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PubMed1996

[Asymptomatic pulmonary embolism and venous thrombosis of the lower limbs. Study with spiral x-ray computed tomography].

AIM: Spiral Computed Tomography (CT) allows diagnosis and follow-up in pulmonary embolism (PE). MATERIAL AND METHOD: We studied prospectively with spiral CT 21 patients to evaluate the frequency and the extent of asymptomatic PE in the patients with lower limbs venous thrombosis and no pulmonary symptomatology. RESULTS: We observed a asymptomatic PE in 8/21 cases (34%). Extensive pulmonary thrombosis could be observed despite normal presentation. There was no association between the localization of PE topography and, the extent of the lower limb venous thrombosis extent. CONCLUSION: This study shows about the capability for CT to evaluate PE severity and clinical underestimation PE occurrence.

Female↗
PubMed1989

A prospective double-blind trial of a low molecular weight heparin once daily compared with conventional low-dose heparin three times daily to prevent pulmonary embolism and venous thrombosis in patients with hip fracture.

In a randomized, prospective, double-blind trial, the effect of conventional low-dose heparin (5,000 units every 8 hours) was compared with that of a low molecular weight fragment (2165 LMWH, Kabi Vitrum AB, starting 2,500 units 2 hr before surgery, and then 5,000 units subcutaneously every morning for 9 days). A total of 90 patients admitted because of hip fracture fulfilled the inclusion criteria and were analyzed for development of pulmonary embolism and deep vein thrombosis: 46 patients were included in the low molecular weight heparin (LMWH) group, and 44 in the conventional heparin group. Two and three, respectively, died before diagnostic tests were performed. In the remaining patients a ventilation-perfusion lung scan was performed 8 days after intervention. In the first 57 patients studied a bilateral ascending venography was performed on the ninth day only if clinical symptoms suggested a deep venous thrombosis. Because of the rate of venous thrombosis detected in those patients was unexpectedly low, venography was requested in the remaining 33 patients, even if the screening tests were negative. Pulmonary embolism occurred in six patients, all in the LMWH group. Deep vein thrombosis occurred in 14 patients in the LMWH group and in six patients in the conventional heparin group. Both differences are statistically significant. Mortality did not differ between the groups, nor did haemorrhagic complications. Our findings suggest that, in patients with hip fracture, LMWH is not useful at the dosage used.

Aged↗
PubMed2002

Caval filter placement for pulmonary embolism in a patient with a deep vein thrombosis and primary intracerebral haemorrhage.

Treatment of deep vein thrombosis and pulmonary embolic disease when full anticoagulation is absolutely or relatively contraindicated is difficult. We report on a case where the chosen treatment proved unsuccessful. Our patient had a primary intracerebral haemorrhage, complicated by a proximal deep vein thrombosis and despite placement of a vena caval filter, had multiple pulmonary emboli and died.

Aged↗
PubMed1984

Intrabronchial bleeding and life-threatening atelectasis in pulmonary embolism.

A patient with deep vein thrombosis and pulmonary embolism was admitted after profuse hemoptysis. On the third day of heparin treatment intrabronchial bleeding recurred, leading to life-threatening atelectasis of the left lung. The bleeding coincided with a hypertensive attack. Intrabronchial bleeding after pulmonary embolisation is a rare but potentially lethal complication.

Adult↗
PubMed1995

[Indications for prophylactic vena cava filters introduced subcutaneously in patients with thromboembolic disease--preliminary report].

In 10 patients with thromboembolic disease 1 Gunther filter and 9 LGM filters were inserted. Indications for filter placement were: pulmonary hypertension caused by recurrent pulmonary embolism in 3 cases; planned surgery in 2 patients with pulmonary embolism and deep venous thrombosis; recurrent pulmonary embolism despite of anticoagulant treatment in 2 cases, previously performed thrombo-endarterectomy in 1 case; contraindications for anticoagulant treatment in 1 case and complications of anticoagulant therapy also in 1 case. No serious complications after filter placement were observed.

Adult↗
PubMed2001

Factors V leiden and II 20210A in patients with symptomatic pulmonary embolism and deep vein thrombosis.

PURPOSE: Factor V Leiden and factor II 20210A are inherited disorders of the clotting system that occur frequently in patients with deep vein thrombosis. We conducted this study to determine whether these factors are also common in patients with pulmonary embolism. SUBJECTS AND METHODS: We determined the prevalence of factor V Leiden and factor II 20210A in 773 consecutive patients with objectively documented symptomatic deep vein thrombosis or symptomatic pulmonary embolism, or with a combination of these disorders. RESULTS: Isolated symptomatic deep vein thrombosis occurred in 345 patients; isolated symptomatic pulmonary embolism occurred in 236; and both anomalies occurred in 192. Factor V Leiden was present in 21 (9%) of the patients with isolated symptomatic pulmonary embolism, in 30 (16%) with both manifestations, and in 63 (18%) with isolated symptomatic deep vein thrombosis (P = 0.007). Factor V Leiden was more common among patients with deep vein thrombosis (odds ratio [OR] = 2.1; 95% confidence interval [CI]: 1.2 to 3.7; P = 0.006) or both pulmonary embolism and deep vein thrombosis (OR = 1.8; 95% CI: 1.0 to 3.3; P = 0.07) than among patients with isolated pulmonary embolism. Factor V Leiden was less common in massive pulmonary embolism (5% [7 of 127]) than in submassive pulmonary embolism (13% [21 of 155], P = 0.03). We found no significant difference in the prevalence of factor II 20210A among the three groups. CONCLUSION: Factors V Leiden and II 20210A vary in prevalence among patients with pulmonary embolism and deep vein thrombosis, suggesting that the risk of pulmonary embolization may vary among patients who have different causes of venous thromboses.

Adult↗
PubMed1977

A comparative study of dextran-70, warfarin and low-dose heparin for the prophylaxis of thrombo-embolism following total hip replacement.

In a randomized, controlled clinical study, dextran-70, warfarin, or low-dose heparin were administered to patients undergoing total hip replacement on one surgical unit in an attempt to prevent deep venous thrombosis and pulmonary embolism. Calf vein thrombosis was detected by the 125I-fibrinogen uptake test. None of the methods prevented calf vein thrombosis (dextran-70, 51%; warfarin, 58-6%; heparin, 52-6%). Pulmonary embolism was completely prevented in patients treated with warfarin but occurred in 4% of patients treated with dextran-70 and 15-5% of those treated with low-dose heparin. The incidence of complications of therapy was small and comparable in each group. It is suggested that calf vein thrombosis is a frequent and in itself a non-serious complication of total hip replacement surgery and that emphasis might be placed more usefully on prevention of pulmonary embolism.

Aged↗
PubMed1990

[Fatal pulmonary embolism in venous thrombosis of the leg and pelvis during lysis therapy].

A 19-year-old girl had for four weeks the clinical signs of recurrent pulmonary emboli and deep-vein thrombosis (tachycardia, dyspnoea, right inguinal pain), which had been misdiagnosed. The correct diagnosis was made only after drastic deterioration in her condition following appendicectomy for falsely diagnosed appendicitis. Urokinase infusion (80,000-160,000 IU/h for 11 days) having failed to bring about improvement, much greater than ultra-high much less than thrombolysis with streptokinase was begun (250,000 IU streptokinase over 30 min, followed by 9 million IU over 6 hours). Fatal pulmonary embolism occurred seven hours after the end of the infusion. Autopsy revealed extensive separation of thrombotic material in the pelvic veins. This observation and other reports should serve as a warning against using streptokinase in ultra-high doses if large veins, as those in the pelvis, are involved.

Adult↗
PubMedDate not supplied

Shifting pulmonary embolism management to primary care.

Deep vein thrombosis and pulmonary embolism are a major cause of hospital admissions. This article examines the way patients can be treated in an outpatient setting and how this can improve the patient's quality of life as well as provide cost benefits to the NHS.

Ambulatory Care↗