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At least 1,117 records · Page 62Linked to original sources
PubMed1980

[Prevention of deep venous thrombosis (TVP) and pulmonary embolism. Comparison of heparin (3 x 5000 IU/day), heparin (2 x 5000 IU/day) + 0.5 mg dihydroergot, and physiotherapy (intermittent compression stockings + physical exercise). Value of Doppler diagnosis in systematic detection of TVP compared with phlebography and scanning of the legs using labelled fibrinogen].

We compared the protective value of the above treatments in 227 randomised patients. Investigations in each patient included pulmonary scanning before and after operation, repeated postoperative Doppler and radioactive limb scanning completed by phlebography to confirm positive results. The heparin DHE group and the "physiotherapic" group each totalized 76 patients and the heparin group 75. These comparable groups show that HDHE and heparin prophylaxis are identical; but physiotherapy is perhaps better. Compared with phlebography leg scanning sensitivity is 95%, whilst it's specificity is 99%. Doppler sensitivity is only of 21%, whilst it's specificity is 95%. In conclusion, "physiotherapic" prophylaxis, including Flowtron, is as effective as heparin alone. Doses of heparin may be reduced, without loss of effect, if supplemented by a veinoconstrictive agent as DHE. The low Doppler sensitivity contraindicates its use in asymptomatic DVT detection.

Adult↗
PubMed1996

[From the history of thrombosis prevention and treatment].

Rudolf Virchow described not only his famous triad in the 1840s but also the relationship between thrombosis and pulmonary embolism. Deep vein thrombosis (DVT) was recognized as postoperative complication from the 1890s. The preventive measures were directed against the factor blood stasis until heparin was applied clinically in the 1930s. The Swiss surgeon K. Lenggenhager was probably the first who recommended low dose heparin prophylaxis in 1940 on a rational experimental basis. Perhaps because his results were published only in German this application form became not popular before the great studies of Kakkar in the 70s took place. The introduction of low molecular weight heparins in the 80s simplifies prophylaxis and therapy of DVT again. The descriptions of deficiency of natural coagulation inhibitors start with antithrombin III in 1961. The recent discovery of the molecular basis of activated protein C resistance made history today.

Anticoagulants↗
PubMed1996

[Right ventricular thrombosis and pulmonary thrombosis associated with venous-peritoneal diversion (Le Veen). Diagnosis with transesophageal echocardiography].

Central venous thrombosis (CVT) and pulmonary embolism (PE) are complications that have been reported in association with the use of venous-peritoneal shunts (Le Veen). CVT usually develops around the proximal end of the catheter; the clinical course is varied and usually requires venous imaging to confirm the diagnosis. We present a case of CVT associated with PE, in which the thrombus was located in the right ventricular cavity (distal to the catheter tip). Two-dimensional transesophageal echocardiography was used for diagnosis and follow-up.

Echocardiography, Transesophageal↗
PubMed1997

[Thromboembolic complications in inflammatory bowel disease].

Thromboembolic complications during the course of inflammatory bowel disease are infrequent but are mainly found in young patients and are associated with a high morbimortality. The etiopathogenesis of these complications has been widely debated and the existence of coagulation alterations and fibrinolysis have been suggested. Nonetheless, the mechanism must be complex since not only do not all the patients with these alterations present this complication but neither do all the patients with thromboembolism have recognized coagulation disorders. The most common clinical presentation is deep vein thrombosis with pulmonary embolism with arterial thrombosis being rare. Five patients with Crohn's disease and two with ulcerative colitis who presented a total of new thromboembolic episodes, six arterial (1 in primitive iliac artery, 1 in common femoral artery, 1 in humeral-axillary artery, 2 in internal carotid and 1 in superior mesenteric artery) and three of venous localization (1 in brachyocephalic-subclavian trunk, 1 axillary and 1 iliac-femoral/pulmonary thromboembolism) are reported. An updated review of the etiopathogenesis, presentation, treatment and prophylaxis of the thromboembolic complications of inflammatory bowel disease is presented.

Adult↗
PubMed1997

Clinical epidemiology of venous thromboembolic disease. Results of a French Multicentre Registry.

OBJECTIVE: Between July 1992 and December 1994, 16 French hospital centres, mainly cardiological, participated in a non-controlled observational study on venous thromboembolic disease. The objective of this survey was to collect data concerning the current status of pulmonary embolism and deep venous thrombosis. PATIENTS: During this period, 547 patients were included: 446 with deep venous thrombosis and 387 with pulmonary embolisms. RESULTS: Mean age of patients was 63 +/- 21 years. There were no significant differences between the sexes. Pulmonary embolism and deep venous thrombosis tended to occur more frequently during the autumn and winter. In 30% of cases, prior deep venous thrombosis or pulmonary embolism was noted. No cause was found for the condition in 47% of cases. Ultrasound (echocardiography and/or venous ultrasound) was the most frequently requested investigation. Intravenous heparin remains the most widely used treatment (76%). Oral anticoagulation was begun before day 3 in less than 31% of cases. Thrombolytic treatment was used in 20% of pulmonary embolism cases, but was rarely prescribed for deep venous thrombosis (2.2%). The hospital recurrence rate (12/547 cases) was fairly low. The search for occult malignancy, performed in 48% of cases, seems to remain one of the major concerns of physicians. The combined pulmonary embolism and deep venous thrombosis mortality rate was 4.4%, while the death rate for pulmonary embolism alone was 6.2%.

Adult↗
PubMed1996

Diagnosis of pulmonary embolism.

Present opinion combines the diagnosis and management of deep venous thrombosis and pulmonary embolism. Regarding deep venous thrombosis, clinical assessment based on major and minor diagnostic points in combination with ultrasound of the lower extremities showed useful positive predictive values when the clinical assessments and ultrasound were concordant. Subtle calf asymmetry may call attention to the possibility of thromboembolic disease. The prevalence of acute pulmonary embolism at a general hospital was evaluated. Importantly, the prevalence of unrecognized pulmonary embolism at autopsy has not changed in three decades. Further evaluation was made of the alveolar arterial oxygen difference in the diagnosis of acute pulmonary embolism. As with the partial pressure of oxygen in arterial blood, the alveolar arterial oxygen difference is usually abnormal, but a normal value does not exclude pulmonary embolism. The criteria used for a low probability interpretation of ventilation-perfusion lung scans in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) were modified. Criteria for a very low probability assessment (< 10% positive predictive value) were also determined. Progress was made with helical CT and contrast-enhanced electron-beam CT, but with present technology their roles are limited. Selective digital subtraction angiography with a flow-directed catheter was useful in some patients. A strategy for diagnosis of thromboembolic disease that uses serial noninvasive leg tests was described. This strategy reduces the number of pulmonary angiograms required.

Angiography, Digital Subtraction↗
PubMed1997

Risk for venous thrombosis related to antiphospholipid antibodies in systemic lupus erythematosus--a meta-analysis.

OBJECTIVE: To describe the relative risk for venous thrombosis (VT) associated with antiphospholipid antibodies (aPL) in systemic lupus erythematosus (SLE). DESIGN: Systematic review and meta-analysis of 26 articles that examined the association between aPL and VT in SLE. SETTING: Mostly secondary and tertiary referral centres. PATIENTS: 2249 patients with SLE, 1120 tested for LA (lupus anticoagulant) and 1563 tested for aCL (anticardiolipin antibodies). MAIN OUTCOME MEASURES: A summary of study characteristics and a critical appraisal of study quality were done. Two statistical combinations of 18 primary studies that examined the association of VT and LA and of 14 studies that examined the association of VT and aCL were performed to estimate the risk for VT associated with aPL. RESULTS: The odds ratios of the risk of VT related to the LA summarized from 18 studies were 5.61 [95% CI; 3.80-8.27] overall, 6.32 [CI; 3.71-10.78] for deep venous thrombosis and pulmonary embolism, 11.6 [3.65-36.91] for recurrent venous thrombosis after the first event. The odds ratios of the risk of VT related to aCL summarized from 14 studies were 2.17 [95% CI; 1.51-3.11] overall, 2.50 [CI; 1.51-4.14] for deep venous thrombosis and pulmonary embolism, 3.91 [1.14-13.38] for recurrent venous thrombosis after the first event. CONCLUSIONS: Patients with SLE and LA are at approximately six times greater risk for VT than patients without LA, whereas patients with SLE and aCL are approximately two times greater risk for VT than patients without aCL. We have identified important methodologic limitations and differences in study characteristics. Other risk factors for VT have not been thoroughly evaluated in these studies. Further studies are needed that provide an accurate estimate of the absolute risk for aPL related VT.

Antibodies, Anticardiolipin↗
PubMed2000

A new method for measuring D-dimer using immunoturbidometry: a study of 255 patients with suspected pulmonary embolism and deep vein thrombosis.

D-Dimer testing has been suggested as a non-invasive method for the exclusion of pulmonary embolism (PE) and deep vein thrombosis (DVT). In this study, we compared a new method, the Miniquant D-dimer (Biopool International, Ventura, California, USA) to other previously validated D-dimer methods used for the purpose. Patients who were undergoing a definitive diagnostic study for thromboembolism had a blood sample drawn at that time. A whole-blood D-dimer (SimpliRed; Agen Biomedical Ltd, Brisbane, Australia) test was performed, and residual plasma was frozen and later analyzed using two enzyme-linked immunosorbent assay (ELISA) methods (D-dimer Gold; Agen, and Asserachrome D-Di; Stago International, Parsippany, New Jersey, USA) and the Miniquant D-dimer. Once all samples were analyzed, the correlation and accuracy of the Miniquant was compared with the ELISA method using Spearman's regression and Dunn's multiple paired comparison. All D-dimer methods were compared with radiographic studies. The data was analyzed collectively and segregated into in-patient (n = 112) and out-patient (n = 143) populations. The Miniquant D-dimer sensitivity, specificity and negative predictive value (NPV) for all patients were 95, 21, and 94% for DVT, and 100, 26, and 100% for PE. This new D-dimer method demonstrates acceptable sensitivity in patients with PE and DVT and, based on the high NPV of this method, it can be used for the exclusion of thromboembolism.

Adult↗