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PubMedDate not supplied

Thromboembolic events associated with balloon-assisted coil embolization: evaluation with diffusion-weighted MR imaging.

BACKGROUND AND PURPOSE: Thromboembolic events may occur during or after the treatment of intracranial aneurysms with Guglielmi detachable coils (GDCs). The purpose of this study was to determine the frequency of thromboembolic events associated with balloon-assisted coil placement and to investigate possible risk factors for these events during balloon-assisted coil placement and embolization. METHODS: Twenty patients with cerebral aneurysms treated with balloon-assisted coil placement and embolization at our institution were included. All patients underwent diffusion-weighted (DW) imaging within 6 hours after the procedure. Two neuroradiologists reviewed all DW images to detect ischemic lesions. RESULTS: Hyperintense lesions compatible with thromboembolic events were detected on DW images of four (20%) patients. Three lesions were in the territory of posterior circulation, and one was in the territory of anterior circulation. The occurrence of new lesions was strongly associated with the number of times the microcatheter or coil was repositioned and removed and with the size of the aneurysmal neck (P < .01). DW imaging findings did not suggest a strong correlation between the occurrence of new ischemic lesions and potential risk factors (maximum balloon inflation time, number of times the balloon was inflated, etc.) associated with balloon-assisted coil placement and embolization (P > .05). CONCLUSION: The risk of thromboembolic events during the treatment of intracranial aneurysms with balloon-assisted techniques is not more significant than when conventional GDC techniques are used. The only variables found to influence this risk during or after balloon-assisted coil placement were microcatheter repositioning, coil removal and repositioning, and size of the aneurysmal neck.

Adult↗
PubMed2005

Thromboembolic complications of malignancy. Part 1: Risks.

Thromboembolism affects many patients with solid tumors and clonal hematologic malignancies. Pathogenetic mechanisms include inflammatory- and tissue factor-mediated coagulation, natural anticoagulant deficiencies, fibrinolytic alterations, hyperviscosity, and activation of platelets, endothelial cells, and leukocytes. High rates of venous thromboembolism (VTE) occur with advanced pancreatic, breast, ovarian, germ cell, lung, prostate, and central nervous system cancers. Hodgkin disease, non-Hodgkin's lymphoma, myeloma, paroxysmal nocturnal hemoglobinuria, and certain leukemias also predispose to venous thromboembolism. Arterial and venous events occur with polycythemia vera and essential thrombocythemia. Central venous catheters and prothrombotic antitumor regimens augment the risk in some patients. Part 1 of this two-part article addresses pathophysiology, clinical presentations, and risk of malignancy-associated thrombosis. Part 2, which will appear in next month's issue, covers prophylaxis and treatment of these thromboembolic complications.

Humans↗
PubMed1992

Postoperative low-dose heparin decreases thromboembolic complications in neurosurgical patients.

Thromboembolic complications are a major cause of postoperative morbidity and mortality in the neurosurgical patient. Prophylaxis with lower extremity pneumatic compression boots (PCBs) reduces the incidence of lower extremity deep vein thrombosis (DVT) but has not been shown to affect the incidence of pulmonary embolism (PE). Prophylaxis with low-dose heparin has consistently reduced the incidence of both DVT and PE in studies on general surgical patients but has not been adopted for use in neurosurgery primarily for fear of causing catastrophic hemorrhage. We report on a series of 138 consecutive adult patients who underwent major neurosurgical procedures on a general neurosurgical service at our institution. Patients were treated with intraoperative PCBs and, starting on the morning of the first postoperative day, with a regimen of 5000 U of heparin administered subcutaneously twice daily. This treatment was continued until patients were fully ambulatory. PCBs were discontinued 24 hours after the first administration of heparin. None of the heparin-treated patients suffered postoperative hemorrhage. We compared this series with a control group of 473 adult patients who had previously undergone major neurosurgical procedures on the same neurosurgical service. These patients had been treated with intraoperative and postoperative PCBs alone. The control group had a 3.2% incidence of thromboembolic complications (15 of 473; eight DVT, seven PE). Prophylaxis with PCBs plus heparin significantly (P = 0.020) reduced the incidence of thromboembolic complications: no PCBs/heparin-treated patient exhibited clinical evidence of PE or DVT (0%, 0/138). We conclude that a combination of intraoperative PCBs and postoperative low-dose heparin is a safe and effective method by which to reduce thromboembolic complications in the neurosurgical patient.

Adult↗
PubMed1992

Venous thromboembolism in patients undergoing rehabilitation for stroke.

OBJECTIVE: To determine the incidence of venous thromboembolism during rehabilitation for stroke and to identify factors that alter its risk. DESIGN: Cohort. SETTING: Tertiary care stroke rehabilitation program. PATIENTS: 102 consecutive patients undergoing rehabilitation for stroke. INTERVENTIONS: Impedance plethysmography (IPG) as routine screening and in patients with symptoms of deep venous thrombosis (DVT). MAIN OUTCOME MEASURES: DVT, pulmonary embolism (PE), death from PE. RESULTS: Venous thromboembolism was documented in 11 patients (11%) an average of 60 days after stroke onset (range 14-138 days); 2 patients (2%) died from PE. DVT was found on routine IPG screening in six patients and verified by IPG in two clinically symptomatic patients. The odds of developing venous thromboembolism was 17.6 (95% confidence interval: 2.2-143.5) in patients who were bedridden or wheelchair-bound at the time of admission. CONCLUSIONS: The incidence of venous thromboembolism is high and greatest in bedridden or wheelchair-bound patients undergoing stroke rehabilitation; randomized trials evaluating the safety and efficacy of screening and/or prophylaxis in such patients are required.

Aged↗
PubMed2006

[Thrombophilic conditions in the pathogenesis of venous thromboembolism].

Thrombophilic conditions are congenital or acquired hemostatic disorders pathophysiologically or statistically associated with higher risk of thrombosis. Their most important clinical manifestation is venous thromboembolism. In more than 50% of persons with non-induced thrombosis, some of the known thrombophilias can be found. Persons with congenital thrombophilias have, contrary to those without any thrombophilias, most of all an increased risk of an initial thromboembolic event while the impact of congenital thrombophilic conditions on their recurrence is not so clear. In patients with idiopathic thrombosis is the risk of recurrence 7-10% a year even at the absence of known thrombophilias. The risk of a recurrent event is influenced by a set of other factors (prevailing or undetected trigger factor, proximal thrombosis and pulmonary embolism, incomplete rechanneling of a thrombotic vein, presence of some thrombophilias, high level of D-dimers after discontinuation of the anticoagulant treatment). Their identification and consequent monitoring are decisive in the choice of an optimum treatment and the duration of their administration in secondary prevention of venous thromboembolism. In the primary venous thrombosis prevention, the knowledge of general trigger factors and the individual risk characteristics of the given patient is important, which means also timely detection of thrombophilic conditions in patients who profit from it, i.e. if they display at least medium probability of detection. A universal long-term prophylaxis in so far asymptomatic carriers of congenital thrombophilias is not indicated with regard to potential complications of anticoagulant treatment. Women with thrombophilic disorders are under an increased risk of a thromboembolic event when using hormonal contraceptives and during pregnancy. There is also a higher incidence of pregnancy complications connected with disorders in blood circulation of placental vascular tree.

Female↗
PubMed2006

[Prevention of venous thromboembolism in psychiatry].

The hospitalized patients of the psychiatric wards represent a risk group for the development of venous thromboembolism. Apart from sedative administration, total movement reduction, bad life style and daily routine and increased body weight, there is negative impact of dehydration, prolonged hospitalization and sometimes immobilisation in consequence of mechanical restraints. A large amount of patients are treated with antipsychotics that have a series of adverse effects. Depending of the drug used, the most frequent of them are somnolence, fatigue, extrapyramidal syndrome, hypotension, hepatotoxicity, increased body weight, prolongation of the QT interval of the ECG with a risk of ventricular arrhythmias, hematopoietic disorders, lipid or glycide metabolism disorders or hyperprolactinemia. Another potential adverse effect of these drugs is the heightened risk of venous thromboembolism development (deep vein thrombosis and/or pulmonary embolism). There is the risk of a pathological blood clotting event in psychiatric patients, especially those treated with antipsychotics. Although it is not high, it can have fatal consequences when combined with a relatively frequent pulmonary embolism and difficult diagnostics of thromboembolism. An algorithm for thromboembolism prevention has been developed. It involves important general risk factors of venous thrombosis (VTE history, immobilisation, malignancy, age over 75 years etc.) and also markers (physical restraints, dehydration, obesity, antipsychotics use) that can participate in the pathogenesis of venous thrombosis in the hospitalized psychiatric patients with limited motility. The authors believe that this prophylaxis is indicated, safe, effective and that it improves the quality of life at relatively low costs.

Anticoagulants↗
PubMedDate not supplied

[Effect of anesthesia and anticoagulant prophylaxis on the occurrence of postoperative thromboembolic complications in orthopedic patients].

Different prevention regimens of venous thromboembolism, by using the low molecular-weight heparin Fraxiparin, were studied in 152 patients who had undergone major orthopedic leg surgery under spinal and general anesthesia. The regimens differed in the time of Fraxiparin administration (before or after surgery). Fraxiparin and spinal anesthesia were found to promote the lower incidence of venous thromboembolism. The preoperative preventive treatment of venous thromboembolism, by using a low molecular-weight heparin in patients undergoing spinal anesthesia is unnecessary because of a high risk of epidural hematomas. If the risk for venous thromboembolism is higher before surgery and remains the same after it, thromboprophylaxis should be prolonged for at least one month.

Adult↗
PubMed2006

Neuroleptics: increased rate of venous thromboembolic events.

(1) Neuroleptics have long been implicated in venous thromboembolic effects. (2) A cohort study of elderly patients showed that users of atypical neuroleptics have twice the relative risk of hospital admission for thromboembolism (95% confidence interval 1.50-2.70). (3) Results of a case-control study of 42 patients with a history of venous thromboembolism were similar: the risk of thrombosis increased by a factor of at least 7 among users of conventional neuroleptics under 60 years of age. (4) A case-control study of 62 cases of fatal pulmonary embolism showed a 13-fold higher risk among neuroleptic users. (5) It is not possible to compare the risks associated with conventional and atypical neuroleptics. (6) In practice, the risk of venous thromboembolism should be taken into account when deciding whether or not to prescribe a neuroleptic, and it should also be borne in mind during treatment.

Antipsychotic Agents↗
PubMed1991

Therapy of acute thromboembolism with heparin and warfarin.

The indications, efficacy, dosage, administration, and monitoring of heparin and warfarin therapy for acute thromboembolic events are reviewed, with emphasis on recent changes in treatment recommendations. High-dose heparin therapy is indicated for acute deep-vein thrombosis and pulmonary embolism. Heparin therapy as an adjunct to thrombolytic agents for acute myocardial infarction is becoming increasingly accepted. Heparin therapy for acute thromboembolic events consists of a dosage that elevates the activated partial thromboplastin time to 1.5 to 2.0 times the control value; formerly, 1.5 to 2.5 times control was considered therapeutic. The recommended heparin dosage is a bolus dose of 70-100 units/kg followed by an infusion of 15-25 units/kg/hr. To prevent recurrent thromboembolism, most patients require long-term therapy following acute treatment; this typically consists of warfarin, which should be initiated on day 1 or 2 of heparin therapy whenever possible. For most indications, the intensity of warfarin has been reduced to a dosage that elevates the prothrombin time to 1.3 to 1.5 times control. Alternative therapies (low-molecular-weight heparins) and routes (subcutaneous heparin) should be further investigated. Current recommendations for heparin and warfarin therapy of acute thromboembolism include reduced intensity of both drugs and shortened duration of therapy. Since the therapeutic ranges for both heparin and warfarin therapy have been compressed, closer monitoring may be necessary to achieve and maintain adequate anticoagulation.

Acute Disease↗
PubMed1990

[Ambulatory thromboembolism prevention in traumatology using self-injection of heparin].

In a retrospective and prospective study, 303 patients with fractures of the ankle joint treated surgically with postoperative immobilization in a plaster cast were analysed. After the introduction of thromboembolism prophylaxis with heparin for all outpatients immobilized by plaster casts the incidence of thromboembolic complications decreased significantly, from 4.5% to zero. The prophylaxis was well accepted, about 90% of the subcutaneous injections being administered by the patients themselves or family members. No serious complications were seen. Therefore, this effective prophylaxis of thromboembolism should be practised in all outpatients with a plaster cast on the lower limb and an elevated risk of thromboembolism. A simple check-up to identify patients at risk is suggested.

Ankle Injuries↗
PubMed1989

[Complications following preventive treatment of thromboembolism with Dihydergot-heparin].

The observation of two cases of ergotism after administration of dihydroergotamine (Dihydergot-heparin (DHEH], led to review of the literature concerning documentation of the use of this drug in postoperative thromboembolism prophylaxis and the incidence of complications to this treatment. DHE is supposed to exert a selective constrictive effect on veins. There are now, however, numerous reports of ergotism because of arterial spasm. Some authors find better thromboembolic prophylactic effect, when DHE is used in combination with low-dose heparin (LDH) while others cannot show any advantages of using this drug. Several trials show that the best method for thromboembolic prophylaxis consists of graduated supportive stockings (TED) combined with LDH. The use of DHE in postoperative thromboembolism prophylaxis cannot be recommended. TED combined with LDH should be preferred.

Dihydroergotamine↗
PubMed1985

A multivariate pattern recognition study of risk-factors indicating postoperative thromboembolism despite low-dose heparin in major abdominal surgery.

The object of the present investigation was to identify those who, among high-risk patients, would "break through" low-dose heparin prophylaxis and develop thromboembolism after major abdominal surgery. Twenty-nine variables (clinical characteristics, pre- and postoperative coagulation and fibrinolytic factors) from 19 patients with and 26 patients without thromboembolism were analyzed by means of a multivariate supervised pattern recognition technique (SIMCA). We found no statistically significant difference between patients with and without thromboembolism. Thus, in the studied group of high-risk patients it was not possible to identify a predictive index for selection of individual patients liable to develop postoperative thromboembolism despite low-dose heparin prophylaxis in major abdominal surgery.

Abdomen↗
PubMed1988

Fixed- vs adjusted-dose heparin in the prophylaxis of thromboembolism in spinal cord injury.

Thromboembolism is a common and occasionally catastrophic complication in patients with spinal cord injury and complete motor paralysis. We, therefore, evaluated the efficacy and safety of two prophylactic regimens, using heparin in either fixed doses of 5000 U given subcutaneously twice daily or in doses adjusted to prolong the activated partial thromboplastin time (APTT) to approximately 1 1/2 times control. Patients were monitored with daily clinical examinations, serial impedance plethysmography, and Doppler flow studies. All events suspected to be thromboembolic were confirmed by venography, ventilation-perfusion scans, or pulmonary angiography. Seventy-five patients were randomized, and 58 (29 in each group) either remained in the study for more than seven weeks or experienced a thrombotic or hemorrhagic event. Patients on the adjusted-dose regimen received a mean (+/- SD) of 13,200 +/- 2200 U of heparin per dose and had an APTT 1 1/2 times higher than those on the fixed-dose regimen. Thromboembolism was detected in nine (31%) of 29 patients randomized to the fixed-dose regimen and two (7%) of 29 on the adjusted-dose regimen. While no patient who received the adjusted dose and whose APTT reached the target level had a thrombosis, bleeding occurred in seven patients. No patient on the fixed-dose regimen bled. We conclude that patients with spinal cord injury who can be maintained on doses of heparin sufficient to prolong their APTT to 1 1/2 times control values will be spared thromboembolic complications, but these patients are at high risk of bleeding, especially if they have trauma to other tissues in addition to their spinal cord injury.

Adolescent↗
PubMed1987

[Thromboembolism complications following acute hemiplegias].

143 patients with acute onset of hemiplegia transferred to our unit for rehabilitation were analysed retrospectively for the development of deep vein thrombosis or pulmonary emboli. 26% of the patients had suffered thromboembolic events, in more than half of the cases within the initial four weeks after hospital admission. Hemiplegia seems to be the main risk factor for thromboembolic complications, whereas age and sex had no further impact on the rate of occurrence in our series. Nor did we find a correlation between the extent of the paresis in the involved lower extremity or the degree of restriction of mobility and the incidence of thromboembolic disease. Because of the high frequency of thromboembolic complications in our patients we recommended prophylactic treatment with low dose heparin given subcutaneously, followed by oral anticoagulant therapy with vitamin K antagonists, provided there are no contraindications.

Adolescent↗
PubMed1985

[Thromboembolism of the general and pulmonary circulation (according to data from the Office of Pathological Anatomy of the Latvian Republic for 1976-1983)].

Thromboembolism was found in 1060 (11.9%) of 8926 retrospectively studied autopsies. Thromboembolism of the lesser (pulmonary) circulation was the most frequent (7.3%), the domination of females was noted (62.8%). Peak in both males and females was within the age group of 70 to 79 years. The most frequent source of the pulmonary circulation thromboembolism was the lower limb veins. Thromboembolism of the pulmonary (31.9%) and greater (61%) circulation was most frequently observed in the ischemic heart disease. Monthly variations were not statistically significant.

Adult↗
PubMed1984

Pathological study on livers with noncirrhotic portal hypertension and portal venous thromboembolic occlusion: report of seven autopsy cases.

Seven adult autopsied cases with noncirrhotic portal hypertension and thromboembolic occlusion of the large extra- and intrahepatic portal veins are presented. There were two types of portal venous occlusion: old thromboembolic occlusion (group A, two cases) and fresh thromboembolic occlusion (group B, five cases). In group A the occlusion was complete and the affected veins, which were identified clearly by elastic fiber stains, were characteristically shrunk to cause a long-standing portal hypertension. Extra- and intrahepatic collaterals were prominent. In group B the extra- and, sometimes, intrahepatic larger portal veins with fresh thromboemboli revealed variable degrees of phlebosclerosis, probably resulting from organization of repeated portal venous thromboemboli. These sclerotic changes further extended into the medium-sized and smaller intrahepatic portal veins. The latter and other hepatic morphology resembled those of idiopathic portal hypertension without larger portal venous occlusion (group C). Thus, in group B the widespread involvement of the portal venous system by thromboembolic events, particularly the smaller ones, might be important not only for the development of portal hypertension but also for understanding the hepatic pathology of idiopathic portal hypertension.

Adult↗
PubMed1983

Postoperative thromboembolism and risk factors in elective hip surgery.

The incidence of pulmonary embolism determined by perfusion - ventilation lung scintigraphy was 19% in 108 consecutive patients undergoing elective hip operations. Twelve patients had clinical symptoms. The sensitivity of clinical symptoms was 30 and the specificity 93%. Warfarin was used as prophylactic anticoagulant. The incidence of deep vein thrombosis examined by contrast venography was 43%. Only one patient developed femoral vein thrombosis propagating from the calf region. From the clinical risk factors, overweight had a statistically significant relationship to thromboembolism (p = 0.005). Age over 60 years was positively associated but the difference was not significant. When operation time exceeded 150 min the risk increased significantly (p less than 0.01). A large volume of blood loss at operation showed an increased but statistically insignificant trend towards thromboembolism. There were no fatal emboli. Although prophylactic warfarin treatment is not able to prevent the development of thromboembolism, it probably reduces the incidence of fatal pulmonary emboli. Of clinical and operative risk factors overweight and increasing operation time seem to have the strongest relationship to thromboembolism.

Adult↗
PubMed1983

The incidence of thromboembolic disease.

The incidence of thromboembolism was determined by a survey of 7986 orthopedic patients who had 5966 operations at a university hospital during a three-year period. Patients were analyzed to determine thromboembolic risks with respect to the orthopedic diagnosis to assist in providing the patient with informed consent and to identify patients who need prophylactic anticoagulation therapy. The patient population was divided into three risk classes: Class 1, low-risk patients, including children, all upper-extremity patients, and adult non-surgical ambulatory rehabilitation patients; Class 2, medium-risk patients, including all adult lower-extremity patients and patients with spine problems and no history of thromboembolic disease; Class 3, high-risk patients, including all patients with a previous history of thromboembolic disease or venous stasis disease. Class 1 patients require no prophylactic anticoagulation, Class 2 patients should be treated with dextran or aspirin, and Class 3 patients should be treated with warfarin. The calculated mortality for Class 2 patients, excluding hip problems, is 0.26%; mortality for acute spinal cord injuries is 2.9% and for hip surgery 2.2%.

Adolescent↗