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At least 883 records · Page 49Linked to original sources
PubMed2006

Referent d-dimer enzyme-linked immunosorbent assay testing is of limited value in the exclusion of thromboembolic disease: result of a practical study in an ED.

OBJECTIVE: The aim of this study was to assess in clinical practice the accuracy of a referent d-dimer enzyme-linked immunosorbent assay for the exclusion of venous thromboembolic disease (VTED). PATIENTS AND METHODS: An observational prospective study took place in an emergency department; 205 consecutive outpatients suspected of having VTED were included. Blood samples were collected at admission for VIDAS DD measurement. Venous thromboembolic disease was confirmed by standard clinical imaging. All patients were followed up at 3 months. RESULTS: Venous thromboembolic disease was confirmed in 57 patients (28%). The sensitivity and negative predictive value of a DD assay lower than 500 ng/mL were 78% (95% confidence interval = 67%-87%) and 84% (95% confidence interval = 73%-90%), respectively. Twelve patients had a false-negative DD with one or more of the following: (a) symptoms reported for more than 15 days (n = 2), (b) prior anticoagulation (n = 3), (c) distal VTED (n = 5), or (d) high clinical probability (n = 3). CONCLUSION: In our cohort of patients, DD was less accurate than previously reported, with an upper estimate of the sensitivity of only 87%.

Adult↗
PubMed2004

Relation of C-reactive protein correlates with risk of thromboembolism in patients with atrial fibrillation.

The relation between C-reactive protein, an inflammatory marker, and thromboembolic risk factors was investigated in 104 patients with atrial fibrillation and found that patients with transesophageal echocardiography identified thromboembolic risk factors had greater C-reactive protein levels than those without (1.00 vs 0.302 mg/dl). C-reactive protein also correlated with clinical stroke risk factors. Increased C-reactive protein levels were also independently associated with transesophageal echocardiographic thromboembolic risk factors.

Adult↗
PubMed2006

Comparison of a single end point to determine optimal initial warfarin dosing (5 mg versus 10 mg) for venous thromboembolism.

There remains considerable controversy regarding optimal initial warfarin dosing in patients with acute venous thromboembolism. Therefore, an open-label, randomized trial comparing 2 warfarin initiation nomograms (5 vs 10 mg) was conducted in patients with acute venous thromboembolism. All participants received fondaparinux for > or = 5 days as a "bridge" to warfarin. The primary end point was defined as the number of days necessary to achieve 2 consecutive international normalized ratio laboratory test values > 1.9. A total of 50 patients were enrolled and randomly assigned to each of the treatment arms. The median time to 2 consecutive international normalized ratios was 5 days in the 2 groups. There was no statistical difference in achieving the primary end point using either the 5- or the 10-mg nomogram (p = 0.69). These results should provide clinicians with increased warfarin dosing options in patients presenting with acute venous thromboembolism.

Acute Disease↗
PubMed2006

Thromboembolic prophylaxis in plastic surgery a 12-year follow up in the UK.

Potentially fatal thromboembolic events prevail post-operatively despite the widespread availability of proven methods of prophylaxis. In 1992 Dujon et al published an article which reviewed thromboembolic prophylaxis methods of Consultant Plastic Surgeons in the UK and Ireland. Our follow up study surveyed all current Consultant B.A.P.S members using a modified postal questionnaire to assess practice nationwide. Our conclusions were drawn from comparisons made between the two populations some twelve years apart. Our results show a dramatic change from the previous findings. Since 1992 86% of respondents have developed a set prophylaxis protocol (compared to 19%). The use of low molecular weight heparin has drastically increased by 24% to 76%, the use of flow-tron boots (or similar) has increased by 22% to 68%, the use of TED stockings has increased by 12% to 83%, the use of multi-modality prophylaxis has increased by 27% to 79% Our results demonstrate a definite shift towards multi-modal thromboembolic prophylaxis, possibly due to increased awareness of available technologies and subsequent reduction in costs.

Anticoagulants↗
PubMedDate not supplied

Venous thromboembolism in earthquake victims.

Sudden death from pulmonary thromboembolism following an earthquake has not been reported to date. This is a published case report of a 48-year-old woman who died suddenly of a pulmonary embolism on October 28, 2004. She lived in the Chuetu District in Japan, where a big epicentral earthquake occurred on October 23. She evacuated her house with her family and spent 4 of 5 nights in a private car. Until November 1, 8 persons who had been living out of their cars after evacuation from their houses in the District were treated for pulmonary thromboembolism. The immobility that comes with living in a car should be recognized as a risk factor for venous thromboembolism. In addition, potential preventive measures should be recommended, including provisions for emergency shelters, access to other temporary housing, public education, and the use of compression stockings.

Automobiles↗
PubMed2005

On-scene physician assessment of thromboembolic etiology in out-of-hospital cardiac arrest.

Out-of-hospital cardiac arrest (OOHCA) treatment produces dismal recovery rates. Newer, directed therapies such as thrombolysis may be best considered if possible etiologies can be assessed immediately. We conducted a prospective, pilot, feasibility study of on-scene physician assessments in non-traumatic OOHCA. Physicians responded to the scene and reported likelihood of thromboembolic etiology based on detailed history and physical assessments. Included were 136/148 OOHCAs during the 6-month study period; median age was 69.5 years and 72% were men. Physicians judged 103/136 (76%) of arrests to be of thromboembolic etiology and would have recommended thrombolytic bolus in 83/136 (61%). Among 19 instances of physician-reported contraindications, 17 (90%) were not true contraindications. Median age was lower in the group recommended for thrombolysis. Thromboembolic etiology as judged by on-scene physicians was common and physicians recommended thrombolytic bolus commonly. Contraindications were highly overestimated. These data may be useful in the consideration of innovative, directed therapies such as thrombolysis in attempts to improve outcomes from OOHCA.

Aged↗
PubMed1976

Living with prosthetic heart valves. Subsequent noncardiac operations and the risk of thromboembolism or hemorrhage.

A total of 111 survivors of prosthetic valve insertion were followed an average of 4 years to assess the risk of thromboembolism or hemorrhage. Non-cloth-covered ball and/or disc valve prostheses were used, and all patients received long-term anticoagulant therapy. During the follow-up period the patients with mitral or combined valve replacement suffered four times more thromboembolic episodes and had a poorer survival rate than the patients with isolated aortic valve replacement. The management of anticoagulation and the complications resulting from 44 subsequent noncardiac operations were analyzed. Anticoagulation was discontinued before 25 noncardiac operations in patients with isolated aortic valve prostheses and there were no perioperative thromboemboli. Ten operations were performed on patients with mitral or combined valve prostheses with cessation of anticoagulation prior to surgery and there were two deaths due to perioperative thromboemboli. Unanticipated hemorrhage was encountered in four of nine patients in whom anticoagulation was maintained during surgery. Cessation of anticoagulation for 3 to 5 days appears safe in patients with aortic prostheses who require subsequent noncardiac operations. The incidence of thromboembolism in patients after mitral or combined valve replacement is high and constitutes a major risk whether or not a subsequent operation is required.

Aortic Valve↗
PubMed1977

Prevention of arterial thromboembolism with acetylsalicylic acid. A controlled clinical study in patients with aortic ball valves.

Prevention of arterial thromboembolism with acetylsalicylic acid (ASA) was studied in 148 patients with single Starr-Edwards aortic ball-valve prostheses. These patients are suitable for such a study because they have a high incidence of arterial emboli derived mainly from thrombi formed on the valves. They were given either 1 Gm. of ASA daily or placebo in combination with anticoagulants, and were observed for 2 years. Only two emboli occurred in patients receiving ASA, none of them severe. In the placebo group 12 thromboembolic episodes were diagnosed in 10 patients, and three with cerebral emboli died; in one a subdural hematoma unrelated to the embolus was found. In addition, one fatal and the one nonfatal intracranial bleeding occurred in each group, whereas gastrointestinal complications were seen more frequently in patients taking ASA. It is concluded that ASA combined with anticoagulants offered a significantly better protection against arterial thromboembolism than did anticoagulant therapy alone.

Adult↗
PubMed1989

Antithrombotic therapy in acute myocardial infarction: prevention of venous, left ventricular and coronary artery thromboembolism.

The antithrombotic approach to patients with acute myocardial infarction in the prevention of venous, left ventricular and coronary artery thromboembolic events should be based on an understanding of pathogenesis and risk. Coronary thrombotic events involve conditions of high shear rate present in areas of vessel stenosis or disrupted atherosclerotic plaque, which lead to activation of both platelets and the coagulation system, and are best prevented by platelet inhibitors alone or in combination with an anticoagulant. However, thromboembolism that originates in the venous system or cardiac chambers is related to situations of blood stasis and low shear rate, which predominantly result in clotting activation and fibrin-thrombus formation and are best approached with anticoagulant therapy. For prevention of venous thrombosis and pulmonary embolism, early mobilization is essential and should be supplemented by low-dose heparin in patients at high risk, including the elderly and those with large infarcts, heart failure or previous thromboembolic events. For prevention of left ventricular mural thrombosis and systemic embolism, high-dose heparinization is indicated in patients with large infarcts, particularly in the anterior location and in those with heart failure. Subsequently, warfarin therapy should be considered for patients at high embolic risk, including those with echocardiographic evidence of mobile and protruding thrombi, severe left ventricular dysfunction or prior emboli. In patients with acute infarction, aspirin is recommended for preventing coronary reocclusion and reinfarction. Although anticoagulants may also be of benefit for this purpose, their use is still controversial.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed1997

Thromboembolic risks of left atrial thrombus detected by transesophageal echocardiogram.

Patients with left atrial thrombus are considered at high risk for thromboembolic events. The actual prognosis of these patients and the features most predictive of future events are unclear. We performed transesophageal echocardiograms in 2,894 patients over a 6 1/2-year period; 94 (age 69 +/- 11 years, 59 men, 83 in atrial fibrillation) were found to have left atrial thrombus. The thrombi were considered mobile in 45 patients and 33 patients had thrombus with a maximum dimension > or = 1.5 cm. Seven of the 94 patients with prosthetic valves were excluded from follow-up analysis. Over a follow-up period of 25.3 +/- 19.2 months, 17 patients had suffered a stroke or embolic event (event rate 10.4% per year) and 27 had died (mortality 15.8% per year). Cox proportional hazard regression analysis identified a maximum thrombus dimension > or = 1.5 cm (RR 19, p = 0.002), history of thromboembolism (RR 4.2, p = 0.038), and mobile thrombus (RR 5.3, p = 0.02) as predictors of subsequent thromboembolism. Moderate or severe left ventricular dysfunction was the only significant predictor of death (RR 2.9, p = 0.04). Gender, age, warfarin therapy at follow-up, atrial fibrillation, location (cavity vs appendage) of thrombus, and spontaneous echocardiographic contrast were not significant. Aggressive antithrombotic therapy may be indicated in these high-risk patients.

Adult↗
PubMed1997

Risk of thromboembolism in chronic atrial flutter.

Anticoagulant therapy is not conventionally used in the treatment of patients with atrial flutter. This recommendation has been based on sparse clinical experience, and recent preliminary reports suggest a significant risk of thromboembolism for these patients. A retrospective study was undertaken to assess the frequency of thromboembolic events as well as potential risk factors for these events in a cohort of patients with atrial flutter referred for radiofrequency ablation treatment. Eighty-six consecutive patients with a primary diagnosis of atrial flutter were evaluated. A history of embolic events was noted in 12 of 86 patients (14%) with atrial flutter, with an annual risk of approximately 3%. There were no differences in the prevalence of coronary artery disease, cardiomyopathy, valvular disease, or atrial fibrillation between the 2 groups of patients having an embolic event and those of patients without embolic events. Left ventricular function and left atrial size were also similar between the 2 groups. The only significant risk factor was hypertension (p < 0.05). However, in a regression model with other clinical variables (i.e., age, gender, left atrial size, presence or absence of any cardiac disease, length of time in flutter, left ventricular function, type of flutter, flutter cycle length, type of secondary arrhythmias) no significant predictors were found. Patients with transient ischemic attacks or pulmonary emboli were then excluded from the analysis in order to compare the thromboembolic risk in the present study to that reported in major atrial fibrillation trials. The overall risk becomes 7% (6 of 86), which over a mean follow-up period of 4.5 years yields an annual risk of approximately 1.6%. Although this risk is only 1/3 of that for patients with atrial fibrillation, this risk is higher than previously recognized for patients with chronic atrial flutter. Anticoagulant therapy should be seriously considered for these patients.

Adult↗
PubMed1995

Lupus anticoagulant, heparin use, and thrombocytopenia in patients with chronic thromboembolic pulmonary hypertension: a preliminary report.

PURPOSE: An increased occurrence of thrombotic events has been described in patients exhibiting a lupus anticoagulant (LA). In patients with chronic, major vessel thromboembolic pulmonary hypertension, not only has there been a relatively high frequency of the LA, but also an unexpected association with heparin-related thrombocytopenia. This retrospective report emphasizes the frequency of this association. PATIENTS AND METHODS: We retrospectively reviewed the medical records of 216 patients admitted to the University of California, San Diego, Medical Center who were being considered for surgical correction of their chronic thromboembolic pulmonary hypertension. For each patient, the following information was sought: presence of an LA, variation in platelet numbers during the preoperative evaluation, and determination of whether an observed thrombocytopenia was related to heparin use. RESULTS: An LA was found in 23 of the 216 patients (10.6%). Of the remaining patients, sufficient platelet data for comparison were available for 68 patients. These 68 patients constituted the control group. Within the LA group, platelet counts during the preoperative evaluation declined to 51.6% +/- 16.7% of baseline counts, a highly significant difference (P < 0.0001) compared with the non-LA control group, who underwent a comparable evaluation with similar heparin exposure. In addition, heparin-associated thrombocytopenia developed in 13 of the 23 LA patients (56.5%) and in none of the control patients. Heparin-induced arterial thrombosis was implicated as the cause of a myocardial infarction in 1 of the patients with heparin-associated thrombocytopenia. CONCLUSIONS: In patients with chronic thromboembolic pulmonary hypertension, a high incidence of the LA and an accompanying association with heparin-related thrombocytopenia have been observed. Although further prospective studies of this relationship are needed, physicians should be alert to the possibility of thrombocytopenia when using heparin for patients exhibiting an LA.

Anticoagulants↗
PubMed1998

Genetic susceptibility to pregnancy-related venous thromboembolism: roles of factor V Leiden, prothrombin G20210A, and methylenetetrahydrofolate reductase C677T mutations.

OBJECTIVE: This study's objective was to evaluate the association between venous thromboembolism during pregnancy and the postpartum period and the factor V Arg 506 Gln (factor V Leiden), the prothrombin G20210A, and methylenetetrahydrofolate reductase C677T polymorphisms. STUDY DESIGN: In this case-control study 42 case patients and 213 control subjects (parous age-matched women without history of thrombosis) were genotyped for all the polymorphisms. Moreover, antiphospholipid antibodies and protein C, protein S, and antithrombin III deficiencies were investigated in each case. RESULTS: Ten case patients (23.8%) and 4 control subjects (1.9%; odds ratio 16.3, 95% confidence interval 4.8-54.9) carried the factor V Leiden mutation; 13 case patients (31.0%) and 9 control subjects (4.2%; odds ratio 10.2, 95% confidence interval 4.0-25.9) were carriers of the prothrombin G20210A allele. Finally, 12 case patients (28.6%) and 34 control subjects (16.0%; odds ratio 2.1, 95% confidence interval 1.0-4.5) were homozygotes for methylenetetrahydrofolate reductase C677T. Overall, mutations were found in 25 case patients (59.5%) and 47 control patients (22.2%; odds ratio 5.2, 95% confidence interval 4.9-19.6). One patient carried the antithrombin III deficiency and 1 the protein S deficiency, whereas 2 women had a primary antiphospholipid syndrome. CONCLUSIONS: The significant risk estimates of having a pregnancy-related venous thromboembolism in the presence of the prothrombotic genetic risk factors analyzed suggest to screen for these mutations women with a personal history of thromboembolic events during pregnancy or the postpartum period.

Adult↗
PubMed1984

Prevention of thromboembolism using aspirin after mitral valve replacement with porcine bioprosthesis.

The thromboembolic rate of 768 patients who were treated only with aspirin after mitral valve replacement or mitral plus aortic valve replacement with porcine bioprostheses was evaluated. We analyzed the thromboembolic rate for the whole series and for subgroups of patients categorized by atrial fibrillation, giant left atrium, left atrial thrombosis, and dosage of aspirin (1 gm daily or 0.5 gm every 48 hours). The total embolic rate was 1.4% (11/768). No patient in sinus rhythm had an embolic event. The embolic rate for patients in atrial fibrillation was 1.9% (11/583). There were no embolic events in 31 patients with a giant atrium. An embolic event occurred in 1 of 42 patients with atrial thrombosis (2.4%). Patients treated with 1 gm of aspirin daily had a 3% embolic rate (9/295) while the incidence was 0.4% (2/473) in those treated with 0.5 gm every 48 hours (p less than 0.01). Administration of aspirin after mitral valve replacement with a bioprosthesis is a very effective treatment for prevention of thromboembolism. In our experience, this treatment provides protection equal to or better than that offered by oral anticoagulants for patients in atrial fibrillation as well as for patients with a giant atrium or atrial thrombosis at operation. The dosage and timing of aspirin administration may markedly affect the result of this type of treatment. Oral anticoagulation with coumarin derivatives may not be appropriate after mitral valve replacement with a bioprosthesis, and platelet antiaggregates should be used for this purpose in the future.

Adolescent↗
PubMed1982

Thromboembolic complications of current cardiac valvular prostheses.

Thromboembolic complications associated with twelve different models of currently available aortic and mitral valve prostheses are reviewed. There is a need to standardize definitions of thrombotic phenomena and to report these events for valve model and anatomic location actuarially and in terms of incidence per 100 patient-years of follow-up. The incidence of thromboemboli is less than 2 per 100 patient-years for aortic biological valves without coumarin anticoagulation and for the best mechanical valves with coumarin. For mitral biological prostheses with and without coumarin, and for the best mechanical mitral valves with coumarin, the incidence approximates 4 per 100 patient years. The incidence of mortality and morbidity due to coumarin anticoagulation in patients with prosthetic valves is 0.17 and 2.2 per 100 patient-years, respectively. Omission, poor control or withdrawal of coumarin anticoagulation substantially increases the incidence of thromboemboli in patients with mechanical valves. Some reports suggest that the combination of dipyridamole and coumarin may further reduce thromboembolic complications without increasing bleeding problems. Atrial fibrillation clearly increases thromboembolic complications, but the importance of other factors such as atrial clot, large left atrial size, history of emboli, and first postoperative year is less definite.

Aortic Valve↗
PubMed1998

Thromboembolism and mechanical heart valves: a randomized study revisited.

BACKGROUND: This study was designed to revise and substantiate previous inferences, based on short-term follow-up, about differences in the incidence of anticoagulant-related events after heart valve replacement among patients who had been randomly assigned to receive either a Björk-Shiley, Edwards-Duromedics, or Medtronic-Hall mechanical heart valve prosthesis. METHODS: Intermediate-term follow-up to January 1995 was completed in 418 of 419 patients randomized to receive one of three types of heart valve prostheses between January 1982 and January 1987. Median follow-up was 98.5 months. Multivariable analysis in the hazard function domain was performed to identify factors that influenced the incidence of time-related thromboembolism and bleeding. These findings were compared with those made previously after a median follow-up of 37.5 months. RESULTS: No differences were found among the three prostheses in rates of anticoagulant-related hemorrhage. However, the incidence of thromboembolism was higher after mitral valve replacement among patients who had received the Medtronic-Hall prosthesis (linearized rate, 5.4% per patient year; 70% confidence interval, 4.0% to 7.1%), compared with Edwards-Duromedics (1.3%; 70% confidence interval, 0.4% to 3.0%) and Björk-Shiley prostheses (1.2%; 70% confidence interval, 0.6% to 2.2%). CONCLUSIONS: At long-term follow-up, in contrast to the findings at short-term follow-up, patients with either Björk-Shiley or Edwards-Duromedics prostheses had low rates of thromboembolism, whereas higher rates occurred in patients with a Medtronic-Hall prosthesis in the mitral position.

Anticoagulants↗
PubMed2001

Further characterisation of a thromboembolic model of stroke in the rat.

We have used magnetic resonance imaging (MRI) techniques to characterise a rat model of thromboembolic stroke. The consequences of acute perfusion deficit associated with a middle cerebral artery occlusion (MCAo) by a newly formed thrombus was mapped by interrogation of the tissue oxygenation status using gradient echo methods and production of T2* maps. Final infarct size was subsequently assessed at 24-h post-ischaemia by histology with 2,3,5-triphenyltetrazolium chloride (TTC) staining. Animals displayed an infarct volume of 178.7+/-84.2 mm(3) (mean+/-S.D.) with a large coefficient of variation (47%) and range of values (85.6--265.5 mm(3)). This variability provided us with an opportunity to assess the relationships between early imaging observations and eventual infarct size. For a single cerebral slice, at the centre of the MCA territory, a relationship between the area of reduced T2* at 1 and 2 h post MCAo correlated highly with final lesion area (Spearman rank correlation, r=0.98, P<0.01, n=9). Lesion volumes in the thromboembolic MCAo model were compared with a 120-min occlusion, 22-h reperfusion protocol using an intraluminal thread MCAo approach. For the thromboembolic model, the total lesion volume was found to be smaller (178.7+/-84.2 vs. 243.3+/-50.1 mm(3), mean+/-S.D., Student's t-test P=0.046) and showed a greater variability (coefficient of variations: 47% vs. 21%). These data underline the relative variability of this embolic model and provide important preliminary information regarding the value of early changes in T2* in predicting eventual infarct size.

Animals↗
PubMed1997

First-time use of newer oral contraceptives and the risk of venous thromboembolism.

Recent epidemiologic studies reported that the risk of venous thromboembolism (VTE) was higher with the use of the newer third generation oral contraceptives than with second generation agents. Although the overall findings of these studies are similar, the results, as they relate to patterns and duration of oral contraceptive use particularly among first-time users, are inconsistent. We reanalyzed data from the Transnational case-control study to assess the risk of VTE associated with first-time use of oral contraceptives as a function of its duration of use. Over the period 1993 to 1995, 471 cases of venous thromboembolism were identified in Germany and the United Kingdom. For each case, up to four controls were obtained, for a total of 1772 controls. Data on oral contraceptive use and confounding variables, including data on sociodemographic, lifestyle, medical history, and family history of disease, were obtained by interview. Data analysis was based on the 105 cases and 422 controls who were first-time users of second or third generation agents, or never users of oral contraception. Rate ratios, adjusted for confounders and approximated by odds ratios, were estimated as a continuous function of duration of oral contraceptive use by logistic regression and quadratic spline models. We found, for first-time users, that the adjusted rate ratio of VTE as a function of the duration of oral contraceptive use is essentially identical for second and third generation pills relative to never users. This rate ratio increases to around 10 in the first year of use and decreases to around two after 2 years of use, remaining at this risk level thereafter for both second and third generation agents. We conclude that second and third generation agents are associated with identical risks of venous thromboembolism when they are prescribed to women who are using oral contraceptives for the first time ever.

Adult↗