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At least 1,279 records · Page 71Linked to original sources
PubMed1999

Venous thromboembolism prophylaxis after total hip or knee arthroplasty: a survey of Canadian orthopedic surgeons.

OBJECTIVE: To determine the pharmacologic and physical modalities used by orthopedic surgeons in Canada to prevent venous thromboembolism (deep venous thrombosis and pulmonary embolism) after total hip or knee arthroplasty. DESIGN: Mail survey sent to all members of the Canadian Orthopaedic Association. SETTING: A nation-wide study. METHODS: A total of 828 questionnaires, designed to identify the type and frequency of prophylaxis against venous thromboembolism that were used after hip and knee arthroplasty were mailed to orthopedic surgeons. OUTCOME MEASURES: Demographic data and the frequency and type of thromboprophylaxis. RESULTS: Of the 828 surveys mailed 445 (54%) were returned, and 397 were included in this analysis. Of the respondents, 97% used prophylaxis routinely for patients who undergo total hip or knee arthroplasty. Three of the 397 (0.8%) did not use any method ofprophylaxis. Warfarin was the most common agent used (46%), followed by low-molecular-weight heparin (LMWH) (36%). Combination therapy with both mechanical and pharmacologic methods were used in 39% of patients. Objective screening tests were not frequently performed before discharge. Extended prophylaxis beyond the duration of hospitalization was used by 36% of physicians. CONCLUSION: Prophylaxis for venous thromboembolism with warfarin or LMWH has become standard care after total hip or knee arthroplasty in Canada.

Anticoagulants↗
PubMed1999

[An autopsy case of pulmonary thromboembolism associated with chlorine gas poisoning].

We report a rare case of sudden death of a patient with acute pulmonary thromboembolism associated with chlorine gas poisoning. A 21-year-old man in a water-filtration plant accidentally inhaled highly concentrated chlorine gas. He was immediately brought to a hospital after exposure. On admission, the patient had clouding of consciousness, dyspnea, and deep cyanosis. Arterial blood gas values indicated severe hypoxemia; PaO2 was 35.9 mmHg and PaCO2 was 42.4 mmHg. The clinical course was uneventful and he was satisfactorily recovering. However, ten days after admission he became sick and markedly cyanotic. He lost consciousness and then he went into cardiopulmonary arrest. Despite efforts at resuscitation, he died. An autopsy revealed bilateral pulmonary thromboembolism, although he apparently did not have any risk factor for embolism. The toxicity of chlorine gas may be related to the pulmonary thromboembolism, but the mechanisms leading to his death are unclear.

Accidents, Occupational↗
PubMed1999

[Chronic thromboembolic pulmonary arterial hypertension].

Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon disease with a severe prognosis. Initially considered as a constantly fatal disease, it can be cured since the advent in the late 80's of thromboendarterectomy. CTEPH occurs in approximately 0.1% of patients who survive acute pulmonary embolism. Such outcome is due to the failure of the normal thrombi resolution in the pulmonary circulation. This disease is observed in both sexes and occasionally as early as in the third decade. Many patients have no history of acute venous thromboembolism which is responsible for the frequent diagnosis delay. Therefore, it is of paramount importance to search for pulmonary vascular disease when patients complain solely of dyspnea on exertion. These patients should undergo echocardiography and, if necessary, right heart catheterization. Once the diagnosis of pulmonary hypertension is established the next step is to find the cause. Ventilation-perfusion scanning is probably the most sensitive non-invasive test to provide evidence that pulmonary hypertension is related to chronic thromboembolism. Angiography and helical computed tomography allow to confirm the diagnosis of CTEPH and to determine whether it is accessible or not to thromboendarterectomy. Most patients who undergo thromboendarterectomy improve clinically and in terms of gas exchange and pulmonary hemodynamics. When thrombi are inaccessible surgically, patients should be placed on the list for lung transplantation if they fulfill the criteria established for primary pulmonary hypertension. When all surgical procedures are contraindicated, anticoagulant and oxygen therapy remain the sole possibility of treatment.

Anticoagulants↗
PubMed2000

16(R)-hydroxyeicosatetraenoic acid, a novel cytochrome P450 product of arachidonic acid, suppresses activation of human polymorphonuclear leukocyte and reduces intracranial pressure in a rabbit model of thromboembolic stroke.

OBJECTIVE: Activated polymorphonuclear leukocytes (PMNs) have been suggested to contribute to the development of increased intracranial pressure (ICP). We recently demonstrated that human PMNs produce a novel cytochrome P450-derived arachidonic acid metabolite, 1 6(R)-hydroxyeicosatetraenoic acid [16(R)-HETE], that modulates their function. It was thus of interest to examine this novel mediator in an acute stroke model. METHODS: 16-HETE was assessed initially in a variety of human PMN and platelet in vitro assays and subsequently in an established rabbit model of thromboembolic stroke. A total of 50 rabbits completed a randomized, blinded, four-arm study, receiving 16(R)-HETE, tissue plasminogen activator, both, or neither. Experiments were completed 7 hours after autologous clot embolization. The primary end point for efficacy was the suppression of increased ICP. RESULTS: In in vitro assays, 16(R)-HETE selectively inhibited human PMN adhesion and aggregation and leukotriene B4 synthesis. In the thromboembolic stroke model, animals that received 16(R)-HETE demonstrated significant suppression of increased ICP (7.7 +/- 1.2 to 13.1 +/- 2.7 mm Hg, baseline versus final 7-h time point, mean +/- standard error), compared with either the vehicle-treated group (7.7 +/- 0.9 to 15.8 +/- 2.6 mm Hg) or the tissue plasminogen activator-treated group (7.6 +/- 0.6 to 13.7 +/- 2.1 mm Hg). The group that received the combination of 16(R)-HETE plus tissue plasminogen activator demonstrated no significant change in ICP for the duration of the protocol (8.6 +/- 0.6 to 11.1 +/- 1.2 mm Hg). CONCLUSION: 16(R)-HETE suppresses the development of increased ICP in a rabbit model of thromboembolic stroke and may serve as a novel therapeutic strategy in ischemic and inflammatory pathophysiological states.

Animals↗
PubMed2000

[Pulmonary thromboendarterectomy for chronic pulmonary thromboembolism in three patients with systemic lupus erythematosus and antiphospholipid syndrome].

Pulmonary hypertension (PH) is a serious and often fatal complication of systemic lupus erythematosus (SLE). Several potential mechanisms have been postulated for narrowing of vessels as a result of pulmonary vasculitis and pulmonary thromboembolism caused by antiphospholipid antibodies. Pulmonary thromboendarterectomy for chronic pulmonary thromboembolism is performed to alleviate pulmonary hypertension. We report three rare cases of SLE with antiphospholipid syndrome in patients who presented with PH secondary to chronic pulmonary thromboembolism. Pulmonary thromboendarterectomy was performed, and all patients remained well without deterioration of PH after surgery. Pulmonary thromboendarterectomy should be considered as an effective method of treatment for this disease.

Adult↗
PubMed2001

[Surgical treatment for chronic pulmonary thromboembolism in a patient with protein C deficiency].

Medical therapy for chronic pulmonary thromboembolism is limited, and surgical treatment has become more frequent recently. We have performed pulmonary thromboendarterectomy on a patient with chronic pulmonary thromboembolism accompanied by protein C deficiency. The patient was a woman aged 68 years who had protein C deficiency. The preoperative condition was New York Heart Association functional class IV. Hypoxemia, marked pulmonary hypertension, and low cardiac output were observed. After a median sternotomy, moderate hypothermia was induced using a cardiopulmonary bypass, and thromboendarterectomy in the pulmonary artery was performed. The arterial blood oxygen concentration improved, and the mean pulmonary pressure decreased. The cardiac output also increased, and New York Heart Association functional class improved to I. Pulmonary thromboendarterectomy under cardiopulmonary bypass was effective for chronic pulmonary thromboembolism accompanied by protein C deficiency.

Aged↗
PubMed2001

[A case of pulmonary thromboembolism with heparin-induced thrombocytopenia].

In February 2000, a 70-year-old man was admitted to our hospital complaining of back pain and dyspnea on exertion. Pulmonary thromboembolism was diagnosed, and he was treated with intravenous urokinase and heparin. The pulmonary thromboembolism improved, though heparin-induced thrombocytopenia (HIT) was subsequently observed. The thrombocytopenia was then improved by withdrawing the intravenous heparin, but thrombosis appeared extending from both femoral veins to the inferior vena cava. The thrombosis was dispersed by catheter-directed thrombolysis. There have been few reports of HIT in Japan. Heparin is frequently used for the treatment of pulmonary thromboembolism, but special care must be taken, since severe thrombotic complications are associated with HIT.

Aged↗
PubMedDate not supplied

[Helical computerized tomography of the thorax in the diagnosis of unresolved chronic pulmonary thromboembolism].

We assessed the diagnostic usefulness of helical CT scan of the thorax in the setting of chronic thromboembolic pulmonary hypertension by prospectively comparing the results of helical CT scan to those of the pulmonary angiogram (gold standard). We studied 40 patients with diagnosis of pulmonary hypertension of diverse etiology (mean age: 40.7 +/- 12 y.o.; mean systolic pulmonary artery pressure: 91 +/- 33 mmHg)). Thirty of these patients fulfilled the diagnostic criteria of chronic thromboembolic pulmonary hypertension and the other ten were used as controls. Diagnosis in control patients included: primary pulmonary hypertension (4); patent ductus arteriosus (2); atrial septal defect (1); rheumatic valve disease (1); ischemic heart disease (1); and acute pulmonary embolism (1). Both helical CT scan and pulmonary angiogram were part of the routine diagnostic work up of these patients, and were, performed and interpreted almost simultaneously (within one week) by a different group of investigators in a blind manner. Only the diagnostic accuracy of the method regarding central (major arteries) vascular lesions was evaluated. Helical CT scan had an overall sensitivity of 100% (29/29), and a specificity of 91% (10/11). Positive predictive and negative predictive values were 96.6% (29/30) and 100% (10/10), respectively. Overall diagnostic accuracy was 97.5% (39/40). We conclude that helical CT scan of the thorax is an excellent alternative approach for the diagnosis of major arteries lesions in the setting of chronic thromboembolic pulmonary hypertension.

Adolescent↗
PubMed2001

Our experience of surgical treatment for chronic pulmonary thromboembolism.

Chronic pulmonary thromboembolism is one of the causes of pulmonary hypertension and carries a poor prognosis. Medical therapy is generally unsatisfactory, and surgery provides the only possibility of a cure. Though over 1400 cases have undergone pulmonary thromboendarterectomy (PTE) worldwide, the surgical procedure is performed with success only at a few institutions. It is important to select suitable patients, to perform PTE (not an embolectomy) and to manage successfully postoperatively. We report our experiences of surgical treatment for chronic pulmonary thromboembolism. Between June 1986 and March 2001, 50 patients (15 men, 35 women) underwent PTE at our hospital. The mean age was 51.3 years (range 22-73). We have adopted two surgical approaches to PTE. The number of operation deaths was 9 (18.0%). Forty-one patients survived, and the declines in their mean pulmonary arterial pressures (m-PAP) and pulmonary vascular resistance (PVR), and the inceraeses in cardiac indices (C.I.), were significant postoperatively. Their PaO2 improved significantly after 6 months. The symptoms were markedly reduced, and survival after PTE was 86-88% at 10 years. The only therapeutic alternative to PTE is lung transplantation. The great advantage of PTE includes an excellent long-term results without the risks associated with chronic immunosuppression and potential for chronic allograft rejection. We conclude that PTE can improve the prognosis of selected patients with chronic pulmonary thromboembolism, and morphological classification by CT scan could be useful for predictions about the surgical accessibility.

Adult↗
PubMed2002

Update of the management of venous thromboembolism.

Venous thromboembolism is the third most common cardiovascular disease. Its treatment is based in unfractionated heparin (UFH), but the advance of low molecular weight heparins, with clinical efficacy at least similar to UFH and better safety profile, have changed the therapeutic consensus. The highly relevant physiopathologic information has contributed to understand the paradoxical thrombotic mechanisms associated with heparin induced thrombocytopenia. New drugs, such as danaparoid sodium, lepirudin and argatroban, are an alternative to anticoagulation by heparin when this adverse reaction occurs. Another relevant progress was the determination of optimal duration of oral anticoagulation in order to prevent thromboembolic recurrences. In the meantime, other pharmacological approaches (thrombolytics and antiplatelet agents) have been assessed in several trials of limited value outcomes. Prophylactic measures like graduated compression stockings/intermittent external pneumatic compression and inferior vena cava filters have shown efficacy in primary and secondary prevention in patients with different risks of thromboembolic recurrence.

Administration, Oral↗
PubMed2002

Treatment of venous thromboembolism with the oral thrombin inhibitor, ximelagatran.

BACKGROUND: Venous thromboembolic diseases are treated initially with low molecular weight heparin followed by oral coumarins. OBJECTIVES: To investigate an orally available direct thrombin inhibitor for the acute treatment of venous thromboembolism as well as for prophylaxis of recurrent events. METHODS: The direct thrombin inhibitor ximelagatran was compared with subcutaneous LMW heparins followed by oral warfarin in a double-blind randomized prospective multicenter trial in patients with acute VTE. A pharmacokinetic study was performed in the VTE patients. For assessing the prevention of recurrent VTE, double-blind prospective randomized studies were conducted as follows: a) ximelagatran compared to warfarin for 6 months, and b) prolonged anticoagulation of ximelagatran vs. placebo for 18 months after termination of 6 months coumarin therapy. RESULTS: Two dose-finding studies and the pharmacokinetic analysis of ximelagatran in acute VTE were completed. About 2,500 patients were randomized to investigate 2 x 36 mg ximelagatran versus 2 x 1 mg/kg body weight enoxaparin followed by warfarin. The study hypothesized that the efficacy was equal in both treatment regimens for recurrent VTE documented by objective methods. The second study, with 1,234 patients, aimed to demonstrate a reduced incidence of recurrent thromboembolic events documented by objective methods after 18 months of treatment with 2 x 24 mg ximelagatran daily compared to placebo. CONCLUSION: These large-scale clinical trials will soon yield the results of the comparison between oral ximelagatran and subcutaneous LMW heparin for treatment of acute VTE, and of warfarin for prophylaxis of recurrent events for 6 months and for a prolonged prophylaxis for another 18 months.

Administration, Oral↗
PubMed2003

Diagnosis of venous thromboembolic disease in cancer patients.

Venous thromboembolic disease is a common but likely underdiagnosed condition in the cancer patient population. Timely and accurate diagnosis of venous thromboembolism is imperative due to the unacceptable morbidity and mortality associated with a misdiagnosis. Because diagnosis of the condition based on clinical grounds alone is unreliable, physicians should select an appropriate objective diagnostic test to confirm or refute their clinical impressions. Compression duplex ultrasound is the best initial imaging test for both suspected upper- and lower-extremity deep venous thrombosis. Magnetic resonance venography (MRV) is a valid alternative when ultrasound is inconclusive, but contrast venography remains the "gold standard." Suspected pulmonary embolism should be initially evaluated by helical (spiral) computed tomography (CT) or ventilation/perfusion lung scintigraphy, the former being preferred in cases of obvious pulmonary or pleural disease. Indeterminate studies should prompt performance of contrast pulmonary angiography. Inferior vena cava thrombosis is also best assessed by contrast venography, with MRV and CT reserved as alternative imaging modalities. Evidence to date suggests that D-dimer assays remain unreliable in excluding venous thromboembolism in cancer patients. A newer latex agglutination D-dimer assay may prove to be clinically useful in this setting.

Biomarkers↗
PubMed2003

[Profiles of medical malpractice in the prophylaxis of pulmonary thromboembolism].

Deaths caused by pulmonary thromboembolism (PTE) are often of forensic interest, due to the frequent preexistence of a traumatic event the suddeness of death, and possible professional responsibility. Early diagnosis of vein thromboembolism is often difficult. Fatal PTE usually presents itself on an unexpected and large scale, chronologically occurring shortly before death and thus irreconcilable with any consequent efficacious therapy. Pharmacological prophylaxis, aiming at reducing the state of blood hypercoagulability, is the elective therapeutic strategy for vein thromboembolism. These are the premises for this work which, after a brief pharmacological and clinical description of heparin prophylaxis and a review of data emerging from a sample of 24 deaths due to PTE, makes some considerations regarding professional responsibility.

Anticoagulants↗
PubMedDate not supplied

[Pulmonary thromboembolism and deep venous thrombosis in the antiphospholipid syndrome--case report].

INTRODUCTION: Systemic lupus erythematosus is a multisystemic disease of unknown etiology with diverse clinical symptoms depending on the organ affected. Plasma of affected patients contains a specific anticoagulant called lupus anticoagulant. It is an antibody which belongs to the class of antiphospholipid antibodies which bind to phospolipid-binding proteins, molecules of natural coagulation inhibitors, thus increasing the risk of thrombosis. Systemic lupus erythematosus commonly affects the skin, joints, serosa, hematopoietic tissue, kidneys and the nervous system. Pulmonary symptoms may manifest as pleurisy, pneumonia, chronic interstitial pulmonary disease, but pulmonary thromboembolism is the most common pulmonary manifestation. CASE REPORT: This is a case report of a young female patient who has been suffering from systemic lupus erythematosus for twenty years. She was treated for superficial thrombophlebitis for several times. She was admitted to our hospital a year before, when she developed pulmonary thromboembolism following deep venous thrombosis of the right leg, although at that time she was treated by oral anticoagulants. She was discharged from hospital with vena cava filter placement and further anticoagulant treatment. In a one year period she was hospitalized again due to relapse pulmonary of thromboembolism. DISCUSSION: Thrombotic complications in systemic lupus are more frequent in patients with antiphospholipid antibodies. Prevention of thrombotic complications by anticoagulant agents in patients who already developed thrombotic manifestations is considered necessary. CONCLUSION: Anticoagulant treatment should be, for preventive reasons, introduced in all patients with a systemic disease and with anticoagulant factor, even if they haven't developed a thrombotic attack and they should undergo prothrombin time measurements and INR: 3-4.

Adult↗
PubMed2003

[The problem of postoperative venous thromboembolic complications in general surgery].

The paper reviews occurrence, diagnostic tools venous thromboembolic complications. Cost effectiveness of preventive measures for venous thrombosis and pulmonary embolism in general surgery is analysed. The study included 45 patients who underwent elective (21) and urgent (24) abdominal and pelvic interventions. Each patient was examined with ultrasonic with color Doppler imaging before and 8-10 days after surgery. Deep venous thrombosis of lower limbs was diagnosed in 11.1%, most of cases being asymptomatic. Ultrasonic angioscanning appeared to be an acute and reliable diagnostic tool for this pathology. Various approaches to the management of patients at thrombotic risk are reviewed. Cost effectiveness analysis of anticoagulation prevention for postoperative venous thromboembolic complications must address the problem: is prevention outcome worth those extra efforts? Surveillance of 500 patients at high thrombotic risk has shown that preventive use of low weight heparin (Clexane) is economically beneficial then conventional Heparin, the more in the absence of special preventive strategy. Targeted prevention in patients with different risk of postoperative venous thromboembolic complications can yield more then 3-fold reduction in occurrence of these complications.

Adult↗
PubMed2003

[Pulmonary thromboembolism associated with familial protein C deficiency type I].

A 66-year-old man was admitted to our hospital because of progressive dyspnea on effort. Arterial blood gas analysis showed severe hypoxemia, and a chest radiograph revealed reticular shadows in both lower lungs and an increase of the cardiothoracic ratio. Echocardiography demonstrated mild indentation of the interventricular septum toward the left ventricle, moderate pericardial effusion and pulmonary hypertension. From these data, we diagnosed pulmonary thromboembolism and started anticoagulation therapy. After the addition of the administration of warfarin and oxygen therapy, his symptoms disappeared. However, we could not obtain more supporting evidence of thromboembolization by methods of ventilation-perfusion scanning, digital subtraction angiography of the pulmonary artery, or venography. Blood coagulation analysis demonstrated that the patient's plasma protein C antigen levels and its activity were depleted. The patient's son had a history of thrombophlebitis and pulmonary embolization, and his data of protein C antigen levels was also decreased. Therefore, this patient was found to have a character of familial protein C deficiency type I. We could not get the conclusive proof of pulmonary thromboembolism, but we considered that the presence of familial protein C deficiency may cause exacerbation of pulmonary hypertension.

Aged↗
PubMed2003

[Current status of postoperative venous thromboembolism].

Venous thromboembolism has been a common illness even in Japan and gets increased social as well as medical attention, especially during postoperative period. The most effective way of reducing unexpected death from postoperative venous thromboembolism is to institute a comprehensive institutional policy of primary prophylaxis in patients at risk. Since the clinical experience has shown that there are ethnic differences between Japanese and westerners in coagulability, it will be inappropriate to assume that the results of western studies are fully applicable to the clinical situation in Japan. Although it is difficult to prepare the guideline for prophylaxis of venous thromboembolism based on reliable evidence for Japanese currently, available epidemiologic information has been obtained in orthopedic or gynecologic fields.

Anticoagulants↗
PubMed1992

Pulmonary thromboembolism in thalassemic patients.

Chronic pulmonary thromboembolism plays an important role in cardiac failure which is a major cause of death in thalassemic patients over 20 years of age. This report is a study of autopsy lung tissue from 58 patients with beta-thalassemia/hemoglobin E disease (beta-thal/HbE), including whole lungs from five, 13 patients with hemoglobin H disease (HbH), and eight patients with beta-thalassemia major (beta-thal) including whole lung from one. Pulmonary thromboembolic lesions were found in 24 of 58 (41%) patients with beta-thal/HbE, of which 21 of 39 (54%) were splenectomized patients and 3 of 19 (16%) were nonsplenectomized patients, with the incidence increasing with age. Lung maps showed the greatest number of lesions in the lingula, right middle lobe, and anterior segments of both upper lobes. Pulmonary thromboembolic lesions were also found in one of 13 HbH patients and one of 8 beta-thal patients, both splenectomized. Eight of the 27 patients with these lesions had right ventricular and 14 biventricular hypertrophy, reflecting the deleterious effect of such lesions. Possible causative factors are discussed.

Adolescent↗