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At least 1,243 records · Page 69Linked to original sources
PubMed1992

[The echocardiographic demonstration of a right atrial thrombus and its embolization into the lung].

A 43-year-old man was hospitalized because of extensive bilateral pulmonary tuberculosis. After several weeks of tuberculostatic treatment--at first applied orally, then because of nausea and vomiting parenterally via a central venous catheter--he acutely developed nocturnal dyspnoea and symptoms of shock requiring artificial ventilation. Echocardiography demonstrated dilatation of the right ventricle and a large floating thrombus in the right atrium. During the examination complete displacement of the worm-like thrombus into the pulmonary artery was observed echocardiographically. Despite anticoagulation and immediate operation the patient died 2 days later of protracted shock. The thrombus was found to have been formed in the superior vena cava after placement of the central venous catheter.

Adult↗
PubMed2003

Determining institution-specific costs of thromboembolic events with an algorithm and spreadsheet.

A systematic process whereby an institution may perform a pharmacoeconomic analysis of all direct medical costs associated with the diagnosis and treatment of venous thromboembolic events (VTEs) that reflects both institution-specific costs and clinical practice patterns is described. Current Content, International Pharmaceutical Abstracts, and MEDLINE were searched to identify English-language articles addressing procedures for diagnosing and treating symptomatic deep-vein thrombosis and pulmonary embolism. From the information gathered, a diagnostic algorithm and a resource spreadsheet were developed. The diagnostic procedures were classified as standard, alternative, confirmatory, or supplemental. The spreadsheet resources were assigned priorities based on practice standards and quantified on the basis of units typically used in the clinical setting. Three major categories of resources were identified: diagnostic, treatment, and laboratory test monitoring. Diagnostic procedures consisted of five subcategories containing 31 cost resources, treatments consisted of nine subcategories with 26 cost resources, and laboratory monitoring tests consisted of 9 cost resources. Units of use for all resources identified were also noted. A systematic process utilizing a diagnostic algorithm and a spreadsheet was developed to facilitate the determination of institution-specific costs associated with the diagnosis, treatment, and laboratory test monitoring of VTEs.

Algorithms↗
PubMedDate not supplied

Hospital guidelines for use of low-molecular-weight heparins.

OBJECTIVE: To describe the development of guidelines for initial use of low-molecular-weight heparins (LMWHs) and other anticoagulants in acute-care hospitals that are part of a national group purchasing organization (GPO). DATA SOURCES: A systematic literature search (1970-December 2001) was conducted to identify evidence on the efficacy of various anticoagulants for initial therapy in deep-vein thrombosis and pulmonary embolism, and in treatment of acute coronary syndrome. A group consensus method was then used to develop guidelines. Guidelines were reviewed and revised by an internal expert panel as well as an external expert panel. Final guidelines were disseminated to GPO members and assistance was provided with implementation at the local level. RESULTS: The final set of guidelines is described. The guidelines are organized based on recommended therapeutic options for each indication. For each option, consensus opinion is provided on the level of evidence that exists in the literature, comparisons of cost and convenience, and additional dosing information. The guidelines were disseminated along with supporting material to interested GPO member hospitals, and teleconferences were held to facilitate implementation at the local level. The guidelines were initially implemented at 18 hospitals across the country. CONCLUSIONS: The process by which these guidelines were developed, plus the final set of guidelines, may be useful to hospitals and healthcare systems contemplating or engaged in a similar effort with this class of drugs.

Anticoagulants↗
PubMed2005

Pulmonary thromboembolism associated with Klippel-Trenaunay syndrome.

Klippel-Trenaunay syndrome (KTS) is a rare congenital anomaly characterized by unilateral limb overgrowth, venous varicosities, and capillary malformations (port wine stains) of the affected limb or limbs. Large venous malformations such as those observed in KTS are rare, and many physicians are unfamiliar with the potential complications, which include hypercoagulability, thrombosis, and pulmonary embolism (PE). As a result, patients may suffer from delayed diagnosis of a potentially life-threatening thromboembolic event. We present 2 cases of children with KTS complicated by PE, and we review the English-language literature regarding pathophysiologic features, interventions, and outcomes of PE in the setting of KTS among both pediatric and adult patients, with emphasis on issues relevant to pediatricians.

Acute Disease↗
PubMed1999

Two instruments to determine activated partial thromboplastin time: implications for heparin monitoring.

STUDY OBJECTIVE: To measure the difference in therapeutic ranges of activated partial thromboplastin time (APTT) between two laboratory devices. DESIGN: Prospective, controlled laboratory study. SETTING: University-affiliated hospital. PATIENTS: Thirty inpatients receiving intravenous unfractionated heparin for treatment of myocardial infarction, unstable angina, deep venous thrombosis, or pulmonary embolism. INTERVENTIONS: Therapeutic APTT ranges were determined by a portable (whole blood assay) and a central laboratory device (plasma assay) based on heparin serum concentrations. They were compared with APTT ranges equivalent to 1.5-2.5 times the mean normal determination. MEASUREMENTS AND MAIN RESULTS: The central laboratory and portable devices produced therapeutic ranges of 61-93 and 56-73 seconds, respectively. Both differed from conventional therapeutic ratios of 1.5-2.5 times the mean normal (41-68 sec). Mean absolute APTT differences between instruments were statistically significant (12 +/- 20 sec, p<0.006), and 58% of paired APTT values differed by more than 10 seconds. CONCLUSION: A fixed APTT ratio as a goal for monitoring unfractionated heparin may result in significant underanticoagulation. Individual therapeutic APTT ranges must be reported for each instrument if more than one is used for heparin monitoring.

Adult↗
PubMed2000

Formulary management of low molecular weight heparins.

Low molecular weight heparins (LMWHs) are increasingly being utilised as anticoagulants in healthcare settings. These agents offer several advantages over standard unfractionated heparin. Indications for LMWHs include deep vein thrombosis and pulmonary embolism prophylaxis, deep vein thrombosis treatment, use in coronary procedures associated with a high risk for bleeding, and in acute coronary syndromes. Prior to being added to formularies, LMWHs should be evaluated for efficacy, safety and economic benefits over other anticoagulants. Institutions should be prepared to conduct their own economic assessments in the absence of readily available studies. There is clear evidence that LMWHs are cost saving or are at least cost effective as thromboprophylactic agents in major orthopaedic surgery. The economic benefits of LMWHs in other surgical situations is less clear. Consistent evidence from several countries indicate that LMWHs are cost saving as anticoagulants for the initial treatment of DVT. Further studies are needed to evaluate the efficacy, safety and economics of LMWHs in other conditions besides hip and knee arthroplasty and general surgery.

Cost-Benefit Analysis↗
PubMed1993

Protein S deficiency: imaging findings.

Protein S deficiency is an autosomal-dominant inherited disorder of coagulation associated with spontaneous and recurrent venous thrombosis. Approximately 5% of patients with deep venous thrombosis of the lower extremities who are less than 45 years old have a deficiency of protein S. Patients frequently have spontaneous and recurrent deep venous thrombosis and pulmonary embolism during young adulthood. Thrombosis occurs less commonly in the splanchnic and cerebral veins. Arterial thrombosis is rare but is seen in the cerebral circulation. Radiologists should include protein S deficiency in the differential diagnosis of unexplained thrombosis in young patients. This pictorial essay illustrates the range of imaging findings encountered in patients with this disorder.

Adult↗
PubMed1986

Underwater diving.

Explore the source record for details and available documents.

Decompression Sickness↗
PubMedDate not supplied

The express study: preliminary results.

The phase III trial EXPRESS was a randomised, double-blind comparison of two anticoagulant therapies used as prophylaxis against venous thromboembolism (VTE) during major elective orthopaedic surgery. The investigational treatment was ximelagatran/melagatran (Exanta), a new direct thrombin inhibitor in both its oral and subcutaneously injectable forms; the comparator was the low molecular weight heparin enoxaparin. Results showed ximelagatran/melagatran was highly statistically significantly superior to enoxaparin in preventing VTE with a relative risk reduction in proximal deep vein thrombosis plus pulmonary embolism of 63.3% (p < 0.000002). The relative risk reduction for total VTE was 23.6% (p < 0.0003). There were no differences in clinically important bleeding events (fatal bleeding, critical organ bleeding and bleeding requiring reoperation) but excess bleeding assessed subjectively was more common in the ximelagatran group than in the enoxaparin group.

Adult↗