Ovarian vein phlebothrombosis and fatal pulmonary embolism.
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Embolism↗
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Results for “PULMONARY EMBOLISM AND THROMBOSIS”
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Venous thrombosis in haemoglobin H disease after splenectomy.
While venous thrombosis and pulmonary embolism are rare among the Chinese, two of nine patients with haemoglobin H disease developed these complications after splenectomy. The clinical data of the two patients were reported and the relevant literature reviewed. It was concluded that the persistent thrombocytosis and an intravascular haemolysis, particularly prominent in this form of thalassaemia, are contributory to the hypercoagulable state.
Adult↗
The effects of flying: processes, consequences and prevention.
The dangers of flying have recently been highlighted in the media; however, the available literature is contradictory, as are current recommendations for travellers. The purpose of this article is to provide an account of the research that has been undertaken to investigate the possible consequences of air travel. It will examine the effect that flying has on the body, especially the respiratory and circulatory systems, by studying the theoretical and empirical literature. The aim is to provide nurses with a sound insight into the effects of long-distance flying on the body, and the potential adverse effects/complications, such as deep vein thrombosis and pulmonary embolism, that may occur as a result. In addition, it provides information on the treatment options available and should enable nurses to give sound prophylactic advice after discharge. By encouraging passengers to take precautions, the number of people affected by flight could be reduced.
Aerospace Medicine↗
Probable interaction between tolterodine and warfarin.
53-year-old woman with a history of deep vein thrombosis and pulmonary embolism was receiving warfarin to prevent thromboembolic complications; her international normalized ratio (INR) had been stable for 1 month. Extended-release tolterodine 4 mg/day was then prescribed to manage overactive bladder. On her next anticoagulation clinic visit, the patient's INR had increased, although the dosage of warfarin had been reduced when the tolterodine had been prescribed. Due to the absence of other contributing factors and the temporal relationship between tolterodine and prolonged INR, the event was determined to be a probable drug interaction. When patients are prescribed tolterodine and warfarin concurrently, clinicians should monitor INR carefully, and a reduction in warfarin dosage may be required.
Anticoagulants↗
Rational use of D-dimer measurement to exclude acute venous thromboembolic disease.
Clinical diagnosis of venous thromboembolic (VTE) disease is often inaccurate because signs and symptoms are nonspecific. Testing for the absence of D-dimer levels in the blood of patients with suspected deep venous thrombosis and pulmonary embolism can assist in ruling out these illnesses. Some highly sensitive D-dimer assays have sufficient specificity to assist in the exclusion of VTE disease. Numerous clinical management trials using D-dimer measurement in association with additional diagnostic tests have shown that it is safe to withhold anticoagulant therapy in selected patients with suspected VTE disease who have negative D-dimer assay results. Applying these diagnostic strategies can potentially decrease the need for radiological testing. The simplicity of measuring D-dimer levels creates the potential for misuse. For safe patient management, clinicians must understand the indications for and limitations of D-dimer measurement in the diagnosis of VTE disease.
Antifibrinolytic Agents↗
[D-dimer in the year 2000: current data and new perspectives].
D-dimer is a product of cross-linked fibrin degradation by the fibrinolytic system. It has been shown to be highly sensitive and moderately specific for venous thromboembolic disease. Thus, the most common clinical use of D-dimer relates to its negative predictive value for deep vein thrombosis and pulmonary embolism. Diagnosis, however, should not be based solely on this parameter, and an integrated strategy that combines clinical approach (pre-test probability), a non-invasive test (ultrasonography or lung scan) and D-dimer assay is highly recommended. Over the last years a number of studies have demonstrated that D-dimer may also enable the prediction of the complications of atherothrombosis inasmuch as the data available suggest a significant association of D-dimer with the risk of coronary artery disease independent of classic risk factors. Moreover, elevated plasma D-dimer seems to be a marker of a systemic prothrombotic state, and anticoagulation can normalize its levels. However, further studies are needed to assess whether or not this parameters is of clinical value to predict or prevent arterial thrombotic events in the single patient.
Algorithms↗
[The possibilities of vascular complications in the course of hepatic amebiasis].
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Amebiasis↗
[Prophylaxis of venous thromboembolism in otolaryngology--head and neck surgery].
Venous thromboembolic disease (deep vein thrombosis and pulmonary embolism) is a frequent and dangerous complication of surgical procedures. Guidelines considering prophylaxis in patients who have a risk of this complication exist in most surgical specialties. In otolaryngology it is a rare illness but a lack of Polish literature and quite few world publications on this subject made the authors check through the literature referring to venous thromboembolic disease in otolaryngology and maxillofacial surgery and indexed in the EMBASE and MEDLINE data bases up till 2003. Incidence of the disease, risk factors with regard to the kind of surgery and prophylaxis methods were presented, all with the aim of creating a kind of a guide useful in clinical practice in ENT.
Humans↗
[Main antithrombotic drugs in the therapy and prevention of arterial and venous thrombosis].
The author reviews the use of the main antithrombotic drugs (thrombolytics, dicumarol compounds, heparins and anti-platelet drugs) in the treatment and prophylaxis of the main nosographic syndromes of arterial and venous thrombosis. In the context of arterial thrombosis the paper initially reports the results of the main controlled trials on ischemic cardiopathy (treatment of acute infarction, primary and secondary prophylaxis for re-infarction, post-infarction ventricular thrombosis, stable and instable coronary angor, percutaneous angioplasty, aortocoronary by-pass, stent, valve prosthesis, atrial fibrillation). Turning to peripheral arteriopathies the treatment of acute attacks is death with separately from prophylactic treatment (reduction of atheromatous progression, improved vascular perfusion, reduction of concomitant cardiac and cerebral events, behaviour of carotid stenoses). Vascular cerebropathy is examined during the acute (treatment of ictus in early days) and later phases (prophylaxis of recidivation of ictus). With regard to venous thrombosis, the paper separates the treatment of profound thrombosis and pulmonary embolism (often secondary to the former) from prophylaxis of profound thrombosis; the latter is classified into forms occurring during general surgery (abdominal, pelvic, urologic), orthopedic surgery (hip prosthesis, gonopathies) and general medicine. The author ends the review by making a schematic analysis of the areas of elective use of the above antithrombotic drugs with reference to the nosographical forms examined in the paper.
Coronary Artery Disease↗
Inherited thrombophilia and first venous thromboembolism during pregnancy and puerperium.
Venous thromboembolism is a rare but threatening complication of pregnancy. Little conclusive information is available on the actual risk of venous thromboembolism during pregnancy or puerperium in women with inherited thrombophilia, particularly in carriers of factor V Leiden and of the G20210A prothrombin gene mutation. To determine the pregnancy-related and puerperium-related risk of venous thromboembolism in women with inherited thrombophilia, we performed a case-control study on 119 women who had a first episode of deep vein thrombosis and/or pulmonary embolism during pregnancy or puerperium and 232 healthy women who had at least one pregnancy without thrombosis. Inherited thrombophilia was diagnosed in 47 patients (39.5%) and 15 controls (6.5%). The relative risk of venous thromboembolism was 10.6 (95% CI, 5.6-20.4) for heterozygous carriers of factor V Leiden, 2.9 (95% CI, 1.0-8.6) for heterozygous carriers of the prothrombin mutation and 13.1 (95% CI, 5.0-34.2) for those with antithrombin, protein C or protein S deficiency taken together. Sixty-eight of the 119 women (57%) had thrombosis after delivery, confirming the puerperium as a particularly high-risk period. When women were divided into two groups of those with antenatal or postnatal thrombosis. the relative risks associated with each type of inherited thrombophilia were of similar magnitude. In conclusion, women with inherited thrombophilia have an increased risk of venous thromboembolism during pregnancy. Among thrombophilic abnormalities, the prothrombin mutation was the weakest risk factor. Thrombosis occurred more frequently in puerperium than in pregnancy, whether or not thrombophilia was diagnosed.
3' Untranslated Regions↗
[When to suspect pulmonary embolism in a patient with deep venous thrombosis?].
The approach to take in trying to establish or disprove a diagnosis of pulmonary embolism in the presence of deep vein thrombosis is the subject of some controversy nowadays. Systematic perfusion lung scan can be proposed, given the mediocre specificity of the clinical symptoms of embolism or the high frequency of asymptomatic pulmonary embolism. This strategy, however, is not validated in terms of cost-efficacy. In practical terms, favourable evolution and the low rate of recurrent embolism observed with a well executed anticoagulant treatment pleads against systematic scintigraphy. Because of its moderate sensitivity, systematic echocardiography probably should not be an element of the assessment of asymptomatic pulmonary embolism. The advent of spiral CT scan in the management of such patients could however make it necessary to reconsider this position, by allowing complete venous and pulmonary examination in thrombo-embolic disease.
Echocardiography↗
Thrombosis and embolism.
Prevention offers the best approach to limiting morbidity and mortality from deep vein thrombosis and pulmonary embolism in obstetric patients. The use of anticoagulant drugs during pregnancy, however, can be problematic, from the maternal or the fetal point of view. Deciding on the best management is further limited by the lack of controlled clinical trials in the obstetric setting. From the data available, it can be recommended that anticoagulant prophylaxis should be targeted at groups of patients at high risk of thrombosis during pregnancy and the puerperium. Heparin is the agent of choice in most situations during pregnancy for the prophylaxis of venous thrombosis, while warfarin is still the most effective agent for the prevention of systemic embolism from artificial cardiac valves. Prophylactic measures against venous thrombosis are probably underused in the puerperium. Controlled clinical studies are urgently required to optimize prophylaxis of venous thromboembolism associated with pregnancy, and large studies may be more feasible in the puerperium when the incidence of thromboembolism is highest.
Coronary Thrombosis↗
Deep venous thrombosis and the risk of pulmonary embolism. A systematic study.
The influence of several diseases and clinical conditions on the presence of pulmonary embolism (PE) in a large series of patients with deep venous thrombosis (DVT) in the lower extremities was analyzed prospectively. Lung scan findings from a series of 434 consecutive patients with DVT (with and without symptoms of PE) were studied and then correlated to five clinical variables: age, sex, elapsed time since clinical symptoms had appeared in the leg to diagnosis, degree of proximity of venous thrombus, and the presence or not of several risk factors that could have predisposed to thrombus development. According to scintigraphic findings, 164 patients were considered to have PE (asymptomatic in 76 of them), while 200 patients were classified as having only DVT. Lung scan was considered to be indeterminate for PE in 70 patients, and they were not included in the study. No differences were found in terms of age, sex, interval of time elapsed since onset of symptoms to diagnosis, or in the degree of proximity of the thrombus. However, several differences between groups were found when comparing the presence or absence of several predisposing factors for thrombosis: DVT developing in immobilized patients was associated with a significantly lower incidence of PE as compared with nonimmobilized patients (p = 0.005). Conversely, patients with a history of venous thromboembolism (VTE) had a significantly higher rate of embolism (31/51 vs 133/313; p = 0.01). On logistic regression analysis, a history of VTE showed a statistically significant association with more than a twofold higher risk of having PE for patients with such an antecedent. Our findings suggest that different pathophysiologic pathways could perhaps explain differences in embolic potential.
Causality↗
[Association of pulmonary embolism secondary to deep venous thrombosis and left atrial myxoma: case report and review of the literature].
Left atrial myxoma is a benign tumor but it has a high prevalence of important complications. We report a case of a 73-year-old man affected by hypertension and chronic atrial fibrillation admitted to our hospital for pulmonary embolism, that resulted associated with a proximal deep venous thrombosis of the right leg and with an unknown left atrial myxoma.
Administration, Oral↗
[Thrombophlebitis and pulmonary embolism in congenital factor XII deficiency].
The case of a young man hospitalised for bilateral lower limb deep vein thrombosis is reported. None of the usual causes were found after systematic wide-ranging investigation. The only abnormality on admission was a spontaneous increase in the cephalin-kaolin time to 65 seconds compared to a control time of 40 seconds. Measurements of the clotting factors showed a moderate and isolated deficiency in factor XII (30 p. 100), also present in a brother (50 p. 100) and a sister (42.5 p. 100). Fibrinolytic therapy was administered : an initial course of Streptokinase was followed by extension of a left femoral vein thrombosis and pulmonary embolism. Two courses of Urokinase were given with an eight day interval without significantly improving the venous circulation. This case is an example of thrombogenic disease due to a deficiency of a clotting factor resulting in non-activation of physiological fibrinolysis.
Adult↗
[A case of pulmonary embolism with diabetes insipidus developed after removal of craniopharyngioma].
A case of pulmonary embolism associated with diabetes insipidus is reported in an 18-year-old male. The patient, who had been treated with DDAVP for diabetes insipidus and hydrocortisone for hypocorticism for two years after first operation for the removal of craniopharyngioma, was admitted with recurrence of that tumor. Diabetes insipidus immediately after second operation was controlled with intermittent drip infusion of a small amount of aqueous pitressin under monitorings of body weight hourly using a patient weighing system to keep the weight changes within +/- one kilogram. Serum and urine electrolytes levels, osmolarity, and free water clearance were also monitored every three hours to maintain water-electrolytes balances appropriately. Postoperative course had been uneventful except that CSF rhinorrhea occurred 7 days after operation. The patient was, then, kept in bed with horizontal plane to avoid further leakage of CSF. Two days later, he developed chest pain suddenly with tachypnea, tachycardia, and general cyanosis. The arterial-BGA showed PaO2 of 53.5mmHg and PaCO2 of 35.3mmHg in room air. The definite diagnosis of pulmonary embolism was made by technetium microaggregate lung perfusion scans and by pulmonary angiograms. The patient was treated with heparin, 15000IU/day, and urokinase, 720000IU/day. The symptoms due to pulmonary embolism had improved gradually within a couple of weeks. Recent articles have shown an unexpected high incidence of deep vein thrombosis and pulmonary embolism in neurosurgical patients associated with the elevation of blood coagulability. Brain tumors, especially suprasellar mass with hypothalamic dysfunction have been suggested to cause thromboembolic disorders frequently. The clinical course was described and factors causing pulmonary embolism on this patient was discussed.
Adolescent↗
[Diagnostic and therapeutic approach in patients with suspected pulmonary embolism: application of decision analysis].
BACKGROUND: Pulmonary arteriography is the most effective test for the diagnosis of pulmonary embolism but it is relatively complex and not without risk. Since around 70% of the patients with pulmonary embolism present thrombosis of the veins of the lower limbs, the performance of diagnostic phlebography and echography in patients suspected of having pulmonary embolism was analyzed and compared with pulmonary gammagraphy. METHODS: The methodology of decision analysis was applied to evaluate the performance of the different strategies in the cases of high, medium or low clinical suspicion of pulmonary embolism (prevalence of 70%, 30%, and 10%, respectively) in patients with or without concomitant diseases. RESULTS: In patients with low suspicion, the use of echography allowed a survival of 97.8-98.2% of the ideal survival to be achieved. In those with medium suspicion, phlebography demonstrated the best performance (survival of 97.3-98.0% versus 96.3-97.3% achieved with echography). In cases og high suspicion isolated echography and phlebography showed low performance (survival lower than 96% of the ideal) with arteriography being required if the results of the aforementioned were negative. In any case, if the prevalence of pulmonary embolism is greater than 30%, it is better to treat all, rather than none, of the patients. The strategies based on pulmonary gammagraphy did not provide better results. CONCLUSIONS: Echography and phlebography allow diagnosis of patients with low or medium suspicion of pulmonary embolism with an acceptable performance without carrying out arteriography. Nonetheless, high clinical suspicion requires the use of pulmonary arteriography in half of the patients.
Decision Support Techniques↗