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PubMedDate not supplied

Issues of thrombosis and hemorrhagic events in patients with cancer.

It is clear that patients with malignancy, particularly adenocarcinomas, have an increased propensity to thrombosis. It also appears that patients with malignancy and thrombosis are relatively refractory to warfarin therapy and some may not respond ideally to heparin preparations. Occult malignancy in patients with unexplained thrombosis is of concern; however, the incidence varies with the age of the patient approaching 10% in those over 50 years of age. The extent of the evaluation for an underlying occult malignancy should be dictated by clinical judgment. Recurrent unexplained DVT, resistance to warfarin, and thrombosis of unusual sites are the major clues to significantly enhance the suspicion of an occult malignancy. In general, patients with thrombosis and malignancy need not be evaluated for hereditary or acquired hemostasis defects; finding one of these defects is both unlikely and will probably not alter antithrombotic therapy. Hemorrhage in cancer patients is usually due to thrombocytopenia related to chemotherapy (particularly solid tumors) or bone marrow failure (usually leukemias), or disseminated intravascular coagulation (DIC). DIC is usually seen in M-3 and M-4 leukemia or in septic patients with solid tumors. Finally, catheter thrombosis is a common problem in patients with cancer and can be significantly decreased with the routine use of low-dose warfarin therapy.

Catheterization↗
PubMed2005

Importance of T2*-weighted gradient-echo MRI for diagnosis of cortical vein thrombosis.

We examined six patients with isolated venous thrombosis (n = 2), or venous thrombosis combined with sinus thrombosis (n = 4) (CVT). The clinical symptoms were non-specific (acute cephalea, paresis, epileptic seizure, progressive speech disorder). All examinations were performed on a 1.5 T system (Magnetom Symphony, Siemens, Erlangen, Germany), maximum gradient field strength 30 mT/m, minimal gradient rise time 450 micros, according to the following protocol: Transverse T2-weighted turbo spin-echo (TSE), fluid attenuated inversion recovery (FLAIR), T1-weighted spin-echo (SE), before and after administration of contrast medium, T2*-weighted conventional gradient-echo (GRE), T2*-weighted spin-echo echo planar imaging (SE EPI), both without and with diffusion weighting as well as two-dimensional (2D) venous time-of-flight (TOF) MRA. The venous thromboses were best detectable in the T2*-weighted conventional GRE sequence in all patients. In two patients, the CVT was discernible only in this sequence. The sinus thrombosis was well discernible only in the T2*-weighted GRE sequence in only one case; in the remaining cases it was detectable only with difficulty. For these cases, other sequences such as SE, diffusion-weighted, or 2D-TOF-MRA sequence were superior. The T2*-weighted conventional GRE sequence was superior to the T2*-weighted SE EPI sequence in all patients. To sum up, it can be concluded, that T2*-weighted conventional GRE sequences are possibly the best method of detection of acute cortical vein thromboses. Therefore, it seems to be of benefit to integrate a T2*-weighted conventional GRE sequence into the MR-protocol for the diagnosis of isolated cortical vein thrombosis.

Adult↗
PubMed1995

Function of von Willebrand factor after crossed bone marrow transplantation between normal and von Willebrand disease pigs: effect on arterial thrombosis in chimeras.

von Willebrand factor (vWF) is essential for the induction of occlusive thrombosis in stenosed and injured pig arteries and for normal hemostasis. To separate the relative contribution of plasma and platelet vWF to arterial thrombosis, we produced chimeric normal and von Willebrand disease pigs by crossed bone marrow transplantation; von Willebrand disease (vWD) pigs were engrafted with normal pig bone marrow and normal pigs were engrafted with vWD bone marrow. Thrombosis developed in the chimeric normal pigs that showed normal levels of plasma vWF and an absence of platelet vWF; but no thrombosis occurred in the chimeric vWD pigs that demonstrated normal platelet vWF and an absence of plasma vWF. The ear bleeding times of the chimeric pigs were partially corrected by endogenous plasma vWF but not by platelet vWF. Our animal model demonstrated that vWF in the plasma compartment is essential for the development of arterial thrombosis and that it also contributes to the maintenance of bleeding time and hemostasis.

Animals↗
PubMed1991

Light reflection rheography: an effective non-invasive technique for screening patients with suspected deep venous thrombosis.

Light reflection rheography is a simple non-invasive technique for assessing venous function in the leg. One hundred and twenty-four patients referred for venography with a clinically suspected deep venous thrombosis were investigated by light reflection rheography to determine the accuracy of the technique in diagnosing acute thrombosis. In half of the patients venography confirmed a deep venous thrombosis. Light reflection rheography had a sensitivity of 92 per cent and a specificity of 84 per cent in detecting acute thrombosis. The technique had a negative predictive value of 92 per cent in selecting those patients with no thrombosis. Light reflection rheography can be performed at the bedside or in the radiography department which makes it a suitable technique for screening patients with suspected deep venous thrombosis.

Female↗
PubMed1985

99mTc-plasmin test in deep vein thrombosis of the leg.

A 99mTc-plasmin test and phlebography were performed on 45 consecutive unselected patients with suspected deep vein thrombosis of the leg. Phlebography showed thrombosis in 15 cases. In fourteen of these patients there was a positive result in the plasmin test. Eleven other patients had a positive plasmin test result as well. The most common causes for a false-positive result in the plasmin test in the diagnosis of deep vein thrombosis were acute inflammatory disease and disturbance in venous flow without fresh thrombosis. The sensitivity of the plasmin test in the diagnosis of deep vein thrombosis was 93% and the specificity was 63%. It is concluded that the plasmin test can be used for the screening of deep vein thrombosis.

Adult↗
PubMed2003

Deep vein thrombosis and systemic inflammatory response: a pilot trial.

INTRODUCTION: Symptoms of deep vein thrombosis as swelling, erythema, pain and calor have been suspected of being caused by an inflammatory reaction of the affected leg. We therefore performed a prospective pilot trial to study a possible systemic inflammatory response induced by deep vein thrombosis. PATIENTS AND METHODS: We determined white blood cell count and plasma C-reactive protein in 100 consecutive patients with suspected deep vein thrombosis. The final diagnosis was based on the results of duplex sonography or ascending venography. RESULTS: Deep vein thrombosis was diagnosed in 37 patients (37%). White blood cell count (P = 0.012) and plasma C-reactive protein values (P < 0.001) were significantly increased in patients suffering from deep vein thrombosis. There was no correlation of white blood cell count or C-reactive protein with the thrombotic burden or the duration of symptoms. CONCLUSION: In patients with deep vein thrombosis, thrombus formation and consequent vein wall damage induce a systemic inflammatory reaction which is reflected by significantly increased levels of white blood cells and plasma C-reactive protein.

Acute-Phase Reaction↗
PubMed1981

Postoperative venous thrombosis. Evaluation of five methods of treatment.

Five methods for preventing deep venous thrombosis in postoperative patients were evaluated and compared with a control group. Five hundred patients from five surgical specialties were studied. The incidence of deep venous thrombosis was 37.3 percent in the control group but significantly less within all treatment groups. The minidose heparin group had the highest incidence (26.9 percent) because there were a large number of bilateral thromboses. The antistasis modalities did slightly better than the drugs; the intermittent pneumatic compression group had the fewest thromboses (11.9 percent). The significant risk factors for postoperative deep venous thrombosis are (1) obesity, (2) malignancy, (3) a history of venous disease, major surgery or major fracture, (4) length of surgery greater than 1 hour, and (5) increasing age. Four nonfatal pulmonary emboli occurred in 500 patients. Two were in women with hysterectomies in whom thrombosis had never been detected in an extremity; it is presumed that these clots arose from pelvic veins. It is thus recommended that patients in these high risk groups be treated prophylactically with one of the aforementioned modalities to decrease the risk of postoperative deep venous thrombosis. Of the different methods used to detect deep venous thrombosis, iodine-125 fibrinogen scanning was superior to both impedance plethysmography and venous Doppler ultrasound. One hundred percent of the thrombi were identified with scanning, whereas far fewer were detected with the latter methods. It is recommended that fibrinogen scanning be used clinically in patients in high risk categories who are undergoing major operative procedures.

Adult↗
PubMed1983

Therapeutic and clinical course of deep vein thrombosis.

We have reviewed our experience with the treatment of 250 patients with deep vein thrombosis diagnosed by contrast venography. The level of thrombosis was recorded according to the anatomic level to which it extended. A third of the patients had cancer, and the most common clinical findings were swelling and pain. The risk of the development of pulmonary embolism, based on the anatomic level of initial deep vein thrombosis, revealed the following: 12 of 115 patients (10 percent) with level I (calf) deep vein thrombosis developed pulmonary embolism, as did 2 of 27 patients (7 percent) with level II (popliteal) disease, 5 of 60 (8 percent) with level III (thigh) disease, 1 of 19 patients (5 percent) with level IV (groin) disease, and 2 of 26 patients (8 percent) with level V (iliac) disease. Based on our favorable experience with heparin we believe that heparin is the treatment of choice for deep vein thrombosis regardless of the anatomic level. The incidence of pulmonary embolism does not appear to be influenced significantly by the level of the deep vein thrombosis.

Adolescent↗
PubMed1991

Efficacy of a postoperative regimen of enoxaparin in deep vein thrombosis prophylaxis.

Venous thromboembolism is a common complication in patients undergoing elective hip replacement, in whom the incidence of calf vein thrombosis is 40% to 60%; proximal vein thrombosis, 20%; and fatal pulmonary embolism, 1% to 2% when prophylaxis is not used. A double-blind, randomized trial comparing low-molecular-weight heparin (enoxaparin) with placebo for the prevention of venous thrombosis in patients undergoing elective hip surgery was carried out. Prophylactic treatment with a fixed dose was begun postoperatively and continued for 14 days. Fifty patients in each treatment group underwent surveillance with 125I-fibrinogen leg scanning and impedance plethysmography. In the first 24 patients, venography was performed only if their surveillance test was positive. Venography was requested in the remaining 76 patients even if the screening tests were negative; in this latter group, venous thrombosis occurred in 4 patients (10.8%) given enoxaparin and 20 patients (51.3%) given placebo (p = 0.0002). The corresponding rates for proximal vein thrombosis were 5.4% and 23.1%, respectively (p = 0.029). In the entire group of 100 patients, venous thrombosis occurred in 12% of those given enoxaparin and 42% of those given placebo (p = 0.0007). The corresponding rates for proximal vein thrombi were 4% and 20%, respectively (p = 0.014). The observed hemorrhagic rate was 5% in each treatment group. The results of this study show that prophylaxis with fixed-dose enoxaparin is effective and safe for patients undergoing elective hip replacement.

Heparin, Low-Molecular-Weight↗
PubMed1989

Effects of ONO-3708, an antagonist of the thromboxane A2/prostaglandin endoperoxide receptor, on platelet aggregation and thrombosis.

The beneficial effects of an antagonist of the thromboxane A2/prostaglandin endoperoxide receptor, 7-[2 alpha,4 alpha-(dimethylmethano)-6 beta-(2-cyclopentyl-2 beta- hydroxyacetamido)-1 alpha-cyclohexyl]-5(Z)-heptenoic acid (ONO-3708) on thrombosis were examined. ONO-3708 at 0.1-3 microM inhibited the human platelet aggregation induced by thromboxane A2, prostaglandin H2, collagen, ADP (secondary phase) and epinephrine (secondary phase) without affecting prostanoid synthesis and the content of cyclic AMP in platelets. The in vivo effects, on coronary thrombosis in this case, were examined in two canine models. ONO-3708, 3 to 300 micrograms/kg i.v., prevented dose dependently the coronary thrombosis induced by partial obstruction of the coronary artery. ONO-3708, 3 micrograms/kg per min i.v., significantly prevented electrically stimulated coronary thrombosis without affecting systemic blood pressure and heart rate. These results indicate that the thromboxane A2/prostaglandin endoperoxide receptor could play an important role in the pathogenesis of thrombosis and that ONO-3708 may have therapeutic advantages in preventing thrombosis.

Animals↗
PubMed1994

The changing scene of hepatic vein thrombosis: recognition of asymptomatic cases.

BACKGROUND/AIMS: Hepatic vein thrombosis is thought to be manifested by ascites, abdominal pain, and hepatomegaly, with a uniformly poor prognosis. However, new imaging techniques allow for the diagnosis of hepatic vein thrombosis in asymptomatic cases. The aim of our study was to re-evaluate symptoms and prognosis in patients with hepatic vein thrombosis. METHODS: Eighty-one patients with hepatic vein thrombosis were analyzed. Forty-seven patients were admitted from 1970 to June 1987 (group I, before Doppler ultrasonography and magnetic resonance imaging were introduced at our hospital) and 34 from July 1987 to June 1991 (group II). RESULTS: When comparing the two groups, age, sex ratio, and causes of hepatic vein thrombosis did not differ. Eight group II patients (asymptomatic patients) had no ascites, hepatomegaly, or abdominal pain. One major hepatic vein remained patent in 41% of group II patients, compared with 12% in group I (P < 0.05). Intrahepatic collaterals were seen in 79% of group II patients, compared with 21% of group I patients (P < 0.01). All asymptomatic patients had large intrahepatic and portasystemic collaterals. At 3 years, death occurred in 22% of group II patients and in 45% of group I patients. No asymptomatic patient died. CONCLUSIONS: Asymptomatic hepatic vein thrombosis is associated with the spontaneous development of large intrahepatic and portosystemic collaterals. In asymptomatic patients, prognosis at 3 years seems to be good, and surgical therapy may not be required.

Adult↗
PubMed1994

Deep venous thrombosis following total hip arthroplasty. Effects of prolonged postoperative epidural anesthesia.

The authors studied the use of epidural anesthesia prolonged to 48 hours of epidural analgesia in 120 total hip arthroplasty patients in a case-control fashion. One half of the patients received prolonged epidural anesthesia, while the other matched half received general endotracheal anesthesia. Venograms were obtained after surgery and graded in blind fashion by a single radiologist. The overall incidence of deep venous thrombosis in the epidural versus general anesthetic groups was 23 (14 of 60 patients) versus 40% (24 of 60) (P < .05). There was an identical incidence--8.3% (5 of 60 patients)--of proximal thrombosis in the two groups, and all of the difference in the overall rates of thrombosis occurred in the calf. Fifteen percent (9 of 60 patients) of the epidural patients and 31.6% (19 of 60) of the general anesthetic patients demonstrated this finding (P < .05). Of the 10 proximal clots, 8 (80%) were found in the operative leg, while only 29 (59.2%) of the 49 calf clots were found in the operative leg. Prolonged epidural anesthesia significantly decreases the incidence of deep venous thrombosis after total hip arthroplasty, with its most apparent benefit on calf vein thrombosis secondary to its hyperkinetic effect on lower limb blood flow. The observation that it has no demonstrable effect on the prevention of proximal thrombosis and our finding that the majority of proximal clots are in the operative leg suggest that thrombi in the thigh may be the result of a different primary pathogenic mechanism that is more related to endothelial injury than to changes in viscosity or blood flow.(ABSTRACT TRUNCATED AT 250 WORDS)

Analgesia, Epidural↗
PubMed1975

The relationship of axillary venous thrombosis to the thoracic outlet compression syndrome.

In a relatively small personal series (41 patients) of first rib resections for thoracic outlet compression, I have encountered 8 patients in whom venous obstruction at the thoracic outlet was the major component. Four of the 8 had typical "stress" thrombosis of the axillary vein. Angiography demonstrated a tight thoracic outlet to be the underlying cause of the venous thrombosis. In the 4 patients with venous compression but without thrombosis, angiograms suggested that each was a candidate for axillary venous thrombosis unless the underlying thoracic outlet compression syndrome was relieved. Although thoracic outlet compression has been documented as a cause of "stress thrombosis" of the axillary vein, the relationship of the two conditions apparently is often overlooked, even by experienced thoracic surgeons. Representative case histories and angiograms are presented to demonstrate the close relationship of thoracic outlet compression and axillary venous thrombosis.

Adult↗
PubMed1998

The factor V Leiden mutation increases the risk of venous thrombosis in patients with inflammatory bowel disease.

BACKGROUND & AIMS: Thromboembolic disease is a significant cause of morbidity and mortality in patients with inflammatory bowel disease (IBD). The aim of this study was to determine the incidence and possible association of the factor V Leiden mutation with the development of thrombosis in patients with IBD. METHODS: This retrospective study included 11 patients with IBD and arterial or venous thrombosis and 51 patients with IBD and no history of thrombosis who were matched for age, sex, ethnic/racial origin, and type of IBD (controls). The presence of the factor V Leiden mutation was determined by coagulation assay and confirmed by a polymerase chain reaction method. RESULTS: Four of 11 IBD patients (36%) with thrombosis and 2 of 51 IBD controls (4%) were heterozygotes for the factor V Leiden mutation (relative risk, 14.00; 95% confidence interval, 1.55-169.25; P = 0.009, Fisher exact test). All thrombotic events in the patients with activated protein C resistance were venous with a calculated prevalence of 50% (4 of 8 patients) and a relative risk of venous thrombosis in IBD patients with factor V Leiden of 23 (95% confidence interval, 2-294; P = 0.005). CONCLUSIONS: In patients with IBD, inheritance of the factor V Leiden mutation results in a significant increased risk of venous thrombosis.

Adolescent↗
PubMed2002

Seasonal variations of deep vein thrombosis and its influence on the location of the thrombus.

The role of season as a predisposing factor for the development of deep vein thrombosis is controversially discussed. We analysed retrospectively seasonal variations in the occurrence of deep vein thrombosis of the leg in 905 patients between 1996 and 2000. Additionally, we evaluated the relationship between the season and the location of the thrombus. Our study revealed that the frequency of deep vein thrombosis of the leg was significantly higher during the winter half than during the summer half (p < 0.001). Regarding the seasonal variation of the location of the thrombus, distal deep vein thrombosis was more frequent during the winter half while proximal deep vein thrombosis was diagnosed more often during the summer half of the year. In conclusion, we suggest that the season has an influence on the development of deep vein thrombosis in the leg as well as on the location of the thrombus.

Adult↗
PubMed1997

Clinical evaluation of an immunoturbidimetric D-dimer assay in the diagnostic procedure of deep vein thrombosis and pulmonary embolism.

We investigated 128 patients with suspected deep vein thrombosis and 26 patients with suspected pulmonary embolism. Plasma cross-linked fibrin degradation products were measured instantly by a new rapid and fully quantitative immunoturbidimetric assay (Boehringer Mannheim) which recognizes the D-dimer epitope by antibody-coated latex particles. Diagnosis of deep vein thrombosis was established by either ascending venography (n = 105) or colour duplex ultrasound (n = 8), whereas for the exclusion of deep vein thrombosis only venography was accepted. The sensitivity/specificity for the diagnosis of deep vein thrombosis was 98%/44%. Patients with suspected pulmonary embolism were examined by pulmonary angiography (n = 19) or perfusion lung scanning alone (n = 6), if sufficient. One pulmonary embolism was diagnosed at post-mortem examination. For pulmonary embolism, sensitivity/specificity was 100%/50%. These findings indicate that the new immunoturbidimetric technique is as reliable as former ELISA methods and allows to rule out thromboembolic disorders. D-dimers showed a correlation to the extent of the deep vein thrombosis, proximal thrombosis producing higher D-dimer levels. Patients presenting immediately after the onset of symptoms were found to have higher D-dimers than patients examined after a few days. A quantitative D-dimer measurement thus seems to provide precious additional information of the duration and the extent of thromboembolic disease.

Adult↗
PubMedDate not supplied

Venous thrombosis due to poor anticoagulant response to activated protein C: Leiden Thrombophilia Study.

We undertook a population-based case-control study to test the clinical importance of a hereditary abnormality in the coagulation system, characterised by poor anticoagulant response to activated protein C (APC), which is associated with familial thrombophilia. The abnormality was detected in 64 (21%) of 301 unselected consecutive patients younger than 70 years, with a first, objectively confirmed episode of deep-vein thrombosis and without underlying malignant disease. Among 301 healthy control subjects matched for age and sex, the frequency was 5% (14 subjects). Thus, there is a seven-fold increase in risk of deep-vein thrombosis in subjects with a poor response to APC (matched odds ratio 6.6 [95% CI 3.6-12.0]). In addition, there was a clear inverse relation between the degree of response to APC and thrombosis risk. In the families of the patients an autosomal dominant mode of transmission of the abnormality was confirmed. 9 of 10 thrombosis patients with a poor response to APC had 1 parent with a similar poor response, whereas 9 of 10 patients with normal tests had parents with equally normal tests. The abnormality was found in both parents of 1 patient with an extremely poor response to APC; this patient is probably homozygous for the abnormality. We conclude that the poor response to APC is the most important hereditary cause of venous thrombosis. Its high prevalence in a series of unselected patients will make testing of all thrombosis patients for this abnormality worth while.

Adolescent↗
PubMed1978

Vascular-laboratory diagnosis of clinically suspected acute deep-vein thrombosis.

Doppler ultrasound, impedance plethysmography, and contrast venography were performed in 207 lower limbs suspected of harbouring deep-venous thrombosis, to clarify the diagnostic value and limitations of the non-invasive methods. Doppler ultrasound and impedance plethysmography were accurate in 96% and 95% of normal limbs, respectively. In limbs with venographic evidence of thrombosis requiring treatment, Dopper ultrasound and impedance plethysmography correctly detected thrombosis in 60% and 97%, respectively. Doppler ultrasound was 97% accurate in recognising chronic venous insufficiency. Impedance plethysmography was incorrectly positive in 74% of limbs with chronic venous insufficienv cy which had no venographically detected thrombosis. These findings suggest that, for the accurate diagnosis of clinically suspected deep-vein thrombosis, venography is necessary only in patients with chronic venous insufficiency who have normal Doppler ultrasound tests and abnormal impedance plethysmograms and in patients with abnormal cardiac haemodynamics. In this series, 86% of limbs would have been spared venography had non-invasive tests been used. Venography, however, remains the standard test for the detection of minor calf-vein thrombosis. A diagnostic and therapeutic schema is proposed.

Chronic Disease↗