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PubMed2004

[Thromboembolic complications in patients undergoing in vitro fertilization: retrospective clinical study].

OBJECTIVE: To determine the incidence and the type thromboembolic complications in patients undergoing in vitro fertilization (IVF). To evaluate their clinical course, the influence on reproductive outcomes, and the prevalence of thrombophilia in these women. DESIGN: Retrospective clinical study. SETTING: Assisted Reproduction Center, Department of Obstetrics and Gynecology, 1st Faculty of Medicine and General Faculty Hospital, Charles University, Prague. METHODS: The data, reflecting the diagnosis of thromboembolism (TE), were collected from all patients, who have undergone the IVF cycle in our clinic for the last 7 years. The following data were analyzed in these patients: medical history, type and course of TE, type and effect of ovarian stimulation, clinical pregnancy achievement, occurrence of ovarian hyperstimulation syndrome (OHSS), results of testing for thrombophilia, pregnancy course and outcome. RESULTS: From 2748 IVF cycles 3 cases of TE were found (0.11%). In all cases the unilateral thrombosis of internal jugular vein associated with OHSS, manifesting in 1st trimester of pregnancy and not complicated with pulmonary embolism occurred. At least two thrombophilic markers have been detected in all these women. The clinical course of TE, as well as of the whole gestation was favorable. Prevalence of TE in patients with severe OHSS was 4.1% (2 women from 49). CONCLUSION: The incidence of thromboembolism in women undergoing IVF is low. It appears almost exclusively in association with OHSS and the typical finding is deep venous thrombosis in the neck area. In our opinion, while screening of thrombophilia in all patients from IVF program is not indicated, the routine testing of most common thrombophilic markers in pregnant women with OHSS could decrease the risk of these serious complications.

Adult↗
PubMed1992

Hypercoagulable states in arterial thromboembolism.

Hypercoagulable states are disorders of blood coagulation, which include deficiencies of natural anticoagulants, disorders of the fibrinolytic system, presence of antiphospholipid antibody and abnormalities of platelet function. These disorders are well known causes of venous thromboembolic disease and are being recognized in association with arterial thromboembolic occurrences with increasing frequency. The performance of standard prosthetic vascular reconstructions may result in disastrous outcomes in patients with unrecognized and untreated hypercoagulable states. From 1986 to 1990, we identified 12 patients with hypercoagulable states, six of whom presented with evidence of arterial thromboembolism. All of the patients were men who smoked and were somewhat younger than the usual patient with atherosclerosis. Their ages ranged from 41 to 62 years. Four patients presented with ischemic rest pain, one patient with blue toe syndrome and one with rapidly progressive claudication. Four patients had undergone prior vascular reconstruction and two had previous pulmonary emboli. Evaluation of these patients to identify hypercoagulability included determinations of prothrombin time (PT) and partial thromboplastin time (PTT), platelet count, antithrombin III, protein C, free protein S and total protein S levels, along with platelet aggregometry. Two patients had protein S deficiency, one had protein C deficiency, one patient had protein C and S deficiency and two patients had hyperaggregable platelets. Four patients had prosthetic reconstructions and two had autogenous reconstructions. Three of the four patients undergoing prosthetic reconstructions had subsequent loss of limb and one patient died. Only one patient with prosthetic reconstruction had a patent graft on long term anticoagulation. Both patients undergoing autogenous procedures had successful revascularization with limb salvage.

Adult↗
PubMed2004

[Prevention and treatment of venous thromboses and thromboembolism: pentasaccharides as novel anticoagulants selectively blocking Xe factor, their position and potential (data of the XIX International Congress on Thromboses and Hemostasis)].

Drug prevention and treatment of venous thromboses and thromboembolism remain a serious problem in the management of surgical and therapeutic patients. Pentasaccharides, novel anticoagulants selectively blocking Xe factor have a great potential for their use in the given area. It has been demonstrated at the preliminary stages of the study of these antithrombotic agents that their pharmacokinetics permits subcutaneous drug injection once a day (for fondaparinux) and once for 7 days (for indraparinux) without the necessity of making routine coagulologic control. The drugs are marked by bioavailability approximating 100%, linear dose-dependent pharmacokinetic profile at subcutaneous injection; they do not undergo metabolism and are excreted largely with urine. Fondaparinux, the first representative of this class anticoagulants, has evidence for the effectiveness and safety, obtained in large randomized studies carried out in orthopedic and traumatologic patients. The given paper reports the new positive data on evaluation of the preventive action of fondaparinux in therapeutic subjects end patients who had undergone abdominal surgical interventions. Moreover, in large comparative studies , this anticoagulant did yield to the standard agents applied to the treatment of thrombosis of the deep veins and thromboembolism of pulmonary artery branches. Being more handy in use fondaparinux is capable of replacing antithrombotic agents (without efficacy and safety loss) used nowadays for preventive and therapeutic purposes. In the event of successful completion of the evaluation of idraparinux, another pentasaccharide intended for many months of anticoagulant treatment, the goal-oriented use of pentasaccharides is potentially capable of supplanting all the "old" antithrombotic agents from the schedule of the short-term and prolonged prevention and treatment of venous thromboses and thromboembolism.

Adult↗
PubMed2004

Venous thromboembolism prophylaxis: role of factor xa inhibition by fondaparinux.

Fondaparinux (Arixtra, GlaxoSmithKline, Philadelphia, PA.) is the first synthetic selective factor Xa inhibitor. A worldwide phase III program, that consists of four randomized, double-blind trials, in patients who underwent surgery for hip fracture, and elective hip replacement and elective major knee surgery was conducted to compare the benefit-to-risk ratio of a subcutaneous 2.5 mg once-daily regimen of fondaparinux starting postoperatively versus enoxaparin in preventing venous thromboembolism. The overall incidence of venous thromboembolism up to day 11 was reduced from 13.7% in the enoxaparin group, to 6.8% in the fondaparinux group, with a relative risk reduction of 50.6% in favor of fondaparinux (95% confidence interval: 40.9% to 59.1%, p<0.001). The overall incidence of clinically relevant bleeding was low and did not differ between the two groups. The benefit of fondaparinux was consistent across all types of surgery and all subgroups. The further randomized, double-blind PENTHIFRA-PLUS trial showed that extending fondaparinux prophylaxis from one to four weeks after hip fracture surgery was well tolerated and, compared to one-week fondaparinux, dramatically reduced delayed venous thromboembolism events from 35.0% to 1.4% (p<0.001). Four-week fondaparinux could become the standard thromboprophylaxis after hip fracture surgery. Fondaparinux is the first selective factor Xa inhibitor approved for use in thromboprophylaxis after orthopedic surgery.

Arthroplasty, Replacement, Hip↗
PubMed2004

[Venosus thromboembolism in pregnancy--case report].

Venosus thromboembolic disease is an important problem in pregnant women. The overall risk of venosus thromboembolism in pregnancy is 6-times greater then in non pregnant women. In the article we present a case of a pregnant woman with venosus thromboembolism. The analysis of the pregnancy and mode of delivery, development of disease, diagnostic and therapeutic method.

Adult↗
PubMed2005

Venous thromboembolism in morbid obesity and trauma. A review of literature.

Deep venous thromboembolism (DVT) is common and leads to disability, economic loss and even death. The aims of this paper are to start from the basic knowledge that we have about DVT and to tailor our knowledge to the treatment and diagnosis of thromboembolism in obese patients and trauma patients, which are among the patients who have a high risk of developing DVT and pulmonary embolism. Venous thromboembolism is a common complication in patients with major trauma, and effective, safe prophylactic regimens are needed. The patients are treated effectively with heparin and low molecular weight heparins, which are shown to be safe and effective. Morbid obesity is a disease that affects 10% of Americans and increases the incidence of DVT. Forty mg of enoxaparin subcutaneously twice a day seems to be a better DVT prophylaxis than the 30 mg twice a day. Many patients admitted to the hospital are morbidly obese; therefore, we suggest they start on low molecular heparin. The high morbidity of these patients is because most of them are bedridden, which increases the chance of DVT and death from pulmonary embolism. Trauma increases the chance of having DVT. Low molecular weight heparin or heparin is a safe and extremely effective method of preventing DVT in high-risk trauma patients.

Humans↗
PubMedDate not supplied

Thromboembolic disease in hip replacement surgery.

Total hip replacement surgery carries the risk of thromboembolic complications, which could be fatal. Over the last three decades however, the risk has decreased considerably thanks to progress made in the understanding of the physiopathogenetic mechanism of thromboembolic disease and perioperative prophylaxis. It is the purpose of this study to discuss the main medical and surgical preventive measures that must be carried out before, during and immediately after surgery. The old concept of deciding thromboembolic prophylaxis after surgery is now obsolete.

Adult↗
PubMed2006

Mitigation of device-associated thrombosis and thromboembolism using combinations of heparin and tirofiban.

Combined anti-platelet-anticoagulant therapy is increasingly being used to reduce the risk of device-induced thrombosis and thromboembolism. However, direct quantitative confirmation of the effectiveness of this combination approach is lacking. This study was undertaken to quantify the effects of various combinations of heparin (anticoagulant) and tirofiban (antiplatelet agent) on device-induced thrombosis and thromboembolism using a coronary stent as a prototype device. Adult sheep were implanted with ex vivo carotid-carotid shunts containing replaceable tubing segments in which nitinol stents were deployed. Nine combinations of heparin (average activated clot time = 129, 199, and 355 seconds) and tirofiban (0%, 50%, and 100% platelet inhibition) were tested at random with three replicates per animal. Thrombus weight on the stent at the end of each experiment (1 hour) was measured, and emboli released from the stent were continuously monitored during the experiment using a light scattering microemboli detector. With no tirofiban, increasing the heparin concentration was associated with a decreased endpoint thrombus weight (p < .05) but with a slight (non-significant) increase in the number of downstream thromboemboli. However, the presence of tirofiban decreased both thrombus weight and thromboemboli numbers (p < .05), regardless of the heparin concentration. In the presence of medium or high tirofiban, an increase of heparin from low to medium levels also decreased both thrombus weight and thromboemboli numbers (p < .05). Heparin alone does not provide adequate protection against thromboembolism (and may actually increase it by reducing thrombus cohesive strength). However, the combination of heparin and tirofiban is effective in reducing both thrombus and thromboemboli, and an optimal combination may exist.

Animals↗
PubMed1991

Pathophysiology of venous thromboembolism.

Venous thromboembolism is complex with a multifactorial etiology. The Virchow triad (changes in blood flow, changes in vessel wall, and changes in the properties of blood) gives the main factors involved in venous thromboembolism. Venous stasis during immobilization in general anesthesia, stroke with hemiparesis, and heart failure plays a central role. The thromboembolic process can be initiated by a disturbance in the normal "hemostatic balance," with an increased thrombogenic potential, due to release of thromboplastin and collagen exposure during vessel wall injury by stasis and hypoxia, decreased fibrinolysis during surgery, malignancy, among others. Many substances modify these processes, including heparan sulfate, AT III, protein C, t-PA inhibitor, and alpha 2-antiplasmin.

Blood Coagulation↗
PubMed1991

[Non-medicamentous prevention of thromboembolic disease].

Virchow's work has showed that thrombogenic situations may have a hematological, either congenital or acquired, parietal or hemodynamic nature. Primary and secondary non-medicamentous prevention of thromboembolism is aimed at screening the patients at risk, avoiding or reducing the alterations of the venous walls, and, most importantly, improving failing or altered venous hemodynamics. The authors review the various clinical and biological situations entailing an increased thrombogenic risk. They sum up the various methods of prevention of venous stasis: Nard's method, associating bandages and deambulation, as well as various techniques of contention, hemodilution, compression with inflatable boots, electric stimulation or assisted mobilization. These methods are used as ambulatory or bedside treatments and in the intra- and perioperative periods, as the case may be. The few studies relating to non-medicamentous methods of prevention of thromboembolism demonstrate their great effectiveness, which is equal to that of the modern heparin treatments. The prevention of thromboembolism is best carried out by associating the latest chemical therapies to non-medicamentous physical methods, which are still of current interest.

Humans↗
PubMed1991

[Atrial fibrillation--thromboembolism and prevention].

Chronic non-rheumatic atrial fibrillation is associated with a risk of thromboembolic complications of about 5% per year. Previous myocardial infarction seems to be a significant risk factor for development of thromboembolic complications in chronic atrial fibrillation, whereas paroxysmal atrial fibrillation and isolated atrial fibrillation in younger patients may be associated with a lower risk of emboli. Silent cerebral infarction occurs more often in chronic atrial fibrillation than among controls in sinus rhythm. Three prospective trials of patients with atrial fibrillation found effect of warfarin on the occurrence of thromboembolic complications. In one study aspirin 325 mg daily was effective in patients below 75 years of age, but not in patients above this age. The other trials revealed no effect of aspirin.

Aged↗
PubMed1991

[Thromboembolism in patients with apical lesion caused by chronic chagasic cardiopathy].

The thromboembolism in patients with apical lesion of the chronic Chagas' heart disease diagnosticated by left cineventriculography are present in this study. The series comprises 32 females and 23 males between the ages of 22 and 69 years, all presenting cardiovascular symptoms, 20 in cardiac failure (10 with left ventricular failure and 10 in congestive heart failure). Heart size was normal in 35 instances and 20 showed cardiomegaly on chest X-ray examinations (slight in 8, moderate in 6 and marked in 6). The following morphological aspects of the apical lesions were observed: mammillary-23 (41.82%); digital-18 (32.73%) and semilunar-14 (25.45%). In 8 cases (14.54%) intraventricular thrombi were detected and 10 these were associated with discinetic areas. Seventeen episodes of thromboembolism occurred in 14 (24.45%) patients including 7 to the brain, 9 to the lung and 1 to the iliac right artery, mostly in patients with heart failure. Eight were women and 6 were men, varying between 30 and 62 years of age, the morphological aspects of the apical lesion were semilunar in 8 and mammillary in 6. Cardiac pacemakers were implanted in 8 cases due to complete A-V block in 6, to sinus node disfunction in 1, and to sinus arrest in 1. In 4 cases (28.57%) intraventricular thrombi were detected, in 3 occasioned thromboembolism to the brain. Thrombo-embolic phenomena occurred in the 11 nonsurvivors. The most frequent cause of death was heart failure in 8 followed by cerebro-vascular attacks in 3, after a follow-up period of 19 to 176 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Recurrent thromboembolism disclosing protein C deficiency. Apropos of a case with familial investigation].

Every thromboembolic manifestation, especially in young subjects, calls for an aetiological study in which haemostasis is evaluated primarily with assays of physiological coagulation inhibitors: protein C, protein S and antithrombin III. Protein C deficiency is found in 6 to 7% of thromboembolic manifestations. We report the case of a 21-year old man who had phlebitis followed by pulmonary embolism without facilitating factors. Protein C level was 50% of normal value (0.50 IU/ml). The patient received heparin, subsequently replaced by oral anticoagulants after a long period of overlap between the two treatments. The outcome was favourable. Family investigation yielded a history of thromboembolic accidents in several members of the family, some of whom were protein C deficient (50% of normal value). Protein C synthesis is vitamin K-dependent. Protein C deficiency is transmitted as an autosomal dominant trait. Normal values range from 0.65 to 1.35 IU/ml. Clinically, 25% of the patients are said to be asymptomatic. The first thrombotic accidents occur in young subjects (mean age 29 +/- 14 years). Several points emerge from this case: full evaluation must be performed, especially in young subjects; family investigation consolidates the diagnosis and enables symptomatic protein C deficient patients to be treated and thrombotic manifestations to be prevented by effective anticoagulant therapy in high-risk situations; a prolonged period of heparin-oral anticoagulant overlap is needed to avoid cutaneous necrosis.

Adult↗
PubMed1990

The cost-effectiveness of prevention of post-operative thromboembolism.

In recent years, value for money in health care has become of increasing concern. There are various ways to perform an economic evaluation, the most simple being a cost-effectiveness analysis, where differences in costs will influence the choice between methods. Cost-utility and cost-benefit analyses represent more advanced forms of economic evaluations. In this cost-effectiveness analysis, the following three strategies aimed at solving the problem of post-operative thromboembolic complications were compared: (a) no prophylaxis but treatment of occurring complications, (b) general prophylaxis with low-dose heparin for patients over 40 years of age and (c) selective treatment based on post-operative surveillance with a fibrinogen uptake test. Moreover, these alternatives were evaluated for three types of surgery: general abdominal surgery, cholecystectomy and elective hip surgery. Costs for thromboembolic and haemorrhagic complications were estimated from data available for patients hospitalized in Malmö. A sensitivity analysis was made with regard to the frequency of thrombosis, prophylactic effect and treatment costs. Health care costs would be minimized with general prophylaxis in hip and general surgery, whereas no prophylaxis is the most cost-effective alternative in cholecystectomy patients, i.e. with a frequency of thrombosis below 8%. General prophylaxis minimized the duration of patients' health losses due to thromboembolic disease in general, as well as in elective hip surgery. After cholecystectomy, no difference in health loss for the individual was found between the alternative of no prophylaxis and general prophylaxis. Selective treatment was always the least satisfactory alternative in all categories and always the most expensive.

Cost-Benefit Analysis↗
PubMed1990

Risk factors for thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study.

As previously reported, 1007 patients with chronic atrial fibrillation participated in the Copenhagen AFASAK study. Before inclusion to trial, they all had a physical examination, chest roentgenogram, and echocardiogram with determination of left atrial size. This study evaluated the importance of cardiovascular risk factors for development of thromboembolic complications. To exclude any treatment effects on occurrence of thromboembolic complications, we included only the 336 patients from the placebo group. Using Cox's regression model, previous myocardial infarction was a significant risk factor for development of thromboembolic complications. Age, gender, heart failure, chest pain, hypertensive heart disease, diabetes, systolic and diastolic blood pressure, smoking, relative heart volume, and left atrial size were all without statistical importance.

Aged↗
PubMedDate not supplied

[Prevention of thromboembolic disease in gynecologic surgery].

The authors present the results of their blind prospective comparative study of the postoperative thromboembolic protection of 490 gynecologic patients. Among them 250 (51%) were protected by a low dose heparin (LDH) subcutaneously in 12-hour intervals, 240 (49%) received heparindihydergot (HDHE). Thromboembolisms diagnosed by the 125J fibrinogen uptake test appeared in 26 (10.4%) patients protected by LDH and 23 (9.6%) by HDHE. The most frequent risk factors in patients with thromboembolisms were malignant diseases, obesity, varicose veins, hypertension and a history of deep vein thrombosis or pulmonary embolism. Haemorrhages appeared in 7 (2.8%) patients protected by LDH and 8 (3.3%) by HDHE.

Adult↗
PubMed1990

[Hip arthroplasty and thromboembolic complications].

Orthopedic départment of Centre hospitalo-universitaire de Brest use one upon another two procedures: from 1974 to 1984, for 1287 cases the prevention of thromboembolic complications is done with the help of subcutaneous heparin at standard dose during 12 days; the clinical diagnosis in confirmed by an isotopic phlebography and isotopic lung scan. In 1986 and 1987, for 391 cases this prevention is done with the help of subcutaneous heparin in adapted doses during 21 days; the clinical diagnosis is confirmed by X ray phlebography and isotopic lung scan. The frequency of thromboembolic complications has been 4.6% in the first period and 1.2% in the second period. This results confirm the role of heparin in preventing post operative thromboembolic complications after total hip replacement. The results after knee arthroplasty are not so good.

Aged↗
PubMed1990

[Streptodecase-2 in the treatment of acute myocardial infarct, unstable stenocardia, thromboembolism and thrombosis].

Eleven patients underwent thrombolytic therapy with streptodekase-1 and 19 with streptodekase-2. Of these, 11 patients suffered acute myocardial infarction, 10 had unstable angina pectoris, 6 thromboembolism of the pulmonary artery, 2 thromboembolism of the peripheral arteries and 1 thrombosis of the femoral vein. Administration of streptodekase-2 brought about an increase of the total blood fibrinolytic activity (the fibrinolysis time dropped from 248.8 +/- 82.1 to 137.5 +/- 42.5 min after 12 h), plasmin activation (from 0.00 +/- 0.00 to 23.5 +/- 7.5 mg after 24 h), reduction of the plasminogen content (from 94.0 +/- 2.5 to 46.8 +/- 5.3% after 12 h). The parameters of the coagulation hemostasis did not undergo any appreciable changes. Fibrinolysis activation following streptodekase-2 administration was unchanged within the first 48 hours. No material differences were identified in fibrinolysis activation in patients given streptodekase-2 and streptodekase-1. Administration of streptodekase-2 was found to exert a marked beneficial clinical effect on acute myocardial infarction, unstable angina pectoris, thromboembolism of the pulmonary and peripheral arteries.

Aged↗