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PubMed2006

Increased thromboembolic events after lung transplantation.

BACKGROUND: Lung transplantation is a good therapeutic option for end-stage lung disease. Data on thromboembolic complications following lung transplantation are scarce. STUDY OBJECTIVES: To evaluate the incidence of thromboembolic events following lung transplantation, and to determine their possible association with hypercoagulable state. DESIGN: Retrospective study in a single, tertiary-care, university-affiliated referral center. SUBJECTS AND METHOD: The records of 70 patients who underwent lung transplantation in our institution between September 1997 and September 2003 were reviewed for thromboembolic complications. Parameters pertaining to risk of thrombophilia were measured in the patients with thromboembolic complications. RESULTS: Thromboembolic complications developed in 6 of the 70 patients (8.6%) at 4 to 24 months after transplantation: deep vein thrombosis (DVT) in 2 patients, pulmonary embolism (PE) in 1 patient, both DVT and PE in 1 patient, and retinal vein thrombosis in 2 patients. The fibrinogen level was elevated in all six patients, and factor VIII, IX, and/or XI levels were elevated in five patients. Heterozygosity for 5 10-methylene tetrahydrofolate reductase was documented in two patients, and mutation for factor II or factor V-Leiden mutation was found in one patient. Levels of protein C and protein S and activated protein C resistance were within normal range in all patients. Four patients had mildly elevated levels of at least one antiphospholipid antibody; none had a positive lupus anticoagulant test result. Overall, all patients demonstrated abnormalities on hypercoagulability tests. CONCLUSIONS: Thromboembolic complications occur at a high rate (8.6%) in lung transplant recipients and are associated with abnormalities in hypercoagulability. The cause remains unclear. Our results should prompt a high index of suspicion for these potentially fatal complications, which would lead to early diagnosis and successful treatment.

Adolescent↗
PubMed2002

Venous thromboembolism: implications for gene-based diagnosis and technology development.

Venous thromboembolism is an hypercoagulable state that frequently reflects a complex interplay between inherited, acquired and environmental factors. The overall incidence of venous thromboembolism, which increases with age, is approximately 1:1000 in the US and Western Europe. In addition to known risk factors such as pregnancy and cancer, genetic variants can also increase the venous thromboembolism risk. Once such genetic variant, FV Leiden is characterized by single-point mutation and has been found in approximately 20% of idiopathic venous thromboembolism cases. The discovery of FV Leiden unleashed an increased interest in the genetics of venous thromboembolism as well as other cardiovascular diseases. Because FV Leiden was not only defined by only one common single nucleotide polymorphism but was also widely prevalent, impetus for the development of novel mutation detection methodologies and platforms for DNA analysis in both the clinical and research laboratory was greatly accelerated. An overview of this technology and its relationship to the genetics of venous thromboembolism is reviewed.

Activated Protein C Resistance↗
PubMed2000

Anticoagulant treatment of thromboembolism with intravenous heparin therapy in the early postoperative period following total joint arthroplasty.

BACKGROUND: Treatment of thromboembolism with intravenous heparin therapy in the early postoperative period after total joint arthroplasty has been associated with a high rate of complications. The purpose of the present study was to compare the rate of bleeding complications in a group of patients who required intravenous heparin therapy for the treatment of thromboembolism after total hip or knee arthroplasty with the rate in a control group of patients who received only prophylactic anticoagulation. METHODS: The postoperative courses of forty-four consecutive patients who were managed with intravenous administration of heparin and oral administration of warfarin for the treatment of a thromboembolic event following unilateral total hip or knee arthroplasty were compared with those of a control group of 376 consecutive patients who had these same procedures but did not have a thromboembolic complication. The patients in the control group were managed with prophylactic anticoagulation with use of enoxaparin. Sixty-eight percent (thirty) of the forty-four patients in the heparin group received the initial dose of heparin on or before the fourth postoperative day, and 82 percent (thirty-six) received an initial bolus of 5000 units of heparin at the initiation of therapy. RESULTS: The rate of bleeding complications was 9 percent (four of forty-four) in the heparin group, compared with 6 percent (twenty-three of 376) in the control group (p = 0.44). The mean transfusion requirement in the heparin group (1.8 units of packed red blood cells) was significantly greater than that in the control group (0.8 unit) (p < 0.0001). Three of the four patients who had a bleeding complication while receiving heparin and warfarin had coagulation parameters that were substantially higher than recommended levels. The mean duration of hospitalization in the heparin group (fifteen days) was significantly longer than that in the control group (seven days) (p < 0.0001). CONCLUSIONS: The results of the present study suggest that the use of intravenous heparin therapy for the treatment of thromboembolism in the early postoperative period after total joint arthroplasty is associated with a rate of bleeding complications that is similar to that associated with the use of prophylactic anticoagulation with use of enoxaparin alone. One should expect an increased transfusion requirement and a longer duration of hospitalization for patients who require intravenous heparin therapy for the treatment of a thromboembolic event.

Adult↗
PubMed2001

Prolonged enoxaparin therapy to prevent venous thromboembolism after primary hip or knee replacement. Enoxaparin Clinical Trial Group.

BACKGROUND: Patients undergoing hip or knee joint replacement are at risk for venous thromboembolic complications for up to twelve weeks postoperatively. We evaluated the efficacy and safety of a prolonged post-hospital regimen of enoxaparin, a low-molecular-weight heparin, in this patient population. METHODS: Following elective total hip or knee replacement, 968 patients received subcutaneous enoxaparin (30 mg twice daily) for seven to ten days, and 873 were then randomized to receive three weeks of double-blind outpatient treatment with either enoxaparin (40 mg once daily) or a placebo. The primary efficacy end point was the prevalence of objectively confirmed venous thromboembolism or symptomatic pulmonary embolism during the double-blind phase of treatment. RESULTS: Of the 873 randomized patients, 435 underwent elective total hip replacement and 438 underwent elective total knee replacement. Enoxaparin was superior to the placebo in reducing the prevalence of venous thromboembolism in patients treated with hip replacement: 8.0% (eighteen) of the 224 patients treated with enoxaparin had venous thromboembolism compared with 23.2% (forty-nine) of the 211 patients treated with the placebo (p < 0.001; odds ratio, 3.62; 95% confidence interval, 2.00 to 6.55; relative risk reduction, 65.5%). Enoxaparin had no significant benefit in the patients treated with knee replacement: thirty-eight (17.5%) of the 217 patients treated with enoxaparin had venous thromboembolism compared with forty-six (20.8%) of the 221 patients treated with the placebo (p = 0.380; odds ratio, 1.24; 95% confidence interval, 0.76 to 2.02; relative risk reduction, 15.9%). Symptomatic pulmonary embolism developed in three patients, one with a hip replacement and two with a knee replacement; all had received the placebo. There was no significant difference in the prevalence of hemorrhagic episodes or other types of toxicity between the enoxaparin and placebo-treated groups. CONCLUSIONS: Prolonging enoxaparin thromboprophylaxis following hip replacement for a total of four weeks provided therapeutic benefit, by reducing the prevalence of venous thromboembolism, without compromising safety. A similar benefit was not observed in patients treated with knee replacement.

Adult↗
PubMed1995

Bleeding and thromboembolism during anticoagulant therapy: a population-based study in Rochester, Minnesota.

OBJECTIVE: To estimate the incidence of and identify risk factors for hemorrhage and thromboembolism during long-term anticoagulant therapy. DESIGN: We conducted a population-based retrospective cohort study of all residents of Rochester, Minnesota, in whom a course of warfarin therapy intended to last for more than 4 weeks was initiated between Sept. 1, 1987, and Dec. 31, 1989. METHODS: Medical records were reviewed, and pertinent data were compiled. All bleeding complications were classified as minor or major on the basis of the bleeding severity index, and thromboembolic events were classified as major if they were fatal or life-threatening. Cumulative incidences of adverse events were analyzed statistically. RESULTS: During the study period, 261 patients had incident courses of anticoagulation (52% were male, 61% were 65 years of age or older, and 31% were 75 years of age or older), with 221 patient-years of warfarin exposure. The primary indications for anticoagulation were venous thromboembolism (39%); stroke or transient ischemic attack (21%); atrial fibrillation (11%); and coronary artery disease, procedures for coronary artery disease, or cardiomyopathy (7%). The cumulative incidence of major hemorrhage at 1, 3, 12, and 24 months was 1.6%, 3.3%, 5.3%, and 10.6%, respectively, and of major or minor thromboembolic events was 2.3%, 5.0%, 7.4%, and 13.1%, respectively. In multivariate analysis, (1) a malignant condition was significantly associated with major hemorrhage; (2) malignant disease and history of peptic ulcer were significantly associated with the combined outcome of major or minor hemorrhage; and (3) malignant disease was significantly associated with any thromboembolism. Age, sex, atrial fibrillation, history of gastrointestinal hemorrhage, history of peptic ulcer, alcohol abuse, hypertension, stroke, and the Charlson comorbidity index were not significantly associated with major hemorrhage. CONCLUSION: In this population-based study, including a high proportion of elderly patients, malignant disease at initiation of warfarin anticoagulation was significantly associated with both major hemorrhage and any thromboembolism. Advanced age is not a contraindication to anticoagulant therapy.

Age Factors↗
PubMed1997

Variability in anticoagulation control predicts thromboembolism after mechanical cardiac valve replacement: a 23-year population-based study.

OBJECTIVE: To assess optimal control of blood anticoagulation to maximize antithrombotic protection after mechanical cardiac valve replacement. DESIGN: A population-based study of 96 patients with a mean follow-up of 7.7 years (range, 1 month to 23 years) was performed in Olmsted County, Minnesota, and 10,301 prothrombin time (PT) ratios were determined after mechanical heart valve replacement. MATERIAL AND METHODS: PT ratios were analyzed in a new time-dependent Cox proportional-hazards model by defining an algorithm for comparing variability in PT ratios at each month of follow-up and relating these to thromboembolic events. The new method was compared with several conventional time-independent definitions. RESULTS: During 740 person-years of follow-up, 19 of 96 patients (20%) had 27 thromboembolic events. Of these 19 patients, 8 (42%) had events within 3 months after valve replacement. Freedom from any thromboembolic event was 72% at 15 years. The event rate was high (7.5% per year) during high variability and low (0.9% per year) during low variability in the PT ratio. This relationship was lost when time dependence was removed. More PT ratios were less than 1.5 during high (27%) than during low (19%) variability. Several conventional definitions of adequacy of anticoagulation that averaged PT ratios before a thromboembolic event or throughout follow-up or that compared the proportion of PT ratios above or below a fixed ratio did not define or only partially defined different thromboembolic risks. CONCLUSION: Periods of high and low variability of PT ratios define high and low risk of thromboembolism, respectively.

Adult↗
PubMed1997

Factor V Leiden mutation and the risks for thromboembolic disease: a clinical perspective.

BACKGROUND: A single point mutation in the gene coding for coagulation factor V results in a form of factor Va that is resistant to degradation by activated protein C and leads to a relative hypercoagulable state. This mutation, factor V Leiden, is found in 4% to 6% of the U.S. population. PURPOSE: To review clinical data on factor V Leiden mutation, with emphasis on prevalence of and risks for thromboembolism and implications for screening and management. DATA SOURCES: A MEDLINE search of the English-language literature published between 1993 and April 1997 and an extensive bibliography review. STUDY SELECTION: Case-control and prospective cohort studies were reviewed if clinical features of thromboembolic disease associated with factor V Leiden mutation or resistance to activated protein C were presented. Original research articles were reviewed if they addressed the identification of the laboratory abnormality of activated protein C or factor V Leiden mutation. Case reports and case series were reviewed when no analytic data were available. DATA EXTRACTION: Review of the identified articles. DATA SYNTHESIS: Factor V Leiden mutation is associated with three- to sixfold increases in risks for primary and recurrent venous thromboembolism, especially in patients without transient risk factors, such as surgery or trauma. Risks for venous thromboembolism in genetically affected persons are substantially higher among patients with coexistent predispositions for thrombosis, such as advanced age, use of oral contraceptives, hyperhomocystinemia, and deficiencies of protein C and protein S. Factor V Leiden mutation does not seem to increase risks for arterial thrombosis. Whether patients with the mutation would benefit from more intense or prolonged anticoagulation is unknown. CONCLUSIONS: The presence of factor V Leiden mutation predisposes patients to venous thromboembolism, but screening for this disorder is of uncertain utility. Decisions about whether to screen for the mutation will depend on the results of clinical trials designed to evaluate the benefit-to-risk ratio of long-term anticoagulation in the secondary prevention of venous thromboembolism in patients with resistance to activated protein C.

Contraceptives, Oral↗
PubMed1999

[Survey of atrial fibrillation and thromboembolism in the elderly: a multicenter cooperative study. Research Group for Antiarrhythmic Drug Therapy].

A multicenter, retrospective study was undertaken to survey the prevalence of thromboembolism complicated with atrial fibrillation and the efficacy of treatment in both elderly and younger patients. The primary prevention group consisted of 1,810 patients without prior cerebral thromboembolism, and was divided into the elderly patient group (> or = 65 years old, 588 patients) and younger patient group (< 65 years old, 1,222 patients). The elderly group had higher prevalences of chronic atrial fibrillation (65.3% vs 56.4%, p < 0.001) and ischemic heart disease and hypertension (16.8% vs 9.3% and 34.2% vs 24.4%, respectively, p < 0.001) and lower prevalence of treatment with warfarin (9.2% vs 20.1%, p < 0.001). Elderly patients with mitral valve disease and hypertension had lower prevalence of treatment with warfarin as compared with younger patients (p < 0.001). This was also true for the secondary prevention group of 147 patients with prior history of cerebral infarction (p < 0.001). During the mean follow-up period of 4.6 years, patients with underlying cardiac diseases had a higher risk of thromboembolism compared with those without cardiac diseases for both the elderly (12.1% vs 6.1%, p < 0.05) and younger (7.5% vs 3.6%, p < 0.02) groups. Treatment with antiplatelets or warfarin could reduce the risk of thromboembolism in the elderly group (p < 0.1) and the younger group (p < 0.001). The risk of major hemorrhagic complication, i.e., gastrointestinal tract or intracranial hemorrhage, was quite low in patients receiving antithrombotic drugs. The present study indicates that the attitude toward the use of warfarin for prevention of thromboembolism is conservative and the risk of thromboembolism is higher in elderly patients with atrial fibrillation in Japan. Our attitude to the use of antithrombotic drugs in elderly patients with atrial fibrillation needs to be modified.

Aged↗
PubMed1999

APC-resistance is a risk factor for postoperative thromboembolism in elective replacement of the hip or knee--a prospective study.

Postoperative venous thromboembolic complications are commonly seen after total replacement of the hip or knee. Recently, an inherited defect with resistance to the anticoagulant activity of activated protein C (APC-resistance) has been detected. APC-resistance seems to be a common risk factor, especially in Sweden, and it increases the propensity for venous thrombosis. This study assesses the prevalence of APC-resistance in a general population and its clinical significance for patients undergoing surgery associated with a high risk of thromboembolic complications. In a prospective cohort study, we analysed for APC-resistance in 645 consecutive patients before elective replacement of the hip or knee at 3 hospitals in southern Sweden. Thromboprophylaxis with LMWH-heparin was given to all patients throughout the hospitalisation period. We recorded events of clinical thromboembolism for 3 months postoperatively. Venography, ultrasonography or pulmonary scintigraphy was requested by the clinicians according to the existing routines, i.e. only patients with symptoms of thromboembolism were examined. A thromboembolic complication was registered in 20 (3.1%) patients. Fifty per cent of the venous thrombi had a proximal location. Only 0.3% of the patients had verified pulmonary embolism. APC-resistance was found in 14.1% of the patients, of whom 9.9% had experienced postoperative thromboembolism compared with 2.0% of the patients without APC-resistance (p<0.0007). We conclude that APC-resistance is a frequent risk factor for symptomatic postoperative deep venous thrombosis with an estimated relative risk of 5.0 (95% confidence interval: from 1.9 to 12.9) in elective replacement of the hip or knee.

Activated Protein C Resistance↗
PubMed1999

[Thromboembolism--genetic and acquired risk factors].

Within the last few years, the knowledge of hereditary and acquired risk factors for venous thromboembolism has increased. Antithrombin-, protein C- and protein S-deficiency have been known since a long time as hereditary risk factors. Since 1993, three hitherto unknown risk factors have been described, the APC (activated protein C) resistance, hyperhomocysteinemia and a polymorphism in the 3-UT region of the prothrombin gene. These risk factors are relatively common in the normal population (in total 10-15%) and are found in 30-50% of patients with venous thromboembolism. The most important acquired risk factor for thromboembolism is the antiphospholipid antibody syndrome (APLS). The APLS is found in around 3% of patients with thromboembolism, patients with these abnormalities have a high risk for recurrency. The upper mentioned risk factors for thromboembolism do not only increase the risk for spontaneous thrombosis, but also the risk for thrombosis during typical high risk situations, such as surgery, trauma of the lower extremities, pregnancy and delivery. APC resistance and antithrombin deficiency increase the risk for development of thrombosis during oral contraceptive intake. Patients, in whom one of the upper mentioned risk factors have been diagnosed, should receive thrombosis prophylaxis during high risk situations. Not all patients with one thromboembolic event and a known risk factor are candidates for long-term oral anticoagulant treatment. Long-term oral anticoagulant treatment should be introduced after exclusion of major contraindications in patients with recurrent events, patients with a combination of risk factors and a life threatening event.

Contraceptives, Oral↗
PubMed1999

[Major thromboembolic complications during oral anticoagulant therapy. Importance of level of anticoagulation].

PURPOSE: The incidence of major thromboembolic complications in patients on oral anticoagulant therapy (OAT) and the correlation of this with the intensity of the OAT and the INR level at the time of the episode have been assessed in our study. PATIENTS AND METHODS: We have carried out a retrospective study including 1350 patients with an overall follow-up period of 6432 patient-years. The mean INR level throughout OAT and at the time of the mayor thromboembolic event were considered. The statistical analysis was performed by means of a survival analysis test. RESULTS: The incidence of major thromboembolic complications found in our study was 1.18/100 patient-years. Those patients with a mean INR below the therapeutic range showed significantly a higher risk (3.31 times higher) of suffering from some sort of major thromboembolic complication. Mean INR level at the time of the event was 1.9 and 47% of those patients had an INR level < 2 at the time of the thromboembolic complication. CONCLUSIONS: The probability of suffering a major thromboembolic complication for those subjects on OAT increases as the INR falls below the therapeutic range; therefore we must pay special attention to this factor in order to avoid any further recurrences.

Administration, Oral↗
PubMedDate not supplied

[Venous thromboembolism and neoplasms].

Venous thromboembolism, including deep vein thrombosis and pulmonary embolism, is a major cause of morbidity and mortality. In most cases, one or more risk factors for removable or persistent venous thromboembolism can be identified. Persistent risk factors include inherited or acquired abnormalities of the hemostatic system and cancer. As Armand Trousseau first suggested, venous thromboembolism may be the first clinical manifestation of an occult cancer. This relationship has recently been confirmed by methodologically well designed studies. Furthermore, venous thromboembolism is the second cause of death in patients with clinically overt cancer. This review summarizes the state of the art of this association. The clinical trials described focus on the need to perform screening for occult cancer in patients with idiopathic venous thromboembolism. How extensive this screening should be is still matter of debate. On the other hand, patients with clinically overt cancer should be considered at high risk for developing venous thromboembolism, and adequate prophylaxis should be used.

Humans↗
PubMed2001

[Spinal anesthesia: a protective factor in thromboembolic disease. A retrospective cohort study of 484 arthroplasties].

OBJECTIVES: To compare general and spinal anesthesia in the context of thromboembolic disease after orthopedic surgery in patients receiving prophylactic therapy with low molecular weight heparins. PATIENTS AND METHOD: Of the 484 arthroplasties studied retrospectively, 209 involved total hip prostheses, 111 partial hip prostheses and 164 total knee prostheses. Spinal anesthesia (epidural or subarachnoid) was provided in 328 cases and general anesthesia in 156. Thromboembolic disease was diagnosed if the patient presented a compatible clinical picture or if there was confirmation by Doppler ultrasonography and/or venography for deep venous thrombosis or by scintigraphy for pulmonary embolism. Related factors studied were age; weight; prior fractures of the lower extremity; a history of thromboembolism, diabetes, high blood pressure or heart disease; and medication. RESULTS: Twenty-one patients experienced thromboembolic complications, 12 after general anesthesia and 9 after spinal anesthesia, the incidence in the latter being significantly lower (p < 0.01, odds ratio 3.23, 95% CI). Multivariant analysis also showed a significant increase in thromboembolic disease (p = 0.05) among patients over 70 years of age (odds ratio 2.67, 95% CI). CONCLUSIONS: Spinal anesthesia provides some protection against thromboembolic disease in arthroplasty. Age is a risk factor.

Adolescent↗
PubMed2002

Thromboembolic prophylaxis for patients with a fracture of the proximal femur.

Patients with a fracture of the proximal femur are at high risk for thromboembolic complications necessitating some form of preoperative and postoperative thromboembolic prophylaxis. Despite the knowledge that patients with a proximal femur fracture are at particularly high risk for both deep venous thrombosis and pulmonary embolism, there is no consensus on which strategy is most effective at preventing thromboembolic events in this patient population. The pathophysiology and associated risk factors for thromboembolic complications in this patient population are discussed. We present a review of studies that address the efficacy and safety of both mechanical and pharmacological methods of thromboembolic prophylaxis to assist the orthopedic surgeon in selecting among the different modalities available for thromboembolic prophylaxis.

Anticoagulants↗
PubMed2002

[Long-term outcome of acute massive pulmonary thromboembolism following thrombolysis].

OBJECTIVE: To evaluate in-hospital course and long-term outcome of acute massive pulmonary thromboembolism after thrombolysis and to determine its prognostic factors. METHODS: A total of 260 patients was retrospectively reviewed and followed up for 3.9 - 8.4 years. Close attention was paid to the clinical events, including death, recurrent thromboembolic events, chronic thromboembolic pulmonary hypertension, bleeding complications attributed to anticoagulant therapy, and requirement of oxygen therapy at home. Kaplan-Meier event-free survival curves were generated. RESULTS: The in hospital mortality rate was 8.5%, in which 68.2% were due to pulmonary thromboembolism itself, and the follow-up mortality rate was 31.7%, in which 29.2% were due to recurrent embolism. Univariate analysis showed that six variables were associated with the occurrence of clinical events: (1) Prior thromboembolic diseases; (2) Duration of anticoagulant therapy less than 6 months; (3) Inferior vena cava filter placement; (4) Remaining right ventricular dysfunction/dilatation after thrombolysis detected by echocardiography; (5) Systolic pulmonary pressure > 50 mm Hg after thrombolysis by echocardiography; (6) Greater than 30% residual obstruction of pulmonary vasculature identified by lung ventilation/perfusion scintigraphy before hospital discharge. Multivariate analysis identified three independent risk factors for long-term mortality of acute massive pulmonary thromboembolism after thrombolysis: (1) Systolic pulmonary artery pressure > 50 mm Hg (RR: 3.78, 95% CI = 2.70 - 4.86); (2) Right ventricular dysfunction/dilatation (RR: 2.18, 95% CI = 1.48 - 2.88); (3) Greater than 30% obstruction of pulmonary vasculature (RR: 1.99, 95% CI = 1.25 - 2.70). CONCLUSIONS: Doppler echocardiographic assessment after thrombolysis and ventilation/perfusion scintigraphy prior to hospital discharge are valuable to establish a new baseline condition, which is informative for risk stratification and prognostication of long-term outcome.

Aged↗
PubMed1992

The prevalence of factor XII deficiency in 103 orally anticoagulated outpatients suffering from recurrent venous and/or arterial thromboembolism.

One hundred and three patients suffering from recurrent venous thrombosis, recurrent arterial thromboembolism and/or recurrent myocardial infarction and 50 healthy subjects were tested for Hageman factor (FXII) coagulant activity and antigen. Among the 103 patients we identified 15 subjects with FXII deficiency (15%), 3 with protein C deficiency (3%) and 3 with protein S deficiency (3%). Combined FXII and protein C, protein S or antithrombin III deficiency was not observed. The 103 patients were divided into subgroups according to the type of thrombotic complication. Among patients with exclusively recurrent venous thromboembolism 8% (p = 0.153) were deficient in FXII. Among patients suffering from recurrent arterial thromboembolism and/or myocardial infarction, the incidence of FXII deficiency was significantly higher (20%, p less than 0.003). In 67% of the patients with FXII deficiency a positive family history of thrombosis could be established. In contrast, only 32% of all venous and 28% of all arterial thrombosis patients had a positive family history. We believe that reduced levels of FXII should be considered as a risk factor in the development of thromboembolism. Consequently, more attention should be payed to the measurement of FXII when evaluating thromboembolic risk factors especially in cases of recurrent arterial thromboembolism and/or myocardial infarction.

Acenocoumarol↗
PubMed2003

[An aetiological survey of venous thromboembolic disease. What examinations for which patients? 104 observations].

OBJECTIVE: The objective of the study was to determine, depending on the risk profile of the patients and characteristics of the venous thromboembolic disease (VTED), the interest of an aetiological control in the search for a neoplasia or abnormality in haemostasis among a cohort of patients hospitalised for deep-vein thrombosis (DVT) and/or pulmonary embolism (PE). METHOD: This was a single centre, retrospective study of 104 files of patients hospitalised over a period of 3 years for DVT and/or PE in a department of internal medicine, in an intensive care unit. The patients included must have been diagnosed with DVT and/or PE, confirmed by respectively venous Doppler, pulmonary scintigraphy and pulmonary angiography or spiralled tomodensitometry. The thromboembolic risk factors and the supplementary examinations conducted for etiological research were analysed. RESULTS: In our population, with a mean age of 71.4 years, 98 patients exhibited at least one thromboembolic risk factor. The thromboembolic episode was considered as idiopathic in 33 patients, i.e. in 31.7%. An abnormality in haemostasis was discovered in 10 patients, with a mean age of 57.5 years and 7 exhibited personal or familial past history of venous thromboembolic disease. Nine neoplasia were discovered, 4 of which were at metastatic stage. There was no significant difference in discovery of a neoplasia with regard to age, but it was more frequent in cases of seemingly idiopathic thrombosis. Anamnesis and the clinical examination suggested its existence in 6 patients. Abdominal-pelvic sonography was sufficient to orient the etiological research in 7 cases. The other examinations without clinical orientation (endoscopy, tumour markers) provided no further contribution. CONCLUSION: We feel that systemic exhaustive survey in search of the etiology of a DVT/PE in all patients is not warranted. Simple explorations--including interrogation, complete clinical examination, current biological examinations (blood count, sedimentation rate), pulmonary x-ray and abdominal-pelvic sonography--were evocative in our series. Haemostasis tests should be reserved for young patients or for those in whom thromboembolic events occur repeatedly. The more specific examinations should be set-aside for patients in whom this first assessment has not suggested an underlying carcinoma.

Adult↗
PubMed1992

The prevalence of risk factors for venous thromboembolism among hospital patients.

BACKGROUND: This study provides an estimate of the prevalence of risk factors for venous thromboembolism among hospital patients. METHODS: The presence of risk factors for venous thromboembolism was determined from a retrospective review of the medical records of 1,000 randomly selected patients in 16 acute care hospitals in central Massachusetts. RESULTS: The most common risk factors for venous thromboembolism were age 40 years (59%) or more, obesity (28%), and major surgery (23%). The average number of risk factors increased with increasing age. One or more risk factors for venous thromboembolism were present in 78% of hospital patients, two or more in 48%, three or more in 19%, four or more in 6%, and five or more in 1%. CONCLUSION: Risk factors for venous thromboembolism are common among hospital patients, suggesting that prophylaxis should be widely employed. The cost-effectiveness and risk benefit of prophylaxis is well established in patients undergoing major surgery. Further studies are needed to confirm the benefit of prophylaxis in patients with nonsurgical risk factors for venous thromboembolism.

Age Factors↗