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At least 1,045 records · Page 58Linked to original sources
PubMed2003

Low-molecular-weight heparin (nadroparin) and very low doses of warfarin in the prevention of upper extremity thrombosis in cancer patients with indwelling long-term central venous catheters: a pilot randomized trial.

BACKGROUND AND OBJECTIVES: Upper extremity thrombosis is a major complication of central venous catheters implanted for chemotherapy in cancer patients. Vitamin K antagonists and low-molecular-weight heparins have been recommended in this setting, but their relative benefit-to-risk ratios have never been compared. DESIGN AND METHODS: A prospective, randomized, open, parallel-group, multicenter trial was performed comparing the antithrombotic efficacy and safety of warfarin and the low-molecular-weight heparin, nadroparin, in cancer patients who had undergone central venous catheter implantation. Warfarin was given orally at a fixed daily dose of 1 mg and nadroparin was injected subcutaneously at a fixed daily dose of 2,850 IU for 90 days, or until venographically-confirmed thrombosis occurred. The primary efficacy outcome was the occurrence of upper extremity thrombosis confirmed by venography performed 90 days after insertion of the catheter, or earlier if symptoms of thrombosis had appeared. Safety end-points were bleeding and thrombocytopenia. RESULTS: Fifty-nine patients were included in the study. A total of 21 and 24 patients in the nadroparin and warfarin groups, respectively, were evaluable for primary efficacy. Six out of the 21 patients in the nadroparin group (28.6%) and 4 out of the 24 patients in the warfarin group (16.7%) had venographically-documented upper extremity thrombosis at day 90 (p=0.48). Safety was satisfactory and similar with both treatments. INTERPRETATION AND CONCLUSIONS: Warfarin at a fixed, very low dose and nadroparin at a fixed, prophylactic dose had comparable benefit-to-risk ratios in the prevention of thrombosis associated with central venous catheters in cancer patients.

Aged↗
PubMed2003

Concomitant heterozygous factor V Leiden mutation and homozygous prothrombin gene variant (G20210A) in patient with cerebral venous thrombosis.

BACKGROUND: Factor V Leiden mutation represents the most common genetic risk factor of venous thrombosis in Caucasian population. A common mutation in prothrombin gene, which is due to G-->A transition at position 20210, is also associated with elevated prothrombin concentration and thrombosis. Both this mutations may constitute concomitant risk factors for deep venous thrombosis. CASE REPORT: A 29-years old woman was admitted in the Emergency Department because of severe headache with vomiting that she suffered for a few days without any neurological deficits. In the Emergency she presented first in her life tonic-clonic seizures followed by right hemiparesis and aphasia and than was admitted to hospital. CT and MR scan showed a large lesion in the left fronto-parietal region with extent edema, which was first diagnosed as tumor. Following MR showed more lesions and typical signs of sinus thrombosis. She improved quickly after stroke without any anticoagulant treatment. Genetic study revealed factor V Leiden mutation and homozygous mutation G20210A in prothrombin gene. CONCLUSIONS: Both mutations found in this case, alone, are not a high risk factors for venous thrombosis but together may increase 5-10 fold risk of venous thrombosis. Venous stroke must be considered always in acute neurological events with organic brain lesions, especially in young

Adult↗
PubMedDate not supplied

Trauma as a risk factor for thrombosis in children: a report of three cases.

Thromboembolism is described as a multifactorial disorder including both congenital and acquired risk factors in children. Among these, trauma has been suggested as a possible risk factor for development of thrombosis. In this study, we reviewed the data of 158 children with thrombosis. Trauma was the major risk factor for thrombosis in three children. Cerebral infarction and cerebral venous thrombosis were detected in two patients, and thrombosis of the inferior vena cava and left renal vein in the third. In addition, the factor V Leiden mutation was demonstrated in two trauma patients with thrombosis.

Child↗
PubMed2003

The BEST study--a prospective study to compare business class versus economy class air travel as a cause of thrombosis.

BACKGROUND: As many as 10% of airline passengers travelling without prophylaxis for long distances may develop a venous thrombosis. There is, however, no evidence that economy class travellers are at increased risk of thrombosis. OBJECTIVES: A suitably powered prospective study, based on the incidence of deep-vein thrombosis (DVT) reported in previous studies on long-haul flights, was designed to determine the incidence of positive venous duplex scans and D-dimer elevations in low and intermediate-risk passengers, comparing passengers travelling in business and economy class. PATIENTS/METHODS: Eight hundred and ninety-nine passengers were recruited (180 travelling business class and 719 travelling economy). D-dimers were measured before and after the flight. A value greater than 500 ng/ml was accepted as abnormal. A thrombophilia screen was conducted which included the factor V Leiden mutation, the prothombin 20210A mutation, protein C and S levels, antithrombin levels, and anticardiolipin antibodies immunoglobulin G (IgG) and immunoglobulin M (IgM). On arrival, lower limb compression ultrasonography of the deep veins was performed. Logistical regression analysis was used to determine the risk factors related to abnormally high D-dimer levels. RESULTS: Only 434 subjects had a full venous duplex scan performed. None had ultrasonic evidence of venous thrombosis. Nine passengers tested at departure had elevated D-dimer levels and these volunteers were excluded from further study. Seventy-four of the 899 passengers had raised D-dimers on arrival. Twenty-two of 180 business class passengers (12%) developed elevated D-dimers compared with 52 of 719 economy class passengers (7%). There was no significant association between elevation of D-dimers and the class flown (odds ratio (OR) 0.61, p = 0.109). The factor V Leiden mutation, factor VIII levels and the use of aspirin were, however, associated with raised D-dimers (OR 3.36, p = 0.024; OR 1.01, p = 0.014; and OR 2.04, p = 0.038, respectively). Five hundred and five passengers were contacted within 6 months and none reported any symptoms of a clinical thrombosis or pulmonary embolus. CONCLUSION: The incidence of ultrasonically proven DVT is much lower than previously reported. However, more than 10% of all passengers developed raised D-dimers, which were unrelated to the class flown. A rise in D-dimers is associated with an inherent risk of thrombosis and/or thrombophilia, demonstrates activation of both the coagulation and fibrinolytic systems during long-haul flights, and may indicate the development of small thrombi.

Adult↗
PubMed1992

Antiphospholipid antibodies and thrombosis in systemic lupus erythematosus: comparison of three lupus anticoagulant assays and anticardiolipin ELISA in 188 patients.

The presence of antiphospholipid antibodies (aPL) in 188 unselected patients with systemic lupus erythematosus was studied using the recalcification time, kaolin clotting time (KCT), dilute Russell's viper venom time (dRVVT) and anticardiolipin ELISA (aCL) to identify patients with a high or low risk of thrombosis among patients with aPL. aPL were detected by at least one method in 104 (55%) of the patients. Despite heterogeneity, lupus anticoagulant (LA) methods correlated reasonably well with each other (r = 0.736-0.968), but poorly with aCL (r = 0.241-0.549). Positivity in LA assays and immunoglobulin G (IgG)-aCL were associated with patients who experienced thrombosis (P less than 0.001 for all assays). Patients with both LA and aCL had experienced thrombosis more often than those having only one (odds = 6.3, P less than 0.001). When patients with aPL were ranked by relative strength of the finding and divided into tertiles, a history of thrombosis was associated with membership in the strongest tertile of at least one assay (odds = 4.2, P = 0.002). LA and aCL had similar sensitivities for thrombosis (61% and 63%, respectively), but LA was more specific than aCL (79% vs 53%). The best combination of two assays was KCT with dRVVT (61% sensitivity, 87% specificity). Maximal sensitivity (71%) for thrombosis could be achieved by adding IgG-aCL to these two assays, but specificity was lower (73%). In conclusion, a high thrombotic risk among patients with aPL was indicated by the simultaneous presence of both LA and aCL, strongly positive aPL, and, among aCL, IgG-class antibodies.

Adolescent↗
PubMed1992

Mechanical cardiac valve thrombosis. Is fibrinolysis justified?

BACKGROUND: Thrombosis is a serious complication of heart valve replacement, and management is often difficult. In recent years, thrombolytic therapy has been used as the primary technique by some investigators. METHODS AND RESULTS: Sixty-four consecutive patients presenting with 75 instances of prosthetic heart valve thrombosis (41 mitral, 33 aortic, one tricuspid) were treated with fibrinolytic agents. Obstructed prosthetic valves comprised 39 tilting disc and 36 bileaflet valves. The time interval between valve replacement and obstruction ranged from 15 days to 192 months (mean, 38 months). Fibrinolytic agents used were streptokinase (42 patients), urokinase (27 patients), or recombinant tissue-type plasminogen activator (six patients). Immediate results of fibrinolytic treatment were 1) full success after one or several consecutive fibrinolytic regimens in 55 cases (73%), 2) incomplete improvement in two cases, and 3) failure in 18 cases, leading to an emergency surgery in nine cases. Nine patients died (four strokes, four cardiac arrests, one hemorrhage). Only one severe hemorrhagic complication was observed, but 11 cases of embolism occurred during fibrinolytic treatment (14.6%) (four major cerebral embolisms with death). The immediate efficacy was better for thrombosed aortic prosthesis than with the mitral prosthesis (85% versus 63%). CONCLUSIONS: Fibrinolytic treatment appears to be an attractive nonsurgical alternative for prosthetic heart valve thrombosis, but because of the risk of cerebral embolism, its use should be reserved for tricuspid valve thrombosis or critically ill patients with mitral or aortic valve thrombosis. The use of a fibrinolytic agent in cases of small, nonobstructive paravalvular thrombosis demonstrated with transesophageal echocardiography needs further studies.

Aortic Valve↗
PubMed2003

[Agenesis of inferior vena cava combined with multiple genetic predisposition in the case of deep venous thrombosis in a young male].

Deep venous thrombosis in the young age may be a complication of the rare congenital abnormality of the vena cava inferior. Genetic factors predisposing to thrombophilia in coincidence with vena cava malformation put the patients at much higher risk to develop thrombosis. The authors report a case of a 25-year old male who suffered from a massive deep venous thrombosis derived from the vena poplitea involving the vena iliaca communis. The molecular genetic examination of the patient revealed his combined genetic predisposition to venous thrombosis (Heterozygosity for Factor V. Leiden, Heterozygosity for prothrombin G20210A). Authors conclude that it is essential to perform all the relevant molecular genetic examinations to identify the presence of thrombophilic vulnerabilty and radiological imaging procedures in all cases of young patients with deep venous thrombosis if the suspicion of vascular malformation arises. The review of the literature revealed that the vena cava malformation in association with genetic factor predisposing to thrombophilia is an infrequent condition. In the authors knowledge this is the first report presenting a multiple combined genetic predisposition of risk factors in deep venous thrombosis.

Adult↗
PubMed2004

Thrombosis and drug-eluting stents: a critical appraisal.

The clinical consequences of stent thrombosis are frequently catastrophic. This article reviews the factors previously implicated in the occurrence of stent thrombosis and analyzes recent reports of thrombosis involving a new sirolimus-eluting stent (Cypher). Factors associated with stent thrombosis include intrinsic stent thrombogenicity and patient-, target lesion-, and procedure-related issues. Stent design may influence the degree of platelet activation after coronary stent deployment. In drug-eluting stents, the mechanical properties of the bare metal stent platform might be altered by the polymer coating, and the propensity for thrombosis might be influenced by both the polymer coating and the medication with which it is impregnated. Cumulative data for the Cypher stent do not suggest a propensity for thrombosis, but several caveats should be observed to enhance the safety of the device.

Equipment Safety↗
PubMed2004

[Detection and morphofunctional predictors of left auricular thrombosis in patients with atrial fibrillation].

Atrial fibrillation significantly worsens quality and duration of patient's life because of frequent development of thromboembolic complications. The main cause of these complications is formation of intracardiac thrombosis. Prevalence of left atrial thrombosis in patients with atrial fibrillation varies from 8 to 24%. About 90% of thromboses are localized in left auricle. This paper contains review of different methods of detection of left auricular thrombosis. Main structural and functional predictors of thrombosis and possibilities of modern techniques of their visualization are also described. Different methods of echocardiography first of all transesophageal echocardiography are at present foremost in assessment of structural and functional predictors of thrombosis development. With the help of transesophageal echocardiography it is possible to accomplish functional monitoring of the state of left auricle during treatment with different drugs and/or after cardioversion. Detection of risk factors of left auricular thrombosis is an important clinical task because it allows to select a group of high risk patients in which long-term therapy with anticoagulants is indicated.

Anticoagulants↗
PubMed1992

Is anticoagulation indicated for asymptomatic postoperative calf vein thrombosis?

The purpose of this study was to determine the effect of anticoagulation on the incidence of thrombotic propagation and pulmonary embolism in patients with calf vein thrombosis after total hip or total knee arthroplasty. Patients undergoing arthroplasties had prospective surveillance for postoperative deep vein thrombosis by both bilateral contrast venography and venous duplex scanning. Calf vein thrombosis was documented by venography in 42 patients (50 limbs), including 29 of 253 patients undergoing total hip arthroplasty (11.4%) and 13 of 99 patients undergoing total knee arthroplasty (13%). Of patients on whom follow-up duplex scans were performed, heparin followed by warfarin anticoagulation was used in 11 (13 limbs) and withheld in 21 (25 limbs). Propagation of thrombosis to the popliteal or superficial femoral vein or both was detected by serial duplex scanning in 3 of 13 treated limbs (23%) and 2 of 25 untreated limbs (8%), (p = 0.43). All thrombus propagations were detected within 2 weeks of the operative procedure. There were no pulmonary emboli or deaths. Propagation of asymptomatic calf vein thrombosis after arthroplasty was not influenced by anticoagulation, suggesting that postoperative calf vein thrombosis need not be routinely treated. Serial venous duplex scanning is useful to identify the occasional patient in whom thrombotic propagation requiring anticoagulation develops.

Aged↗
PubMed1977

[pH measurements in the vascular wall of dogs with electrically induced thrombosis of the femoral artery].

Electrically induced thrombosis is often used for pathophysiologic and therapeutic experiments. The pH value of the vascular wall was measured to approach the features of this thrombosis. After inducing thrombosis by direct current, pH value of the intima of femoral artery was found decreased. The anode was inserted in the lumen. As to the behavior of the pH value, electric thrombosis and clinical thrombosis are similar. Electric thrombosis therefore seems to be valuable for comparing investigations.

Animals↗
PubMedDate not supplied

Anticoagulation protocol and early prosthetic valve thrombosis.

BACKGROUND: [corrected] Prosthetic valve thrombosis is a major cause of morbidity and mortality following heart valve replacement with a mechanical valve. METHODS AND RESULTS: 538 patients who underwent mechanical valve replacement between April 1999 and June 2003 were included in the study. They were divided into two groups. Group A (n=245) consisted of patients who underwent mechanical valve replacement between April 1999 and June 2001. Anticoagulation was started on the first post-operative day and consisted of only oral nicoumalone. Group B (n=293) consisted of patients who underwent mechanical valve replacement between July 2001 and June 2003; enoxaparin was started six hours following surgery in addition to oral nicoumalone which was started on first post-operative day. Fifteen (6.1%) patients in group A developed early prosthetic valve thrombosis at an interval of 4.33+/-0.97 months (range 3-6 months) following surgery. Ten had prosthetic valve thrombosis in the mitral position and five had prosthetic valve thrombosis in the aortic position. In group B, six (2.1%) patients developed early prosthetic valve thrombosis at a median interval of 4.58+/-0.9 months (range 3.5-6 months) in the mitral position (p=0.01). CONCLUSIONS: Addition of enoxaparin to the anticoagulation regime in the immediate post-operative period significantly reduces early prosthetic valve thrombosis.

Adolescent↗
PubMed2005

Thrombosis, thrombophilia, and thromboprophylaxis in pregnancy.

Normal pregnancy is accompanied by changes in coagulation that have likely evolved to protect women from the bleeding challenges of miscarriage and childbirth. Consequently, pregnant women are at an increased risk of thrombosis. The most important risk factors are thrombophilia and a history of thrombosis. Most thromboses in pregnancy occur in the left lower extremity, but pelvic vein thromboses are not uncommon. Thrombophilia increases not only the risk of maternal thrombosis but also the risk of poor pregnancy outcome. All pregnant women should be asked about a personal or family history of thrombosis and the details of their obstetrical history. Some women should undergo laboratory testing, particularly those with a personal history of thrombosis or a history of poor pregnancy outcome. The purpose of testing is to help determine which women should receive anticoagulation therapy, which is used not only to treat venous thromboembolism, but also to prevent thromboembolism and reduce the risk of poor pregnancy outcome in women with thrombophilia. Low-molecular-weight heparins are preferred over unfractionated heparin because they have a longer half-life and are presumed to have fewer side effects. Their longer half-life is a disadvantage around the time of delivery when unfractionated heparin, with its shorter half-life, is easier to manage. The risk of thrombosis is higher postpartum than during pregnancy, so anticoagulation therapy is usually continued for at least 6 weeks after delivery.

Algorithms↗
PubMedDate not supplied

Postoperative portal vein thrombosis in patients with hepatosplenic mansonic schistosomiasis: relationship with intraoperative portal pressure and flow. A prospective study.

BACKGROUND/AIMS: Portal vein thrombosis is a frequent postoperative complication after esophagogastric devascularization with splenectomy. The aim of this study was to analyze biochemical, hematological, coagulation blood tests and intraoperative portal vein hemodynamics after surgical treatment of hepatosplenic Mansonic schistosomal portal hypertension. METHODOLOGY: Forty patients with hepatosplenic schistosomiasis with indication for surgical treatment were prospectively studied. All patients underwent routine pre- and postoperative biochemical, hematologic, coagulation blood tests and intraoperative portal hemodynamic evaluation (portal pressure and portal flow) before and after esophagogastric devascularization and splenectomy using a 4-F thermodilution catheter introduced inside the portal vein. RESULTS: Portal vein thrombosis, diagnosed by routine postoperative Doppler ultrasonography was found in 22 patients (55%). It was partial in nineteen and total in three. In patients with postoperative portal thrombosis, we observed a reduction in portal flow of 971 +/- 592 mL/min (42 +/- 16%) at the end of the surgery, while this reduction was of 720 +/- 644mL/ min (33 +/- 30%) in those with postoperative pervious portal vein (p = 0.245). The decrease in portal pressure was the same in both groups: 7.2 +/- 3.0 mmHg (23 +/- 10%) and 7.6 +/- 3.8 mmHg (27 +/- 14%) with and without thrombosis respectively (p=0.759). There was also no significant difference between patients with and without portal vein thrombosis regarding pre- and postoperative hemoglobin level or platelet levels, coagulation tests, portal vein diameter and spleen's weight. CONCLUSIONS: Portal vein thrombosis was observed in 55% of the patients but this complication did not show any correlation with the decrease in portal flow or pressure or with biochemical, hematologic, coagulation blood tests, portal vein diameter or spleen's weight.

Endoscopy, Digestive System↗
PubMed2005

[Portal vein thrombosis in patients with thrombophilia--own observations].

Portal vein thrombosis is one of the main prehepatic causes of portal hypertension. The most frequent causes of thrombosis in this localization, apart from hepatic cirrhosis, are the following: acute inflammatory diseases and abdominal cancers, traumas, proliferative diseases of the hematopoietic system. In recent years attention was given to disorders in hemostasis, such as thrombophilia, in the course of which thrombosis development is particularly common. The authors present 10 patients after an incident of portal vein thrombosis, in which primary hepatic pathology was excluded and tests directed at thrombophilia were performed. In seven patients abnormalities in the examined parameters were found, and what is more, in two cases they had a complex character and involved more than one parameter. In five patients hyperhomocysteinemia was found. Among them, in two patients there was also a decreased protein S activity and in one of them there was also APC-resistance. In the next two patients there were abnormalities in one of the examined parameters - APC-resistance. Hyperhomocysteinemia was found in all patients with idiopathic thrombosis, and in one of them there were concurrent changes in protein S activity and APC-resistance. In patients with the history of portal vein thrombosis diagnostics of thrombophilia should be performed.

Adult↗
PubMed2006

No added value of the methionine loading task in assessment for venous thrombosis and cardiovascular disease risk.

Homocysteine is a risk factor for cardiovascular disease and venous thrombosis. Clinical guidelines differ in their recommendation whether or not to measure homocysteine after methionine loading. In this study, we investigated the added value of the methionine loading test next to fasting homocysteine levels for identifying subjects at risk for venous thrombosis or cardiovascular disease, using Receiver Operating Characteristic (ROC) curves. The analysis was performed in 185 patients with recurrent venous thrombosis, 130 patients with cardiovascular disease and 601 controls. The discriminatory power of the fasting homocysteine measurement alone for identifying subjects at risk of venous thrombosis expressed as the area under the ROC curve (AUC) was 0.61 (95%CI 0.56-0.66). Using both a fasting homocysteine measurement and a methionine loading test together yielded a similar AUC of 0.65 (95%CI 0.60-0.69), indicating no added value of methionine loading next to fasting homocysteine measurement in identifying subjects at risk for thrombosis. Similar results where found for cardiovascular disease,with an AUC of 0.62 (95%CI 0.57-0.67) for the fasting homocysteine measurement alone and an AUC of 0.62 (95% CI0.57-0.67) for the combination of both the fasting and the post-load homocysteine measurement. The methionine loading test has no added value next to measuring fasting homocysteine levels for identifying subjects at risk for venous thrombosis or cardiovascular disease and for that reason should not be used in clinical practice.

Aged↗
PubMed2006

[Comparative research of thrombosis animal model induced byendotoxin in combination with carrageenan in different animals].

OBJECTIVE: To compare the development of thrombosis animal model induced by endotoxin(LPS) in combination with carrageenan (Ca) in different animals. METHOD: Two species of rats (SD and Wistar) and three species of mice (Kunming, ICR and Balb/c mice) were employed in the study. The animals of each species were randomly divided into control group and model group (LPS/Ca treatment). The animals in the model group were pretreated with Ca ip at the doses of 25 mg x kg(-1) for rats and 150 mg x kg(-1) for mice, and then treated by LPS iv sixteen hours later, while in the control group were given normal saline (NS). Thrombosis in tails was observed at 24 h after LPS iv. Hematologic parameters were tested for all the animals from each species, and the blood concentration of TNFalpha and IL-6 at different time in SD and Wistar rats were measured. RESULT: LPS/Ca combinatory treatment could induce thrombosis animal model in all five animal species, and the thrombus could be clearly observed on the tails. All species had the similar change in hematologic parameters characterized as the significant decrease of white blood cells and platlets. Inflammatory factors TNFalpha and IL-6 could be largely induced in blood of both SD and Wistar rats at 2 h after LPS iv, but both inflammatory factors only transitorily exist in blood at the early stage of thrombosis model formation. CONCLUSION: LPS/Ca combinatory treatment can successfully induce thrombosis animal model in all tested animal species, and thus this model has extensive animal candidates. The secretion of a large amount of inflammatory factors plays a crucial role in the formation of thrombosis animal model.

Animals↗
PubMed2006

Very late bare-metal stent thrombosis. A case report and review of the literature.

Stent thrombosis is a catastrophic event characterized by the acute thrombotic occlusion of a previously-stented segment of a coronary artery. It usually presents as an ST-segment elevation myocardial infarction and/or death, and most commonly occurs within the first several weeks after stent placement. Stent thrombosis is classified as either subacute stent thrombosis (SAT), occurring within 30 days of stent placement, or as late stent thrombosis (LST), occurring after 30 days. While very late stent thrombosis (VLST), occurring beyond 1 year, is not uncommon with the use of drug-eluting stents, it is distinctly unusual with the use of bare-metal stents. We report a case of very late thrombosis of a bare-metal stent occurring 717 days after implantation.

Aged↗