Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One hundred fifty seven consecutive octogenarians (mean age +/- standard deviation, 82.4 +/- 1.9 years) underwent coronary artery bypass grafting with hypothermia (mean temperature, 21.8 degrees +/- 1.8 degrees C), hyperkalemic cardioplegia, and cardiopulmonary bypass in a 9-year period. Sixty-six percent were male. Preoperatively, 115 patients (73%) were in New York Heart Association functional class IV, with the remainder being in either class III (23%) or class II (4%). Twenty percent of the patients had major complications including postoperative hemorrhage (15), sepsis (9), cerebrovascular accident (6), third-degree heart block (5), renal failure requiring dialysis (1), and pulmonary embolism (1). The 30-day or in-hospital mortality rate was 7.0%. Mean total hospital stay was 26.1 +/- 17.9 days. One-year and 5-year actuarial survival rates were 85% and 62%, respectively. Higher mortality was seen to be associated with New York Heart Association class IV, left ventricular ejection fraction less than 0.40, and lesser values for cardiac output and cardiac index. At the 6-month postoperative follow-up, 73% of the survivors reported that their general health had improved as compared with before operation. This experience demonstrates that for select octogenarians with unmanageable angina pectoris, coronary artery bypass grafting is an effective therapeutic option.
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PMID:Morbidity and mortality after coronary artery bypass in octogenarians. 203 31

In 539 consecutive stroke patients admitted to a rehabilitation department, we studied the possible role of atrial fibrillation as a risk factor for deep venous thrombosis and pulmonary embolism by analyzing a series of relevant clinical data in patients with and without atrial fibrillation and in patients with and without venous thromboembolic complications. Deep venous thrombosis as well as advanced age and cardiac disease were significantly (p less than 0.001) more frequent in patients with atrial fibrillation. However, in a model of simultaneous logistic regression carried out on the presence of absence of venous thromboembolic complications, atrial fibrillation was the only significant risk factor. In view of the morbidity and mortality linked to deep venous thrombosis, our findings argue for preventive anticoagulation therapy in stroke patients suffering from atrial fibrillation and merit further study.
Stroke 1991 Jun
PMID:Atrial fibrillation as a risk factor for deep venous thrombosis and pulmonary emboli in stroke patients. 205 76

In patients with ischemic stroke the risk of provoking hemorrhagic infarction must be balanced against the risk of deep vein thrombosis and potential pulmonary thromboembolism. In a retrospective study we reviewed the records of 262 ischemic stroke patients admitted in 1984 and of 315 patients admitted in 1988. In 1984 only six (2.3%) patients were treated with low-dose subcutaneous heparin, while 126 (40%) in 1988. In 1984 seventy-five (28.6%) patients died and in 48 of them post-mortem examination was performed, while in 1988 seventy-four (23.5%) patients died and in 30 of them the autopsy was performed. Pulmonary embolism was revealed in 25 patients on post-mortem examination in 1984 and none of them was treated with heparin. In 1988 only eight patients (two were on heparin) had pulmonary embolism. Hemorrhagic infarction was found in only seven cases (only two of them were on heparin) of all pathological examinations. We conclude that preventive low-dose subcutaneous heparin is safe and effective in decreasing mortality due to pulmonary embolism in patients with ischemic stroke.
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PMID:Low-dose subcutaneous heparin decreases mortality from pulmonary embolism in patients with ischemic stroke. 207 30

The effectiveness and safety of a very low molecular weight heparin fraction were evaluated in the prevention of deep-vein thrombosis in patients confined to bed due to hemiplegia consecutive to a recent cerebral infarction. CY 222 was administered within 48 hours of the stroke by one single daily subcutaneous injection of 0.6 ml (= 15,000 U AXa IC) during 14 days. This randomized pilot study involved 30 patients. The effects of CY 222 were assessed in a group of 15 patients compared with a control group of 15 untreated patients. No deep-vein thrombosis was detected by the labelled fibrinogen test in the treated group, as against 12 patients in the control group. Six patients (3 in each group) died during the study. One case of lethal pulmonary embolism was observed and confirmed at autopsy in the control group. In the remaining 5 patients, no systematic autopsy which would have asserted the absence of pulmonary embolism or drug-induced haemorrhage was performed. Numerous standard laboratory tests confirmed that CY 222 was well tolerated.
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PMID:[Prevention of deep venous thrombosis of the leg by a very low molecular weight heparin fraction (CY 222) in patients with hemiplegia following cerebral infarction: a randomized pilot study (30 patients)]. 215 40

Low molecular weight heparins (LMWHs) have been prepared from unfractionated heparin by means of different fragmentation or fractional procedures with the aim of obtaining a more effective and/or safer antithrombotic agent than standard heparin (SH). LMWHs resulting from different production procedures are structurally heterogeneous; this could account for the different efficacy and safety observed clinically. Many clinical trials have been carried out on the prevention of deep-vein thrombosis (DVT) and pulmonary embolism in patients undergoing major abdominal or orthopedic surgery, hemodialysis or affected by non-hemorrhagic stroke. Moreover, experience is accumulating on the use of LMWHs in the treatment of DVT. LMWHs have been shown to be an effective antithrombotic agent in preventing DVT in general surgery when compared to placebo. Furthermore, CY 216, given once daily, is at least as effective as standard heparin given twice or three times daily. In two studies CY 216 was more effective than standard heparin. However, the promising experimental findings that LMWHs produce less bleeding than standard heparin have not been proved yet. There is convincing evidence that PK 10169 is effective in preventing DVT in patients undergoing hip surgery. In one study PK 10169 was more effective than standard heparin. Both ORG 10172 and KABI 2165 were effective in the prevention of DVT in patients with stroke but the safety in terms of bleeding remains to be established. The role of LMWHs in DVT treatment has yet to be established. The dose of LMWHs which offers the best risk-benefit ratio must be established for each compound before LMWHs are accepted as standard prophylaxis or treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Low molecular weight heparins]. 216 9

Low molecular weight heparins (LMWHs) have been prepared by means of different fragmentation or fractionation procedures with the aim of obtaining a more effective and/or safer antithrombotic agent than standard heparin (SH). LMWHs resulting from different production procedures are structurally heterogeneous; this could account for the different efficacy and safety observed clinically. Many clinical trials have been carried out on the prevention of deep-vein thrombosis (DVT) and pulmonary embolism in patients undergoing major abdominal or orthopedic surgery, hemodialysis or affected by non-hemorrhagic stroke. When given once daily, LMWHs are at least as effective in all indications as SH given twice or three times daily and some of them resulted even more effective than SH in general and in orthopedic surgery. The role of LMWHs in the treatment of DVT and their superiority over SH in terms of bleeding remain to be established.
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PMID:Clinical experience with low molecular weight heparins. 217 77

Plasma protein C exerts anticoagulatory effects by inactivating factors V and VIII. Hereditary protein C deficiency is transmitted as an autosomal dominant disorder. Homozygous individuals usually develop purpura fulminans as newborns; heterozygous protein C-deficient individuals are at increased risk for venous thrombosis and pulmonary embolism. However, arterial thrombosis has been only rarely observed. We describe a young patient with heterozygous protein C deficiency who experienced a severe stroke due to thrombotic occlusion of the left middle cerebral artery.
Stroke 1990 Jul
PMID:Ischemic stroke due to protein C deficiency. 219 15

Epidemiologic studies carried out in the UK in the late 1960s and 1970s suggested a strong link between oral contraceptive (OC) use and certain cardiovascular diseases. Most striking was the increased risk (2-4 times) of myocardial infarction in OC users compared to nonusers. OC use was also associated with a greater than average risk of subarachnoid hemorrhage, thrombotic stroke, and fatal pulmonary embolism. It is important, however, to reassess these risks in light of changes that have occurred since these early studies. Most notably, the OCs currently being marketed contain lower estrogen/progestin dosages than earlier formulations and the majority of OC use is concentrated in the under 30 year age group. In fact, preliminary results from a case- control study begun in 1968 suggest that the risk of OC-related myocardial infarction has dropped in recent years as a result of these changes. At present, data have been analyzed for 130 cases 16-39 years of age who died of myocardial infarction and an additional 237 women who died of subarachnoid hemorrhage. 24% of the myocardial infarction cases were OC users at the time of death compared to 19% of matched controls. This produces a relative risk of 1.8 for OC users, which is statistically significant yet lower than that identified in earlier studies. The data confirm that cigarette smoking is another important risk factor for myocardial infarction; the risk increased nearly 12-fold in smokers compared to nonsmokers. The risk of myocardial infarction in women who both smoked and used OCs was increased over 50-fold. The risk of subarachnoid hemorrhage was 1.4 in the current study, which is similar to that found in earlier research; again, the risk was greater among OC users who smoked.
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PMID:An epidemiologic survey of cardiovascular disease in women taking oral contraceptives. 219 99

In a prospective, community-based study of 675 consecutive patients with a first-ever stroke, of whom over 90% had computed tomography (CT) and/or necropsy examinations, 129 deaths occurred within 30 days of the onset of symptoms, a case fatality rate (CFR) of 19%. The 30 day CFR for patients with cerebral infarction was 10% (57 of 545, for primary intracerebral haemorrhage 52% (34 of 66), for subarachnoid haemorrhage 45% (15 of 33) and for those of uncertain pathological type 74% (23 of 31). The CFR for patients who had been functionally dependent pre-stroke was 33% compared with 17% for those who had been independent pre-stroke. The age-adjusted relative risk of death for patients who had been functionally dependent pre-stroke was not significantly greater (1.8, 95% confidence interval 0 to 4.3). There was a significant trend for CFR to increase with age (Chi square for trend = 4.0, p less than 0.05). This relationship was found in those patients who had been functionally independent prestroke (Chi square for trend = 7.9, p less than 0.005) but not in those who had been dependent pre-stroke (Chi square for trend = 0.5, NS). The pattern of increasing CFR with increasing age amongst those who had been independent prestroke was seen particularly in patients with cerebral infarction (Chi square for trend = 8.6, p less than 0.005). The age-adjusted relative risk of death for patients with cerebral infarction who had been functionally dependent pre-stroke was 2.2 (95% confidence interval 1.2 to 4.1). Fifty three percent of all deaths within 30 days of stroke were due to the direct neurological sequelae of the stroke. Patients with primary intracerebral or subarachnoid haemorrhages were significantly more likely to die in this way than those with cerebral infarction (relative risk 4.1; 95% confidence interval 3.4-4.9) and 56% of such deaths occurred within 72 hours of onset. In patients with cerebral infarction, 51% of deaths were due to complications of immobility (for example, pneumonia, pulmonary embolism) and these were more likely to occur after the first week. These findings have implications for clinical practice and the planning of clinical trials.
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PMID:The frequency, causes and timing of death within 30 days of a first stroke: the Oxfordshire Community Stroke Project. 226 60

Nurses administering heparin should be aware that arterial or venous heparin-induced thrombosis may be a paradoxical effect of the heparin itself and can result in stroke, myocardial infarction, pulmonary embolism, loss of limb, and even death.
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PMID:White clot syndrome: a life-threatening complication of heparin therapy. 222 68


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