Bilateral plantar tendinitis during levofloxacin therapy.
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Anti-Bacterial Agents↗
Biomedical subjects
Sebastian Schellong
Publications and source records attributed to Sebastian Schellong.
[Deep venous thrombosis and pulmonary embolism. Prophylaxis and therapy].
Venous thromboembolism is a common cause of morbidity and mortality with an estimated annual incidence of 1:1,000. Several patient groups at risk can be differentiated, according to the presence of endogenous factors (such as hereditary thrombophilic disorders), but much more by exogenous factors (underlying disease). This results in risk-adapted recommendations for prophylaxis and therapy, which will be discussed in the following overview.
Anticoagulants↗
Deep vein thrombosis: Current diagnostic strategy.
Over the last 15 years, diagnostic strategies to diagnose deep vein thrombosis (DVT) and pulmonary embolism (PE) have changed significantly. The gold standard for detecting DVT is still venography, but invasivity, radiation, contrast media, and the painful injection in pedal veins are limiting factors for initial and repeat examinations. The introduction of DVT scores, D-dimer testing, and venous ultrasound has made venography replaceable in most cases. This review focuses on different diagnostic strategies for clinicians in hospitals as well as for general practitioners using practical approaches.
Journal Article↗
Rates of proximal deep vein thrombosis as assessed by compression ultrasonography in patients receiving prolonged thromboprophylaxis with low molecular weight heparin after major orthopedic surgery.
Patients undergoing major orthopedic surgery are at an increased risk of thromboembolism even after the acute postoperative phase. Therefore, prolonged thromboprophylaxis is currently recommended and widely used. The length of hospital stay after major orthopedic surgery is steadily decreasing and most patients are transferred to specialized rehabilitation centers in the early postoperative phase. Consequently, thromboprophylaxis is usually given during the rehabilitation period. Previously there have been no systematic studies of how many patients with asymptomatic thrombosis are transferred to a rehabilitation center or how many patients develop deep vein thrombosis (DVT) during rehabilitation. In the present study, 238 patients who had undergone major orthopedic surgery were examined by compression ultrasonography on day 1 or 2 and on day 20 of their rehabilitation phase in order to detect asymptomatic proximal DVT. Sonograms were read centrally with blinding to the clinical course of the patients. All patients received standard thromboprophylaxis during the acute postoperative phase. Prolonged thromboprophylaxis with enoxaparin was given during the rehabilitation phase. The mean duration of thromboprophylaxis was 36.8 days. At admission to the rehabilitation center, proximal DVT was identified in 16 patients (6.7%). New proximal DVT at discharge from the rehabilitation center was identified in 3.2% of patients following prolonged thromboprophylaxis with enoxaparin. In conclusion, a considerable percentage of patients with asymptomatic proximal DVT are transferred to rehabilitation centers following major orthopedic surgery. Using prolonged thromboprophylaxis, new proximal DVTs will still develop during rehabilitation, but at a low rate.
Aged↗
[Prophylaxis of recurrence during transient risk in patients with previous venous thromboembolism].
BACKGROUND: Current data allows first recommendations for the management of patients with previous venous thromboembolism (VTE) whose risk of recurrence is transiently increased. METHODS: The literature about the risk of VTE recurrence in common clinical situations is analyzed, and recommendations for the diagnostic and therapeutic management and patient counseling are given. CONCLUSIONS: Perioperative replacement of oral anticoagulants by low molecular weight heparins (LMWH) is effective and safe in patients treated for VTE. After a triggered first episode of VTE, the same prophylaxis in situations of transient risk is recommended as for patients without previous VTE. Patients with previous VTE who are pregnant or scheduled for hormonal therapy require a detailed exploration, as management is influenced by several factors. In the postpartal period, patients with previous VTE should receive prophylactic anticoagulation. In malignant disease, anticoagulation should be continued over the time of active malignancy; LMWH appear to have a more favorable profile than oral anticoagulants.
Anticoagulants↗
[Thrombophilic disorders in venous thromboembolism. The clinical perspective].
BACKGROUND: Treatment of venous thromboembolism should consider the influence of thrombophilic disorders on the risk of recurrence. Diagnostic tests should be guided by their expected relevance to therapy. A competent and straightforward clinical approach to venous thromboembolism requires knowledge of the current data regarding stratification of risk of recurrence in thrombophilic patients. METHODS: Focusing on clinical management, the current literature on thrombophilia is analyzed. Recommendations are given taking into account the risk of first and recurrent thromboembolism, the bleeding risk under anticoagulation, and validated therapy strategies. A rational diagnostic approach in the light of potential therapies is suggested. CONCLUSION: The recurrence risk after triggered venous thromboembolism is low, and anticoagulation does not need to be extended beyond 6 months. Idiopathic or thromboembolism in unusual locations is associated with a higher recurrence risk since underlying thrombophilia is more common in these patients. These cases merit laboratory screening for thrombophilic factors (whose relevance is discussed), and extended anticoagulation is indicated (1 year; in severe thrombophilia several years). In recurrent venous thromboembolism anticoagulation is ideally continued for 4 years, or longer in the absence of complications.
Anticoagulants↗
Practicability and limitations of enhanced external counterpulsation as an additional treatment for angina.
BACKGROUND: An increasing number of clinical studies indicates reduction of angina and myocardial ischemia by enhanced external counterpulsation (EECP) therapy. However, given the wide range of contraindications and the long duration of treatment, eligibility and practicality issues have not been addressed systematically. HYPOTHESIS: Of all candidates for EECP (patients with drug-refractory angina without possibility of revascularization), the majority either have contraindications or have practical problems complying with the time demands that this therapy imposes. In the rest, EECP leads to satisfactory results. METHODS: During 18 months, every consecutive patient with angina despite medical and interventional therapy was evaluated for EECP at one center. Treated patients underwent a bicycle exercise test and perfusion imaging before and after the standard course of 35 h of EECP. In addition, patients were asked about frequency of angina and nitroglycerin usage before and after EECP, and all patients filled out a final questionnaire 1 year after the end of therapy. RESULTS: Overall, 48 patients were considered candidates for EECP. Of these, 24 were excluded for medical reasons: poor ejection fraction (4), peripheral artery disease (4), anticoagulation (4), and atrial fibrillation (3). Eight further patients declined EECP for lack of time or accommodation. Another 3 of the 16 remaining patients dropped out because of side effects. In the 13 patients who finished the treatment course, weekly anginal episodes were reduced by 48% (p < 0.05), on-demand nitroglycerin puffs were reduced by 51% (p < 0.05), work capacity was improved by 22% (p < 0.05), and the number of reversible perfusion defects in perfusion scans decreased nonsignificantly (-28%). However, 4 of 13 treated patients determined 1 year later that the detriment of loss of time exceeded the benefits of EECP. CONCLUSION: Similar to previous reports, our study confirms the reduction of angina and improvement of work capacity after EECP. However, using established contraindications, approximately two-thirds of patients considered to be candidates had to be excluded, and one-third of the treated patients regarded EECP therapy retrospectively as too time consuming.
Angina Pectoris↗
Coagulation factor V G allele and HR2 haplotype: factor V activity, activated protein C resistance and risk of venous thrombosis.
Factor V Leiden is a well-known risk factor for venous thrombosis. The dual role of factor V as a coagulatory and anticoagulatory cofactor permits the assumption that further mutations in the factor V gene are of importance in the study of the risk of thrombosis. Relevant studies to date have given rise to a controversy over this risk for the HR2 haplotype. For the G allele, defined in our work group as a G at the nucleotide positions 2391, 2663, 2684 and 2863, there have been to date no other investigations of thrombotic risk. In a case-control study on 347 patients with deep venous thrombosis (DVT) and 282 controls, we investigated the association of the HR2 haplotype and the G allele with DVT. We found no association between HR2 haplotype and DVT [odds ratio (OR) 0.87; 95% confidence interval (CI) 0.58-1.30; P = 0.537]. The frequency of the G allele was, on the contrary, higher in the control group than among the patients (OR 0.68, 95% CI: 0.53 to 0.89; P = 0.005). The factor V activity of the HR2 carriers was lower than that of the wild type and G allele carriers. The HR2 haplotype exhibited a moderate influence on activated protein C response. This study presented no evidence of thrombotic risk for the HR2 haplotype alone. The results here permit the assumption of a protective effect of the G allele. The source of a possible protective influence of the G allele on thrombotic risk is at present unclear.
Activated Protein C Resistance↗
Ultrasound screening for distal vein thrombosis is not beneficial after major orthopedic surgery. A randomized controlled trial.
Ultrasound screening for deep vein thrombosis (DVT) after orthopedic surgery revealed thrombosis in up to 30% of patients, but the clinical impact of screening for distal thrombosis has not been established. Three hundred and forty six patients after hip or knee replacement and postoperative standard prophylaxis of 10 days low molecular weight heparin (LMWH) were randomized to receive either prolonged prophylaxis with LMWH or postoperative ultrasound screening for proximal and distal thrombosis. All thrombosis found in screening was treated. Patients with a negative screening test did not receive any heparin after day 10. The cumulative rate of proximal thrombosis and symptomatic pulmonary embolism until day 35 postoperatively was determined. In 174 screening patients, ultrasound found 55 cases of distal (31.6%) and 9 cases of proximal (5.1%) in-hospital thrombosis. In 108 screening patients without thrombosis at discharge 7 new distal (6.5%) and 6 new proximal (5.6%) thrombotic events occurred by day 35. In 163 patients with prolonged prophylaxis, 33 cases of distal (20.2%) and 7 cases of proximal (4,3%) thrombotic events occurred by day 35. The cumulative rate of proximal events was 8,7% in the screening group and 4.3% in the prophylaxis group (p=0.12). In conclusion, ultrasound screening for thrombosis does not reduce the rate of proximal thrombosis and symptomatic pulmonary embolism 35 days after hip or knee replacement surgery.
Aged↗