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PubMedDate not supplied

[Recurrent venous thromboembolism caused by heparin cofactor II deficiency. A case].

We report the case of a 28-year-old man who was admitted in an emergency because of severe abdominal pain with gastrointestinal haemorrhage and shock. Laparotomy showed infarction of the small intestine with mesenteric veins thrombosis. Severe thromboembolic complications occurred during the post-operative period: bilateral femoral deep vein thrombosis with pulmonary embolism, axillary and subclavian vein thrombosis associated with an intravenous catheter, portal hypertension related to portal vein thrombosis and cavernoma, thrombosis of the superior longitudinal sinus. Laboratory investigations performed after thrombotic episodes and repeated 5 years later evidenced a type 1 Heparin Cofactor II deficiency (HCII Ag by EID: 40 percent; functional Tollefsen's method: 60 percent). This heterozygous deficiency was also found in one of the patient's sons. This is the first reported case of HCII deficiency associated with mesenteric infarction and cerebral thrombophlebitis. The relationship between these severe venous thrombotic episodes and the HCII deficiency is discussed in relation to the dermatan sulphate-HCII couple physiology. Vascular injury may act as a triggering factor in patients with HCII deficiency.

Adult↗
PubMed1991

Thrombosis prophylaxis with subcutaneous heparin Ca injection in the course of caesarean sections.

Subcutaneous low-dose Heparin Ca injections were given as prophylactic treatment to 31 women who were candidates for Caesarean section and were at high risk of thrombo-embolism. Postoperative deep vein thrombosis or pulmonary embolism did not occur in the treated cases. Local or systemic haemorrhages or other reactions were not observed. The controlled haematological parameters changed as expected. According to the opinion of the authors Heparin Ca may be successfully used for the prevention of the postoperative complications of Caesarean section.

Adult↗
PubMed1994

Recurrent pulmonary embolism in patients treated because of acute venous thromboembolism: a prospective study.

OBJECTIVE: To evaluate the risk of pulmonary embolism (PE) despite adequate heparin therapy in a large series of patients with acute deep venous thrombosis and/or pulmonary embolism. DESIGN: Prospective study. SETTING: University Hospital Germans Trias i Pujol, Badalona, Spain. MATERIALS: 348 patients admitted because of deep venous thrombosis in the lower limbs and/or pulmonary embolism. A baseline lung scan was obtained initially in every patient, whether the original diagnosis was PE or deep vein thrombosis (DVT). Repeat chest X-ray and lung scans were obtained routinely at 8 days of heparin onset. OUTCOME MEASURES: The primary trial endpoint was a finding of confirmed, clinically apparent recurrent PE; in addition, laboratory evidence of subclinical PE at the repeat scan was also considered. RESULTS: PE recurrences were found in 23/348 patients (7%). No significant differences were found in age and sex distribution, or in the degree of DVT proximity between patients who developed and those who did not develop recurrences. Recurrent PE was more commonly found in patients with scintigraphic evidence of PE on admission, irrespectively of the original diagnosis being DVT or PE (18/151 vs. 3/155; p = 0.0005, Fisher's exact test). Recurrences were also more common in patients in whom thrombosis developed in the absence of any known risk factor (10/70 vs. 13/278; p = 0.007). The logistic regression analysis confirmed the statistical significance of these two clinical variables. CONCLUSIONS: Pulmonary embolism despite adequate heparin therapy is not an uncommon event. It appears possible to identify a subgroup of patients at a higher risk, and, modify treatment accordingly.

Adolescent↗
PubMed1991

[Clinico-pathological analysis of 100 autopsy cases of massive or submassive pulmonary thrombo-obstruction in cardiovascular and pulmonary diseases].

A clinico-pathological analysis of 100 autopsy cases of thrombo-obstruction in the segmental and those bigger arteries of the lungs caused by cardiovascular and pulmonary disease was reported. These complications of pulmonary thrombosis and/or embolism were more commonly observed in rheumatic heart disease (29% of the same disease in autopsies), congestive cardiomyopathy (26%) and cor pulmonale (19%). There were 2-4% of the autopsy cases of other cardiovascular and pulmonary diseases. The pulmonary thrombo-obstruction and/or infarction were more frequent in right lower lobes of the lungs and they were often multiple. The pulmonary infarction occurred in 76% of these cases. 35% of 100 cases occurred with sudden death. Only 13% of 100 patients with pulmonary thrombosis and/or embolism were diagnosed before autopsy. The causes of pulmonary thrombo-obstruction and the diagnostic suggestion were discussed in this paper.

Adolescent↗
PubMed1996

[Should postoperative thromboembolism prevention be extended to the post-hospitalization phase?].

A large number of patients medically treated for deep vein thrombosis and pulmonary embolism have a history of surgery in the immediate past. We therefore inquired whether it is possible to identify specific risk factors which would allow general recommendations for anticoagulation therapy in the postdischarge period. During the 30-month study period 325 patients were treated at the Cantonal Hospital, Aarau, for DVT and/or pulmonary embolism. 35 (10.8%) had undergone surgery 8 weeks previous to admission. Perioperative management (anticoagulation, chronology, mobility etc.) was analyzed retrospectively. 20% of the 35 patients with postdischarge deep vein thrombosis and/or pulmonary embolism had previously undergone an ambulatory surgical procedure. A large number of thromboembolic complications occurred between the 4th and 12th day after discharge. In 40% of the patients, however, they occurred after the 14th posthospital day. High- and low-risk patients were impossible to define on the basis of the type of surgery, length of hospital stay and time course of thromboembolic complications. We conclude that prophylaxis of thromboembolism in ambulatory surgery should be re-thought: patients undergoing arthroscopy should receive prophylaxis for thromboembolism for at least 4-6 weeks post discharge.

Adult↗
PubMed2005

Oral direct thrombin inhibitor ximelagatran compared with warfarin for the prevention of venous thromboembolism after total knee arthroplasty.

BACKGROUND: Warfarin, which requires coagulation monitoring, is associated with relatively high rates of thromboembolism despite providing adequate prophylaxis. This study compared an oral direct thrombin inhibitor, ximelagatran, with warfarin in order to evaluate the safety and efficacy of the medication for the prevention of venous thromboembolism in patients undergoing total knee arthroplasty. METHODS: Following surgery, patients were randomly assigned to fixed-dose oral ximelagatran (36 mg twice daily) or warfarin (target international normalized ratio, 2.5), both administered for seven to twelve days in a double-blind, double-dummy design. Warfarin was initiated on the evening of the day of surgery, and ximelagatran, on the morning after surgery. The primary efficacy end point was the incidence of asymptomatic deep-vein thrombosis determined by bilateral venography, objectively confirmed symptomatic deep-vein thrombosis or pulmonary embolism, and death from all causes during treatment. RESULTS: Adequate venograms or confirmed symptomatic events (efficacy population) were obtained for 1949 patients. Venous thromboembolism and death from all causes occurred in 22.5% (221) of 982 ximelagatran-treated patients and in 31.9% (308) of 967 warfarin-treated patients (p < 0.001). Proximal deep-vein thrombosis and pulmonary embolism were observed in 3.1% (thirty) and 0.2%, respectively, of the patients in the ximelagatran group and in 3.4% (thirty-three) and 0.4%, respectively, of the patients in the warfarin group. The six deaths from all causes included 0.3% (four) of the ximelagatran-treated patients and 0.2% (two) of the warfarin-treated patients. Major bleeding was noted in 1% (twelve) of the ximelagatran-treated patients and in 0.4% (five) of the warfarin-treated patients (p = 0.09). CONCLUSIONS: Oral ximelagatran (36 mg twice daily), administered without coagulation monitoring or dose adjustment and started the day after total knee arthroplasty, demonstrates superior efficacy compared with warfarin prophylaxis, with no wound complications and no significant difference with respect to bleeding events, although the rate of major bleeding events was greater with ximelagatran than with warfarin. LEVEL OF EVIDENCE: Therapeutic Level I.

Aged↗
PubMed1990

[Hemorheology and blood thrombotic potential in pulmonary thromboembolism].

Examination of 138 patients with acute venous thrombosis of the lower limbs, which was complicated by thromboembolism of the pulmonary artery in 49 of them, showed the rheologic status to be disturbed to a greater extent in patients with pulmonary embolism than in those with acute venous thrombosis. An interrelationship between the rheologic properties and the coagulation system of the blood in various conditions of the hemostasis system was revealed. It is pointed out that pathogenetically grounded correction of the disorders of the blood coagulation and rheologic systems is necessary in choosing the method for treatment and prevention of acute venous thrombosis and pulmonary embolism.

Acute Disease↗
PubMed1994

Pulmonary embolism following laparoscopic cholecystectomy: report of two cases and review of the literature.

Laparoscopic abdominal surgery is considered a low-risk procedure for postoperative thromboembolic disease. We report two cases of pulmonary embolism following laparoscopic cholecystectomy, review the incidence of deep venous thrombosis and pulmonary embolism in laparoscopic cholecystectomy, and suggest a specific prophylactic scheme for patients undergoing laparoscopic cholecystectomy. In spite of the low incidence of postoperative thromboembolic disease following minimally invasive procedures, the risk of pulmonary embolism must not be underestimated and its symptoms must not be underdiagnosed.

Adult↗
PubMed2004

Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients.

BACKGROUND: Considerable variability exists in the use of pharmacological thromboprophylaxis among acutely ill medical patients, partly because clinically relevant end points have not been fully assessed in this population. We undertook an international, multicenter, randomized, double-blind, placebo-controlled trial using clinically important outcomes to assess the efficacy and safety of dalteparin in the prevention of venous thromboembolism in such patients. METHODS AND RESULTS: Patients (n=3706) were randomly assigned to receive either subcutaneous dalteparin 5000 IU daily or placebo for 14 days and were followed up for 90 days. The primary end point was venous thromboembolism, defined as the combination of symptomatic deep vein thrombosis, symptomatic pulmonary embolism, and asymptomatic proximal deep vein thrombosis detected by compression ultrasound at day 21 and sudden death by day 21. The incidence of venous thromboembolism was reduced from 4.96% (73 of 1473 patients) in the placebo group to 2.77% (42 of 1518 patients) in the dalteparin group, an absolute risk reduction of 2.19% or a relative risk reduction of 45% (relative risk, 0.55; 95% CI, 0.38 to 0.80; P=0.0015). The observed benefit was maintained at 90 days. The overall incidence of major bleeding was low but higher in the dalteparin group (9 patients; 0.49%) compared with the placebo group (3 patients; 0.16%). CONCLUSIONS: Dalteparin 5000 IU once daily halved the rate of venous thromboembolism with a low risk of bleeding.

Acute Disease↗