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PubMed2001

A comparison of three rapid D-dimer methods for the diagnosis of venous thromboembolism.

We compared three rapid D-dimer methods for the diagnosis of venous thromboembolism. Patients presenting to four teaching hospitals with the possible diagnosis of deep vein thrombosis or pulmonary embolism were investigated with a combination of clinical likelihood, D-dimer (SimpliRED) and initial non-invasive testing. Patients were assigned as being positive or negative for deep vein thrombosis or pulmonary embolism based on their three-month outcome and initial test results. The three D-dimer methods compared were: (a) Accuclot D-dimer (b) IL-Test D-dimer (c) SimpliRED D-dimer. Of 993 patients, 141 had objectively confirmed deep vein thrombosis or pulmonary embolism. The sensitivity of SimpliRED, Accuclot and IL-Test were 79, 90 and 87% respectively. All three D-dimer tests gave similar negative predictive values. The SimpliRED D-dimer was found to be less sensitive than the Accuclot or IL-Test. When combined with pre-test probability all three methods are probably acceptable for use in the diagnosis of venous thromboembolism.

Fibrin Fibrinogen Degradation Products↗
PubMed1998

Symptomatic endpoints for venous thromboembolism treatment.

Clinical trials evaluating antithrombotic therapy for the treatment of deep vein thrombosis require that the diagnosis is confirmed by objective testing prior to patient entry into the study. Two basic approaches may then be taken for defining endpoints to assess the efficacy of antithrombotic treatment. In the first approach, the diagnostic test is repeated at a predetermined time following the initiation of the interventional therapy. In the second approach, no further diagnostic testing is routinely performed for a minimum of 3 months following patient enrolment after the diagnosis of venous thromboembolism for evidence of symptomatic recurrent deep vein thrombosis or pulmonary embolism. This approach is used in later-phase clinical trials to examine whether a novel therapeutic agent is as safe and effective as the drugs currently used for management of venous thromboembolism. Symptomatic recurrent deep vein thrombosis and pulmonary embolism confirmed by objective testing are clinically important causes of patient morbidity, place patients at increased risk of fatal pulmonary embolism, cause increased rates of chronic thromboembolic complications and have resource consequences. Studies utilizing symptomatic recurrent deep vein thrombosis or pulmonary embolism as endpoints have been responsible for most of the treatment advances in the management of patients with venous thromboembolism that have been observed in the past 40 years. Although confirmation of recurrent venous thromboembolism is not possible in all patients, clinical trials using rigorous methodology can minimize the potential bias caused by the limitations of diagnostic test results. There is a need to develop better objective tests in the future, to distinguish previous from recurrent venous thromboembolism.

Anticoagulants↗
PubMed2005

Oral contraceptives and the risk of venous thromboembolism.

BACKGROUND: Oral contraceptives were introduced in the late 1950s, and their use has altered society and has led to radical changes. Combined oral contraceptives are considered the most acceptable, effective, and most easily reversible method of contraception. In the early 1960s, an association between venous thrombosis and pulmonary emboli and oral contraceptive use was identified. In response, the amount of estrogen used in these contraceptives was decreased. Later, the concept that reducing the dose of estrogen would eliminate the risk of venous thrombosis was strongly challenged. OBJECTIVE: The available epidemiologic data and the mechanisms that underly the risk of venous thromboembolism as a side effect of oral contraceptive use will be described. Clinical implications based on both the relative and absolute risks in the general population and in women with a known tendency for venous thromboembolism will be discussed. METHODS: A literature search of MEDLINE was conducted for the years 1995 through 2005, using search word combinations including oral contraceptive, estrogen, progestin, venous thrombosis, venous thromboembolism, pulmonary emboli, and pulmonary embolism. Relevant articles relating to the topic of oral contraceptives and the risk of venous thromboembolism were studied and summarized for inclusion in this review article. RESULTS: Certain third-generation progestins in low-estrogen preparations were found to increase the risk of venous thrombosis and pulmonary embolism. Also, the realization that genetic factors play a role in the degree of thrombosis risk led to insights into the hemostatic changes that occur during oral contraceptive use and that predispose women to thrombosis. Known risk factors for venous thromboembolism-inherited thrombophilia, a personal history of venous thromboembolism, and obesity-pose varying degrees of concern for both women and their physicians regarding the safety of oral contraceptives. CONCLUSION: In order to prevent venous thromboembolism, prudence is required when prescribing oral contraceptives to women who have an increased risk of that condition. Furthermore, having a risk factor may not be an absolute contraindication to the use of oral contraceptives, but it offers the opportunity for women to make informed decisions about their use. In the future, researchers should focus on developing effective oral contraceptives that are even safer than those that are available today.

Cardiovascular Diseases↗
PubMed1996

Pulmonary embolism and deep venous thrombosis during pregnancy or oral contraceptive use: prevalence of factor V Leiden.

Activated protein C resistance caused by factor V Leiden mutation is the most common inherited cause of an underlying predisposition to pulmonary embolism (PE) and deep venous thrombosis (DVT). We studied the frequency of the factor V Leiden mutation in 50 women who had PE and/or DVT during or after pregnancy or during oral contraceptive use. Ten (20%; 95% CI 10% to 34%) of the 50 women were heterozygous for the mutation. First-trimester PE or DVT developed in 6 (60%; 95% CI, 26% to 88%) of the 10 women with the mutation compared with 3 (8%; 95% CI 2% to 20%) of 40 women without the mutation (p = 0.0009). These data indicate that the factor V Leiden mutation is an important risk factor for PE or DVT during pregnancy (especially the first trimester), after pregnancy, or during oral contraceptive use.

Adolescent↗
PubMed1986

Infective endocarditis in children: a current diagnostic trend and the embolic complications.

Twenty-three cases of IE, of which 91% had underlying congenital heart diseases were diagnosed by positive blood culture or vegetative lesion detected by 2-D ECHO when a patient revealed clinically suspicious episodes. VSD and TOF were the most common underlying heart diseases. The vegetation was detected successfully by 2-D ECHO in 91% of the cases. The causative organisms were identified in 83% of the cases. Streptococcus viridans and Staphylococcus aureus were the two major organisms detected. Candida albicans was found in 3 postoperative and fatal cases. Embolic complications occurred in 7 cases (30.5%): five cases of pulmonary infarction and two of cerebral infarction. The overall mortality was 22%. We recommend early surgical intervention whenever a patient reveals a very large vegetation with animated movability, and emphasize the importance of a proper prophylaxic regimen.

Adolescent↗
PubMed1990

[Clinical aspects of staphylococcal endocarditis].

Patients with staphylococcus endocarditis hospitalized at the Cantonal Hospital Lucerne from 1971 to 1988 are reviewed. A total of 50 patients fulfilled the diagnostic criteria (in 60% of the cases the diagnosis was definite, in 26% probable, and in 14% possible). These 50 patients with staphylococcus infection account for 29% of all patients with infective endocarditis seen during this time interval. Staphylococcus endocarditis affected the mitral valve in 48%, the aortic valve in 36% and--unexpectedly often--the tricuspid valve in 30%. In 54% previously normal valves were infected. Diminished host defence (predominantly intravenous drug addiction and diabetes) was a predisposing feature in 52% of the patients. The average duration of symptoms before diagnosis was 11 days, and in patients with right heart endocarditis it was 21 days. In 20% the condition was not diagnosed before autopsy. The clinical picture was relatively nonspecific: 50% of patients had no diagnostic heart murmur and 10% had no fever. The dominant--often misleading--symptoms were due to embolic complications. Two thirds of the cases with right heart endocarditis had pulmonary emboli. In 38% of the patients endocarditis resulted in heart failure. Overall mortality was 51% and correlated with age and the presence of heart failure, uncontrolled infection or cerebral embolism. In contrast to the high mortality in patients with mitral valve infection (61%), only one of the 11 patients with isolated right heart endocarditis died.

Endocarditis, Bacterial↗