Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “THROMBOEMBOLISM”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 361 records · Page 20Linked to original sources

Pulmonary thromboembolism and venous thrombosis in the Chinese.

In 3,876 autopsies performed between 1964 and 1974 in adult Hong Kong Chinese, the incidence of pulmonary thromboembolism was 0.75%. In a prospective study of 70 autopsies, the right lungs were inflated, fixed, slab-sectioned, and studied for pulmonary thromboembolism. Twenty-seven per cent had evidence of pulmonary thromboembolism, although in only one case was the lesion the cause of death. In another 62 autopsies, routine dissection of pelvic and both lower extremity veins revealed that 18% had evidence of thrombosis. Eighty-three per cent of these had pulmonary thromboembolism; in 3 of these 62 cases (5%) pulmonary thromboembolism was the cause of death. Massive pulmonary thromboembolism in the Hong Kong Chinese is much less frequent than in Caucasians. The finding of many small asymptomatic pulmonary thromboemboli in both racial groups suggests that pulmonary circulation performs a physiologic filtering function. The rarity of massive clots in the Chinese warrants further investigation and special attention to biomechanics of thrombosis formation and detachment.

Adolescent↗

Lupus anticoagulant, high levels of anticardiolipin, and anti-beta2-glycoprotein I antibodies are associated with chronic thromboembolic pulmonary hypertension.

OBJECTIVE: To evaluate the prevalence of lupus anticoagulant (LAC) and anticardiolipin antibodies (aCL), and that of anti-beta2- glycoprotein I (anti-beta2-GPI) and prothrombin antibodies in patients with pulmonary hypertension (PH). METHODS: Fifty-four consecutive patients with PH were studied: 23 with primary, 20 secondary, and 11 chronic thromboembolic PH. LAC was diagnosed by screening and confirmatory coagulation tests, while aCL, anti-beta2-GPI, and prothrombin antibodies were measured by ELISA. RESULTS: Prevalence of aPL was higher in patients with chronic thromboembolic PH compared to the other 2 groups. The prevalence in chronic thromboembolic PH vs primary and secondary PH was: LAC 63.6 vs 13.0 and 10.0%, p < 0.001; aCL-IgG 54.5 vs 17.4 and 15.0%, p < 0.02; anti-beta2-GPI-IgG 36.4 vs 0 and 0%, p < 0.001; and prothrombin antibodies-IgG 36.4 vs 8.7 and 5.0%, p < 0.05. No differences between groups were found for any antibody of IgM isotype. Antibodies detected in patients with primary and secondary PH were of low titer, so considering only moderate or high titers these differences were greater for aCL-IgG (odds ratio, OR 24.6, confidence interval, CI 3.0-282, p = 0.0004) and IgM (OR 35.0, CI 2.9-1692, p = 0.0007) and remained significant for anti-beta2-GPI-IgG (OR = undefined, p = 0.006). Multivariate analysis showed that only LAC and aCL-IgG at moderate or high levels were independent variables associated with chronic thromboembolic PH. CONCLUSION: The presence of LAC, moderate or high levels of aCL-IgG, or anti-beta2-GPI-IgG was strongly associated with that of chronic thromboembolic PH. These data are in agreement with the close relationship observed among these 3 variables and thromboembolism in patients with aPL.

Adult↗

Changing clinical practice. Prospective study of the impact of continuing medical education and quality assurance programs on use of prophylaxis for venous thromboembolism.

OBJECTIVE: To determine the effect of continuing medical education (CME) with and without a quality assurance component (CME+QA) on physician practices in the prevention of venous thromboembolism. METHODS: A communitywide study was performed in 15 short-stay hospitals in central Massachusetts. The study population included 3158 patients in acute-care hospitals with multiple risk factors for venous thromboembolism. Study hospitals were randomly assigned to one of two educational strategies or to a control group that received no intervention. RESULTS: The proportion of patients at high risk for venous thromboembolism who received effective methods of prophylaxis increased significantly from 29% in 1986 to 52% in 1989 (P < .001). This increase was seen in all study groups: control hospitals, 40% to 51% (P < .001); CME hospitals, 21% to 49% (P < .0001); and CME+QA hospitals, 27% to 55% (P < .0001). The increase in prophylaxis use from 1986 to 1989 was significantly greater among patients cared for in hospitals whose physicians participated in a formal CME program (an increase of 28%) than in control hospitals (an increase of 11%) (P < .001). There was no significant difference in the use of prophylaxis in hospitals whose physicians received CME+QA interventions compared with hospitals whose physicians received CME interventions alone (identical increases of 28%). CONCLUSION: A formal CME program significantly increased the frequency with which physicians prescribed prophylaxis for venous thromboembolism. We believe the key factor in our CME interventions that motivated clinicians to change their practices was the provision of hospital-specific data demonstrating a compelling need for improvement. Despite the substantial investment by hospitals in QA, traditional QA intervention appeared to provide no additional benefit. Even after extensive CME/QA interventions, prophylaxis for venous thromboembolism remained underutilized, suggesting the need to develop new approaches to changing clinical practice.

Aged↗

Hyperhomocyst(e)inemia and the increased risk of venous thromboembolism: more evidence from a case-control study.

BACKGROUND: Elevation of plasma homocyst(e)ine level is an independent risk factor for arterial and venous thrombosis. We studied the degree to which hyperhomocyst(e)inemia contributes to the development of venous thromboembolism, using a retrospective case-control study design. METHODS: Cases were individuals with objectively confirmed venous thromboembolism and no history of atherosclerosis seen at the Toronto Hospital Thrombosis Clinic, Toronto, Ontario, between January 1, 1996, and July 31, 1998. Three controls were matched for every case according to sex and age within 5 years and were derived from a large community cohort. All subjects underwent assessment for fasting plasma homocyst(e)ine levels. Hyperhomocyst(e)inemia was defined as a fasting total homocyst(e)ine concentration above the 95th percentile control value. RESULTS: Seventy cases and 210 matched controls were included. Men and women were equally represented, and most were younger than 60 years. Among cases with venous thromboembolism, the mean (+/- SD) plasma homocyst(e)ine level was significantly higher than in controls (13.0 +/- 6.9 micromol/L vs 9.0 +/- 4.8 micromol/L, respectively; P<.001). Sixteen (23%) of 70 cases had hyperhomocyst(e)inemia compared with 10 (5%) of 210 controls (odds ratio, 5.9; 95% confidence interval [CI], 2.5-13.8). Among subjects aged 60 years or younger, the odds ratio was 4.9 (95% CI, 1.4-16.4), while for those aged 60 years or older, it was 7.3 (95% CI, 2.2-24.0). Even with the exclusion of cases showing abnormal renal function or low serum vitamin B12 or folate levels, the odds ratio remained significantly elevated at 3.3 (95% CI, 1.1-10.0). CONCLUSIONS: We found that fasting hyperhomocyst(e)inemia is a significant risk factor for venous thromboembolic disease in patients at a thrombosis clinic. Given the magnitude of effect and consistency across these studies, it is likely that homocyst(e)ine plays a causative role in the development of venous thrombosis, and it should be considered in the workup for venous thromboembolism.

Adult↗

Management of venous thromboembolism: past, present, and future.

Venous thromboembolism, including deep vein thrombosis and pulmonary embolism, represents a significant source of morbidity and mortality in the United States and worldwide. The pharmacologic management of venous thromboembolic disease has witnessed significant advances since oral anticoagulant and heparin therapies began to gain widespread use more than 50 years ago. Cumulative clinical experience gained from using these 2 classes of antithrombotic agents for the prevention and treatment of venous thromboembolism in high-risk patients pointed to a number of efficacy and safety limitations. This prompted further research and the eventual introduction, in the 1980s, of low-molecular-weight heparin(s) as a potentially superior therapeutic modality. Within the last decade the pace of development of newer classes of antithrombotic agents for venous thromboembolism prevention and treatment (as well as other indications) has accelerated. Among agents at late stages of investigation are ximelagatran (a direct thrombin inhibitor), nematode anticoagulant peptide c2 (a tissue factor VIIa inhibitor), and sodium N-[8(2-hydroxylbenzoyl)amino]caprylate (SNAC)/heparin (a heparin derivative). The most recently approved agents for venous thromboembolism indications include the heparinoid, danaparoid sodium, and the newly introduced selective factor Xa inhibitor, fondaparinux.

Anticoagulants↗

Preexisting morbidity as an independent risk factor for perioperative acute thromboembolism syndrome.

HYPOTHESIS: Preexisting morbidities are risk factors for perioperative arterial or venous thromboembolic events and subsequent death within 30 postoperative days. DESIGN: Prospective cohort study. SETTING: University-affiliated general hospital. PATIENTS: A total of 21,903 surgery patients treated from January 1, 1991, through December 31, 2002. MAIN OUTCOME MEASURES: Independent risk factors for perioperative arterial or venous thromboembolic events. RESULTS: History of atrial fibrillation and coronary artery disease increased the risk of myocardial infarction (odds ratio [95% confidence interval], 4.3 [2.8-6.7]). History of stroke increased the risk of stroke (2.4 [1.4-4.1]) and death (4.7 [1.3-17.3]). Diabetes mellitus increased the risk of myocardial infarction (2.1 [1.3-3.2]), and hyperuricemia increased the risk of stroke (3.5 [1.2-9.8]), and both increased the risk of death (4.3 [1.3-14.1] and 11.8 [2.2-63.5], respectively). History of myocardial infarction increased the risk of deep vein thrombosis (7.7 [1.7-34.7]). Cancer increased the risk of all thromboembolism (2.4 [1.9-3.2]). Trend analysis showed that preexisting morbidities will increase 1.5-fold and thromboembolic events will increase 3-fold during the next decade. CONCLUSION: Cardiac and cerebrovascular diseases, metabolic diseases, and cancer are becoming increasingly high-risk comorbidities for perioperative acute thromboembolism syndrome.

Aged↗

Incidence and risk factors of thromboembolism in systemic lupus erythematosus: a comparison of three ethnic groups.

OBJECTIVE: To compare the incidence and risk factors for thromboembolic events in systemic lupus erythematosus (SLE) patients of different ethnic backgrounds. METHODS: SLE patients who were newly diagnosed or were referred within 6 months of diagnosis between 1996 and 2002 were prospectively followed up for the occurrence of thromboembolic events. Cumulative hazard and risk factors for thromboembolism were evaluated and compared among patients of different ethnic origins. RESULTS: We studied 625 patients who fulfilled the American College of Rheumatology criteria for SLE (89% women): 258 Chinese, 140 African Americans, and 227 Caucasians. The mean +/- SD age at SLE diagnosis was 35.7 +/- 14 years. After a followup of 3,094 patient-years, 48 arterial events and 40 venous events occurred in 83 patients. The overall incidence of arterial and venous thromboembolism was 16/1,000 patient-years and 13/1,000 patient-years, respectively. The cumulative hazard of arterial events at 60 months after the diagnosis of SLE was 8.5%, 8.1%, and 5.1% for the Chinese, African Americans, and Caucasians, respectively. The corresponding cumulative risk of venous events was 3.7%, 6.6%, and 10.3%, respectively (P = 0.008 for Chinese versus Caucasians, by log rank test). Smoking, obesity, antiphospholipid antibodies, and use of antimalarial agents and exogenous estrogens were less frequent in the Chinese patients. In Cox regression models, low levels of high-density lipoprotein (HDL) cholesterol, Chinese ethnicity, oral ulcers, and serositis predicted arterial events, whereas male sex, low levels of HDL cholesterol, antiphospholipid antibodies, non-Chinese ethnicity, obesity, renal disease, and hemolytic anemia predicted venous events. CONCLUSION: There are ethnic differences in the incidence of arterial and venous thromboembolism in patients with SLE that cannot be fully explained by the clinical factors studied. Further evaluation of other genetic and immunologic factors is warranted.

Adult↗

Heparin with and without graded compression stockings in the prevention of thromboembolic complications of major abdominal surgery: a randomized trial.

One hundred and seventy-six patients scheduled for elective major abdominal surgery were randomized to two prophylactic regimens to prevent postoperative thromboembolism. All patients were screened with the 125I-labelled fibrinogen uptake test, and thromboembolism was verified by ascending phlebography and/or perfusion/ventilation lung scintigraphy. In the group of patients receiving low-dose heparin treatment (5000 units twice daily subcutaneously) 12 per cent developed thromboembolic complications. In the other group, where low-dose heparin treatment was supplemented with graded compression stockings only 2 per cent developed thromboembolism. It is concluded that the combination of low-dose heparin and the use of graded compression stockings is superior to heparin alone in preventing thromboembolism following major abdominal surgery.

Abdomen↗

Postoperative thromboembolism after day-case herniorrhaphy.

Thromboembolism is a serious complication of surgery and prophylaxis is therefore recommended. This study examines a new aspect of the problem, the incidence of thromboembolism after day-case surgery. From 1982 to 1992, 2281 patients underwent day-case repair for inguinal hernia management. Hospital admission for thromboembolism within the first 30 days after surgery was identified by computer linkage to the National In-Patient Register, which contains details of all hospital admissions in Denmark. One patient developed non-fatal pulmonary embolism. No other patients were admitted to hospital with venous thromboembolism within 30 days of herniorrhaphy. It is concluded that there is no need for routine prophylaxis for thromboembolism in day-case hernia surgery.

Adolescent↗

Effectiveness of an inferior vena caval filter as a preventive measure against pulmonary thromboembolism after abdominal surgery.

In three patients with a previous history of pulmonary thromboembolism, inferior vena caval filters were inserted before elective laparotomies to prevent a recurrent pulmonary thromboembolism. Two patients had colon cancer and underwent colectomies, while the other had myoma uteri, which might have been the cause of deep vein thrombosis, and thus a hysterectomy was performed. In spite of their poor risks, their postoperative courses were fairly good owing to perioperative management including anticoagulant therapy, and no recurrence has been observed since the operation in every case. A pulmonary thromboembolism is a fatal complication which follows deep vein thromboses. In patients with such a previous history, the risk is much higher after a laparotomy because of long-term bed rest, hypercoagulability, and so on. The mortality rate after a recurrence of pulmonary thromboembolism is reported to reach 30% without adequate therapy, whereas it is reduced to 8% with anticoagulant therapy, and to 0.8% with additional inferior vena caval filter placement. Considering the feasibility of insertion and the low incidence of complications, preoperative inferior vena caval filter placement is thus recommended for patients having a previous history of either pulmonary thromboembolism or deep vein thrombosis.

Aged↗

Failure in prophylactic management of thromboembolic disease in colorectal surgery.

The operative courses of 294 elective consecutive colorectal resections were reviewed in order to evaluate the morbidity and mortality of postoperative thromboembolic complications. All patients received low-dose heparin prophylaxis. Fifty-seven patients were screened for deep venous thrombosis with the fibrinogen uptake test, and treatment of thromboembolism was started if the diagnosis was established by venography and/or pulmonary scintigraphy. Neither the morbidity nor mortality from clinical thromboembolic complications was lowered in the group of patients who were screened. Rectal surgery seems to carry a higher risk of postoperative thromboembolic complications than colon surgery, and thromboembolic complications are responsible for about half of the postoperative deaths following elective colorectal surgery.

Aged↗

The risk of venous thromboembolism is markedly elevated in patients with diabetes.

AIMS/HYPOTHESIS: Diabetes mellitus is associated with several changes in coagulation and fibrinolysis that may lead to a thrombogenic propensity. However, it is not known whether these perturbations actually cause increased risk of venous thromboembolism. METHODS: In a retrospective population-based study we evaluated the medical records of all 302 adult patients who were admitted to the Umea University Hospital with verified deep vein thrombosis or pulmonary embolism during the years 1997 to 1999. The patients were classified as diabetic (n=56) and non-diabetic (n=246) according to clinical information. The total number of diagnosed diabetic patients in different age groups in the catchment area was obtained from computerised registries in the primary health care centres and the Umea University Hospital, and data on the background population were collected from the Swedish population registry. RESULTS: The annual incidence rate of venous thromboembolism among diabetic patients in the population was 432 per 100,000 individuals (95% CI 375-496). In non-diabetic individuals it was 78 (95% CI 68-88). The age-adjusted incidence rate among the diabetic population was 274 (95% CI 262-286). The annual incidence rate of venous thromboembolism was elevated in type 1 and type 2 diabetic patients and the incidence rates were 704 (95% CI 314-1,566) and 412 (95% CI 312-544) respectively. The overall standardised morbidity ratio was 2.27 (95% CI 1.75-2.95), i.e. diabetic patients were more prone to venous thromboembolism after adjustment for age differences. CONCLUSIONS/INTERPRETATION: These results suggest that the age-adjusted risk for venous thromboembolism is more than two-fold higher among diabetic patients than in the non-diabetic background population.

Adult↗

Current use of thromboembolism prophylaxis for laparoscopic cholecystectomy patients in Sweden.

BACKGROUND: The need for thromboembolism (TE) prophylaxis during laparoscopic surgery is not well established. The aim of this study was to investigate current TE prophylaxis in patients undergoing laparoscopic cholecystectomy (LC) in Sweden. METHODS: Mail questionnaire to all Surgical Departments in Sweden about the current use of thromboembolism prophylaxis in patients undergoing laparoscopic cholecystectomy. RESULTS: The response rate was 78 of 80 departments of surgery (98%). Seventy reported performing LC. Thirty-six percent used thromboembolism prophylaxis in all patients, 17% in most, 9% in half their patients and 39% only rarely. The current use of thromboembolism prophylaxis ranged from low-molecular-weight heparin for 7 days + stockings in all patients to no prophylaxis at all in the majority of patients. CONCLUSIONS: The use of thromboembolism prophylaxis in LC patients is highly variable, even in the small and homogenous country of Sweden. Further studies concerning the risk of TE complications after laparoscopic surgery are warranted.

Cholecystectomy, Laparoscopic↗

Cardiac thrombosis and thromboembolism in chronic Chagas' heart disease.

A retrospective study of Chagas' heart disease was carried out by a review of 1,345 autopsy reports, with special reference to cardiac thrombus and thromboembolic phenomena. The incidence of cardiac thrombus was higher in cases of heart failure (36%) than in cases of sudden death (15%), higher in heavier hearts, and unrelated to age or sex. The left- and right-sided cardiac chambers were equally affected by thrombus. Endocarditis and blood stasis were considered important factors in the pathogenesis of cardiac thrombus. Thromboembolic phenomena were more common in the systemic circulation but caused relatively more deaths by pulmonary embolism. Fourteen percent of patients with thromboembolic phenomena died from them. Patients with multiple thromboembolic phenomena had a higher risk of death from embolism. Cardiac thrombosis or thromboembolic phenomena, or both, were present in 44% of the cases studied. Prophylactic measures should be taken for these important complications of Chagas' heart disease.

Arterial Occlusive Diseases↗

Osteoporotic fractures and the recurrence of thromboembolism during pregnancy and the puerperium in 184 women undergoing thromboprophylaxis with heparin.

OBJECTIVE: To study the effect of long-term treatment during gestation with heparin on the incidence of osteoporotic fractures and thromboembolic recurrence. STUDY DESIGN: Long-term subcutaneous prophylaxis with heparin twice daily in pregnancy was prescribed for 184 women, during a decade because of an increased risk of thromboembolism. The dosage of heparin was adjusted to anti-factor Xa activity or activated partial thromboplastin time and different regimens were given, depending on the risk of recurrence. RESULTS: For the total group the mean dosage of heparin ranged from 13,000 to 40,000 IU per 24 hours (mean 19,100 IU per 24 hours), and the average duration of treatment was 25 weeks. Symptomatic osteoporotic fractures of the spine occurred post partum in four women, for whom the mean dosage of heparin ranged from 15,000 to 30,000 IU per 24 hours (mean 24,500 IU per 24 hours), and the duration of treatment ranged from 7 to 27 weeks (mean 17 weeks). In spite of prophylaxis with heparin, thromboembolic complications occurred in five women. They had either nonsatisfactory concentrations of heparin according to our regimen or were later diagnosed as having a coagulation disorder known to increase the risk of thromboembolism. CONCLUSION: Osteoporotic vertebral fractures were found in 2.2% of the women, and a relationship to the amount of heparin was indicated, although fractures were not avoided during low-dose, short-term prophylaxis. Recurrence of thromboembolism occurred in 2.7% of the patients, but if a strict heparin adjustment had been performed, recurrence could probably have been prevented.

Drug Administration Schedule↗

Resistance to activated protein C as a basis for venous thromboembolism associated with pregnancy and oral contraceptives.

OBJECTIVE: Inherited resistance to activate protein C, which is caused by a single factor V gene mutation, is a frequent risk factor for thrombosis. The purpose of this study was to determine the prevalence of activated protein C resistance in women with thromboembolic complications that had occurred in connection with pregnancy or use of oral contraceptives. STUDY DESIGN: Activated protein C resistance was analyzed in women with previous thromboembolic complications in connection with pregnancy (n = 34) or oral contraceptives (n = 28), in healthy fertile women (n = 57), and in women during normal pregnancy (n = 18). Results of the activated protein C resistance test were expressed as activated protein C ratios, values < 2 indicating activated protein C resistance. RESULTS: Activated protein C resistance was found in almost 60% of women with thromboembolic complications during pregnancy and in around 30% of women with thromboembolic complications during treatment with oral contraceptives. In nonpregnant controls approximately 10% had activated protein C resistance. In normal pregnancy activated protein C ratios were similar to those of normal controls. CONCLUSIONS: Activated protein C resistance, which is caused by a genetic defect in the factor V gene, was found to be highly prevalent in women with a history of thromboembolic complications during pregnancy. The gene defect is common in the general population, and the results evoke the question whether it would be reasonable to perform general screening for activated protein C resistance early during pregnancy or before prescription of oral contraceptives.

Adolescent↗

Plasmin-a2-plasmin inhibitor complex in plasma of patients with thromboembolic diseases.

Plasmin generation in vivo was assessed by measuring plasma levels of plasmin-a2-plasmin inhibitor complex (PAP) with an ELISA in 42 patients with arterial or venous thromboembolic diseases. Plasma concentration of PAP was markedly elevated in patients with venous thromboembolic diseases during acute illness (3.32 +/- 3.71 ug/ml, mean +/- SD) as compared to healthy subjects (0.24 +/- 0.13 ug/ml, n = 14), while it was nearly normal (0.30 +/- 0.13 ug/ml) in patients with venous thromboembolic diseases in chronic stage. Patients with arterial thromboembolism had modestly elevated PAP; 1.05 +/- 0.77 ug/ml during acute episode, and 0.84 +/- 0.40 ug/ml in chronic stage. These results indicate that excessive activation of fibrinolytic system (plasmin generation in vivo) occurs actually in many patients with thrombotic diseases, especially in venous thromboembolic diseases during acute illness.

Acute Disease↗

Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality.

OBJECTIVE: The purpose of this study was to estimate the incidence, risk factors, and mortality from pregnancy-related venous thromboembolism. STUDY DESIGN: The Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality for the years 2000 to 2001 was queried for all pregnancy-related discharges with a diagnosis of venous thromboembolism. RESULTS: The rate of venous thromboembolism was 1.72 per 1000 deliveries with 1.1 deaths per 100,000. The risk of venous thromboembolism was 38% higher for women ages 35 and older and 64% higher for black women. Other significant risk factors included thrombophilia, lupus, heart disease, sickle cell disease, obesity, fluid and electrolyte imbalance, postpartum infection, and transfusion. The risk factor with the highest odds ratio, 51.8 (38.7-69.2) was thrombophilia. CONCLUSION: The incidence of pregnancy-related venous thromboembolism was higher than generally quoted. Women ages 35 and older, black women, and women with certain medical conditions and obstetric complications appear to be at increased risk.

Adult↗