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At least 217 records · Page 12Linked to original sources
PubMed1992

Greenfield filter instead of heparin as primary treatment for deep venous thrombosis or pulmonary embolism in patients with cancer.

BACKGROUND AND METHOD: During the last 5 years, the authors placed Greenfield filters as primary therapy in 41 patients with cancer with deep venous thrombosis (DVT) and/or pulmonary embolism (PE) instead of administering heparin. RESULTS: There were no operative deaths. Complications included erythema of the incision in one patient, recurrent PE in one patient, and chronic filter prong penetration of the inferior vena caval wall in one patient. Follow-up was complete for 90% (37 of 41) of the patients. Forty-six percent of the patients died of their cancer early in the study. In follow-up, leg swelling improved completely or partially in 74.5% of patients and was unchanged in 22% of patients. The condition of one patient worsened secondary to recurrent DVT. The patients with improved symptoms also had improved functional ability, whereas those whose condition did not change were mostly bedridden, many with end-stage advanced metastatic disease. CONCLUSIONS: These results indicate that Greenfield filter insertion is safe and effective as primary therapy in patients with cancer with DVT and/or PE.

Adult↗
PubMed2000

Assessment of deep vein thrombosis or pulmonary embolism by the combined use of clinical model and noninvasive diagnostic tests.

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are relatively common diseases and are amenable to therapy but with a potentially fatal outcome if untreated. The diagnosis can be made in most patients with use of the noninvasive imaging tests, but limitations exist. The standard first choice of investigation in patients with suspected DVT is compression ultrasonography (CUS). As with all tests, there is a potential for false-positive and false-negative results. The latter are especially an issue for calf vein thrombi, and this in part has led to the concept of serial CUS testing of the proximal venous system and not imaging of the calf. The premise of the repeat (serial) CUS test is that only thrombi that extend to the proximal system are clinically relevant, and these thrombi will be detected during subsequent testing. However, despite the safety of the serial CUS testing concept, it is inconvenient and expensive. The standard first choice of investigation in patients with suspected PE, the ventilation-perfusion (V/Q) lung scan is nondiagnostic in most cases. In the past few years, the diagnostic process has improved because of the validation of clinical models that accurately categorize patients as having low (5%), moderate (20% to 30%), or high probability (>60%) for venous thromboembolic disease. Among the improvements this provides is the elimination of serial CUS testing if the ultrasound results are normal and the clinical probability is low in patients with suspected DVT. In patients with suspected PE in whom further testing is necessary, determination of clinical probability allows selection of invasive (angiography) or noninvasive testing (serial ultrasound) in patients with non-high-probability V/Q scans. The fibrin degradation product D-dimer has had a high negative predictive value; negative results with enzyme-linked immunosorbent assay (ELISA) tests effectively rule out DVT or PE. In addition, a negative result with less-sentive D-dimer testing and a low clinical probability excludes DVT or PE.

Algorithms↗
PubMed2004

The incidence of deep vein thrombosis and pulmonary embolism after total knee arthroplasty: the screening study by radionuclide venography.

UNLABELLED: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are considered uncommon in Asian populations and thrombo-prophylaxis is rarely indicated. The objective of this study was to investigate the incidence of DVT and PE after total knee replacement in an Asian population. MATERIAL AND METHOD: There were 100 patients who underwent total knee replacement enrolled in this study. No thrombo-prophylaxis was given to these patients. The possible risk factors such as age, sex, body mass index (BMI), operative time and the post-operative blood loss were recorded. RESULTS: The duplex ultrasonography (controlled) showed no evidence of DVT in all cases. There were 67 patients who completed radionuclide venography in this study. The incidence of DVT from positive radionuclide venography was 24% (16/67 patients) and PE was 12% (8/67 patients). All patients with positive imaging studies were asymptomatic. The risk factors were similar in both groups. CONCLUSION: The incidence of DVT and PE in post-operative total knee replacement surgery, although lower than the incidence in Western populations, is higher than previously assumed. The radionuclide venography is less invasive and a useful diagnostic method for both DVT and PE. Because all patients with DVT and PE are asymptomatic, the use of thrombo-prophylaxis should be considered for risk and benefit.

Aged↗
PubMed1994

Collaborative overview of randomised trials of antiplatelet therapy--III: Reduction in venous thrombosis and pulmonary embolism by antiplatelet prophylaxis among surgical and medical patients. Antiplatelet Trialists' Collaboration.

OBJECTIVE: To determine the efficacy of antiplatelet therapy as prophylaxis against deep venous thrombosis or pulmonary embolism in surgical and high risk medical patients. DESIGN: Overviews of all randomised trials of antiplatelet therapy that could have been available by March 1990 and in which deep venous thrombosis was assessed systematically. SETTING: 53 trials (total 8400 patients) of an average of two weeks of antiplatelet therapy versus control in general or orthopaedic surgery; nine trials (600 patients) of antiplatelet therapy versus control in other types of immobility; 18 trials (1000 patients) of one antiplatelet regimen versus another. RESULTS: Overall, a few weeks of antiplatelet therapy produced a highly significant (2P < 0.00001) reduction in deep venous thrombosis. 25% of patients allocated antiplatelet therapy versus 34% of appropriately adjusted controls had deep venous thrombosis detected by systematic fibrinogen scanning or venography, representing prevention in about 90 patients per 1000 allocated antiplatelet therapy. There was an even greater proportional reduction in pulmonary embolism: such emboli were detected among 47 (1.0%) antiplatelet allocated patients versus an adjusted control total of 129 (2.7%), representing prevention among about 17 patients per 1000 treated (2P < 0.00001). In analyses confined to surgical trials, the proportional reductions were similar and separately significant for nonfatal pulmonary embolism (0.7% antiplatelet therapy v 1.8% control; 2P < 0.00001) and for deaths attributed to pulmonary embolism (0.2% v 0.9%; 2P = 0.0001). There was a slight but non-significant excess of deaths from other causes (1.0% v 0.7%), which made the difference in total mortality nonsignificant, though still favourable (1.2% v 1.5%). Information on adding antiplatelet therapy to heparin was limited but, at least for pulmonary embolism, suggested more protection from the combination than from heparin alone. The proportional reduction in the odds of suffering a deep venous thrombosis was roughly the same in patients having general surgery, traumatic orthopaedic surgery, and elective orthopaedic surgery (and in medical patients who were at increased risk of thromboembolism). For pulmonary embolism the numbers affected were smaller, but again the reductions were highly significant both in general surgery (16 (0.5%) v 58 (1.7%) pulmonary emboli; 2P < 0.0001) and in orthopaedic surgery (28 (2.7%) v 63 (6.1%) pulmonary emboli; 2P < 0.0002). CONCLUSION: It had previously been supposed that antiplatelet therapy did not influence venous thromboembolism, and many surgeons and physicians do not use it routinely for thromboprophylaxis, even for patients who are at substantial risk of deep venous thrombosis or pulmonary embolism. These results indicate that antiplatelet therapy--either alone or, for greater effect, in addition to other proved forms of thromboprophylaxis (such as subcutaneous heparin)--should be considered.

Blood Loss, Surgical↗