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PubMed1994

[Paradoxical cerebral embolism during fibrinolysis therapy in deep vein thrombosis and pulmonary embolism].

A 37-year-old woman with increasing dyspnoea over several months suddenly developed severe ortho- and tachypnoea as well as cyanosis of the lips and acrocyanosis. Pulmonary angiography revealed massive bilateral pulmonary emboli with a systolic pulmonary artery pressure of 75 mm Hg. Phlebography demonstrated a thrombotic occlusion of the deep veins of the left leg extending to the distal femoral vein. Thrombolysis treatment was started via an indwelling pulmonary artery catheter (500,000 IU urokinase and 10,000 IU heparin as bolus, then 1 mill. IU urokinase and 1,000 IU heparin per hour). After two hours an incomplete left-sided paresis occurred (involving ocular and facial muscles, dysarthria, left arm and left leg) and the thrombolytic infusion was stopped. But cerebral computed tomography (CT) did not demonstrate any intracerebral haemorrhage. The heparin infusion was restarted (partial thromboplastin time between 70 and 90 s). CT examinations during the next few days showed the development of an ischaemic infarction in the distribution of the right medial cerebral artery. Angiography demonstrated occlusion of the right internal carotid artery. The diagnosis of a paradoxical embolus was supported by easy cardiac catheter passage through a patent foramen ovale. Subsequent pulmonary angiography demonstrated a thrombus-free pulmonary arterial circulation with a normal pulmonary arterial pressure. There was gradual and extensive regression of the incomplete hemiparesis.

Adult↗
PubMed1997

The treatment of deep vein thrombosis and pulmonary embolism.

Deep vein thrombosis and pulmonary embolism can be considered as one clinical entity, termed venous thromboembolism, because of their comparable pathogenesis, treatment and prognosis. In this clinical spectrum of venous thromboembolism a gradient in severity of the disease can be recognized. Therapeutic strategies should be adapted to the extent of the thrombotic disease, varying from surgical or thrombolytic therapy in life-threatening disease to a watchful waiting diagnostic follow-up approach in minimal disease. In patients with established venous thromboembolism (low molecular weight) (LMWH), heparin should be initiated. An overview will be given of the safety and efficacy of the different therapeutic modalities such as thrombectomy, thrombolytic therapy, a watchful waiting diagnostic approach and unfractionated heparin. Furthermore, clinical studies comparing LMWH with unfractionated heparin in the initial treatment of venous thromboembolism will be reviewed.

Anticoagulants↗
PubMed1974

Fibrinogen-detectable thrombosis in the legs and pulmonary embolism.

Thrombosis in the deep veins of the legs commonly follows surgical operations but is often undiagnosed. The fibrinogen uptake test is an aid to its detection. Perfusion lung scanning after injection of labelled macroalbumin aggregates has advanced the diagnosis of pulmonary embolism.Studies were carried out on 40 patients undergoing surgical operation to determine whether the results of the fibrinogen uptake test were correlated with those of ventilation-perfusion lung scanning. A statistically significant relationship was found: 18% of patients had small, clinically silent emboli.

Albumins↗
PubMed1998

Understanding and preventing deep vein thrombosis and pulmonary embolism.

Deep vein thrombosis and its complications, including pulmonary embolism, are major health problems in the United States, resulting in more than 260,000 hospital admissions and 100,000 deaths each year. Thirty percent of patients diagnosed with deep vein thrombosis will experience at least one recurrence of symptoms. To minimize patient morbidity and mortality and to contain health care costs, prevention, early diagnosis, and treatment of these conditions are essential. In this article the incidence pathophysiology risk factors, and clinical course of deep vein thrombosis and pulmonary embolism are discussed, as well as the clinician's role in prevention and treatment.

Adult↗
PubMed2002

Integrated diagnostic approach to suspected deep vein thrombosis and pulmonary embolism.

Diagnosing deep vein thrombosis and pulmonary embolism has become definitely easier and more reliable over the past fifteen years, especially thanks the development of lower limbs venous compression ultrasonography and fibrin D-Dimer measurement. These tests allowed reducing the requirement for venography and pulmonary angiography to a small minority of patients. Simultaneously, ventilation/perfusion lung scan criteria have been standardized, and the performance of spiral computed tomography has been analyzed in an appropriate way. New sequential, mainly noninvasive strategies could be developed that proved to be safe in large-scale prospective cohort studies with prolonged follow-up. They should now be implemented in daily practice according to cost-effectiveness analyses as well as local facilities and expertise.

Diagnostic Imaging↗
PubMed1992

Deep venous thrombosis and pulmonary embolism in pregnancy.

Deep venous thrombosis and pulmonary embolism are relatively frequent occurrences in pregnancy and the postpartum period. The diagnosis of deep venous thrombosis and pulmonary embolism requires accurate objective tests because clinical diagnosis is unreliable. Procedures that expose the fetus to ionizing radiation must sometimes be performed to make an accurate diagnosis; current evidence suggests that the adverse effects to the fetus associated with such procedures are minimal. Heparin is the anticoagulant of choice during pregnancy and is used for both the treatment and prevention of venous thrombosis and pulmonary embolism. Patients with deficiencies of antithrombin III, protein C, or protein S as well as patients with antiphospholipid antibodies are at increased risk for thrombotic complications and require particular vigilance during pregnancy.

Acute Disease↗