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At least 865 records · Page 48Linked to original sources
PubMed1997

Efficacy and safety of a low-molecular-weight heparin and standard unfractionated heparin for prophylaxis of postoperative venous thromboembolism: European multicenter trial.

A randomized, double-blind multicenter trial was performed to compare the safety and efficacy of a new low-molecular-weight heparin (LMWH) (LU 47311, Clivarine) and standard unfractionated heparin for the prophylaxis of postoperative venous thromboembolism. Altogether 1351 patients scheduled to undergo abdominal surgery were included. Main outcome measures included the incidence of thromboembolic events (deep vein thrombosis, pulmonary embolism, or both) and bleeding complications, including wound hematoma. A total of 655 patients received 1750 anti-Xa IU of LMWH plus a placebo injection daily; 677 patients received 5000 IU of unfractionated heparin (UFH) twice a day. Both drugs were found to be equally effective, as 4.7% of patients in the LMWH group and 4.3% in the UFH group developed postoperative thromboembolic complications. However, the incidence of bleeding complications was significantly reduced in the LMWH group: 55 (8.3%) patients in the LMWH group and 80 (11.8%) in the UFH group developed bleeding complications, a relative risk (RR) of 0.70 (95% CI 0.51-0.97;p = 0.03); wound hematoma occurred in 29 (4.4%) of the LMWH group compared with 55 (7.7%) in those in the UFH group for an RR of 0.57 (95% CI 0.37-0.88;p = 0.01). This study confirmed that a very low dose of 1750 anti-Xa IU daily of this new LMWH is as effective as 10,000 IU of UFH for preventing postoperative deep vein thrombosis. At this dose its administration is associated with a significant reduction in the risk of bleeding including wound hematoma.

Adult↗
PubMedDate not supplied

Venous thromboembolism after uterine fibroid embolization.

Thromboembolic complications after uterine fibroid embolization (UFE) are infrequent. The incidence and predisposing factors of thromboembolism after UFE are unknown. We present eight cases of nonfatal thromboembolic complications after UFE and estimate the frequency of such events as 0.4%.

Embolization, Therapeutic↗
PubMed1997

Incidence of objectively diagnosed thromboembolic disease in cancer patients undergoing cytotoxic chemotherapy and/or hormonal therapy.

From August 1993 to May 1994 there were 1505 inpatient and 2590 outpatient chemotherapy treatment episodes at the Clatterbridge Centre for Oncology. A total of 21 thromboembolic events, including two arterial events, were recorded among these patients at a median of 8 weeks from the start of treatment (range 0-14 weeks), and 2 episodes occurred at the time of first presentation. The median age of the patients developing thromboembolism was 53 (range 29-75) years, and there were 14 women and 7 men. In all, 13 of the events (62%) occurred in patients receiving inpatient treatment and 8 (38%), in outpatients. The incidence of thrombosis per treatment episode in inpatients was therefore 0.008 as compared with 0.003 in outpatients. The associated malignancies were breast cancer (5), testicular cancer (4), lung cancer (3), ovarian cancer (3) and non-Hodgkin's lymphoma (2), with bladder, colon, anal and brain cancer providing 1 case each. The following bulky pelvic or para-aortic disease was present in 9 patients: testicular cancer (3), ovarian cancer (3), lymphoma (2) and bladder cancer (1). In all, 20 of the 21 thrombotic episodes were successfully treated, with 1 patient dying from the complications of venous gangrene. Thromboembolic disease is a relatively common and important cause of morbidity and mortality in cancer patients that requires early recognition and treatment.

Adult↗
PubMed2002

Factor V Leiden and prothrombin 20210 G-A mutations in controls and in patients with thromboembolic events during pregnancy or the puerperium.

Factor V Leiden and prothrombin 20210 G-A mutations are independent risk factors for venous thrombosis. We studied the frequency of these mutations in 35 patients who had thromboembolic events during pregnancy and puerperium, and in 32 women who had a history of uncomplicated pregnancy, delivered either vaginally or by cesarean section, and did not have a past history of thromboembolism. Factor V Leiden mutation was present in 7 patients (20%) in the study group. Of these 7 patients, 1 was homozygote, whereas the remaining 6 were heterozygote for the mutation. Prothrombin 20210 G-A mutation was present in 2 patients (5.7%) in the study group. In the control group none of the 32 patients was positive for the factor V Leiden and prothrombin 20210 G-A mutations. Our findings indicate that the factor V Leiden mutation is an important risk factor for thromboembolic disease during pregnancy or puerperium.

Adult↗
PubMed2006

Association between plasma levels of D-dimer and fibrinogen/fibrin degradation products (FDP) for exclusion of thromboembolic disorders.

BACKGROUND: D-dimer and fibrinogen/fibrin degradation products (FDP) levels are elevated in subjects with thromboembolic disorders, and the assays for detection of D-dimer and FDP are used in many laboratories for the investigation of these disorders. The aim of this study was to evaluate the association between the plasma levels of D-dimer and FDP in the investigation of thromboembolic disorders. METHODS: D-dimer and FDP immunoassays were performed in 217 consecutive blood samples from subjects with suspected of thromboembolic disorders by use of Liatest D-dimer and Plasma FDP. RESULTS: FDP results were classified in: <5, 5-20, >20 microg/mL, and D-dimer levels obtained in these groups ranged to 350-1,210 ng/mL, 420-1,960 ng/mL, and 1,190-51,170 ng/mL, respectively. A significant association between D-dimer levels and the reaction times necessary to occur agglutination in latex agglutination test for FDP was observed. CONCLUSIONS: There was an association between plasma levels of D-dimer and FDP. The preliminary determination of FDP levels could be useful because it allows estimating the D-dimer levels before of the automated systems analysis, reducing costs associated to dilutions of plasma samples.

Biomarkers↗
PubMed1990

Thromboembolic complications of atrial fibrillation and their prevention: a review.

Atrial fibrillation (AF) is found in 0.4% of adults younger than age 60 years and in 2 to 4% older than age 60 years, and is associated with a high risk of thromboembolic complications. AF--paroxysmal and chronic--has many etiologies, including rheumatic and nonrheumatic heart disease and thyrotoxicosis. Knowing how strokes occur and what precipitates them--e.g., differentiating between cardioembolic and cerebrovascular causes--is important when deciding on appropriate treatment. Risk factors involved in the development of thromboembolic complications associated with AF are reviewed, focusing on the contributions of thyrotoxic AF, paroxysmal AF (and its transition to chronic AF), enlargement of the left atrium, silent cerebral infarction and decreased cerebral blood flow. Data from several studies are briefly presented, highlighting major outcomes. On the basis of current information about prevention of thromboembolic complications, it seems reasonable to recommend anticoagulant treatment for patients with nonrheumatic chronic AF.

Atrial Fibrillation↗
PubMed1979

Low-dose heparin therapy in the long-term management of venous thromboembolism.

The efficacy of a six-month course of low-dose heparin therapy was compared to a conventional warfarin regimen by a prospective, controlled trial in 48 patients with pulmonary embolism or deep venous thrombosis of the legs. All subjects had complicated medical illnesses and a high risk of recurrent thromboembolism. Bleeding complications were virtually negligible during heparin therapy and occurred significantly more frequently in patients receiving warfarin. Heparin was as effective as warfarin in the prevention of recurrent thromboembolism. Patient compliance with the two treatment regimens was comparable. Self-administered, low-dose heparin therapy is a useful alternative to warfarin in the long-term management of complicated thromboembolic disorders.

Adult↗
PubMed1978

Deaths caused by pulmonary thromboembolism after legally induced abortion.

Pulmonary thromboembolism is an infrequent but serious complication of induced abortion. Of the 104 abortion-related deaths reported to the Center for Disease Control in 1972 through 1975, 10 (9.6 per cent) involved fatal pulmonary embolism; eight of these cases were proved at autopsy. All but one of the women had pre-existing risk factors for thromboembolic disease, including obesity, previous thrombophlebitis, use of oral contraceptives, or type A blood. All but one case occurred in women who had received general anesthesia. In addition, four of the eight women had undergone a concurrent sterilization procedure at the time of the abortion. Preventive efforts should focus on identifying women at high risk for thromboembolic events prior to the abortion procedure and then selecting the abortion procedure least likely to produce postoperative embolism.

Abortion, Induced↗
PubMed1989

Recurrent thromboembolism in pregnancy and puerperium. Is there a need for thromboprophylaxis?

By sending a questionnaire (response rate 93%) to 321 women with a history of venous thromboembolism and previous coagulation tests, 72 patients were identified who had a total of 87 pregnancies after the thromboembolic episode. The main aim of the study was to analyze the influence of prophylaxis during pregnancy and delivery on the development of further thromboembolic complications. During pregnancy there was no difference in frequency of thromboses between the group given prophylaxis (n = 20) and the group not receiving it (n = 67). At delivery the frequency of thrombosis was 5.3% among the 57 women given prophylaxis and 11.1% among the 30 without prophylaxis, a difference that is not significant. The implication of these findings is discussed both concerning the indications for giving prophylaxis and concerning the problem of designing relevant prophylactic trials.

Female↗
PubMed1991

Prophylaxis against venous thromboembolism in surgical patients.

Venous thromboembolic disease is a common, potentially life-threatening, but preventable complication of surgery. Venographic studies have shown a high incidence of deep vein thrombosis in patients who do not receive prophylaxis. The long-term sequelae of deep vein thrombosis in these patients can be disabling, but the exact prevalence of post-thrombotic complications has not been well documented. Fatal pulmonary embolism has been reported in 0.5% to 1% of patients after major abdominal surgery and in 2% to 6% after total hip replacement. Several methods of prophylaxis against venous thromboembolism have demonstrated efficacy, but a surprising number of patients still do not receive prophylaxis. A medical record review in 16 hospitals recently disclosed that only 32% of high-risk patients received prophylaxis, with a range from 9% in a community hospital to 56% in a major teaching hospital. The possible reasons for this comparatively low rate of utilization are discussed. Current issues and future trends in the prophylaxis of venous thromboembolism are briefly summarized.

Humans↗
PubMed1980

Blood coagulation and idiopathic thromboembolism among fertile women.

A case-control study of fibrinolytic activity and antithrombin-III (AT-III) was conducted comparing 16 women within the childbearing ages who had a recent history of idiopathic thromboembolism to 29 age- and race-matched female controls without a history of thromboembolism. All subjects had stopped using oral contraceptives at least 12 months prior to study. No difference in AT-III was evident between cases and controls. The mean fibrinolytic response to venous occlusion in cases was significantly lower; however, baseline fibrinolysis was essentially identical. These data demonstrated a bimodal distribution of fibrinolytic response among controls. By dichotomizing fibrinolytic response between the two modes in the controls, we estimated that the rate of low fibrinolytic response was 6 times as frequent in cases as controls. Thus, low fibrinolytic response may signal a natural predisposition to thromboembolism which could be triggered by use of synthetic estrogens.

Adult↗
PubMed1989

Thromboembolic risk factors in patients undergoing maxillofacial surgery for malignancies.

Venous thromboembolism is a common complication in patients undergoing major surgery. We studied blood coagulation profiles in 16 patients undergoing extensive maxillofacial surgery for oral malignant diseases. Activity of coagulation factor V and levels of antithrombin III were significantly reduced on the first postoperative day. Fibrinogen level showed a continuous increase throughout the observation period. However, no thromboembolic events were observed. It can be concluded that despite a severe alteration of the blood clotting system, maxillofacial surgery does not seem to be associated with postoperative thromboembolism.

Blood Coagulation Factors↗
PubMed1984

A method for monitoring ADP-induced thromboembolism in mice.

A method for monitoring ADP-induced thromboembolism in mice by means of the measurement of respiratory rate and depth was studied. The measurement were accurately carried out with a new method devised by us. In mice intravenously injected with 5-40 mg ADP/kg, it was found that the respiratory rate decreased transiently and dose-responsively, and that the platelet count also decreased transiently. On the other hand, no decrease in respiratory rate after administration of ADP was observed in neuraminidase-pretreated mice, in which the platelet count was significantly reduced. In the histological examination, platelet thrombi formed in the pulmonary vessels were observed 10 sec after administration of 10 and 40 mg/kg of ADP in mice which had not been treated with neuraminidase. The extent of thromboembolism at the dose of 40 mg/kg showed a tendency to be more marked than that at 10 mg/kg. Pretreatment with 300 mg dipyridamole/kg p.o. prevented the respiratory depression at 40 mg ADP/kg. However, with 10 mg dimorpholamine/kg i.v. or 30 mg warfarin/kg p.o., no preventive effect was observed. Therefore, it was concluded that it is possible to monitor ADP-induced thromboembolism in mice by means of the accurate measurement of the respiratory rate and depth.

Adenosine Diphosphate↗
PubMed1990

Dipyridamole combined with anticoagulant in prevention of early postoperative thromboembolism after cardiac valve replacement.

The preventive effect of 300 mg/day dipyridamole, plus warfarin, on the development of thromboembolism after cardiac valve replacement was evaluated. Study 1 involved 71 patients receiving dipyridamole, 100 mg t.i.d., plus warfarin and resulted in a 2.8% incidence of thromboembolism. Study 2 involved 179 patients and compared the effectiveness of slow release capsules with tablet form dipyridamole at the same dosage, both plus warfarin. No thromboembolic episodes occurred in either group. No serious side-effects of dipyridamole were seen in either study. The results suggest that both slow release and tablet form dipyridamole in combination with warfarin are useful in the postoperative management of heart valve replacement.

Adolescent↗
PubMed1991

Impaired fibrinolysis and postoperative thromboembolism in orthopedic patients.

The incidence of deep vein thrombosis (DVT) and pulmonary embolism was studied prospectively in patients undergoing elective total hip replacement. 96 patients were randomly allocated to receive either low molecular weight heparin (LMWH) or unfractionated heparin (UFH). All patients had bilateral phlebography and pulmonary perfusion/ventilation scintigraphy 10-12 days after surgery. The following fibrinolytic variables were analysed in plasma and related to thromboembolism: tissue plasminogen activator (t-PA) activity, t-PA antigen (t-PA Ag), plasminogen activator inhibitor (PAI-1) activity and PAI-1 antigen (PAI-1 Ag). No significant difference was found, regarding the fibrinolytic response to surgery, between patients treated with LMWH and UFH. The level of PAI-1 activity was significantly increased before operation in patients developing DVT as compared to non-DVT patients (p less than 0.03). Immediately after surgery and in the morning the first postoperative day the levels of PAI-1 activity, PAI-1 Ag and t-PA Ag were positively correlated to thromboembolism. PAI-1 activity was the only preoperative fibrinolytic variable correlated to thromboembolism.

Aged↗
PubMed1994

Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo.

OBJECTIVES: The aim of this study was to determine the relations between spontaneous echo contrast, left atrial appendage blood flow velocity and thromboembolism. BACKGROUND: Left atrial thrombus and spontaneous echo contrast, a putative marker of thromboembolic risk, are frequently located in the left atrial appendage. Measurement of left atrial appendage outflow Doppler velocity by transesophageal echocardiography is a recent technique for assessment of left atrial appendage function, which may be important in thrombus formation. METHODS: Transthoracic and transesophageal echocardiographic studies were performed in 140 patients with atrial fibrillation (chronic in 80 patients, paroxysmal in 50 patients, first episode < 2 weeks in 10 patients). The left atrium and appendage were inspected for thrombus and spontaneous echo contrast, which was graded from 0 (none) to 4+ (severe). Outflow velocity profiles were obtained by pulsed wave Doppler at the orifice of the left atrial appendage. RESULTS: Left atrial spontaneous echo contrast was present in 78 patients (56%). In multivariate logistic regression analysis, spontaneous echo contrast was the only significant correlate of left atrial thrombus and was present in 14 (93%) of 15 patients. Spontaneous echo contrast and age were associated positively, and anticoagulant therapy was associated negatively, with previous thromboembolic events. Increasing grades of spontaneous echo contrast were associated with decreasing left atrial appendage blood velocity. The velocity in patients with thrombus was not significantly different from that in patients with 4+ spontaneous echo contrast. In multivariate linear regression analysis, the grade of spontaneous echo contrast was significantly and negatively associated with left atrial appendage velocity (p = -0.0001) and mitral regurgitation (p = -0.0002) and significantly and positively associated with left atrial area (p = 0.0005). The odds ratio for spontaneous echo contrast was 28:1 for low left atrial appendage blood flow velocity (< 35 cm/s) and 96:1 for low velocity and the absence of mitral regurgitation. CONCLUSIONS: Spontaneous echo contrast is the cardiac factor most strongly associated with left atrial appendage thrombus and embolic events. Spontaneous echo contrast formation is promoted by reduced blood flow velocity and increased left atrial size but is diminished by mitral regurgitation.

Adult↗
PubMed1996

Upper extremity thromboembolism after axillary-axillary bypass grafting.

Two patients experienced upper extremity thromboembolism after axillary-axillary bypass grafting (AxAG) for symptomatic subclavian artery stenosis. The first patient, a 67-year-old male, presented with left upper extremity thromboembolism 3 years after AxAG with 8 mm externally support PTFE. An arteriogram revealed a patent AxAG, thrombus in the proximal left subclavian arterial stump just distal to its occlusion, and multiple digital artery emboli. The patient was treated with warfarin for 8 months, with resolution of symptoms. The second patient, a 57-year-old male, occluded his AxAG (8 mm knitted Dacron) with minimal return of symptoms. Non-operative treatment was elected and 4 years later the patient presented with right upper extremity (donor side) thromboembolism. Arteriography revealed occlusion of the AxAG, radial artery, and digital arteries of the index, long and ring fingers. Thrombolytic therapy of the right arm was undertaken with minimal improvement. Subsequent detachment of the AxAG and placement of an interposition reversed saphenous vein graft was performed. Both patients continue to be asymptomatic during follow-up of 4.7 and 2.0 years, respectively.

Aged↗
PubMed1991

Thromboembolism in patients with pericardial valves in the absence of chronic anticoagulation: 12 years' experience.

Between January 1977 and January 1989, 465 pericardial bioprostheses were implanted in 424 patients. The mean age of patients was 59.1 years (range 16-81 y.) At the time of surgery, 68% of the patients suffered from chronic atrial fibrillation. Mitral valve replacement was performed in 167 patients, aortic valve replacement in 216, multiple replacement in 40 (36 mitral and aortic, 3 mitral and tricuspid, and 1 mitral, aortic and tricuspid), and 1 pulmonary valve replacement. The different types of pericardial valve used were: Ionescu-Shiley 408, Mitral Medical 23, Bioflo 30, and Hancock 4. Hospital mortality was 10.1% with an attrition rate of 1.8 episodes per 100 patients/year. The 12-year actuarial survival rate was 65.1%. No patient underwent long-term anticoagulant treatment. The first 144 patients undergoing mitral and multiple valve replacements received temporary anticoagulation for the first 8 weeks after surgery. There was no valve thrombosis observed. Altogether 19 thromboembolic events (6 early and 13 late) were clinically documented. One patient died after an embolic event. The linearized rates of thromboembolism were 1.64 episodes per 100 patients/year for mitral and multiple valve replacements and 0.33 episodes per 100 patients/year for aortic valve replacement, with an overall rate of 1.0 episodes per 100 patients/year. Excluding early thromboembolism, the linearized rate was 1.02 episodes per 100 patients/year overall. The actuarial freedom from embolism was 92.4% overall, 88.2% for the mitral and multiple valve replacement group, and 97.6% for the aortic valve replacement group at a maximum follow-up of 12 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗