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PubMed2003

Venous thromboembolism prophylaxis in medical inpatients: a retrospective chart review.

BACKGROUND: Venous thromboembolic disease (VTE) is a major cause of morbidity and mortality in hospitalized patients. Most hospitalized patients with a fatal pulmonary embolism are medical patients who do not have a history of recent surgery [BMJ 302 (1991) 709; J. R. Soc. Med. 82 (1989) 198]. There is evidence suggesting that VTE prophylaxis is indicated in many high risk medical patients [Chest 119 (2001) 132S; NEJM 341 (1999) 793]. However, previous studies have shown that only about one third of high risk medical patients receive VTE prophylaxis [Ann. Intern. Med. 115 (1991) 591; Chest 106 (1994) 13; Chest 107 (1995) 296]. The objective of this study was to determine the frequency of use of VTE prophylaxis in medical inpatients at two teaching hospitals in Hamilton, Ontario. METHODS: A retrospective chart review of consecutive patients admitted to medical wards at two acute care sites of McMaster University affiliated teaching hospitals between October 10, 2001 and December 11, 2001 was performed. For each patient, demographic data, risk factors for VTE, method of VTE prophylaxis and contraindications to VTE prophylaxis were recorded. RESULTS: 756 patient charts were reviewed and 310 (41%) were excluded because the primary diagnosis required anticoagulation, the patients were being treated with anticoagulation (warfarin or heparin) before admission or the patient was admitted to the intensive care unit. Of the remaining 446 patients, 146 (33%) received some form of VTE prophylaxis. Of the patients receiving prophylaxis, 4% had early ambulation, 9% wore anti-embolic stockings (AES), 1% used intermittent pneumatic compression, 23% used unfractionated heparin and 3% used low molecular weight heparin. Two hundred five (46%) patients had one identifiable VTE risk factor and 63 (14%) had two or more risk factors. Patients with more VTE risk factors were more likely to receive prophylaxis. INTERPRETATION: One third of medical inpatients at two teaching hospitals in Hamilton received some form of VTE prophylaxis.

Adolescent↗

PubMed2002

Primary prevention of deep venous thrombosis and pulmonary embolism in acute spinal cord injured patients.

STUDY DESIGN: Prospective clinical trial. OBJECTIVES: To evaluate the efficacy of a specific protocol for prevention of thrombo-embolic disease occurring during the acute stage of spinal cord lesions, based on the simultaneous use of pharmacological plus mechanical procedures. SETTING: Regional Spinal Unit of Florence, Italy. INTRODUCTION: Deep venous thrombosis (DVT) is a dangerous pathology whose first clinical sign can be represented by unexpected pulmonary embolism (PE). Its incidence in acute spinal cord injured (SCI) patients is reported to range between 9% and 90%. Its prevention represents one of the major challenges for the clinicians involved in the care of such patients. METHOD: Two hundred and seventy-five SCI patients consecutively admitted to our Centre were investigated by colour doppler ultrasonography of lower limbs and pelvis on admission, after 30-45 days and whenever clinically requested. Subcutaneous Nadroparine, a low molecular weight heparin (LMWH), plus early mobilisation, permanently dressed gradient elastic stockings (PGES), and external sequential pneumatic compression (ESPC) of the lower limbs, applied during the first 30 days after injury, were given to all of them. Colour doppler ultrasonography (CDUS) complete investigations of the lower limbs and pelvis were performed on admission, after 30-45 days and whenever clinically requested. The patients were divided into two groups according to their time interval from injury to the admission to our Centre. RESULTS: The incidence of detected DVT was 2% in those patients (99) admitted early to our centre (within 72 h from the trauma), who immediately received our prophylactic protocol. No PE was reported. The other group of patients (176), all admitted between 8 and 28 days (mean 12 days) developed DVT in 26% of cases. None of these patients received ESPC before being admitted to our Centre. No patient had been admitted between 3 and 8 days interval time post injury. CONCLUSION: Early application of pharmacological plus mechanical treatment for DVT prevention produces a marked reduction in such complications. It also reduces the risks of morbidity and mortality in our patients, and, not least, reduces the hospitalization costs during the early period of rehabilitation.

Acute Disease↗

PubMedDate not supplied

Analysis of therapy-resistant venous leg ulcers. Can triple-layer treatment initiate healing?

Chronic leg ulcers represent a major health-care problem with considerable socioeconomic impact. Patients with seemingly therapy-resistant leg ulcers are common to all clinics. The purpose of the present study was to (1) examine a group of patients with nonhealing venous leg ulcers treated with a double-layer bandage and (2) evaluate whether the addition of an interactive hydrocolloid wound dressing could initiate healing in these patients. Twenty-two patients with ulcers caused by venous insufficiency were included. The patients had a mean ulcer duration of 27.6 years. Duration of the present ulcer was at least 1 year (mean >/= 4.1 years). Twenty of the 22 patients showed massive lipodermatosclerosis. Before inclusion, all patients had used double-layer bandage consisting of a zinc-impregnated bandage or stocking and a self-adhesive compression bandage for 1 year or longer without improvement. The new regimen was a triple-layer treatment with the hydrocolloid water applied over the ulcer and the traditional double-layer bandage unchanged. Three patients were dropped from the study. Nineteen patients were followed until healing or for 10 months. Nine of the 19 patients who completed the study healed. Ulcer area was reduced by 70% or greater in 7 patients and by 30% to 40% in two patients. One ulcer did not respond to the treatment and worsened slightly. The results of this study were encouraging and indicate that the triple-layer treatment with the hydrocolloid dressing applied to the ulcer should be evaluated in a randomized, controlled study in patients with less pessimistic prognoses.

Journal Article↗

PubMed2006

[Treatment of primary lower limb lymphedema with ultrasonic assisted liposuction].

OBJECTIVE: To observe treatment effects of primary lower limb lymphedema using ultrasonic assisted liposuction. METHODS: Internal ultrasonic liposculpture system combined postoperative continual elastic stockings or bandages were used for reducing lymphatic burdens of the affected limbs by partly removal of lymphedematous tissues. RESULTS: Edema regression in the affected limbs were obvious at 2 weeks postoperative and kept to stable without recurrence during 1 year follow-up. CONCLUSIONS: Ultrasonic assisted liposuction combined with elastic compression is safe and effective for the treatment of primary limb lymphedema.

Adolescent↗

PubMedDate not supplied

[Effects of compression on venous pressure and limb volume. Paradoxal results].

The effect of elastic stockings on the venous pump are discussed in normal patients as well as patients with chronic venous insufficiency. The effects of compression are explained taking into consideration the nonlinear relationship between venous pressure and volume of the lower extremity. Results that seem paradoxical are therefore better understood.

Bandages↗

PubMed2006

Treatment of classic Kaposi's sarcoma-associated lymphedema with elastic stockings.

Lymphedema of the lower extremities is a frequent complication of Kaposi's sarcoma (KS). Compressive therapy is the basis of treatment for lymphatic disorders, but to the authors' knowledge, there are no controlled trials to evaluate its effectiveness in KS-related lymphedema. Sixty-five patients with classic KS-associated lymphedema limited to below the knee were studied. Fifty patients received below-knee elastic stockings, whereas the remaining 15 did not use any compressive device. Among treated patients, 60% (30/50) experienced a limb volume reduction, while 40% (20/50) had an increase of limb volume. In contrast, all patients (15/15) of the untreated group had an increase of limb volume. No correlation between lymphedema reduction and systemic or local chemotherapy was observed, supporting compressive therapy as the major strategy for the treatment of this condition. Our results suggest that elastic stockings may be important tools for the management of lymphedema associated to classic KS.

Adult↗

PubMed1989

Mechanical prophylaxis of venous thrombosis in patients undergoing craniotomy: a randomized trial.

A randomized, prospective clinical trial of 70 patients undergoing craniotomy was performed to compare and evaluate two forms of mechanical prophylaxis of deep vein thrombosis. Thirty-eight patients received antiembolism stockings, whereas 32 patients received external pneumatic compression. Prophylaxis was begun preoperatively and continued intraoperatively and post-operatively until the patients were ambulatory. Impedance plethysmography was used to detect deep vein thrombosis both preoperatively and postoperatively. Two patients, one from each group, developed thromboembolic complications postoperatively. Impedance plethysmography showed false-positive findings in two additional patients. There were no deaths. The data suggest that either form of mechanical prophylaxis is effective against the development of deep vein thrombosis in this high-risk patient population.

Clinical Trials as Topic↗

PubMed1999

Chronic wounds and nursing care.

This study has collated data on the prevalence of chronic wounds and the demography of patients with these wounds. Diagnostic methods, nursing care, the presence of diabetes and pain are analysed, as well as data on healing, amputation and mortality three months post-study. A total of 694 patients were identified: 406 with leg or foot ulcers, 117 with pressure ulcers and 171 with other wounds. Most patients were treated in the community. Leg ulcer aetiology was verified with ultrasound Doppler examination. There was a correlation between low Norton score (< 20) and severity of pressure ulcer (Stage III or IV). The use of 113 different wound dressings or combinations of products was reported. Time spent on dressing changes was the equivalent of full-time employment for 57 nurses. Wound cleansing was not predominantly performed with tap water, as recommended, but with saline. Almost all patients with venous leg ulcers (88%) were treated with compression but in 35% of these support stockings were used. Pain was present in almost half of all patients, more commonly in Stage III or IV pressure ulcers than in Stages I and II, and was most often reported in older patients. Diabetes was present in 25% of all patients with leg and pressure ulcers, and in 57% of patients with foot ulcers. At three-month follow-up, 28% of pressure ulcers, 40% of leg ulcers and 61% of other wounds had healed. Mortality was 35% in patients with pressure ulcers, 4% in those with leg ulcers and 7% in those with foot ulcers. These data have been presented to politicians in the county, resulting in allocation of resources for a wound healing centre.

Adult↗

PubMed1979

Elastic stockings in the control of hand oedema.

Elastic support and compression in the form of an elastic finger stall or glove seems to be a simple and comfortable way to obviate and reduce oedema of the hand and fingers after surgery or trauma. It may also prove useful in inflammatory conditions such as rheumatoid arthritis, though the authors have not used it as yet for that condition.

Bandages↗

PubMed1992

Mechanical prophylaxis and other modalities.

The efficacy of different mechanical prophylaxes against venous thromboembolism, such as aggressive early mobilization, elastic stockings, continuous passive motion, and external pneumatic compression, is discussed and placed in perspective. The published literature regarding dextran, hydroxychloroquine, and antithrombin III is reviewed and critically assessed in terms of efficacy and safety.

Antithrombin III↗

PubMedDate not supplied

[Static disorders or venous pathology of the foot?].

UNLABELLED: Three types of disorder observed in the foot may have either a mechanical or a vascular aetiology. They are: A) Painful or tired legs, caused by: eversion, inversion or arch collapse of one or both feet. TREATMENT: corrective or compensatory soles depending on the joint mobility and the integrity of the skin. B) Metatarsalgia due to static disorders, incorrect shoes or vascular disorders. TREATMENT: orthopaedic soles, appropriate shoes. C) Burning pain in the toes exacerbated by heat, relieved by cold, due to claw or lateral deformity of the toes or compression of the forefoot and toes (shoes, stockings). TREATMENT: appropriate shoes, protective or corrective orthoplasties.

Foot Diseases↗

PubMedDate not supplied

[Doppler ultrasonic probe and oscillograph in phlebology practice].

The ultrasonic or Doppler probe must become a routine instrument in phlebology. It makes it possible to not only to demonstrate arterial circulatory disorders, but also to approximately estimate the level of secondary effects on the peripheral circulation. Once he knows that there is an arterial pathology, the phlebologist can then decide whether to apply a compressive bandage, to prescribe a degressive support stocking, to inject sclerosing drugs or to resort to foot surgery.

Arteries↗

PubMed1994

Acute and long-term effect of elastic stockings in patients with varicose veins.

The acute and long-term effect of elastic stockings has been evaluated in 20 patients (20 limbs) with grade 2 venous disease. The sites of venous reflux were determined with colour flow duplex scanning. Air Plethysmography was used to measure the amount of venous reflux and the ejecting capacity of the calf muscle pump. The patients were classified in to two different groups, A and B. Both groups of patients wore elastic stockings for four weeks. In group A (no. = 9) the measurements were done before, during and one day after the removal of the stockings, whereas in group B (no. = 11) the last measurements were done immediately after the removal of the stockings. Patients that showed improvement in their haemodynamics were re-examined a week later. Elastic compression appeared to be beneficial in both groups. The application of the elastic stockings improved reflux and the residual volume fraction in both groups and the ejecting capacity of the calf muscle pump in group B. Immediately after the removal of the stockings (Group B) all the measurements regressed to the initial values with the exemption of the residual volume fraction. However, one week later, the latter also regressed to the original value. It is concluded that the beneficial effect of elastic stockings on the venous haemodynamics is present mainly when the stockings are worn. It is completely abolished within a day after their removal.

Bandages↗

PubMedDate not supplied

Accurate selection of compression and antiembolic hosiery.

The use of compression and antiembolic hosiery is widespread in hospital and community settings, but there is wide variation in almost every aspect of selection and prescribing practice. In some localities pharmacists or appliance officers are responsible for selecting a suitable stocking for patients, whereas in others it may be left to medical staff. Anecdotally, there is a lack of knowledge about when and what is safe to prescribe relative to the underlying disorder. This is compounded by discrepancy between the level of compression provided by stockings made according to the European method, and that prescribable under the UK Drug Tariff in primary care. This can result in clinically serious variation in what the patient is given and what his/her condition needs. A particular problem arises when the patient's care is continued following discharge from hospital. In this case not only may an inferior quality product be supplied (meeting the Drug Tariff specifications), but also the compression 'strength' can be unintentionally lower than expected or prescribed. A simple method of prescribing according to condition and pressure has been developed and is outlined here.

Bandages↗

PubMed1993

Microcirculatory effects of elastic stockings in diabetic microangiopathy: a 24-week study.

Patients with diabetic microangiopathy were studied by laser-Doppler flowmetry--measuring skin blood flux at rest (RF) and the venoarteriolar response (VAR) and evaluating the rate of ankle swelling (RAS) to study capillary filtration. After randomisation, 38 patients were treated for 24 weeks with below-knee elastic stockings, and 36--acting as controls--were left without elastic compression. After 12 and 24 weeks, there were no significant changes in the control group, while there was a significant improvement of the microcirculatory parameters in patients using stockings. RF (increased at the beginning of the study) was significantly decreased, the VAR (impaired at the beginning of the study) improved significantly and the abnormally increased capillary filtration decreased. Elastic stockings seem to be useful in diabetic microangiopathy improving microcirculatory parameters and decreasing capillary filtration and oedema. These effects may improve diabetic microangiopathy and possibly slow down its rate of progression.

Bandages↗

PubMed2005

Treatment of osteopenic humeral shaft nonunion with compression plating, humeral cortical allograft struts, and bone grafting.

Surgical stabilization of humeral shaft nonunions can be difficult to achieve if severe osteopenia or loss of bone stock is present. We present a technique whereby a 4.5-mm standard dynamic compression plate is used in conjunction with a humeral cortical allograft strut and bone grafting to stabilize humeral shaft nonunions complicated by severe bone loss. Six patients with established nonunion of the humeral shaft underwent this technique. Union was achieved at an average of 3.4 months (range 2-6 months). Our method using onlay allograft struts can provide an effective alternative in the management of humeral shaft nonunion complicated by severe osteopenia of various etiologies.

Aged↗

PubMed2005

Prevention of venous thrombosis in patients with acute intracerebral hemorrhage.

OBJECTIVE: To assess intermittent pneumatic compression (IPC) in the prevention of venous thromboembolism (VTE). METHODS: The authors randomly allocated patients with a documented intracerebral hemorrhage (ICH) to elastic stockings (ES) alone or combined with IPC. The primary outcome was a combined criteria assessed at day 10: a symptomatic and well-documented VTE, or a death arising before day 10 and related to pulmonary embolism (PE), or an asymptomatic deep vein thrombosis (DVT) of the lower limbs detected by compression ultrasonography (CUS). Outcome assessment was blinded. RESULTS: One hundred fifty-one patients were randomized; 133 (88%) patients were evaluated at day 10. No clinical suspicion of VTE arose before day 10. Fourteen patients died before having a CUS but no death was definitely related to PE. Fourteen asymptomatic DVT were detected by CUS: three (4.7%) in the ES + IPC group (all distal) and 11 (15.9%) in the ES group (three proximal and eight distal). ES combined with IPC is associated with a reduced risk of asymptomatic DVT compared to ES alone: relative risk, 0.29 (95% CI 0.08 to 1.00). CONCLUSIONS: Asymptomatic deep vein thrombosis (DVT) was detected at day 10 in 15.9% of patients wearing elastic stockings alone. Intermittent pneumatic compression significantly decreased the occurrence of asymptomatic DVT for patients with intracerebral hemorrhage.

Acute Disease↗

PubMed1994

Hip joint arthrodesis utilizing anterior compression plate fixation.

Sixteen patients who had undergone hip arthrodesis utilizing an anteriorly placed compression plate were evaluated at an average of 4.5 years after surgery. The technique was designed to facilitate future conversion to a total hip arthroplasty by preserving the abductor musculature. Of the 11 patients who underwent primary fusions, 5 failed to unite (45%). Nonunion occurred in all five (100%) patients undergoing refusion for a failed surgical arthrodesis. The authors conclude that an anterior compression plate alone in patients with limited bone stock does not provide adequate fixation and predisposes the patient to failure of fixation and nonunion.

Adult↗