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PubMed1982

[Venous thromboembolic accidents during idiopathic hyperlipaemia].

The authors report 30 cases of venous thromboembolic accidents during familial hyperlipaemia. This type of accident, never previously described, calls for the following comments: (1) there was a striking number of recurrences in some patients although none of the usual contributing factors of thromboembolic disease were present; (2) the accidents only occurred in patients with endogenous hypertriglyceridemia (mixed type IIb hyperlipaemia, type IV endogenous hypertriglyceridaemia); (3) the accidents ceased completely after the metabolic disorder was corrected. In the prevention of post-operative thromboembolic disease more attention than before should be paid to patients with endogenous triglyceridaemia.

Adult↗
PubMed1994

[Thromboembolic disease in the puerperium (is thrombotic prophylaxis necessary in the puerperium)].

The author makes retrospectively investigation in 3064 young mothers about determination on dependence between thromboembolism and varices in early puerperium. He finds varices in 1.01% of cases from which 84% are without prophylaxis. In 42% of them with complaints are applied medicine. In 0.13% of cases in puerperium develops thrombophlebitis (0.08-1.35% in bibliography information). The author finds in 0.098% of cases pulmonary thromboembolism (0.04-0.05% in bibliography information). In 77% of them he find out birth traumatism. In conclusion the author recommends prophylaxis with Heparin in early puerperium by cases with previous thromboembolism, traumatic parturition and doubt for infection.

Adult↗
PubMed1995

Strategy that includes serial noninvasive leg tests for diagnosis of thromboembolic disease in patients with suspected acute pulmonary embolism based on data from PIOPED. Prospective Investigation of Pulmonary Embolism Diagnosis.

OBJECTIVE: To estimate the percentage of patients with suspected acute pulmonary embolism in whom a noninvasive diagnosis or exclusion of thromboembolic disease might be safely made on the basis of ventilation-perfusion (VQ) lung scans, single noninvasive tests of the lower extremities, and, in patients with adequate cardiorespiratory reserve, serial noninvasive tests of the lower extremities. METHODS: Calculations were made among 662 patients who participated in the collaborative study Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) and who had blood gas values measured while breathing room air and who underwent pulmonary angiography. The diagnostic strategy recommends treatment in all patients with a high-probability VQ scan and no treatment in patients with nearly normal VQ scans. In patients with nondiagnostic VQ scans (intermediate- or low-probability scans), a single noninvasive leg test is recommended. It was assumed that 50% of patients with pulmonary embolism would show deep venous thrombosis with a single noninvasive leg test. If results are abnormal, treatment is indicated. If normal, serial noninvasive leg tests are recommended. Treatment can be withheld if results of serial tests are normal. In patients with poor cardiorespiratory reserve, pulmonary angiography is indicated. RESULTS: A single noninvasive leg test in patients with nondiagnostic VQ scans would show deep venous thrombosis and, therefore, eliminate the need for pulmonary angiography in 53 (11%) of 468 patients (95% confidence interval [CI], 9% to 15%) who otherwise would require angiography. Serial noninvasive leg tests in patients with adequate cardiorespiratory reserve who had a normal result of a single leg test would either show deep venous thrombosis or exclude it in 222 (47%) of 468 patients (95% CI, 43% to 52%). The need for pulmonary angiography, therefore, would be reduced from 468 (71%) of 662 (95% CI, 67% to 74%) if no noninvasive leg tests were performed to 415 (63%) of 662 (95% CI, 59% to 66%) if only a single noninvasive leg test were performed, and further reduced to 193 (29%) of 662 (95% CI, 26% to 33%) if serial noninvasive leg tests were used where appropriate. CONCLUSION: A noninvasive strategy that includes VQ scans, single noninvasive leg tests, and serial noninvasive leg tests would permit a diagnosis of thromboembolic disease or a safe exclusion of thromboembolic disease in 71% of patients with suspected acute pulmonary embolism.

Acute Disease↗
PubMed1995

[Catheterization therapy of thromboembolic arterial occlusions of the lower extremities].

Thromboembolic occlusions of peripheral arteries may threaten the vitality of extremities and sometimes patients life. Till recently the main therapeutic method was Fogarty surgical thromboembolectomy. A less invasive procedure is systemic (intravenous) and local (intraarterial) thrombolysis. All these method have, however, certain disadvantages. A new approach to the treatment for acute and subacute occlusions of peripheral arteries represents catheter thromboembolectomy, which involves the following: a) Aspiration of thromboembolic material--percutaneous thrombembolextraction (PTEE), b) Local infiltration thrombolysis where the catheter penetrates through the occlusion while simultaneously administering a fibrinolytic agent, c) PTA of residual stenosis in case of thrombotic occlusion. A combination of these methods of treatment for thromboembolic occlusions of peripheral arteries is very effective and enables to use a small amount of thrombolytic agent. The thrombosis and the underlying atherosclerotic stenosis are resolved during the same session.

Catheterization, Peripheral↗
PubMed1995

Thromboembolism and antithrombotic therapy in congestive heart failure.

The incidence of thromboembolic events in unselected patients with class II-III congestive heart failure is 1.6-3.5% per year. Marked limitation of exercise capacity and the presence of echocardiographic left ventricular thrombus appear to be associated with an increased risk of thromboembolism. Several studies have reported that anticoagulant therapy does not eliminate the occurrence of thromboembolism. Because the benefit and risks of anticoagulant therapy in patients with congestive heart failure have not been examined in controlled studies, it is difficult to make well-founded recommendations.

Anticoagulants↗
PubMed1995

[Calcium nadroparin in the prevention of thromboembolic disease in elderly subjects. Study of tolerance].

OBJECTIVE: To evaluate the safety of a low molecular weight heparin for the prevention of thromboembolic disease in elderly patients. METHODS: A multicentre, randomized, open study was conducted in 295 patients: 146 patients (mean age 82.8 +/- 0.5 years) received calcium nadroparin and 149 patients (mean age 83.8 +/- 0.6 years) received calcium heparin. All medical patients were hospitalized with transient locomotor disability, requiring prophylaxis for thromboembolism. Patients were randomized to 28-days treatments with either subcutaneous calcium nadroparin 0.3 ml (3075 anti-Xa IU) daily or subcutaneous calcium heparin twice a day (0.2 ml-5000 UI--if bodyweight was less than 70 kg or 0.3 ml-7500 IU--if bodyweight was over or equal to 70 kg). RESULTS: The overall objective was to assess tolerability in terms of premature discontinuation of treatment for any reason: Discontinuation was more frequent in the calcium heparin group (16.1%) than in the calcium nadroparin group (11%), but without statistical significance. Premature withdrawal of therapy definitively attributable to drug administration occurred in 10 patients from the calcium heparin group (1 deep vein thrombus, 1 pulmonary embolus, 4 major bleeding events, 1 thrombopenia, 3 allergic events) and in only 1 from the calcium nadroparin group (1 allergic event). The difference was statistically significant (p = 0.01). CONCLUSIONS: The results of this study offer new evidence to confirm the safety and simplicity of administration of calcium nadroparin in the prevention of thromboembolism in elderly patients.

Aged↗
PubMed1994

[Prevention of venous thromboembolism--in whom, when and how?].

Venous thromboembolic diseases are of major importance with respect to morbidity and mortality. Therefore, efficient prophylaxis is essential. Indication for thromboprophylaxis has to be made individually: In high risk situations, especially in orthopedic surgery, every patient should receive medical prophylaxis, e.g. with heparin, in addition to other preventive measures such as the wearing of elastic stockings or physiotherapy until full mobilization. For high-risk patients having a history of recurrent venous thromboembolism or which are suffering from a thrombogenic disease (e.g. myeloproliferative disorder, especially polycythemia vera, paroxysmal nocturnal hemoglobinuria, systemic lupus erythematosus, homocystinuria) or a hereditary thrombophilia (e.g. deficiency of antithrombin III, protein S, protein C or APC resistance), prophylactic measures should be more generally applied. In these patients, risk factors (e.g. oral contraceptive medication) or risk situations (e.g. long-distance travelling by car or airplane) have to be avoided whenever possible. In inevitable risk situations (e.g. perioperative or peripartal period) prophylaxis is mandatory. It is generally limited to the period of elevated thrombogenic risk and is often effected by application of a low molecular weight heparin. Patients with a history of recurrent thromboembolic events despite elimination of all avoidable risk factors should get a lifelong prophylaxis, usually with oral anticoagulants.

Adult↗
PubMed1994

[Anticoagulant treatment of venous thromboembolic disease: optimal duration of antivitamin K therapy. Review of the literature].

Every clinician managing a patient with venous thromboembolism of the lower limbs is faced with two opposing problems: first the risk of antivitamin K induced haemorrhage requires adequate but not excessive hypocoaguability of limited duration (international normalized ratio between 2 and 3); second the threat of recurrence requiring an adequate level of hypocoaguability of sufficient duration. Recently reported clinical data have greatly changed management attitudes. Current recommendations favour a 6 week regimen of antivitamin K for distal venous thrombosis in patients with thromboembolism of lower limb veins without any other aggravating factor and a 12 week regimen for proximal vein thrombosis or pulmonary emboli, although the therapeutic efficacity and risk remain to be demonstrated with precision. In France, we are conducting a multicentric controlled study with sufficient power (1800 patients) comparing parallel groups of patients: those with distal deep venous thrombosis treated 6 versus 12 week regimens, those with proximal deep venous thrombosis and/or pulmonary emboli treated 12 versus 24 week regimens. The "DOTAVK" study (Durée Optimale du Traitement Antivitamine K) involves patients with first time venous thrombosis or pulmonary emboli and no underlying neoplasia or coagulation disease. The two criteria of outcome are haemorrhage complications and thromboembolic recurrence during treatment and the first year after treatment withdrawal.

4-Hydroxycoumarins↗
PubMed1994

Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: Stroke Prevention in Atrial Fibrillation II Study.

Warfarin is an established treatment for prevention of ischaemic stroke in patients with atrial fibrillation, but the value of this agent relative to aspirin in unclear. In the first Stroke Prevention in Atrial Fibrillation (SPAF-I) study, direct comparison of warfarin with aspirin was limited by the small number of thromboembolic events. SPAF-II aims to address this issue and also to assess the differential effects of the two treatments according to age. We compared warfarin (prothrombin time ratio 1.3-1.8, international normalised ratio 2.0-4.5) with aspirin 325 mg daily for prevention of ischaemic stroke and systemic embolism (primary events) in two parallel randomised trials involving 715 patients aged 75 years or less and 385 patients older than 75; we sought reductions in the absolute rate of primary events by warfarin compared with aspirin of 2% per year and 4% per year, respectively. In the younger patients, warfarin decreased the absolute rate of primary events by 0.7% per year (95% CI-0.4 to 1.7). The primary event rate per year was 1.3% with warfarin and 1.9% with aspirin (relative risk [RR] 0.67, p = 0.24). The absolute rate of primary events in low-risk younger patients (without hypertension, recent heart failure, or previous thromboembolism) on aspirin was 0.5% per year (95% CI 0.1 to 1.9). Among older patients, warfarin decreased the absolute rate of primary events by 1.2% per year (95% CI-1.7 to 4.1). The primary event rate per year was 3.6% with warfarin and 4.8% with aspirin (RR 0.73, p = 0.39). In this older group, the rate of all stroke with residual deficit (ischaemic or haemorrhagic) was 4.3% per year with aspirin and 4.6% per year with warfarin (RR 1.1). Warfarin may be more effective than aspirin for prevention of ischaemic stroke in patients with atrial fibrillation, but the absolute reduction in stroke rate by warfarin is small. Younger patients without risk factors had a low rate of stroke when treated with aspirin. In older patients the rate of stroke (ischaemic and haemorrhagic) was substantial, irrespective of which agent was given. Patient age and the inherent risk of thromboembolism should be considered in the choice of antithrombotic prophylaxis for patients with atrial fibrillation.

Aged↗
PubMed1993

[Prevention of thromboembolic complications with adapted low-dose of antivitamins K after total hip prosthesis].

This study reports the efficacy in the prevention of thromboembolic complications of adapted low-dose oral anticoagulants following total hip replacement. 750 patients undergoing total hip replacement received oral anticoagulants as exclusive drug prophylaxis for thromboembolic complications. These patients were considered preoperatively not to present any particular risk for the development of postoperative thrombosis. Anticoagulant therapy was commenced on the evening of the operation. Eleven pulmonary embolisms (1.5 per cent) were observed, but none of them were fatal. The risk of thrombosis was evaluated in 100 of these 750 patients by means of bilateral venography of the lower limbs: 21 patients developed distal thrombosis (sural veins) and 2 patients developed proximal femoral thrombosis. Only one haemorrhagic complication occurred in the 750 patients of this series. The prothrombin profile determined in the patients developing thrombosis or pulmonary embolism was not significantly different from that of the patients free of any thromboembolic complications. Although oral anticoagulants appear to be particularly effective for the prevention of fatal pulmonary embolism, it is not clear that their efficacy is directly related to the prothrombin time.

4-Hydroxycoumarins↗
PubMed1994

[The HITT syndrome: heparin-induced thrombocytopenia and thrombosis as a cause of paradoxically occurring thromboembolisms].

Heparin since the early sixties has played an important part in prevention and treatment of thromboembolic processes. It has hardly any side effects like allergic reactions but haemorrhage is seen more frequently. A less well-known complication is so-called heparin-induced thrombocytopenia and thrombosis (HITT). There are two different forms: a mild thrombocytopenia, characterised by a decrease in platelet count to 100-150 x 10(9)/l. This form causes no clinical symptoms. The more severe form occurs between the 7th and the 11th day after heparin administration and is characterised by paradoxically occurring thromboembolic complications. This syndrome results from formation of an antigen-antibody complex. If heparin has been administered in the past patients may develop this severe form at the moment of renewed administration. In our hospital during the past 8 years we observed 9 patients with the HITT syndrome presenting with thromboembolic complications. A thrombocyte aggregation test is diagnostically useful. Heparin-free plasma of the patient is mixed with donor thrombocytes, and heparin is added; in the HITT syndrome aggregation occurs. The main therapy is stopping the heparin administration and giving antiaggregants such as dextrans.

Adult↗
PubMed1993

European consensus statement on the prevention of venous thromboembolism. European Consensus Conference, Windsor, U.K., November, 1991.

Since the Consensus Conference of the National Institute of Health in 1986, the developments in the field of prevention of venous thromboembolism were mainly characterized by a more specific and extended use of new prophylactic agents such as low molecular weight heparins as well as the perception that outpatients may be at risk for thromboembolic complications, too. Therefore, in November 1991, a European Consensus Conference on the prevention of thromboembolism was held in Windsor, UK, in order to analyse the risk constellation of various patient populations and to give recommendations for primary prophylaxis in general surgery, urology, neurosurgery, orthopaedic and trauma surgery, obstetrics and gynaecology and medical patients. In addition, the cost-effectiveness of the various methods was highlighted, and the question of secondary prevention addressed. The meeting was organized under the patronage of the European Economic Commission, and experts from 15 different countries were invited to participate. The conference was organized according to acknowledged guidelines of consensus conference organization, i.e. each expert had to formulate his provisional standpoint, the working documents were compiled by the organizer, and this file was sent to the delegates before the conference. During the first part of the meeting, the delegates presented their views in plenary sessions. Controversial points were discussed in working groups, and the results were discussed in plenary sessions. Consensus or lack of accord was documented and the open questions were formulated in order to be answered by future studies. The published statements and recommendations are based on different levels of evidence.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗
PubMed1993

Thromboembolic complications of polycythemia: polycythemia vera versus smokers' polycythemia.

PURPOSE: This report compares patients with the hypercoagulable state of polycythemia vera to patients with secondary polycythemia caused by tobacco use to determine whether the incidence of thromboembolic events is equivalent. METHODS: The medical records of 146 patients with the diagnosis of polycythemia between 1977 to 1990 were reviewed. Patients with transient, relative, or stress polycythemia were excluded from this study as were patients with polycythemia as a result of cardiac or pulmonary anomalies or both. The diagnosis of polycythemia vera (n = 43) was verified by use of the guidelines of the Polycythemia Vera Study Group. The diagnosis of polycythemia caused by smoking (n = 27) was based on an elevated total red blood cell volume, decreased oxygen saturation on arterial blood gas measurement, evidence of chronic obstructive pulmonary disease, and elevated carboxyhemoglobin levels. RESULTS: Twenty-six patients (60%) with polycythemia vera and 11 patients (41%) with smoker's polycythemia had at least one thromboembolic problem. No significant differences existed between the groups with regard to age, hematocrit, or number of cardiac and cerebrovascular events. Overall, patients with polycythemia vera had a greater number of thromboembolic events per patient (p < 0.05) and more peripheral arterial thromboemboli (p < 0.005) than did patients with polycythemia as a result of smoking (Fisher's Exact Test). CONCLUSIONS: Thus the results of this study demonstrate that smokers' polycythemia does not represent a hypercoagulable state equivalent to that of polycythemia vera.

Analysis of Variance↗
PubMed1995

[Thromboembolism and ovarian hyperstimulation].

Three new cases of thromboembolic accidents involving the superior vena cave were associated with ovarian hyperstimulation and multiple pregnancy. On the basis of a review of the literature, three syndromes were individualized. First embolic arteries are infrequent and serious with an important morbidity; low doses of gonadotrophines is sufficient for causing this pathology. Second, thrombosis of the superior vena cava is late, during in vitro fertilization regimens with GnRH analogs complicated with serious hyperstimulation (degree III). Third, pregnancy is always present; pulmonary complications are very uncommon. Thrombosis of inferior vena cava is late, pregnancy is often present but women are frequently at risk of thromboembolic accident. Prevention of hyperstimulation is important. When present, HBPM is recommended for prevention of thromboembolism. Diagnostic of thrombosis is made with clinical examination and morphologic complementary exams such colour-vascular Doppler and magnetic resonance imaging. Curative treatment requires heparinization.

Adult↗
PubMed1995

[Thromboembolic complications in urology].

Using the latest examination methods the authors have proved relatively wide spread recurrence of thromboembolic complications. Proved were even the mortal forms in urology in case of benign diagnosis as well as relatively considerate operational medical performance. An evident effect of prophylactic, physical and especially pharmacological methods was proved in prevention of thromboembolic disorders. Silent form of deep venous thrombosis were diagnosed to patients with mere physical prophylaxis. On the other side unfavourable effect of low molecular weight heparin on blood loses was not proved even in laboratory picture. Higher risk of thromboembolic complications origin was observed even on the 21st postoperation day. Currently authors consult the appropriateness of individual types of prophylaxis with the different urology illnesses risk groups.

Humans↗
PubMed1995

[Duration of antivitamin K therapy in venous thromboembolic disease].

The necessity for anticoagulant treatment after pulmonary embolism or deep vein thrombosis has been demonstrated. The modalities of this treatment have been established, especially the value of initial heparin relayed by oral antivitamin K therapy with a target INR value between 2 and 3. The last question remaining in this protocol is that of the duration of anticoagulant treatment. The choice of duration of anticoagulation should take into consideration two potential complications: haemorrhage due to over-anticoagulation and excessive duration of therapy, and recurrent thromboembolism which could result from an inadequate duration of therapy. Several trials have addressed this question and have led to a consensus of opinion: therefore, secondary venous thrombo-embolic disease, occurring under known, special circumstances, the cause of which has been treated, should be given 4 to 6 weeks anticoagulant therapy. In the other cases, so-called idiopathic venous thromboembolism (the proportion of which is on the increase), recent studies are inadequate to reach a consensus. These "idiopathic" forms are characterised by a higher incidence of recurrent thromboembolism of "secondary" cancer and coagulation abnormalities. The search for the optimal duration of anticoagulant therapy in these forms requires prospective trials taking their features into account and should lead to further therapeutic options. The evaluation of longer treatment protocols with less intensive degrees of anticoagulation and of alternatives to oral vitamin K antagonists is justified.

Anticoagulants↗
PubMedDate not supplied

Thromboembolism associated with junctional escape rhythm and atrial standstill after orthotopic heart transplantation.

We report on thromboembolism in a heart transplant recipient with mechanical atrial standstill and spontaneous echocardiographic contrast during intermittent periods of sinus arrest and junctional escape rhythm. The temporal relationship between the conversion of atrial flutter to junctional bradycardia and two episodes of thromboembolism strongly suggest a role of the lack of atrial contraction during junctional rhythm for the development of spontaneous echocardiographic contrast and thromboembolism.

Arrhythmias, Cardiac↗
PubMed1996

Reliable rapid blood test for the exclusion of venous thromboembolism in symptomatic outpatients.

UNLABELLED: In this study we assessed the reliability of a rapid bed-side whole blood D-dimer assay prospectively in patients with clinically suspected venous thromboembolism, referred to the Academic Medical Centre, Amsterdam. In consecutive outpatients with clinically suspected deep vein thrombosis or pulmonary embolism we measured the sensitivity, specificity and negative predictive value of the assay compared to the outcome of standard diagnostic tests and 3-month follow-up. A total of 234 patients were included; the prevalence of venous thromboembolism was 29%. A sensitivity, specificity and negative predictive value of 100% (95% CI: 95% - 100%), 58% (95% CI: 50%-65%) and 100% (95% CI:96% - 100%), respectively, were obtained. The exclusion rate was 41% of all referred patients. CONCLUSION: The SimpliRED whole blood D-dimer assay appears to be a simple and reliable method for the exclusion of venous thromboembolism in symptomatic outpatients.

Adolescent↗