and immediate anti-coagulator therapy was started. Her condition was improved and chest CT, which was performed three days after the onset of the thromboembolism, showed decreased but still remained thrombus. The anti-coagulator therapy was continued and one month after the onset of the thromboembolism, thrombus was disappeared on chest CT. She is doing well 17 months after surgery. Early diagnosis and treatments are critical for the pulmonary thromboembolism.

Adenocarcinoma↗
PubMed2004

Anticoagulation period in idiopathic venous thromboembolism. How long is enough?

OBJECTIVE: The period of anticoagulation of a first episode of idiopathic venous thromboembolism has been 6 months. It is unclear if such patients would benefit from longer treatment, as there appears to be an increased risk of recurrence after anticoagulation is stopped. METHODS: In a randomized prospective study of 64 patients admitted to King Hussein Medical city, Amman, Jordan, who developed a first episode of venous thromboembolism, 32 patients were given warfarin for 24-months, while 32 patients stopped anticoagulation after completion of 6-months of therapy. Our goal was to determine the effects of extended anticoagulation on rates of recurrence of symptomatic venous thromboembolism and bleeding. The patients were followed for 12-months after stopping anticoagulation. RESULTS: After 24-months, 7 of the 32 patients (21%) who had standard anticoagulation for 6-months had a recurrent episode of thromboembolism compared to one of the 32 patients who received anticoagulation for 24 months (3%). Extended warfarin therapy for 24-months has resulted in an absolute risk reduction of 0.1% (p<0.05). This translates into 8 patients having to be treated for 24-months to avoid one recurrence without increasing the risk of major bleeding. Two patients in each group (6%) had major nonfatal bleeding, all 4 bleeding episodes occurring within the first 3-months of anticoagulation. After 36-months of follow up, the recurrence rate of extended warfarin therapy was only 3 patients (9%), which is a 43% relative reduction in recurrence of thromboembolism compared to standard therapy for 6-months. CONCLUSION: Patients with first episodes of idiopathic venous thromboembolism have an increased risk of recurrent venous thromboembolism and should be treated with oral anticoagulants for longer than 6-months, probably 24-months.

Administration, Oral↗
PubMed2005

[A case of pulmonary thromboembolism in active ulcerative colitis].

Thromboembolic disease is a significant cause of morbidity and mortality in patients with inflammatory bowel disease. The reported incidence is 1-6%. The most common thromboembolic complications are deep venous thrombosis of legs and pulmonary thromboembolism. Cerebral thrombosis, portal vein thrombosis, retinal venous thrombosis and arterial thrombosis were also reported. We experienced a case of ulcerative colitis complicated with pulmonary thromboembolism. The patient was a 70-year-old woman who was diagnosed as ulcerative colitis on colonoscopy. We used prednisolone and sulfasalazine for the treatment of ulcerative colitis. Twenty five days later, she complained of abrupt dyspnea and chest pain. Chest CT and ventilation-perfusion scan revealed a thromboembolism in both lung. After the treatment of heparin & warfarin therapy, follow-up chest CT showed much regressed pulmonary thromboembolism. We report a 70-year-old woman with ulcerative colitis complicated with pulmonary thromboembolism and treated with heparin & warfarin therapy successfully.

Aged↗
PubMed1989

Pulmonary thromboembolism: frequency, site, and vascular change in 103 autopsy cases.

For investigation of the incidence of pulmonary thromboembolism, the sites of thromboemboli, pulmonary vascular changes, detailed clinical and autopsy records, and histological sections of a series of 103 autopsied adults were reviewed. Pulmonary thromboembolism was observed in 38.8% of these cases. Pulmonary thromboembolism tended to be more frequent in older, younger, female, and cancer patients. Thromboembolism was found most frequently in arterioles, followed by muscular arteries. A significant correlation (P less than 0.02) was found between the incidence of pulmonary thromboembolism and the histological changes of endothelial protrusion and vacuolization of the intima in these small pulmonary arteries, but no correlation was found between that of pulmonary thromboembolism and constriction figures. These endothelial changes probably represent previous vasoconstriction. The present observations suggest a significant relationship between pulmonary thromboembolism and vasoconstriction of small pulmonary arteries and suggest that widespread vasoconstriction of pulmonary arteries is important in the pathogenesis and pathophysiology of this condition.

Adolescent↗
PubMedDate not supplied

Multidisciplinary approach to venous thromboembolism.

Venous thromboembolism shows a high incidence and a significant mortality. Even if valid methods are available, thromboembolism is underdiagnosed. There are a number of diagnostic difficulties. They concern the time of the diagnostic suspicion, the patient selection for the various procedures and their combination. These difficulties may be overcome by team work where specialists of different disciplines (surgeons, internists, experts in nuclear medicine, radiologists) integrate their competence to attain the established objectives. The integration results in "synergism", namely an added value greater than the sum of competences of the team components. Thus, an operational unit active 24 hours over 24 must be formed to diagnose and treat the largest number of cases of thromboembolism. To establish the clinical suspicion of thromboembolism is the first indispensable step for patient selection. Thromboembolism should be investigated in all patients with chest pain, dyspnea and tachypnea in the absence of preexisting cardiorespiratory disease. The team should evaluate the impact of signs and symptoms to establish a definitive clinical probability which can direct towards the suitable, least invasive imaging procedure. Perfusion scanning, when highly suggestive or normal, is conclusive. However in 70% of cases it is indeterminate. Thus it should be combined with other procedures and with the clinical assessment. In practice, many dubious cases remain unsolved. The team work represents an organizational response to this diagnostic and therapeutic inadequacy. The real change in strategy which has revolutionized the diagnosis of thromboembolism was the widespread use of color Doppler US in the diagnosis of deep vein thrombosis. Since pulmonary embolism as well as deep vein thrombosis are treated with the same therapy, it is adequate to document the thrombosis also in the absence of a definitive demonstration of embolism. The old-fashioned approach should be reversed and the investigation should be centered on the assessment of deep vein thrombosis: site, emboligenic potential, floating extremity and extension. The integration of the clinical assessment, scanning finding and color Doppler US lowers by about 20% the number of indeterminate cases and indicates the patients for whom pulmonary spiral CT or pulmonary angiography is required. In all patients with cardiorespiratory insufficiency still unsolved after the combination of noninvasive exams, pulmonary angiography or spiral CT is mandatory because of the high risk for death. The remaining ones can be followed with serial color Doppler US exams. The cost/benefit ratio shows that the noninvasive strategy is the least expensive, the least hazardous and the most effective. At present, effective therapies are available for thromboembolism. Standard heparin and low molecular weight heparin fractions, fibrinolytic agents, surgery and recently caval filters are playing a major role in secondary prophylaxis of pulmonary embolism. The therapeutic approach is conditioned by various factors: the features of thrombosis, the presence and entity of pulmonary embolism, the patient cardiorespiratory condition, possible contraindications for anticoagulant and fibrinolytic agents. The presence of such a number of variables makes the use of a therapeutic algorithm, difficult. In this phase, based on our experience we believe that the present solution lies in the activity of an operational team of experts who establish the treatment to be performed.

Cost-Benefit Analysis↗
PubMed1998

Underuse of venous thromboembolism prophylaxis for general surgery patients: physician practices in the community hospital setting.

BACKGROUND: Venous thromboembolism is a common complication of surgery. Although surveys of physician self-reported practices have suggested near universal support for routine use of measures to prevent venous thromboembolism, medical record auditing has demonstrated underuse. OBJECTIVE: To assess physician practices of venous thromboembolism prophylaxis in the community hospital setting. METHODS: Retrospective review of the medical records from 20 hospitals in Oklahoma of 419 Medicare patients aged 65 years or older undergoing major abdominothoracic surgery between April 1 and December 31, 1995. Utilization rates of prophylaxis stratified according to patient risk for venous thromboembolism were measured. RESULTS: Prophylaxis measures were implemented for only 160 (38%) of 419 patients studied (95% confidence interval, 33%-43%). There was little variation in the use of prophylaxis based on the risk for venous thromboembolism. Only 97 (39%) of 250 patients (95% confidence interval, 33%-45%) at very high risk received any form of prophylaxis and of these 97, only 64 patients (66%) received appropriate measures (95% confidence interval, 56%-75%). CONCLUSIONS: Despite widely disseminated, evidence-based recommendations, venous thromboembolism prophylaxis is underused in Medicare patients undergoing major abdominothoracic surgery in community hospitals in Oklahoma.

Abdomen↗
PubMed2000

Recurrent venous thromboembolism after deep vein thrombosis: incidence and risk factors.

BACKGROUND: The recurrence rate after deep vein thrombosis (DVT) is high and the risk factors for recurrent thromboembolic events have only been investigated on a small scale. OBJECTIVES: To estimate the cumulative incidence of recurrent venous thromboembolic events after a first or a second DVT and to identify possible risk factors for recurrent venous thromboembolism. METHODS: We prospectively followed up 738 consecutive patients with an objectively verified symptomatic DVT for 3.7 to 8.8 years. Medical records and death certificates for all patients were reviewed during follow-up and recurrent DVT and pulmonary embolism were registered. RESULTS: The 5-year cumulative incidence of recurrent venous thromboembolic events was 21.5% (95% confidence interval [CI], 17.7%-25.4%) after a first DVT and 27.9% (95% CI, 19.7%-36.1%) after a second DVT. The 5-year cumulative incidence of fatal pulmonary embolism was 2.6% (95% CI, 1.1%-4.1%) after a first DVT. Proximal DVT (relative risk [RR], 2.40; 95% CI, 1.48-3.88; P<.001), cancer (RR, 1.97; 95% CI, 1.20-3.23; P<.001), and history of a venous thromboembolism (RR, 1.71; 95% CI, 1.16-2.52; P<.01) predicted an independently increased risk of recurrent events in multivariate survival analysis. Postoperative DVT (RR, 0.27; 95% CI, 0.13-0.55; P<.001) and a long duration of oral anticoagulation therapy (RR, 0.95; 95% CI, 0.92-0.98; P<.01) involved a smaller risk of recurrent events. Sex, age, initial antithrombotic therapy, or immobilization did not affect the risk of a recurrent event. CONCLUSIONS: The recurrence rate after a symptomatic DVT is high. Patients with proximal DVT, diagnosed cancer, short duration of oral anticoagulation therapy, or a history of thromboembolic events had a higher risk of recurrent events, while patients with postoperative DVT had a lower recurrence rate. This knowledge could help identify patients who might benefit most from prolonged prophylactic treatment in various risk situations.

Adolescent↗
PubMed1976

Thromboembolic disease in renal allograft recipients. What is its clinical significance?

Detailed analysis of the clinical data and autopsy material of 100 consecutive renal transplant recipients revealed significant thromboembolic disease in 25 patients and a total of 41 complications. In six of them, thromboembolism was associated with sepsis. Nine patients died (20% of total number of deaths) due to a primary thromboembolic event. The incidence of pulmonary embolism was 14%; myocardial infarction, 3%; cerebrovascular disease, 4%; renal artery thrombosis, 2%; renal vein thrombosis, 3%; thrombophlebitis/deep vein thrombosis, 13%; and miscellaneous, 2%. The incidence of thromboembolism was higher in patients older than 40 years of age (P = .02) and during the earlier months after transplantation. We summarize the general incidence and mortality related to thromboembolism and discuss the factors predisposing the graft recipient to thromboembolic disease. Prevention and therapy of this complication should decrease the morbidity and mortality in graft recipients and enhance the success of renal transplantation.

Adolescent↗
PubMedDate not supplied

Management of thromboembolic disease associated with pregnancy.

Our objective was to identify practice patterns of members of the Society of Perinatal Obstetricians with regard to the management of thromboembolic disease in pregnant women. We sent survey-questionnaires to members of the Society of Perinatal Obstetricians and requested information on antepartum and postpartum management of four clinical case scenarios. We also requested information on the evaluation of hypercoagulability and on the dosing and monitoring of heparin during pregnancy. We received 515 responses after a single mailing (47%). Most respondents utilize some form of anticoagulation in pregnant women with a history of thromboembolic disease, although there was variation in the duration and intensity of anticoagulation. Nearly all respondents (96%) use full anticoagulation with heparin for pregnant women with prosthetic heart valves. Most respondents evaluate pregnant women for hypercoagulable disorders who present with a thromboembolism or have a history of thromboembolic disease. There is considerable variation with respect to the dosing and monitoring of heparin therapy during pregnancy. Although most SPO members recommend anticoagulation in pregnant women with a history of venous thromboembolism, there is marked variation in the intensity, duration, and monitoring of heparin therapy in pregnant patients. Randomized prospective studies are needed to establish accurate recurrence risks and to evaluate the efficacy of anticoagulation in pregnant women with a history of venous thromboembolism.

Anticoagulants↗
PubMed2003

[Thrombophilic disorders in venous thromboembolism. The clinical perspective].

BACKGROUND: Treatment of venous thromboembolism should consider the influence of thrombophilic disorders on the risk of recurrence. Diagnostic tests should be guided by their expected relevance to therapy. A competent and straightforward clinical approach to venous thromboembolism requires knowledge of the current data regarding stratification of risk of recurrence in thrombophilic patients. METHODS: Focusing on clinical management, the current literature on thrombophilia is analyzed. Recommendations are given taking into account the risk of first and recurrent thromboembolism, the bleeding risk under anticoagulation, and validated therapy strategies. A rational diagnostic approach in the light of potential therapies is suggested. CONCLUSION: The recurrence risk after triggered venous thromboembolism is low, and anticoagulation does not need to be extended beyond 6 months. Idiopathic or thromboembolism in unusual locations is associated with a higher recurrence risk since underlying thrombophilia is more common in these patients. These cases merit laboratory screening for thrombophilic factors (whose relevance is discussed), and extended anticoagulation is indicated (1 year; in severe thrombophilia several years). In recurrent venous thromboembolism anticoagulation is ideally continued for 4 years, or longer in the absence of complications.

Anticoagulants↗
PubMed2004

[Venous thromboembolism prophylaxis].

Venous thromboembolism is a common and frequent complication of hospitalized patients. Some venous thromboembolisms may be subclinical, while others present as symptomatic deep vein thrombosis and/or pulmonary embolism. Venous thromboembolism and pulmonary embolism contribute significantly to inhospital morbidity and mortality. The risk of venous thromboembolism is aggravated by dispositional and/or expositional risk factors. In patients at intermediate or high risk of venous thromboembolism, additional pharmacological thromboembolism prophylaxis becomes mandatory.

Anesthesia↗