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At least 19 recordsLinked to original sources
PubMed1976

Oral contraceptives, antithrombin- III activity, and postoperative deep-vein thrombosis.

Deep-vein thrombosis (D.V.T.) was detected by the fibrinogen-uptake test in six out of a total of thirty-one young women undergoing emergency abdominal surgery who gave a history of recent oral contraceptive intake. In contrast, no D.V.T. developed in nineteen similar patients who were not on oral contraceptives (P less than 0-01). Plasma-antithrombin-III activity was significantly lower preoperatively in patients taking oral contraceptives; postoperative D.V.T. subsequently developed in three out of five patients with preoperative antithrombin-III activity below 50%. In seventy-eight dental patients undergoing molar extraction, antithrombin-III activity was measured before, during, and after operation. Activity fell in all patients during operation, but the fall was significantly greater in women taking oral contraceptives (P less than 0-01). The intra-operative fall in antithrombin-III activity was prevented by a small preoperative dose of subcutaneous heparin.

Adolescent↗
PubMed1976

Preoperative or postoperative deep-vein thrombosis?

The incidence of deep-vein thrombosis as detected by the 125I-fibrinogen test and confirmed by phlebography was 32% in a high-risk group of patients admitted to hospital more than 4 days before operation. 62% of these thrombi were established before operation. Patients with malignant disease and those receiving preoperative intravenous nutrition were particularly prone to this complication. Recognition that asymptomatic thrombosis may be present before operation helps to clarify many of the enigmatic aspects of this condition, and has important implications for the interpretation of the results of clinical trials of prophylaxis. The condition should be suspected in patients transferred for surgery from medical wards, and prophylactic measures should be commenced at the time of admission in high-risk patients.

Adult↗
PubMed1979

[Operative treatment of deep vein thrombosis (author's transl)].

From 1973 to 1977 a total of 63 patients with thrombosis of the deep veins in leg and pelvis and in the V. cava inferior was treated by operative thrombectomy. Prior to the operation all patients were submitted to phlebography. The mean age of all was 52 years. One patient died from pulmonary embolism during thrombectomy, there was no further hospital mortality. Because of low mortality incidence and rarely postthrombotic complications we prefer the operative treatment of deep vein thrombosis. The preoperative cavography helps to avoid pulmonary embolism during thrombectomy.

Adolescent↗
PubMed1978

A prospective study of streptokinase and heparin in the treatment of deep vein thrombosis.

In a prospective trial, 42 medical patients with a history of deep vein thrombosis of less than five days were allocated at random to treatment with streptokinase or heparin. Only patients with extensive thromboses were included. Streptokinase was given in a loading dose of 250 000 IU and a maintenance dose of 100 000 IU/hour for 4 days as a mean. Heparin was given in a loading dose of 15 000 IU and a maintenance dose of 20 000-50 000 IU/day. The therapeutic results were evaluated by phlebography. Significant thrombolysis occurred in 71.4% of 21 patients treated with streptokinase and in 23.8% of the 21 heparin-treated patients. Using the chi2-test for overall association, this difference was statistically highly significant (p = 0.002). Three patients in each treatment group experienced major bleeding, two in each group requiring blood transfusions. Minor bleeding and slight rise in temperature were encountered more often in the streptokinase than in the heparin group. It is concluded that patients with acute deep vein thrombosis with proximal extension of the thrombus beyond the calf veins should be offered a therapeutic trial with streptokinase.

Acute Disease↗
PubMedDate not supplied

Coagulolysis assay in the detection of deep vein thrombosis in the orthopedic patient. A preliminary report.

The recently developed coagulolysis assay was utilized in conjuction with fibrinogen uptake scanning to monitor 91 of 111 consecutive orthopedic patients scheduled for hip surgery or total knee replacement. Sixteen patients had abnormal coagulolysis assays and positive scans. Venography was performed in 15 of these patients, and deep vein thrombosis was documented in 12. Five patients developed pulmonary emboli, including one with negative venogram. Thus, over 80% of the patients in which both the coagulolysis assay and the fibrinogen scan were abnormal had additional documentation of deep vein thrombosis. In 41 patients, the coagulolysis assay was negative. Venograms were not routinely performed in this group. However, 3 patients developed pulmonary emboli indicating that deep vein thrombosis developed in this group. Only one patient had a normal coagulolysis with a positive fibrinogen scan. Venography documented a deep vein thrombosis. Thirty-three patients who had normal coagulolysis assays and negative fibrinogen scans also had no evidence of deep vein thrombosis or pulmonary embolism. The coagulolysis assay appears to be a safe, noninvasive study for the detection of deep vein thrombosis. There was only a one per cent false-negative incidence.

Blood Coagulation Tests↗
PubMed1975

Treatment of deep vein thrombosis with streptokinase.

From September 1962 to May 1972 145 patients with acute or subacute deep vein thrombosis confirmed by phlebography were treated with streptokinase. During the same period 42 patients considered unfit for thrombolytic therapy were treated with herapin and oral anticoagulants. The results, assessed by repeat phlebography, in 93 of the patients treated with streptokinase were compared with those in 42 patients treated with heparin. The age, sex, and severity of occlusion were roughly similar in both groups. Streptokinase treatment was successful in 42 per cent, partially successful in 25 per cent, and unsuccessful in 32 per cent of the 93 patients compared with none, 10 per cent, and 88 percent respectively in the 42 patients treated with heparin. Streptokinase was more effective when the thrombus was in proximal rather than calf veins. Thrombi of more than six days old were readily lysed. Plasma fibrinogen levels were below 0-8 g/1 (80 mg/100 ml) in nearly all patients successfully treated. The incidence of pulmonary embolism was no greater with streptokinase than with heparin treatment. Only prolonged follow-up would show whether thrombolytic treatment would be effective in preventing late complications of deep vein thrombosis such as chronic venous insufficiency.

Adult↗
PubMed1978

Oral anticoagulants controlled by the British comparative thromboplastin versus low-dose heparin in prophylaxis of deep vein thrombosis.

The British comparative thromboplastin (BCT) was used to monitor the effectiveness of oral anticoagulants in preventing deep vein thrombosis (DVT) in patients undergoing major gynaecological surgery. All patients were screened for DVT with the use of the (125)I-fibrinogen scan.One hundred and forty-five patients aged 40 years or more were randomised into three groups. Group 1 received oral anticoagulant (nicoumalone) treatment, stabilised over five days before surgery and continuing into the second postoperative week. The other patients served as two contrast groups and were managed on a double-blind basis. Group 2 received a subcutaneous low-dose regimen of heparin calcium. Group 3 received subcutaneous saline. Eleven of 48 patients in the saline group, three of 49 patients in the heparin group, and three of 48 patients in the oral anticoagulant group developed DVT as judged by (125)I-fibrinogen scanning. The incidences in groups 1 and 2 were significantly lower than in the saline group. The falls in haemoglobin concentration and incidence of haemorrhage were similar in all three groups.The study showed that oral anticoagulant prophylaxis stabilised preoperatively and low-dose heparin were equally effective in preventing deep vein thrombosis in a moderate-risk group. Immediate preoperative prothrombin ratios of 2.0-2.5 and postoperative ratios of 2.0-4.0 with the BCT gave adequate protection without increased haemorrhagic risk.

Acenocoumarol↗
PubMed1979

The incidence of deep vein thrombosis in Hong Kong Chinese after hip surgery for fracture of the proximal femur.

Fifty-three Hong Kong Chinese patients with fractures of the proximal femur have been studied after hip surgery using functional ascending phlebograms for evaluating deep vein thrombosis. There was an incidence of deep vein thrombosis of 53.1 per cent in the fractured limbs and 14.3 per cent in the uninjured limbs. The majority of thrombi (84.6 per cent) were located in the calf. No clinical or fatal pulmonary embolism was observed.

Adult↗
PubMed1978

131I-labeled fibrinogen in the diagnosis of deep vein thrombosis of the lower extremities.

Autologous 131I-labeled fibrinogen was administered to 17 patients during 19 episodes of suspected lower extremity deep vein thrombosis in an attempt to assess its diagnostic accuracy. Serial rectilinear scanning and probe counting of the lower extremities and pelvis were performed and compared with ascending contrast venography. The sensitivities of imaging and counting were 67% and 47%, respectively, and both had a specificity of 95%. The experience with evaluation of deep vein thrombosis of the pelvic and iliac veins was small but suggested that 131I fibrinogen will be of limited use in those vessels.

Fibrinogen↗
PubMed1977

The prevention of deep vein thrombosis, with particular reference to mechanical methods of prevention.

Mechanical methods of preventing deep vein thrombosis have been surveyed. The best means of preventing venous stasis has been shown to be by intermittent compression of the legs. Use of intermittent compression will prevent isotopically detectable deep venous thrombosis in 82 percent of patients and in malignancy in 90 percent of patients. The only other prophylactic measure of comparable effectiveness is administration of low-dose subcutaneous heparin. Intermittent compression need only be applied during the operation and is cheap, foolproof, and safe. Intermittent compression acts by squeezing empty the soleal sinuses and large valve pockets in the major veins in which thrombi form while venous flow is slowed during operation. A combination of intermittent compression and administration of low-dose subcutaneous heparin has been found to be no more effective than is intermittent compression alone.

Adult↗
PubMed1978

Occlusive impedance plethysmography. A noninvasive method of diagnosis of proximal deep vein thrombosis.

The purpose of this study was to assess and confirm the accuracy of impedance plethysmography (IPG) by the occlusive cuff method, in detecting proximal (popliteal, femoral and iliac) deep vein thrombosis in patients with symptomatic limbs. In 27 patients 30 consecutive limbs were studied with concurrent venography and IPG. The IPG result was normal in 9 of 9 limbs which were normal on venography, and abnormal in 15 of 16 limbs which showed venographic evidence of proximal deep vein thrombosis (DVT). An abnormal IPG strongly suggests proximal DVT (predictive value 0.88). A normal IPG virtually rules out proximal DVT (predictive value 1.0).

Adult↗
PubMed1975

Treatment of deep-vein thrombosis with intermittent streptokinase and plasminogen infusion.

17 consecutive patients who presented with extensive deep-vein thrombosis, confirmed by phlebography, were included in this study. Of 12 patients who received streptokinase and plasminogen infusion, complete lysis of thrombi was obtained in 8 and partial but extensive lysis in 4. In contrast, thrombi remained unchanged in each of 5 patients who received the same doses of streptokinase infusion only.

Adult↗
PubMed1978

Vascular-laboratory diagnosis of clinically suspected acute deep-vein thrombosis.

Doppler ultrasound, impedance plethysmography, and contrast venography were performed in 207 lower limbs suspected of harbouring deep-venous thrombosis, to clarify the diagnostic value and limitations of the non-invasive methods. Doppler ultrasound and impedance plethysmography were accurate in 96% and 95% of normal limbs, respectively. In limbs with venographic evidence of thrombosis requiring treatment, Dopper ultrasound and impedance plethysmography correctly detected thrombosis in 60% and 97%, respectively. Doppler ultrasound was 97% accurate in recognising chronic venous insufficiency. Impedance plethysmography was incorrectly positive in 74% of limbs with chronic venous insufficienv cy which had no venographically detected thrombosis. These findings suggest that, for the accurate diagnosis of clinically suspected deep-vein thrombosis, venography is necessary only in patients with chronic venous insufficiency who have normal Doppler ultrasound tests and abnormal impedance plethysmograms and in patients with abnormal cardiac haemodynamics. In this series, 86% of limbs would have been spared venography had non-invasive tests been used. Venography, however, remains the standard test for the detection of minor calf-vein thrombosis. A diagnostic and therapeutic schema is proposed.

Chronic Disease↗
PubMed1979

Ultrasound and clinical diagnosis of deep vein thrombosis of the leg.

The diagnostic precision of clinical evaluation and of ultrasound examination in the diagnosis of deep vein thrombosis was obtained by ascending phlebography. The diagnostic specificity and diagnostic sensitivity of clinical examination was 0.72 and 0.78 and with ultrasound 0.73 and 0.70. With no other examination than phlebography is it possible to demonstrate major central thrombosis in the leg with certainty.

Aged↗
PubMed1979

Audit of anticoagulant therapy of pulmonary embolus, deep vein thrombosis and thrombophlebitis.

The use of heparin sodium and warfarin sodium in the treatment of pulmonary embolus (PE), deep vein thrombosis (DVT) and thrombophlebitis (TP) was studied by a hospital pharmacy department. During a four-month period, the charts of 26 patients were audited for anticoagulant dosages used; laboratory test monitoring of anticoagulant dosage used; laboratory test minitoring of anticoagulant therapy; complications of, contraindications to, and patient compliance with anticoagulant therapy. These variables were evaluated on the basis of compliance with a written anticoagulant protocol. Initial doses of heparin sodium and warfarin sodium were acceptable in 43% of patients. Maintenance dosing with heparin sodium was acceptable in 89% of patients. Activated partial thromboplastin times (APTT) were ordered correctly for 65% of patients. APTTs were within therapeutic ranges in 31% of patients. The duration of heparin-warfarin overlap was possibly to definitely acceptable in 71% of patients. Prothrombin times were properly monitored in 50% of patients. Complications of anticoagulant therapy were evident in only one patient. There were a number of potentially serious diversions from the protocol. The pharmacy department planned to issue bulletins designed to correct the problems.

Adult↗
PubMed1977

Comparison of postoperative coumarin, dextran 40 and subcutaneous heparin in the prevention of postoperative deep vein thrombosis.

A double-blind study was carried out to investigate the effectiveness of several preventive regimens in postoperative deep vein thrombosis (DVT). The regimens consisted of postoperative (p.o.) acenocoumarin, dextran 40 + p.o. acenocoumarin, subcutaneous (s.c.) heparin alone and s.c. heparin + p.o. acenocoumarin. The 313 patients studied were stratified according to age (40-60 vs. less than 60 years) and type of operation (laparotomy, thoracotomy, hip replacement). Dextran 40 + p.o. acenocoumarin was more effective than p.o. acenocoumarin alone, which acted as control. Subcutaneous heparin alone or together with p.o. acenocoumarin was not more effective than p.o. acenocoumarin alone during the first part of the study, when about 4000 IU twice daily were administered accidentally. When the dose had been changed to 5000 IU twice daily, better results were obtained (DVT) incidence 5.9%). The results were strongly influenced by age and type of operation. Almost no DVT occurred in patients below 60 years of age with elective abdominal surgery. The incidence of perfusion disturbances in lung scans in patients with DVT was lowest in those treated with s.c. heparin in combination with acenocoumarin.

Adult↗
PubMed1978

beta-thromboglobulin and deep vein thrombosis.

The measurement of plasma beta-thromboglobulin as a potential diagnostic test for venous thrombosis has been investigated in 16 normal volunteers, 24 patients presenting with deep vein thrombosis (DVT) or pulmonary embolism and 46 patients screened by 125I fibrinogen test (IFT) for post-operative DVT. The normal mean was 33 ng/ml (range 15-117 ng/ml). Of the 24 patients with clinical thrombotic disease 22 presented with DVT confirmed by phlebogram or IFT and 2 presented with embolism confirmed by lung scan. At the time of first presentation 12 out of 24 had betaTG values greater than 70 ng/ml. All except 3 of this group of 24 patients had values of greater than 70 ng/ml at some stage during a subsequent week of daily sampling. DVT was detected in 13 out of 46 screened post-operative patients. There was a rise om betaTG observed within 24 hr of the IFT becoming positive but the mean rise did not reach significance at the 5% level. An association between DVT and high betaTG values has been confirmed. However, its clinical value cannot yet be fully elucidated until factors, probably related to blood sampling and clearance, are further investigated.

Beta-Globulins↗