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PubMed1985

Protection against venous thrombosis in an antithrombin-III deficient patient suffering from episodes of arterial thrombosis requiring major surgery. Effects of oral stanozolol in combination with subcutaneous heparin and intravenous AT-III.

In an antithrombin-III (AT-III) deficient patient suffering from recurrent episodes of venous and arterial thrombosis requiring major surgery an attempt was made to institute antithrombotic protection by long-term stanozolol treatment supplemented during periods of thrombogenic exposure with subcutaneous heparin and, when needed, infusion of AT-III as plasma or concentrate. Stanozolol raised the plasma levels of AT-III, demonstrating a sparing effect on the AT-III needed. Despite the repeated exposures to major surgery, protection against venous thrombosis was complete, but the arterial disease progressed and led to the demise of the patient.

Administration, Oral↗

PubMed1999

Comparison of 3,000 IU aXa of the low molecular weight heparin certoparin with 5,000 IU aXa in prevention of deep vein thrombosis after total hip replacement. German Thrombosis Study Group.

BACKGROUND: The aim of this randomized, double-blind and prospective clinical trial was to investigate whether an increase of the conventional daily dosage (3,000 IU aXa) of the low molecular weight heparin certoparin up to 5,000 IU aXa/day might lower the incidence of deep vein thrombosis (DVT) in patients undergoing elective hip surgery. METHODS: The main criterium of this trial was the incidence of DVT diagnosed by bilateral ascending venography, which was performed either if DVT was clinically suspected or in each remaining patient between the 12th and the 14th postoperative day. A total number of 172 patients were enrolled to receive the conventional dosage of 3,000 IU aXa (Mono-Embolex NM) and 169 patients to receive the high dosage form (5,000 IU aXa) once daily. The mean age (+/-SD) was 69.6+/-9.5 and 67+/-11.7 years. RESULTS: No relevant differences were found concerning predisposing risk factors. The duration of surgery was 93+/-25.2 and 88+/-21.4 min (mean+/-SD). Surgical type and approach were not different between the groups. Deep vein thrombosis was detected in 17 patients (9.9%) in the conventional dose group and in 16 patients (9.5%) in the high dose group (intent-to-treat analysis; n.s.). The rate of bleeding complications was not significantly different except the cell saver volumes (770+/-136 vs 475+/-186 ml; p<0.001). No significant difference was found in the serious adverse event reporting along the lines of EC-GCP (10 vs 8 events; p=0.65). CONCLUSIONS: This clinical trial confirmed that the conventional dosage (3,000 IU aXa/day) of certoparin ensures maximal antithrombotic activity.

Adult↗

PubMed1992

[A case of antiphospholipid syndrome associated with left subclavian artery thrombosis and left external iliac vein thrombosis].

Arterial thrombosis is one of the major symptoms of antiphospholipid syndrome (APS). However, thrombosis in a primary branch of the aorta has rarely been reported in APS. We report here a case of APS complicated by thromboses in both the left subclavian artery and the left external iliac vein. A 32-year-old woman was admitted in May, 1990 complaining of no pulse in the left superficial arteries (e.g., left radial artery) for the past 5 years and acute swelling of the left lower extremity. A left ascending phlebography showed an occlusion of the external iliac vein and arteriography revealed obstruction in the left subclavian artery. Collateral circulations were developed at the site of each thrombus. Clotting and immunological studies revealed a prolonged APTT, a high titer of anticardiolipin antibody and lupus anticoagulant positive. We ruled out various diseases and clinical risk factors predisposing to both arterial and venous thromboses. Accordingly, we concluded that both thromboses were based on APS. Following treatment with anticoagulants, aspirin and corticosteroid, the swelling of her left thigh was diminished and the antibody titer was decreased within 3 months.

Adult↗

PubMed1990

[Thrombus propagation and venous drainage disturbance in cerebral sinus-vein thrombosis--38 autopsied cerebral sinus-vein thrombosis].

38 autopsied cases of cerebral sinus-vein thrombosis (CSVT) in our institute were studied. In this study, special attention was paid for the evolution and fate of venous thrombus. 18 cases showed hemorrhagic infarction or intracerebral hematoma (group 1; G 1). In contrast, no cerebral parenchymal changes were observed in the other 20 cases (group 2; G 2). In 13 of 18 cases of G 1, superior sagittal sinus (SSS) were thrombosed. 10 of these 13 cases showed thrombosed cerebral cortical veins (CV) or deep cerebral veins (DV). In contrast, none of 16 cases of G 1 with thrombosed SSS showed thrombosed CV or DV. All cases of the solitary thrombosis of CV or DV (each 2 cases) belong to G 1. Venous thrombi were divided into three stages according to its process of organization; recent thrombus (R), hyalinized thrombus (H), organized thrombus (O). In the venous thrombi of G 1, 6 cases were R, 6 were partly H, 6 were partly 0. In addition to O, R and H were also observed in group O. Distribution of various stage of thrombus in same case suggested that gradual thrombus evolution had occurred before or after the clinical onset in CSVT. This study suggested: (1) CV or DV occlusion may play an important role for the advent of cerebral parenchymal changes in CSVT. (2) Gradual thrombus evolution after the onset is one of possible causes of slow clinical deteoration after the onset. Therefore, prevention of these thrombus propagation with anti-platelet drugs or fibrinolotic therapy should be recommended for the treatment of CSVT. On the contrary, hyperosmolar agents and diuretics may produce potential risk of dehydration, and as a result, accelerate secondary thrombus extension.

Adolescent↗

PubMed1986

[Secondary thrombosis of the renal veins in thrombosis of the inferior vena cava].

On the occasion of the diagnosis secondary thrombosis of both renal veins made during one's life, resulting from the progressive thrombosis of v.cava inferior, the attention is drawn on that possibility in case of nephrotic syndrome with edema of the lower limbs, showing asymmetry to a certain extent. Diagnostic precision is recommended in such cases, looking for alterations in venous urography, INF or dynamic chamber scintigraphy with 131I-hippuran, perfusion angioscintigraphy with 99Tc-pertechnetate and in computer tomography.

Adult↗

PubMed1981

Further studies on clotting changes in patients with cerebral sinus thrombosis. A case with thrombosis of right transverse sinus.

A 28 year old woman with angiographically proven thrombosis of right cerebral transverse sinus was studied from a clotting point of view. The changes noted were decreased fibrinolytic activity and increased collagen platelet aggregation. The patient presented loss of consciousness, aphasia, mental confusion, migh right hemiparesis, papilloedema. The treatment with dipyridamole, aspirin and a nicotinic acid derivative was followed by good results. After about a month the fundus reverted to normal. A clotting study is indicative in every patient with cerebral venous thrombosis.

Adult↗

PubMed1981

[A case report of superior sagittal sinus thrombosis--evaluation of computed tomographic findings in diagnosis and comprehension of this sinus thrombosis (author's transl)].

A case of superior sagittal sinus thrombosis was reported. A 23-year-old male was admitted to our clinic on August 16, 1978, because of generalized convulsive seizures. he had complained of severe headache and high fever for about 7 days before admission, and on admission he was in slightly drowsy state. At that time, bilateral choked discs and bilateral abducens pareses were found without any other neurological deficit. CT scan on his 1st hospital day revealed only slight compression of the ventricular system without any midline shift. On the 2nd hospital day, he developed sudden left hemiparesis, but his level of consciousness did not deteriorate as that of the previous day, demonstrating clear CSF by lumbar puncture. Right CAG on August 21 revealed delayed circulation, poor-filling of the cortical veins, and narrow superior sagittal sinus showing zigzag shaped margin. CT scan on August 22 showed multiple irregular high dense foci mainly in both parietal lobes and the shift to the left of the ventricular system. Besides, on enhanced CT scan, the so-called "empty triangle" sign was revealed with gyral enhancement. Although an increase of the shift of the ventricular system was demonstrated by the follow-up CT scans, he gradually improved and external decompression was necessitated no longer. He was discharged with slight weakness of the left upper limb after superior sagittal sinus showing good-filling on right CAG performed on September 27 and had been identified. As a result, it was confirmed that in case sinus thrombosis is doubted, follow-up study by CT scan would be significant for the choice of treatments as well as for its diagnosis at its each stage.

Adult↗

PubMed1981

[Thrombosis therapy and the prophylaxis of thrombosis recurrences in obstetrics].

IN general the therapy of thrombosis during pregnancy is carried out with heparin, in which case the initial hospital treatment may be continued later on with double subcutaneous applications of heparin in the out-patient department. Apart from coagulation-physiological parameters plethysmography and/or ultrasound Doppler method serve for the control of the course. Within the prophylaxis of recidivations in earlier thromboembolism during pregnancy regular clinical and apparative controls are performed, in which cases in the last third of the pregnancy the possibilities of the consideration work are used. Immediately pre-, intra- and postpartally heparin is injected with low dose up to the optimum phenprokoumon regulation (beginning with the 2nd day post partum). Thromboses in the anamnesis are no essential risk, when an optimum prophylaxis of thrombosis is guaranteed during pregnancy and puerperium

Adult↗

PubMed1994

[Ovarian hyperstimulation syndrome and thrombosis. Apropos of a case of thrombosis of the internal jugular vein. Review of the literature].

Thrombosis of the internal jugular vein was associated with a severe syndrome of ovarian hyperstimulation. After in vitro fertilization, a twin pregnancy was obtained in a 31-year-old patient with severe endometriosis. On the day of follicle collection, plasma oestradiol was 3050 mg/ml. Ten ovocytes were collected and 3 embryos were implanted. A syndrome of severe ovarian hyperstimulation (ascites, pleural effusion) developed 3 weeks later and symptomatic treatment was given. Phlebitis of the upper left limb was diagnosed at 9 weeks amenorrhoea and echo-Doppler confirmed the diagnosis of subclavian and internal jugular venous thrombosis. Search for a cause was negative excepting a frank drop in protein S activity to 35%. Post-partum assay and assay in family members confirmed that the deficiency was acquired during pregnancy. The clinical course was favourable with anticoagulant therapy (heparin, then low-molecular weight heparin). Intra-uterine death of one of the fetuses occurred at 21 weeks amenorrhoea and a 2,550 g girl was born by vaginal delivery at 36 weeks. The Apgar score at birth was 10/10. In a review of the literature on vascular events in fertilization, programmes showed that severe syndromes of ovarian hyperstimulation, endogenous hyperestrogenism, multiple pregnancy and predominance of upper limb are the most frequently observed criteria. We emphasize the importance of preventing these thromboembolic events with subcutaneous heparin during the first trimester of pregnancy followed by low-molecular weight heparin, particularly in patients with a history of thromboembolism and/or patients with severe ovarian hyperstimulation.

Adult↗

PubMed1993

[Thrombosis: an underestimated complication of central catheters? Subclavian vein, vena cava and renal vein thrombosis after silastic catheters].

Besides systemic infections venous thromboses constitute major complications of central lines used in neonatal intensive care. Male triplet born at 25 weeks of gestation, birthweight 460 g during his first developed a catheter-associated thrombosis of the left vena subclavia without clinical symptoms. In addition, a second catheter-induced thrombosis of the vena cava inferior and right vena renalis manifested with typical clinical symptoms at an age of 4 weeks. Coagulation tests were normal. 7 months later the size and the renal function of the right kidney were markedly reduced. The incidence of catheter-associated thrombotic complications has not been defined yet; thromboses may develop without clinical signs. There is evidence that the rate of this complication is higher than generally assumed.

Blood Coagulation Tests↗

PubMedDate not supplied

Experimental coronary artery thrombosis in the absence of thromboxane A2 synthesis: evidence for alternate pathways for coronary thrombosis.

The actions of the thromboxane synthetase inhibitor, U-63557A, were evaluated in vivo in anesthetized open-chest dogs by inducing left circumflex coronary artery (LCCA) thrombosis with low amperage electrical stimulation (100 microA for 6 h) of the intimal surface of the vessel, and ex vivo by assessing platelet aggregation and TXB2 production. U-63557A, 10 mg/kg + 5 mg/kg/h i.v., reduced ex vivo platelet aggregation in response to arachidonic acid (0.65 mM) by 93 +/- 2% (p less than 0.05, means +/- SEM), whereas the concurrent formation of TXB2 was decreased by 78 +/- 8% (p less than 0.05). TXB2 concentration also was reduced significantly in vivo as measured from coronary sinus blood samples; however, 6-keto-PGF1 alpha concentration was unchanged from predrug values. Despite the significant inhibition of platelet aggregation and TXB2 production, thrombus mass was not reduced: control, 32.0 +/- 5.9 mg (n = 7); U-63557A, 30.8 +/- 12.0 mg (n = 5, p = NS). These results suggest that U-63557A effectively inhibits TXA2 synthetase, but lacks antithrombotic activity in our experimental model. Therefore, substances other than TXA2 may be capable of mediating occlusive coronary artery thrombosis.

6-Ketoprostaglandin F1 alpha↗

PubMed1992

Double-blind, randomized comparison of systemic continuous infusion of 0.25 versus 0.50 mg/kg/24 h of alteplase over 3 to 7 days for treatment of deep venous thrombosis in heparinized patients: results of the European Thrombolysis with rt-PA in Venous Thrombosis (ETTT) trial.

Thirty-two patients with acute, proximal-vein thrombosis were treated with heparin and alteplase (0.25 versus 0.5 mg/kg/24 h during 3-7 days) in a randomized, double-blind, multicenter, European (ETTT) trial. The treatment resulted in a decrease of the venographic Marder's score from 18 (6-25) to 13 (2-24) units (median, range) in Group I (0.25 mg/kg/24 h, n = 15, median decrease 3.0, p = 0.32) and from 17.5 (3-33) to 15.5 (0-27) in Group II (0.5 mg/kg/24 h, n = 16, median decrease 4.0, p = 0.23). Comparison of the sequential venograms could be performed in 14 cases of Group I and in 15 cases in Group II. A minority of patients showed substantial partial recanalization of the initially obstructed veins on the control venogram (one in each treatment group) and most of the control venograms showed either thrombus size reductions (5 in Group I, 7 in Group II) or no change or even deterioration (8 in Group I, 7 in Group II). Major bleedings were observed in 7 patients (7/32, 22%), 5 of them occurring in Group II (5/17, 29%). Thus, the results of the ETTT trial show that the used low dosages of alteplase administered intravenously over 3-7 days in heparinized patients cannot be recommended as a treatment for patients with deep venous thrombosis of lower limbs and/or pelvis. Further studies are needed to define a more suitable dosage regimen of alteplase in this indication.

Adolescent↗

PubMedDate not supplied

Superficial venous thrombosis of the lower extremities co-existing with deep venous thrombosis. A phlebographic study on 57 cases.

The incidence of deep venous thrombosis (DVT) coexistent in patients suffering from superficial venous thrombosis (SVT) has not been well documented. In a series of 57 consecutive patients with SVT of the lower extremities treated in our Department in the last five years without any obvious clinical signs of co-existing DVT, an ascending phlebographic study was performed. Co-existent DVT was disclosed in 19.6% of the patients. There was no correlation between the location or the length of thrombus and the co-existence of DVT. Patients in whom SVT developed in existing varicose veins were younger in age and the incidence of co-existence of DVT was lower. Our findings show that SVT does not always have a benign course. The disclosure of a high incidence of co-existing DVT in our series suggests the necessity of the examination of the deep venous system in all the cases of SVT by using ultrasonic technics, triplex and preferably of the ascending phlebography. The disclosure of DVT in those cases makes the application of anticoagulant treatment mandatory.

Adult↗

PubMed1989

Comparison of real-time B-mode ultrasonography and bilateral ascending phlebography for detection of postoperative deep vein thrombosis following elective hip surgery. The Venous Thrombosis Group.

A prospective study compared real-time B-mode ultrasound examination with bilateral ascending phlebography in the diagnosis of postoperative deep vein thrombosis in 60 patients undergoing elective total hip replacement. The overall sensitivity and specificity of the ultrasound method were 54 and 91%, respectively, and the positive and negative predictive values were 83 and 69%, respectively. The rather low overall sensitivity of the ultrasound method in this study was due to difficulty in detecting thrombi smaller than 1 cm wherever they were located in the deep veins, and in diagnosing thrombi in the calf, regardless of their size. We conclude that real-time B-mode ultrasonography is a technique that can easily be used routinely for detection of postoperative DVT in hip surgery, but its sensitivity for proximal thrombosis (63%) is too low for it to be used alone.

Adult↗

PubMed1998

D-dimer strategy in thrombosis exclusion--a gold standard study in 100 patients suspected of deep venous thrombosis or pulmonary embolism: 8 DD methods compared.

DD are now recognized as a valuable tool to screen patients suspected of deep venous thrombosis or pulmonary embolism before carrying out a gold standard radiologic examination. The newest methods available claim to be able to ascertain the absence of thrombosis, but they have yet to prove their efficiency. We compared the performances of 3 reference ELISA methods (D-DI Asserachrom Stago, D-dimer Enzygnost Behring and Dimertest GOLD EIA Agen), 5 recent rapid methods (VIDAS D-Dimer bioMérieux, Instant IA Stago, Simplired Agen, Nycocard D-dimer Nycomed and Accuclot D-Dimer Sigma Diagnostics) and two routine latex methods (Dimertest American Diagnostica and FDP-Slidex bioMérieux) in 100 patients. One of the rapid quantitative methods was demonstrated to have a level of efficiency comparable to that of ELISA methods. Finally, the cost and efficiency of different strategies were evaluated, the association of a routine latex method with the VIDAS D-Dimer bioMérieux being proven to be the most efficient.

Adult↗

PubMed2003

Imaging characteristics of a novel technetium Tc 99m-labeled platelet glycoprotein IIb/IIIa receptor antagonist in patients With acute deep vein thrombosis or a history of deep vein thrombosis.

BACKGROUND: The diagnosis of recurrent deep vein thrombosis (DVT) is challenging. Imaging with radiolabeled peptides offers a new approach for detecting acute DVT. Technetium Tc 99m ((99m)Tc)-apcitide binds with high affinity and specificity to the glycoprotein IIb/IIIa receptors expressed on activated platelets and, therefore, (99m)Tc-apcitide scintigraphy should be negative with residual abnormalities caused by old, inactive thrombi and positive with new, active thrombi. METHODS: In a prospective multicenter study, (99m)Tc-apcitide imaging was performed on 38 patients with a newly diagnosed first DVT (group 1) and 40 patients with previous DVT, symptoms of postthrombotic syndrome, and chronic intraluminal abnormalities on ultrasonography (group 2). Images were interpreted in a blinded fashion by 2 experts and by newly trained nuclear medicine physicians. The sensitivity and specificity of (99m)Tc-apcitide were determined by calculating the proportion of scans in group 1 patients that were read as "positive for acute DVT" and the proportion of scans in group 2 patients that were read as "negative for acute DVT," respectively. RESULTS: When read by 2 experts, ( 99m)Tc-apcitide had a sensitivity of 92% for both readers and specificities of 82% and 90%. Agreement between the experts was excellent. However, the accuracy and interreader agreement for newly trained nuclear medicine physicians were lower. CONCLUSIONS: Technetium Tc 99m-apcitide scintigraphy has potential utility in suspected recurrent DVT because it detects most acute thrombi and has few false-positive results in patients with previous DVT. However, the accuracy appears to depend on the training and experience of the interpreters.

Acute Disease↗

PubMed2003

Obstinate thrombosis during percutaneous coronary intervention in a case with heparin-induced thrombocytopenia with thrombosis syndrome successfully treated by argatroban anticoagulant therapy.

We describe a case of massive coronary thrombus after the coronary stenting due to heparin-induced thrombocytopenia with thrombosis syndrome (HITTS). Only argatroban was able to resolve the thrombus. This is the first case in which argatroban successfully treated massive thrombus during percutaneous coronary intervention in a patient with HITTS.

Angioplasty, Balloon, Coronary↗

PubMed1998

Syndromes of thrombosis and hypercoagulability. Congenital and acquired causes of thrombosis.

Blood coagulation protein and platelet defects are now known to account for up to ninety percent of unexplained venous thrombosis and up to seventy percent of unexplained arterial thrombotic or ischemic events. This article summarizes the common and uncommon blood protein and platelet defects which should be suspected, and searched for, in patients with such events. Defining such defects will have major impact on secondary prevention and duration of antithrombotic therapy in the afflicted patient and impact on primary prevention for identified family members in those harboring hereditary defects.

Antiphospholipid Syndrome↗