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PubMed1987

[Significance of drug prevention of thromboembolism in urologic risk patients].

The phlebothrombosis and pulmonary embolism are severe postoperative complications. Urological patients are particularly at risk with thrombosis. Therefore it becomes necessary for urology to perform a consequent prophylaxis of thromboembolism which, when an increased risk is present, must contain medicamentous measures. As it is confirmed by evident studies, the low-dose heparin prophylaxis proved as optimum method. A still more effective thrombosis protection can be achieved by the combination of small heparin doses with dihydroergotamine. Retrospectively, 2 comparable groups of urological risk patients with and without heparin prophylaxis were examined. In the adenomectomies under heparin prophylaxis a trend to the reduction of the events of postoperative thromboembolism is revealed. The heparin prophylaxis does not lead to an increase of complications of haemorrhages which need therapy. The prophylaxis of thromboembolism with heparin and a heparin-DHE-combination, respectively, is recommended for the application in urological risk patients.

Dose-Response Relationship, Drug↗
PubMed1989

[Thrombosis and thromboembolism in patients with a Björk-Shiley prosthesis].

Thrombosis and thromboembolism are, in addition to left ventricular function, the basic factors which deteriorate the score and long-term prognosis in patients with valvular prostheses. The authors analyze the problem of thrombosis and thromboembolism in 261 patients with Björk-Shiley's prosthesis who were operated during the last five years. The authors consider as the main risk factors in the first place inadequate anticoagulation treatment, the position of the implant in the mitral orifice, the type of valvular implant and atrial fibrillation. The authors present a brief account of successful thrombolysis of a thrombotized Björk-Shiley prosthesis in the mitral orifice, the basic diagnostic procedure when thrombosis of an artificial valve is suspected and possible ways how to reduce the risk of thrombosis and thromboembolism.

Adult↗
PubMed1989

[Clinical incidence of thromboembolism in neurosurgery].

Deep vein thrombosis and pulmonary embolism are known complications in neurosurgical patients, but prophylactic treatment is not commonly used in neurosurgical units. However the incidence of thromboembolism is comparable to general surgical patients, when reliable tests are applied. This retrospective study examines the clinical incidence of thromboembolism in 1378 neurosurgical patients. A thromboembolic complication is found in 2.6% of the patients, 1.4% of them shows pulmonary embolism. Clinical incidence seems to be small, but adjustment of heparin treatment is always difficult in neurosurgical patients and it is often insufficient. Partial inferior vena cava interruption is indicated in nearly half of the patients. Prospective studies are necessary to appreciate the incidence of deep vein thrombosis in neurosurgical patients with a reliable test. The efficiency and security of the prophylactic methods must be evaluated.

Brain↗
PubMed1986

[Venous thromboembolic disease and Klinefelter's syndrome].

Venous thromboembolic disease was rarely described in association with Klinefelter's syndrome. It is nevertheless more frequent than in a genetically normal male population (5-20 times). This abnormality is not clearly explained. We report a classical case of Klinefelter's syndrome detected by the help of a venous thromboembolic disease. The patient was of blood-group A (the relative incidence of thrombosis is raised among group-A persons as compared with group-O persons). The evaluation disclosed a high rate of beta-thromboglobulin suggesting an underlying hypercoagulability. The abnormal incidence of venous thromboembolic disease among Klinefelter patients may find a partial explanation in this way.

ABO Blood-Group System↗
PubMed1988

The treatment of venous thromboembolism.

Venous thromboembolism is usually treated with heparin followed by oral anticoagulants for approximately 3 months. The optimal length of heparin therapy is uncertain. There is now good evidence that treatment failures are associated with inadequate heparin effects. Heparin can be administered with similar safety and effectiveness by either intravenous infusion or 2 hourly subcutaneous injection. Oral anticoagulant therapy is effective and safe if given in a dose which prolongs the prothrombin time to an international normalized ratio of 2.0 to 2.5. Thrombolytic therapy is indicated in patients with major pulmonary embolism and in selected patients with recent acute venous thrombosis. Vena caval interruption is usually confined to patients who have contraindications to anticoagulant therapy. Surgical removal of thromboembolic obstruction should be considered in selected patients with thromboembolic pulmonary hypertension.

Anticoagulants↗
PubMed1977

Failure of orally administered hydroxychloroquine sulphate to prevent venous thromboembolism following elective hip operations.

In a double-blind, randomized trial of orally administered hydroxychloroquine sulphate in the prevention of venous thromboembolism after elective surgery on the hip, the drug or a placebo was given to fifty consecutive patients. Therapy was commenced on the day before the operation and continued for fourteen days. The diagnosis of deep venous thrombosis was made by daily thermographic scanning of the legs and confirmed by phlebography. The diagnosis of pulmonary embolism was made by perfusion lung scanning. No significant difference in the incidence of thromboembolism was found between treated and control groups. The results provide evidence that substances which reduce the incidence of thromboembolism in general surgery may not be effective in operations on the hip.

Administration, Oral↗
PubMed1988

[Prevention of thromboembolism in patients operated on for hip prosthesis].

The latest research into the prevention of peri- and postoperative thromboembolic disease has found orthopaedic surgery patients to be most at risk. As the genesis of deep venous thrombosis (DVT) is due to haemodynamic, hemorheologic and parietal factors, various prophylactic measures have been considered in the past, measures which have not proved able to provide satisfactory protection in orthopaedics. The results obtained with Defibrotide in a random and controlled clinical study versus calcium heparin involving 211 patients of both sexes candidates to receive total hip arthroplasty and presenting at least one major thromboembolic risk factor are reported. The patients were assigned at random to one of the following treatments: 1) Defibrotide at a dose of 400 mg b.i.d. i.v. in 50 ml phleboclysis in 5 minutes (n = 108); 2) calcium heparin at a dose of 5000 IU t.i.d. subcutaneously (n = 103). The treatment began the day before operation and continued on average up to the eighth day for the Defibrotide group. With the control group it continued until discharge (usually on the 15th day) and at home for about three weeks until the completion of the physiotherapy cycle. In the 108 patients treated with Defibrotide only one case of DVT was reported and in none of these patients were symptoms or signs of pulmonary embolism encountered. In the group treated with calcium heparin 2 cases of clinically and radiologically diagnosed pulmonary embolism and 4 cases of DVT were observed. Although the differences were not statistically significant, the tendency favours Defibrotide. Statistically significant (p less than 0.01) was the difference in postoperative bleeding evaluated with particular attention in patients of advanced age. Further, in the Defibrotide group, scarring was considered excellent in 96% of cases while in the heparin group scarring was excellent in 85% (p less than 0.05). To conclude, the sure clinical effectiveness, tolerance, handiness and lack of interference with clotting functions make Defibrotide a really useful drug for the prevention of thromboembolic episodes in patients undergoing major orthopaedic surgery.

Adult↗
PubMed1987

[Biological rhythm and thromboembolic disease. Physiological, epidemiological and pharmacological aspects].

Arterial and venous thromboembolic disorders are the leading cause of death in most of the advanced nations. The study of physiologic, epidemiologic and pharmacologic relationships of these disorders to biological rhythms, may lead to a better understanding and perhaps a better treatment. Chronophysiologic studies have shown that hemostatic variables follow circadian rhythms. The level of platelets aggregation and of blood coagulation has been found to be increased in the morning and decreased at night, whereas fibrinolytic activity is lower in the morning than in the evening. Chronoepidemiologic studies demonstrated a morning peak for arterial thromboembolic disorders and an evening peak for cerebral bleedings. These facts might partially be explained by circadian variations in hemostasis and suggest a chronotherapeutic approach in thromboembolic disorders. Unfractionated heparin, because of its antithrombotic effect, is one of the major drugs used to treat this disease. However, with such a treatment venous thrombosis recurs or bleeding complications occur yet in about 30% of patients. Chronopharmacologic studies indicate that anticoagulant effect of heparin is minimum in the morning and maximum at night, following the physiologic circadian variation of blood coagulation. Such results suggest that the heparin doses should be modulated as a function of administration times in order to increase its effectiveness and to minimize both bleeding risk and thrombosis. Further studies are needed to evaluate such a proposal.

Biological Clocks↗
PubMed1978

Platelets, thromboembolism and the clinical utility of antiplatelet drugs.

Experience has established a major role for platelets in the pathogenesis of a variety of thromboembolic disorders. Despite advances in several areas, many problems remain. The relevance of platelet function testing to thromboembolic disorders needs clarification. Whether the association of enhanced platelet function and the aforementioned disorders represents cause, effect or nonspecific accompaniment is unknown. The concept of identifying individuals at risk by platelet function testing is attractive but unproved. Whether such individuals would benefit from prophylactic antiplatelet therapy is also unknown. For treatment of most established thromboembolic disorders as well as prophylaxis, the place of antiplatelet drugs is not established. Whether this form of therapy is superior to conventional treatment, adjunctive or of no benefit is not resolved in most instances. Also, the most appropriate antiplatelet drug or combination of drugs, and in which dosages for specific disorders, remains unclear. Well designed, prospective clinical investigation, although cumbersome and time-consuming, will be necessary to answer most of these questions. A final problem area concerns research into the pharmacology of platelet inhibition. It is probable that the ideal antiplatelet agent remains undiscovered. Currently, several investigators are looking into the possibility of manipulating prostaglandin metabolic pathways in hopes of specifically blocking thromboxane generation while allowing production of metabolites inhibitory to aggregation. This exciting approach and other investigations into the biochemical basis of platelet function should lead to the discovery of new antiplatelet agents.

Animals↗
PubMed1987

Long-term performance of the St. Jude Medical valve: low incidence of thromboembolism and hemorrhagic complications with modest doses of warfarin.

Between January 1980 and April 1986, 204 patients were hospital survivors after aortic, mitral, or double valve replacement with the St. Jude Medical valve. One hundred ninety patients underwent anticoagulation with modest doses of warfarin (Coumadin), with prothrombin times in the range of 1.3 to 1.5 times control. Fourteen patients received aspirin and dipyridamole only. Follow-up ranged from 0.5 to 6.6 years (mean 3.1) and was 99.5% complete. The group was analyzed for occurrence of thromboembolism, hemorrhage, valve thrombosis, endocarditis, perivalvular leak, valve failure, late cardiac death, and all morbidity and mortality combined in linear and actuarial terms over the 7 year period. With this anticoagulation regimen, the linear rate for thromboembolism and hemorrhage was 0.67% and 1.3% patient-year, respectively, and the actuarial event-free incidence at 5 years was 97.4% and 94.4%, respectively. There were no instances of structural valve failure and one instance of valve thrombosis in the mitral position. Eighty-seven percent of patients were alive at 5 years and 76.7% of patients were alive and free of all complications at 5 years. We conclude that the St. Jude Medical valve has a low incidence of thromboembolism, hemorrhagic complications, and valve thrombosis in patients receiving modest doses of warfarin.

Actuarial Analysis↗
PubMed1986

Aortic mural thrombus: an occult source of arterial thromboembolism.

During a 28-year period from 1955 to 1983, two cases of massive repetitive arterial thromboembolism from nonaneurysmal aortic mural thrombus were diagnosed antemortem and successfully corrected at the University of California, Los Angeles Medical Center. Within the same time period, 48 cases of nonaneurysmal aortic mural thrombus were identified in 10,671 consecutive autopsies (0.45% incidence). Eight of these patients had evidence of distal embolization (17%), and three had major thromboembolic occlusions, which were considered the proximate cause of death (6%). The latter three patients represented 9% of autopsy-confirmed deaths from peripheral arterial thromboembolism. The diagnosis was established in a 49-year-old man and a 51-year-old woman after a long course marked by recurrent arterial embolization. Despite multiple evaluations, which included angiography, the diagnosis remained elusive until clinical suspicion resulted in complete biplane aortographic survey. Although the morphologic characteristics of this lesion are quite striking, subtle angiographic changes and lack of familiarity with the clinical presentation contribute to the difficulty and infrequency of diagnosis. This unique lesion comprises an important segment of the so-called cryptogenic sources of arterial embolization and can be corrected by a definitive surgical procedure.

Aorta, Abdominal↗
PubMed1987

Thromboembolic disease presenting as fever in spinal cord injury.

A 45-year-old man had complete C5 quadriplegia after sustaining a C6-7 fracture dislocation in a motor vehicle accident. Twenty-six days after injury the patient spiked nightly temperatures of 100.5F to 102.5F. Before a full fever workup could be completed, the patient developed shortness of breath. Thromboembolism was confirmed via venography and Ventilation/Perfusion scan. Other clinical signs of asymmetric swelling or warmth were notably absent throughout the course of the thromboembolic event. The patient became afebrile on the third day of anticoagulant therapy and remained afebrile. This case indicates that thromboembolic disease can present with fever only and the disease should be included in the differential diagnosis for fever in any patient with acute spinal cord injury.

Fever of Unknown Origin↗
PubMed1985

[Postoperative thromboembolism: preventive use of calcium heparin in low doses].

The problem of post-operative thromboembolism is re-examined and the progress made in the prevention of venous stasis and hypercoagulability reviewed. The high incidence of asymptomatic phlebitic phenomena is noted and personal experience of the use of low doses of Calcium heparin in 415 patients undergoing various types of operation is reported. Eight patients had chronic duodenal ulcers. A notable reduction in the incidence of post-operative thromboembolism was confirmed. The value of this preventive method is thus demonstrated, as is the usefulness of analysing haemostatic balance in patients with one or more risk factors for thromboembolism in order to "personalize" the dosage and duration of treatment with Calcium heparin.

Adult↗
PubMed1985

Relationship between thromboembolic complications and intensity of treatment during long-term prophylaxis with oral anticoagulants following DVT.

The frequency of thromboembolic recurrencies during secondary prophylaxis after DVT was retrospectively studied and related to the intensity of the oral anticoagulation. All patients receiving oral anticoagulation after DVT at our hospital during April 1972-May 1980 were studied. Treatment was given to 596 patients for 724 thrombotic events for a total of 4450 months. Thirty-six thromboembolic complications, all objectively verified, occurred. Patients with cancer had complications throughout the entire range of anticoagulation. Patients without neoplastic disease (15 events) never had complications below a prothrombin complex level of 27% as assessed with Simplastin A, corresponding to a BCT-ratio of 1.9. This study confirms, that the lower limit of the therapeutic range, determined by the risk of thromboembolic complications, should be set at a Simplastin A-level of approx. 25% corresponding to BCT 2.0.

Administration, Oral↗
PubMed1977

[The risk of hemorrhage versus the thromboembolic risk in patients with prosthetic valve].

376 adults were followed up for between 2 and 153 months after surgery (mean: 3.8 years); all of them, with the exception of 8, received anticoagulant treatment. The results were subjected to statistical analysis using several tests. Thromboembolic complications occurred in 16 per 100 after 5 years, and 8.5. per 100 of them were fatal. Among the factors favoring this complication are the type of valvular disorder (the rate of throembolism being 4 times greater with mitral valve defects), the type of prosthesis, and the efficiency of the anticoagulant therapy (the risk of thromboembolism being four times greater in those patients whose treatment has been inneffective). Against the vitamin antagonists must be set the haemorrhages: the incidence of lethal haemorrhage in this series was 6.4 per 100 patients per treatment year. There was a proven hypoprothrombinaemia to below the desirable level in two thirds of these cases, and in one case out of four an additional predisposing factor could be demonstrated. Haemorrhage and thromboembolism are together responsible for one in four of the late deaths. In order to reduce the mortality, several solutions are considered, one of which is to utilise anti-aggregation treatment. However, the vitamin K antagonists remain an essential part of treatment in the majority of cases; it can only be justifiable to withhold them in those patients in whom the risks of haemorrhage are for various reasons considered to be too high. The introduction of biological valves or of valves with a lessened risk of embolism is highly desirable in such cases.

Adolescent↗
PubMed1984

Do patients with thromboembolic disease have circulating platelet aggregates?

Reports of circulating platelet aggregates (ie, microemboli) in thromboembolism and other vascular disorders are based on a method (Wu and Hoak , 1974) in which venous blood is collected via scalp vein needle and tubing into either formaldehyde, which fixes aggregates, or EDTA, which disperses them. The ratio of platelet counts in platelet-rich plasma (PRP) from the two blood samples after centrifugation is interpreted as a measure of platelet aggregates in the circulation in vivo. We compared this standard Wu and Hoak technique with a modified one, in which blood was drawn directly into a syringe, and with a third method that avoided centrifugation by counting single platelets in whole blood. Both modified techniques could detect aggregates generated in vitro with adenosine diphosphate (ADP). In 12 normal subjects, the three methods were equivalent, but in 37 patients with thromboembolic disorders, the standard Wu and Hoak method gave a lower ratio than the other methods. Similar results were found in a subset of eight patients with myocardial infarction. Heparin treatment of patients did not influence the results. The data suggest that formation of platelet aggregates occurred during venipuncture. Platelets may be hyperactive in patients with thromboembolic disease and may form aggregates in vitro during collection, but the concept of chronic microembolism in such patients should be reassessed.

Blood Platelets↗
PubMed1978

[Prevention of thromboembolism in surgical gynecology].

It is reported on the prophylaxis of thromboembolic diseases with acetylsalicylic acid (Micristin) in gynaecological surgery. The number of thromboembolic complications clinically ascertained was diminished from 3,25% (without Micristin) to 0,82% (with Micristin). Side effects were rarely observed, laboratory control was not necessary, Low-dose-heparin-prophylaxis were executed on contraindications and incompatibilities of Micristin. The perioperative use of low doses of heparin combined with postoperative use of oral anticoagulants on patients with increased risk of thromboembolism are discussed.

Anticoagulants↗
PubMedDate not supplied

Arterial thromboembolism of the upper extremity associated with the thoracic outlet syndrome.

Acute arterial thromboembolism of the upper extremity associated with the thoracic outlet syndrome is much less frequent than the neurologic manifestations, but is a potential threat to the viability of the limb if not recognized in time. The thromboembolic process originates in a damaged subclavian artery as a result of its prolonged compression, usually by congenital, much more rarely, by acquired anomalies of anatomical structures at the thoracic outlet. Major embolic complications usually occur after months or years of episodal and repetitive microemboli. A comprehensive arteriographic evaluation of the entire arterial tree in addition to other tests is essential for diagnosis. Four patterns of arterial findings are described. The scope of the surgical treatment of these manifestations it twofold: (1) decompression of the subclavian artery and (2) repair of the arterial lesions, often with additional thoracic sympathectomy. Results of management of the arterial lesions are described in three groups, based mostly on a review of data from the literature. In recent years a more aggressive approach to these lesions appears to have resulted in better management of this complex entity. A case report will illustrate some the clinical and pathological aspects of this problem. Early recognition of this unusual thromboembolic process is necessary for achieving a more complete limb salvage.

Arm↗