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PubMed2002

[Incidence of acute cor pulmonale and deep venous thrombosis in acute pulmonary embolism].

OBJECTIVE: Ultrasounds are a useful tool when looking for indirect evidence in favor of pulmonary embolism. The aim of this study was to determine the incidence of acute cor pulmonale and deep venous thrombosis revealed by ultrasonographic techniques in a population of patients presenting with pulmonary embolism. METHODS: 96 consecutive patients with a mean (+/- SD) age of 65 +/- 15 years, admitted to our hospital for pulmonary embolism were included in this study. The diagnosis of pulmonary embolism was made either by spiral computed tomography or selective pulmonary angiography. Each patient subsequently underwent both trans-thoracic echocardiography and venous ultrasonography. The diagnostic criterion used for defining acute cor pulmonale by echocardiography was the right to left ventricular end-diastolic area ratio over (or equal to) 0.6. Diagnosis of deep venous thrombosis was supported by the visualization of thrombi or vein incompressibility and/or the absence of venous flow or loss of flow variability by venous ultrasonography. RESULTS: Using ultrasounds, an acute cor pulmonale was found in 63% of our patients while 79% were found to have deep venous thrombosis and 92% of the patients had either acute cor pulmonale or deep venous thrombosis or both. All of the patients with proximal pulmonary embolism had acute cor pulmonale and/or deep venous thrombosis. The presence of acute cor pulmonale on echocardiography was significantly higher in patients with proximal pulmonary embolism (p < 0.0001). CONCLUSION: This study emphasizes the potential value of ultrasonographic techniques in the diagnosis of acute pulmonary embolism.

Acute Disease↗

PubMed2001

Mutations at the activated protein C cleavage sites Arg336 and Arg562 of factor VIII in Thai patients with venous thrombosis.

Venous thrombosis is a multicausal disease, more than one genetic risk factor may cooperate to effect thrombotic risk. Factor V Leiden is found to be an important hereditary risk factor for venous thromboembolism. Analogous to factor V Leiden, a point mutation at amino acid positions Arg336 and Arg562 in factor VIII may predispose patients to thrombosis. Eighty-one Thai patients with venous thrombosis and 100 Thai healthy volunteers have been studied. Neither heterozygous nor homozygous mutations were detected both thrombosis patients or normal volunteers. However, further studies with larger samples of venous thrombosis patients are recommended.

Adult↗

PubMedDate not supplied

[Treatment of pulmonary embolism and prevention of recurrence by placement of a vena cava filter in deep venous thrombosis: case report].

INTRODUCTION: In patients with pulmonary thromboembolism it is crucial to suspect the disease, establish the diagnosis and initiate anticoagulation treatment as early as possible in order to prevent relapses, which may be fatal. Deep venous thrombosis of lower extremities is the most common site of origin, which initially may remain obscure. CASE REPORT: Two weeks prior to admission the patient had right-sided chest pain accompanied with dyspnea, interpreted and treated as pleuropneumonia. Pulmonary thromboembolism was suspected due to clinical symptoms, chest X-ray, elevated enzyme levels findings, blood gas analysis with hypoxemia and ECG with right heart overload. The diagnosis of pulmonary thromboembolism confirmed by lung scintigraphy presented with perfusion defects. After twenty days of heparin therapy, the patient developed left leg edema. Ultrasound screening confirmed bilateral iliacfemoral popliteal vein thrombosis of iliacofemoropopliteal veins bilaterally. Phlebography performed via jugular vein disclosed thrombotic material in the right common iliac vein, as well as in the vena cava inferior. In the course of the procedure vena cava filter has been placed. DISCUSSION: Although the patient was receiving anticoagulation heparin therapy, he developed pulmonary thromboembolism relapse and deep venous thrombosis. In our patient, vena cava filter placement was aimed at preventing pulmonary thromboembolism relapse. Since a deficit of S protein was also established, the patient is unfortunately likely to develop thrombosis at other sites as well. CONCLUSION: In our patient pulmonary thromboembolism was a consequence of deep venous thrombosis, and the diagnosis was established by ultrasound screening of the lower extremities and confirmed by phlebography. During phlebography vena cava filter was placed in order to prevent pulmonary thromboembolism.

Humans↗

PubMed2000

[Prevention of postoperative deep venous thrombosis in lower limb after operation by intermittent pneumatic compression].

OBJECTIVE: To investigate the effect of intermittent pneumatic compression on prevention of deep venous thrombosis after operation of lower limbs. METHODS: From Oct. 1997 to Aug. 1998, forty cases were received Doppler examination preoperatively, which showed no deep venous thrombosis in all the lower limbs of 40 cases. Among them, 24 cases were received total hip arthroplasties, 4 cases were received total knee arthroplasties and 12 cases were received dynamic hip screw. Postoperatively, every case were continuously received intermittent pneumatic compression for 14 to 21 days (2 hours, qid), and venography were performed on the operated lower limb on the 7th day after operation to check the presence of deep venous thrombosis. RESULTS: Among the 40 cases, there were 4 cases of deep venous thrombosis without symptom of pulmonary embolism, the incidence rate was 10%. CONCLUSION: Intermittent pneumatic compression can significantly reduce the incidence rate of deep venous thrombosis after the operation of the lower limbs.

Adult↗

PubMed1975

[Subcutaneous small heparin doses for the prevention of thrombosis in general surgery and urology].

1. The effectiveness of 3 X 5000 IU s. c. heparin daily (starting preoperatively) for the prevention of postoperative deep vein thrombosis was evaluated in a prospective, controlled, randomized study including general surgical and urological patients. 125I-fibrinogen test was performed daily in all patients. 2. 178 patients fulfilled the conditions of the protocol. 35.8% of the 95 patients in the control group developed deep vein thrombosis, but only 13.3% of 83 subjects in the heparin group did so. The difference is statistically highly significant (p less than 0.001). 3. The vast majority of all thrombi in both groups appeared before the 3rd postoperative day. 4. With 1 exception, all deep vein thrombi in the heparin group started in the mid-calf region. In the control group 5 deep thrombi originated in the popliteal vein. 5. Heparin displays a better effect in males (n = 34; p less than 0.01) than in females (n = 49; p less than 0.025). 6. In patients undergoing surgery for malignant disease heparin does not reduce the incidence of deep vein thrombosis. 7. Heparin is far more effective in patients under 60 years of age than in those over 60 (p less than 0.005). 8. Heparin is more effective in obese patients than in those of normal body build. 9. Heparin prophylaxis also reduces the incidence of deep vein thrombosis in patients who exhibit predisposing factors. In patients of the control group with preexisting disease of the venous system, there were significantly more deep vein thrombi (p less than 0.01) than in those without predisposing factors. 10. In the heparin group 29% of all thrombin time determinations show a definite prolongation of more than 26 sec (normal value 15 sec). 11. In 14 patients (=16.9%) of the heparin group, 21 side effects or complications were seen. Bleeding complications were the main problem, comprising 5 wound hematomas and hematomas at the injection site, 4 postoperative bleeding episodes and 2 reoperations. There were no complications in the control group. 12. According to the results of 10 well controlled studies, there is no doubt that in general surgery small doses of subcutaneous heparin, commencing preoperatively, do reduce the incidence of postoperative deep vein thrombosis to a significant degree. However, whether this form of prophylaxis is also effective in patients with fractures of the hip and in elective hip surgery cannot, on the evidence available, be decided. In the fields of gynecological surgery and urology as well, more data are needed before this form of heparin prophylaxis can be recommended.

Adult↗

PubMedDate not supplied

Graft survival following three occurrences of hepatic arterial thrombosis after living-related liver transplantation. A case report.

Hepatic arterial thrombosis is a major cause of morbidity and graft loss in patients undergoing liver transplantation. We report the case of a patient who underwent living-related liver transplantation and suffered three instances of early hepatic arterial thrombosis requiring revascularization in the first 8 days after grafting. The patient was discharged with good graft function. A 21-month-old female with biliary atresia underwent living-related liver transplantation using her mother's extra-lateral segment. The donor middle hepatic artery was anastomosed end-to-end to the posterior branch of the donor's hepatic artery. The time of operation was 8 hr 36 min, and the blood loss was 193 mL. On postoperative day 5, the patient was returned to surgery to close a perforation in the transverse colon. At operation we found hepatic arterial thrombosis and performed a thrombectomy and redid the arterial anastomosis. Hepatic arterial thrombosis recurred during the operation, so we interposed the recipient's right radial artery between the graft artery and recipient posterior branch. On postoperative day 8, ultrasound showed a fluid collection in Winslow's pouch. After removing the fibrin clot, we discovered that hepatic arterial thrombosis had recurred in the interposed artery. We revascularized the graft using the right gastroepiploic artery. Arterial blood flow was restored, and graft function remained excellent.

Biliary Atresia↗

PubMed2002

Prosthetic heart valve thrombosis: an overview.

BACKGROUND: Valvular heart disease represents a significant burden to patients with cardiovascular diseases. Surgical treatment of diseased heart valves represents a significant advancement for these patients. However, there are specific complications related to prosthetic valves, including valve thrombosis. METHODS: Review article. RESULTS: Thrombosis of a prosthetic heart valve can present with gradual cardiac decline, embolic phenomena, or frank cardiogenic shock. The diagnosis of prosthetic valve thrombosis is by history, physical examination, and by an imaging modality. Treatment of the thrombosed valve is either surgical or with thrombolysis. Both modalities have significant morbidity and mortality. CONCLUSION: Treatment of valvular heart disease does not remove the patient from significant risks. Inherent to a prosthetic heart valve is the risk for valvular thrombosis. Prompt recognition and treatment of prosthetic valve thrombosis is important.

Heart Valve Prosthesis↗

PubMed2002

Protein C, S and antithrombin III levels in patients with acute mechanical valve thrombosis.

BACKGROUND: Mechanical prosthetic heart valve thrombosis is a serious complication with an incidence of 1-6%. The reduction in active vitamin-K dependent protein C and S levels caused by warfarin treatment also results in a prothrombotic state. This study was conducted to investigate the connection between protein C (PC), protein S (PS), antithrombin III (ATIII) deficiency and prosthetic mechanical valve thrombosis. METHODS: Twenty-nine of the 283 patients who underwent valve replacement with St. Jude medical prosthesis had mechanical valve thrombosis (group 2). The rest were considered as group 1. Twelve of the 29 patients (41.4%) had isolated aortic valve replacement, 12 had isolated mitral valve replacement (41.4%) and 5 patients had double valve replacement (17.2%). Most of the patients had rheumatic valve disease at their 1st operation. The mean time of occurrence for mechanical valve occlusion was 4.1+/-1.0 years following surgery. RESULTS: The values of PC, PS and ATIII were obtained when the mechanical valves stuck or at routine follow-up. PC, PS and ATIII levels were significantly lower in the mechanical valve thrombosis group. PC levels were 75.4+/-37.6% and 49.9+/-32.2% in group 1 and 2, respectively (p=0.001). PC, PS and ATIII values were mostly lower in the 2nd group but this difference only became significant after at least 2 years of warfarin usage. CONCLUSIONS: Natural anticoagulant levels can be low during the use of warfarin. In which case the dose can be increased in order to hold the international normalized ratio (INR) at 3-3.5. However, more frequent follow-up is required and patients should be investigated for hypercoagulation states or deficiency in anticoagulant proteins. Patients referred to hospital with any mechanical valve thrombosis or recurrent thromboembolism should be evaluated for hypercoagulant proteins.

Adult↗

PubMed2002

[Activated protein C resistance and deep venous thrombosis in pregnancy].

OBJECTIVE: The aim of the study was to detect the incidence of resistance to activated protein C in pregnant or puerperal women with confirmed diagnosis of deep venous thrombosis or pulmonary embolism. DESIGN: Case-control study. SETTING: Dept. of Obstetrics and Gynaecology, Dept. of Haemato-oncology, Medical Faculty, Palacky University, Olomouc. METHODS: The group of 33 women with confirmed deep venous thrombosis were examined for resistance to activated C protein. The levels of C and S proteins, antithrombin III., prothrombin, heparin II cofactor and plasminogen were measured. Patient with APC ratio below 1.86, were tested by PCR analysis for the detection of the FV:Q506 allele. The control group had 51 pregnant women, chosen randomly. The statistical evaluation was performed by STATISTICA program. For the analyzing of the continuous variables the Students' T-test was used. For the categorical variables the chi 2 test was used (for comparison of 2 relative values). Values below P < 0.01 were considered to be statistically significant. RESULTS: Women who have shown to suffer from deep venous thrombosis (DVT) came to the mean age of 31 +/- 3.1 years, weight 75.3 +/- 7.9 kg and BMI 28.7 +/- 4.3. All of the results above were rendered to be statistically significant. 54.5% of thrombosis occurred in the 3rd trimester, 61% were localised to the left iliofemoral vein. APC resistance appeared in 17 (51%) women with DVT, in comparison to 5 (9.8%) women in the control group (i.e. statistically significant). Factor V appeared in II (33.3%) women, in comparison to 3 (5.9%) women in the control group. CONCLUSION: APC resistance and factor V. Leiden represent as important factors in the aetiology of deep venous thrombosis in pregnancy.

Activated Protein C Resistance↗

PubMed2002

Effort thrombosis of the subclavian-axillary vein.

OBJECTIVE: The aim of this study is to outline the clinical patterns, diagnosis and the outcome of patients with 'effort' subclavian-axillary vein thrombosis. METHODS: The medical records of 7 patients diagnosed with 'effort' subclavian-axillary vein thrombosis between 1992 and 2000 at the Princess Basma Teaching Hospital, Irbid, Jordan were reviewed. Patients with secondary subclavian-axillary vein thrombosis (catheter related or secondary to thoracic outlet compression) were excluded. RESULTS: The clinical presentations of this condition were swelling, pain, and cyanosis of the upper limbs. The presence of dilated superficial vein is a late sign. All patients were treated by non-fractionated heparin continued with warfarin with a favorable outcome. CONCLUSION: Effort thrombosis of subclavian-axillary vein (Paget-Von Schroetter syndrome) is less reported in the literature contrary to secondary subclavian-axillary vein thrombosis. Early and effective anticoagulation constitutes the base of curative treatment. Prevention of recurrence is mandatory.

Adult↗

PubMed2002

Low dose systemic thrombolytic therapy for treatment of deep venous thrombosis.

BACKGROUND: Thrombolytic therapy is still not used widely for treatment of deep vein thrombosis despite its known efficacy. This reluctance to use it stems from worries about its hemorrhagic complications. METHODS: In a 4-year period 97 patients with deep vein thrombosis diagnosed by duplex study were enrolled into the study. Fifty patients received streptokinase as a bolus of 250,000 units followed by 100,000 units/hr with a maximum of 4,000,000 units and 47 patients received anticoagulation with heparin. RESULTS: Minor hemorrhagic complications occurred in 2 patients (4%) in the thrombolytic therapy group. An improvement in the control duplex study was observed in 56% of the patients in the thrombolytic therapy group compared to 5% in the heparin group (p=0.000). The patients treated within 4 days of onset of symptoms had significantly higher success rates compared to those treated later (p=0.000). Higher success rates were obtained for those with either femoral vein or more distal venous thrombosis compared to those with iliac vein and vena cava thrombosis (p=0.007). These results show that systemic low dose streptokinase achieves significantly higher recanalization rates compared to heparin alone. CONCLUSIONS: Hemorrhagic complications at these dose levels are within acceptable ranges. Low dose streptokinase regimen could be beneficial in patients who present within 4 days of femoral or more distal venous thrombosis.

Adolescent↗

PubMed2002

Deep vein thrombosis is not rare in Asia--the Singapore General Hospital experience.

INTRODUCTION: Venous thromboembolism (VTE) is perceived to be rare in Asia, but our recent clinical experience at Singapore General Hospital (SGH) suggests otherwise. Between 1996 and 1997, there were 388 cases of confirmed deep vein thrombosis (DVT). MATERIALS AND METHODS: All patients with symptomatic DVT confirmed by duplex ultrasound studies from January 1996 to December 1997 were retrospectively studied. Their case notes were searched for a record of predisposing risk factors. RESULTS: Ultrasound imaging indicated acute thrombosis in 320 patients (82.5%), and previous, but not acute thrombosis in 68 patients (17.5%). The overall frequency rate of acute DVTs was 15.8 per 10,000 hospital admissions. The average age of patients with acute thrombosis was 58.2 years. 9.2% of patients developed pulmonary embolism (PE). Their most frequently recorded clinical predispositions were immobilisation (67%), malignancy (33%) and recent surgery (30%). One hundred and thirty patients were tested for antithrombin, protein C or protein S deficiency, and the presence of antiphospholipid antibody and 45 (35%) were found to have at least 1 positive result. CONCLUSION: DVT is not uncommon in Singapore. Our frequency rate of acute DVT of 15.8 per 10,000 admissions is much higher than previously reported rates of 2.8 and 7.9 per 10,000 admissions in 1990 and 1992, respectively. These findings confirm the need for increased awareness of VTE in Asian populations, and support the relevance of systematic studies of thrombosis risk and prophylaxis in Asia.

Adolescent↗

PubMed2002

Thrombosis prophylaxis in orthopedic surgery: current clinical considerations.

Thrombosis prophylaxis in orthopedic surgery is an important consideration in order to avoid the morbidity and mortality of venous thromboembolism (VTE). Patients who do not receive prophylaxis, or receive inadequate prophylaxis, may be at risk for clinical or fatal pulmonary emboli, and a fatality, although rare, may be the first sign of a VTE. Although the surgeon may have corrected the patient's orthopedic problem, a symptomatic or asymptomatic venous thrombosis may become a new threat to the patient's quality of life. This problem places such patients at risk for recurrent VTE, as well as post-thrombotic syndrome, a progressive, lifelong disability. Methods of prophylaxis that prevent the most clots result in the fewest venous thromboembolic events, but no one method of prophylaxis is suitable for all patients. In order to select the appropriate modality, a careful risk assessment of each patient is necessary. Those at low or moderate risk levels do not require the same modalities that may be used in a patient with a previous history of thrombosis or with many risk factors. The purpose of this brief review is to examine the complications associated with venous thromboembolism and to discuss, in detail, the risk of thrombosis in orthopedic patients. In addition, thrombosis prophylaxis modalities are discussed and suggestions made based on current Chest Consensus Guidelines and FDA-approved products.

Humans↗

PubMed2002

Effect of extra virgin olive oil on experimental thrombosis and primary hemostasis in rats.

BACKGROUND AND AIM: Olive oil is a particular source of fat in the Mediterranean diet, which is associated with a lower incidence of cardiovascular disease. We investigated the possible antithrombotic role of extra virgin olive oil as a single dietary modification in experimental thrombosis and primary hemostasis models in rats. METHODS AND RESULTS: Two different groups of animals were studied: one fed a usual diet (control group) and the other a diet enriched with extra virgin olive oil (3%; weight/weight). After six weeks feeding, arterial thrombosis was initiated by inserting an artificial prosthesis (or "aortic loop") into the aorta, and venous thrombosis was induced by ligating the inferior vena cava. "Template" bleeding time (BT) was measured, as well as factor VII coagulant activity (FVII:C) and fibrinogen levels. The animals fed the olive oil enriched diet showed a significant delay in the thrombotic occlusion of the "aortic loop" (99 +/- 5 h vs 82 +/- 5 h, p < 0.04), a lower incidence of venous thrombosis (57% vs 86%; p < 0.05) and a prolonged BT (154 +/- 7 sec vs 122 +/- 4 sec; p < 0.01) in comparison with the control group. They had lower plasma fibrinogen concentrations (209 +/- 5 mg/dL vs 233 +/- 4 mg/dL; p < 0.01) but similar FVII:C levels (119 +/- 5% vs 108 +/- 5%; p = NS) despite their lower triglyceride concentrations (52 +/- 5 mg/dL vs 79 +/- 10 mg/dL; p < 0.05). CONCLUSIONS: This study provides the first in vivo experimental evidence of the thrombosis prevention properties of olive oil, which are possibly mediated by reduced fibrinogen concentrations and impaired platelet/vessel wall interactions.

Animals↗

PubMed2003

[Treatment and prophylaxis of deep venous thrombosis with low molecular weight heparins (meta-analysis of clinical trials)].

Deep-vein thrombosis is a relevant problem of today's medicine, because the risk to fall ill with this pathology is 2-5%; it increases in senior age. Direct and indirect acting thrombin inhibitors are used for treatment and prevention of vein thrombosis. Though great efficiency and safety of new anticoagulants (especially factor Xa inhibitors) were proven in clinical studies, unfractionated heparin and low molecular weight heparins are still most widely used in clinical practice. Low molecular weight heparins are obtained by depolymerizing heparin: its molecular weight is being decreased to 3-7 kDa, or 18-20 monosaccharides. Low molecular weight heparins strongly inhibit Xa coagulation factor and faintly - IIa, that's why their anti-Xa/anti-IIa proportion is >1 (unfractionated heparin = 1); enoxaparine and nadroparine show up the highest proportion. The low weight of these heparins determines good pharmacodynamic characteristics: excellent assimilation from subcutaneous layer, long circulation in plasma, infrequent side effects. Due to these characteristics they are convenient, safe and economically worth using (used by subcutaneous injections, prescribed only 1-2 times per day, coagulation control not required, possibility for patient to be treated at home); therefore low molecular weight heparins are more and more often used in treatment of deep-vein thrombosis and also in primary and secondary prevention. They are one of the most efficacious contemporary anticoagulants, which allow to decrease the deep-vein thrombosis treatment and prevention costs. This article presents literature review about low molecular weight heparins, their appliance in treatment and prophylaxis of deep-vein thrombosis.

Adult↗

PubMed2003

[Acute thrombosis of lower extremities. Risk factors, methods of prevention and treatment].

The results of treatment of 526 patients with an acute venous thrombosis of the lower extremities aged from 23 to 70 years, including 140 (36.3%) men and 376 (63.7%) women, were analyzed. The main etiological factors of thrombosis were physical overload, operations with subsequent immobilization, trauma of lower extremities, pregnancy and delivery, tumor of small pelvis and of other localization. In 65 patients an acute venous thrombosis was complicated by thromboembolism of pulmonary artery (TEPA), 2 patients died before initiation of treatment. Conduction of conservative therapy in 314 (94.4%) patients with thrombosis of the lower extremities deep veins using fraxiparine (fraxiparine forte) have allowed to achieve considerable improvement of their state. In 80 patients with thrombosis of subcutaneous veins was performed ligature of mouth for prophylaxis of TEPA, in all of them good clinical result was noted. High efficacy of fraxiparine application in prophylactical dosage for prevention of the venous thromboembolism occurrence was noted.

Acute Disease↗

PubMed1992

[Thrombosis of the posterior scrotal vein: report of two cases].

A 47-year-old architect and a 30-year-old designer of audio goods presented with thrombosis of left and right posterior scrotal vein, respectively. Both had scrotal masses associated with a feeling of heaviness. Physical, operative and microscopic findings were similar. The lesions were palpated as nontender, slender, elastic masses and located parallel to the urethra in the posterior aspect of the scrotum. At surgical exploration the lesions appeared to be thrombosis of posterior scrotal vein and were removed. Both patients have remained well one year in one and four months in the other after operation. Pathological diagnosis for both surgical specimens was organized thrombosis of vein with eosinophilic infiltration. Eosinophilic infiltration to lesions in the present cases and the occupation of patients suggested that some immunological disorders and localized venous stasis for long time during their sitting work might relate to the formation of thrombosis in the posterior scrotal vein. To our knowledge this is the first report of thrombosis of the posterior scrotal vein.

Adult↗

PubMed2002

Intravascular thrombosis as a result of central venous access.

Central venous access represents one of the most basic therapeutic procedures in modern medicine. Unfortunately, numerous advantages that result from maintaining a central venous line are accompanied by some complications among which the venous thrombosis is the most significant clinically. The study was designed to assess frequency and natural history of this complication in the setting at a multi profile clinical hospital. Central venous cannulation was performed by a fully qualified anaesthesiologist in every case. There were 887 cannulations and only 5 patients with clinically significant venous thrombosis. The analysis of the collected data allowed us to state that the frequency of intravascular thrombosis is low, but this complication is often associated with extensive impairment of patency of the central veins. Full recanalization is not always achieved regardless of the treatment applied. Pulmonary embolism in the course of central venous thrombosis was diagnosed in one patient only and appeared as a multiple and fine X-ray infiltrates. It seems that in the presence of permanent or even life threatening complications of central venous thrombosis their risk should be minimized by frequent examination of the cannulation site and early initiation of antithrombotic treatment.

Adult↗