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PubMed2004

Regional differences in rates of diagnosis and mortality of pulmonary thromboembolism.

The rates of diagnosis of deep venous thrombosis, pulmonary embolism (PE), and venous thromboembolism (PE and/or deep venous thrombosis) and the mortality rate of PE in hospitalized patients were evaluated in 4 regions of the United States. Data are from the National Hospital Discharge Survey and the United States Bureau of the Census. The western region of the United States showed a lower rate of diagnosis of deep venous thrombosis and venous thromboembolism and a lower mortality rate of PE than any other region.

Black or African American↗
PubMed2000

Prothrombin gene mutation uncommon in pulmonary embolism.

BACKGROUND: Venous thrombosis followed by pulmonary embolism is one of the most common causes of sudden death among middle-aged adults. Several inherited polymorphisms are associated with heightened risk of venous thrombosis, including mutation at position 20210 of the prothrombin gene and mutation at codon 506 of the factor V gene. METHODS: We studied mutation prevalence in 67 individuals who died of pulmonary embolism and were autopsied in a medical examiner's facility over a 5-year period. Mutations were identified by polymerase chain reaction followed by allele-specific endonuclease digestion. RESULTS: Traditional risk factors for pulmonary embolism (eg, immobility, oral contraceptive use, cancer) were identified in 75%. Heterozygous mutation of the prothrombin gene was found in 3/67 (4%), and heterozygous mutation of the factor V gene was identified in 3/66 (4%). No homozygotes or compound heterozygotes were identified. The prevalence of mutation was not significantly different from that of the general population. CONCLUSIONS: Individuals who die suddenly from pulmonary embolism are not often affected by prothrombin or factor V gene mutations. Therefore, medical examiners need not routinely test for these mutations in individuals who die of pulmonary embolism.

Adolescent↗
PubMed2003

Genetic polymorphisms associated with acute pulmonary embolism and deep venous thrombosis.

Frequently an inherited predisposition to thrombosis remains clinically silent until an additional environmental factor intervenes. The present study aimed to assess distribution of inherited risk factors of venous thrombosis in patients with venous thromboembolism (VTE). The prevalences of factor V Leiden (FV Leiden), prothrombin factor II G20210A (FII G20210A), C677T and A1298C of methylenetetrahydrofolate reductase (MTHFR) mutations were studied in 149 VTE patients and 100 controls. The following key risks were established: previous deep venous thrombosis or pulmonary embolism (23.5%), bed rest (34.2%), immobilisation of lower limb (10.1%), hospitalisation (30.9%) and obesity (28.9%). In 29 (19%) patients and in three (3%) controls FV Leiden was found. A significant association between VTE and FV Leiden was established. There were six (4%) carriers of the FII G20210A among VTE patients and one in the controls. No associations between VTE and MTHFR polymorphisms (C677T, A1298C) were found. In three of 149 patients both FV Leiden and FII G20210A polymorphisms were observed. The mean protein C activity was slightly, though nonsignificantly, smaller in VTE patients. In conclusion, there was a positive association between venous thromboembolism and factor V Leiden. Only a weak trend favouring a relationship between prothrombin factor II G20210A and venous thrombolism was present. No associations between common polymorphisms of methylenetetrahydrofolate reductase and venous thromboembolism were found.

Case-Control Studies↗
PubMed2001

Upper extremity deep venous thrombosis leading to pulmonary embolism after total hip arthroplasty.

Upper extremity deep venous thrombosis most commonly occurs secondary to the presence of subclavian central venous catheters. Of all upper extremity deep venous thromboses, 12% may cause pulmonary embolism; however, pulmonary embolism from a so-called primary thrombosis is uncommon. We report an unusual case of pulmonary embolism after primary deep venous thrombosis in the down arm after total hip arthroplasty.

Adult↗
PubMed1986

[Thrombosis of the inferior vena cava with successive lung embolization in a 15-year-old boy with the nephrotic syndrome].

The authors report on a boy with typical course of recent nephrotic syndrome, who developed massive thrombosis involving the iliac inferior holden veins during the standard therapy with corticosteroid. The first sign of this complication was pulmonary embolism. Thrombosis was treated by surgery, during which 3 large thrombi from veins were removed. The patient developed recurrent thrombosis occurring at the previous sites in the later stage and he died 23 days after the first sign of thromboembolic complication. Autopsy showed only minimal glomerular changes. The cause of the death was massive pulmonary embolisation. The aethiopathogenesis of the complication and preventive approach in children with nephrotic syndrome are discussed.

Adolescent↗
PubMed1986

[Thrombosis of the inferior vena cava with successive lung embolization in a 15-year-old boy with nephrotic syndrome].

The authors report on a boy with typical course of recent nephrotic syndrome, who developed massive thrombosis involving the iliac inferior holden veins during the standard therapy with corticosteroid. The first sign of this complication was pulmonary embolism. Thrombosis was treated by surgery, during which 3 large thrombi from veins were removed. The patient developed recurrent thrombosis occurring at the previous sites in the later stage and he died 23 days after the first sign of thromboembolic complication. Autopsy showed only minimal glomerular changes. The cause of the death was massive pulmonary embolisation. The aethiopathogenesis of the complication and preventive approach in children with nephrotic syndrome are discussed.

Adolescent↗
PubMed1996

Low-molecular-weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement.

BACKGROUND: The risk of venous thromboembolism in patients undergoing total hip replacement is known to be high. However, the optimal duration of prophylaxis with anticoagulant agents after this procedure is unknown. We sought to determine whether one month of anticoagulant therapy with the low-molecular-weight heparin enoxaparin is more effective than enoxaparin therapy given only during the hospitalization for surgery. METHODS: Two hundred sixty-two patients undergoing total hip replacement received enoxaparin during their hospitalizations (average stay, 10 to 11 days). They were then randomly assigned to receive enoxaparin or placebo (131 patients each). Blinded outpatient therapy (or placebo) was continued long enough that the total treatment period, inpatient plus outpatient, was one month for each patient. Bilateral ascending phlebography was performed 19 to 23 days after discharge, with deep-vein thrombosis as the primary end point. Distal and proximal thrombosis, pulmonary embolism, and hemorrhage were also recorded, as were deaths. RESULTS: Venography was adequate in 116 patients in the placebo group and 117 in the enoxaparin group. We observed 43 episodes of deep-vein thrombosis and 2 episodes of pulmonary embolism in the placebo group, but only 21 episodes of deep-vein thrombosis and no episodes of pulmonary embolism in the enoxaparin group (incidence of thromboembolism, 39 percent and 18 percent, respectively; P<0.001). The difference in the incidence of proximal deep-vein thrombosis was also significant (24 percent and 7 percent in the placebo and enoxaparin groups, respectively; P<0.001). Six enoxaparin groups, respectively; P<0.001). Six patients in the enoxaparin group and one patient in the placebo group had hematomas at their injection sites. No patients died or had major complications. CONCLUSIONS: There were significantly fewer venous thromboembolic complications in patients undergoing elective hip replacement when prophylaxis with enoxaparin was given for a total of one month, rather than only during the hospitalization.

Adult↗
PubMed1983

Cerebral emboli of paradoxical origin.

A diagnosis of paradoxical cerebral embolus (PCE) was made in five patients aged 31 to 62 years who sustained eight cerebral ischemic events. No patient had evidence of primary carotid system or left heart disease. A probe-patent foramen ovale was the presumed mechanism in four patients, and an unsuspected congenital atrial septal defect was found in the fifth patient. Clinically apparent pulmonary emboli or venous thrombosis preceded the cerebral event in only one instance. Review of the literature reveals a high mortality with PCE. However, careful clinical search for this lesion may be rewarding: four of our five patients survived. One should consider PCE in any patient with cerebral embolus in whom there is no demonstrable left-sided circulatory source. This principle applies particularly if there is concomitant venous thrombosis, pulmonary embolism, or enhanced potential for venous thrombosis due to, for example, morbid obesity, use of hormonal birth control pills, prolonged bed rest (especially postoperatively), or systemic carcinoma.

Adult↗
PubMed2004

Pancreatic cancer and thromboembolic disease.

Thromboembolic disease is a common complication of pancreatic cancer and is causally associated with the generation of an intrinsic hypercoagulable state. Pancreatic-cancer cells activate platelets and express several procoagulant factors, including tissue factor and thrombin. The activation of coagulation is not simply an epiphenomenon, but might also be related to enhanced tumour growth and angiogenesis. Clinical manifestations of thromboembolic disease in pancreatic cancer include deep venous thrombosis, pulmonary embolism, disseminated intravascular coagulation, portal vein thrombosis, and arterial thromboembolism. Reported incidences of disease range from 17% to 57%. Treatment options include warfarin and low-molecular-weight heparins. Studies over the past decade suggest that long-term use of these heparins in both primary and secondary prevention of venous thromboembolic disease improves outcomes in comparison with warfarin. Further research is needed to understand better the morbidity and mortality associated with this disease in pancreatic cancer and to optimise strategies of prevention and treatment.

Anticoagulants↗
PubMed2001

[Is there justification for varicose vein surgery with local anesthesia in successive procedures? Prospective study of 5,000 crossectomy/stripping operations].

UNLABELLED: In a prospective study we examined the complications of 5,000 operations (n = 876 as outpatient; ligations of the SFJ/SPJ +/- stripping or recurrence operation of the SFJ/SPJ), that were carried out under local anaesthesia in a successive procedure. We registered only the in-hospital complications or those occurring during the first postoperative week of outpatient procedure: Mortality, deep venous thrombosis, pulmonary embolism, major vascular injuries, major nerval injuries, anaesthesia complications. The proof and/or exclusion of complications were done by clinical investigations with the parameters: Mortality, vascular and/or nerval injuries, anaesthesia complications as well as pulmonary embolism. With the parameter deep venous thrombosis n = 2,495 operations were examined by color duplex scan in the region of the sapheno-femoral (popliteal) junction before patients were discharged from hospital/ambulatory therapy. In the other patients the diagnosis was done according to clinical parameters. RESULTS: In the investigation period two complications occurred at the nerval-system after difficult ligation of the SPJ: a) Paresis concerning mainly the peroneal branch of the N. ischiadicus with regeneration after nine months. b) Lesion of the N. tibialis with paresis of the M. abductor digiti minimi that was unchanged after seven months. CONCLUSION: Varicose vein surgery under local anaesthesia as a successive procedure represents a very safe treatment option. A comparison with literature data from prospective or retrospective studies is not possible, because of missing studies and/or unclear information or definition problems. It would be desirable if such studies could be performed.

Adult↗
PubMedDate not supplied

Efficacy of an intravenous low-molecular-weight dermatan sulphate (Desmin) in patients with acute proximal deep venous thrombosis and silent pulmonary embolism. A pilot study.

Ten patients affected by proximal deep venous thrombosis were treated in an open study with a low-molecular-weight dermatan sulphate (Desmin), administered at doses of 400 mg (intravenous bolus) followed by 1200 mg/day infused intravenously for 10 days, without activated partial thromboplastin adjustment. The evolution of the deep vein thrombosis and the presence of silent pulmonary embolism were evaluated by phleboscintigraphy and lung scan, performed before treatment and after 10 days of treatment, and by repeated echocolour-Doppler examination (every 2 days during treatment). The evolution of deep vein thrombosis showed a considerable improvement; similarly, lung scan showed a substantial reperfusion of lung, with regression of perfusional deficit. Repeated echocolour-Doppler examination of the deep venous system during treatment did not document further thrombus extension in any patient. Tolerance and safety were excellent. No adverse effects were observed. These preliminary results indicate that the tested dose of Desmin can be effective in treating deep vein thrombosis and silent pulmonary embolism.

Acute Disease↗