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)

In 1988 and 1989 4581 patients had been hospitalized in the surgical department of the Stadtkrankenhaus Neuwied. These patients were treated prophylactically with a combination of low molecular weight heparin and dihydroergotamine in order to prevent deep vein thrombosis. The observed incidence of DVT and pulmonary embolism was extremely low. In patients who died during hospitalization, death was mainly caused by cancer or multimorbidity. Although some risk factors for developing DVT are recognized, we are at present not able to calculate the individual risk of a patient. Therefore, we need an effective and safe prophylaxis regimen for all patients undergoing surgical operations.
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PMID:[Can the individual risk of the patient for thromboembolic complications be estimated? What references can be used for differential therapeutic procedure?]. 198 3

Protein C (PC) is the central component of a major antithrombotic regulatory system with both anticoagulant and profibrinolytic properties. A deficiency of PC is one of several hereditary abnormalities of haemostatic proteins that have been described in patients with a propensity for thromboembolic complications. Major morbidity is often seen in these patients. The various aspects of hereditary PC deficiency in terms of clinical presentation, genetics, diagnosis and treatment of both homozygous and heterozygous states will be presented. In heterozygous deficiency, the levels of plasma PC are usually between 35% and 65% of normal, whereas the majority of normal individuals have levels between 70% and 130%. PC-deficient patients usually develop venous thrombotic complications between the ages of 15 and 40 years with a high incidence of DVT and pulmonary embolism. The majority of thrombotic lesions appear to develop spontaneously; others are associated with trauma, surgery or pregnancy. Treatment of symptomatic patients is initial heparin therapy followed by coumadin. After multiple thrombotic events, lifelong oral anticoagulant therapy is necessary. The potential complications of treatment are coumadin-induced skin necrosis, heparin-induced thrombocytopenia and bleeding. Homozygous PC deficiency, a rare but fatal hereditary condition, manifests itself with massive DIC and purpura fulminans in the newborn period. Effective treatment for these infants can be instituted with either oral anticoagulant therapy or PC replacement. The heterozygous deficiency of PC is similar to that found in other inherited disorders in that several genetic mechanisms are responsible for the expression of the disease. Both quantitative and qualitative decreases in PC exist, the former being type I deficiency and the latter, type II. The best initial diagnosis of either form involves a clotting (functional) assay while differentiation between the two also requires an antigenic (immunological) assay. Autosomal inheritance with significant variable penetrance is found with profound clinical implications. In summary, PC deficiency is one of a group of inherited disorders termed hereditary thrombotic disease, which may have serious implications for patient morbidity and mortality.
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PMID:Hereditary protein C deficiency: a review of the genetics, clinical presentation, diagnosis and treatment. 210 16

Five hundred indium-111 labeled platelet imaging studies (387 donor and 113 autologous) were performed postoperatively in 473 patients who had undergone total hip replacement, total knee replacement, or internal fixation of a hip fracture to detect occult deep venous thrombosis. All patients had been anticoagulated prophylactically with aspirin, warfarin sodium (Coumadin), or dextran. Thirty-four possible cases of proximal deep venous thrombosis were identified in 28 asymptomatic patients. To verify the scan results, 31 venograms were performed in 25 patients (three refused). In 21 of 31 cases, totally occlusive thrombi were detected; in 5 cases, partially occlusive thrombi were detected; in 5 cases, no thrombus was seen. No patient who had a negative scan nor any patient who had a verified positive scan (and received appropriate heparin therapy) subsequently developed symptoms or signs of pulmonary embolism. One hundred forty-one indium study patients also underwent Doppler ultrasonography/impedance plethysmography (Doppler/IPG) as a comparative non-invasive technique. In 137 cases, the results of the indium study and Doppler/IPG studies were congruent. The indium study had no false negative results that were detected by Doppler/IPG. No patient had any clinically evident toxicity. These results suggest that indium-111 labeled platelet scanning is a safe, noninvasive means for identifying DVT in high risk patients.
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PMID:The use of indium-111 labeled platelet scanning for the detection of asymptomatic deep venous thrombosis in a high risk population. 268 88

Eighty patients undergoing pelvic or abdominal surgery for cancer were randomized in two groups for prevention of postoperative thromboembolism: 40 patients received a 15,000 IU day-1 Calciparine prophylaxis and 40 patients a 5000 anti-Xa U/d Fragmin prophylaxis for 10 days. In the Calciparine group, two patients (5%) developed postoperative pulmonary embolism but none developed it in the Fragmin group. Two patients in the Fragmin group (5%) developed isotopic DVT, which was not confirmed by phlebography. There was no deep vein thrombosis of the lower limbs in the two groups. Important postoperative bleeding (one patient in the Calciparine group and two patients in the Fragmin group) was similar in both groups. Moderate and minor bleeding were significantly lower in the Fragmin group. Haemoglobin and haematocrit changes, total blood loss and transfusion requirements were not different in both groups. It is concluded that, over a 10-day period, one daily 5000 U Fragmin prophylaxis was as effective and safe as three daily 5000 IU Calciparine injections.
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PMID:Low dose heparin versus low molecular weight heparin (Kabi 2165, Fragmin) in the prophylaxis of thromboembolic complications of abdominal oncological surgery. 285 11

A pneumatic compression device was applied to 155 patients with a normal Doppler venous examination who underwent a general surgical procedure of at least 1 hr in duration. One hundred fifty-three patients had neither PE nor DVT clinically or by Doppler studies, one patient had a venographically proven DVT, and one patient had a clinical pulmonary embolism verified by lung scanning. Using clinical and Doppler criteria, the device was effective in the prophylaxis of thromboembolic complications.
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PMID:Pneumatic compression devices for prophylaxis of deep venous thrombosis (DVT). 294 68

Although the exact cause of DVT is not known, venous thrombosis and its sequelae remain important clinical problems. Pulmonary embolism is a significant cause of morbidity and mortality in the hospitalized population, and the postthrombotic syndrome affects a large portion of the general population. While specific screening tests are not readily available to detect those patients who are likely to develop DVT, certain clinical risk factors have been identified that predispose to thrombosis. These groups include patients undergoing a wide variety of surgical procedures, patients with cardiac disease or cancer, pregnant or postpartum women, and individuals with previous history of DVT. The diagnosis of thrombosis is based on clinical findings and must be confirmed with appropriate laboratory tests. While contrast venography remains the gold standard, noninvasive tests have become increasingly more accurate. The recent use of real-time B-mode ultrasonic imaging and duplex sonography for the diagnoses of DVT has been shown to be efficacious. The postthrombotic syndrome with its associated chronic pain and ulcerations remains a significant clinical problem. The general diagnosis of this condition is readily made on clinical grounds in the advanced state. However, exact knowledge of the location and cause of the venous pathology can only be obtained using objective diagnostic tests. Older noninvasive and invasive tests may diagnose the presence of venous obstruction, valvular incompetence, and also may document venous hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Venous thrombosis: the clinical problem. 307 72

The purpose of this study was to analyze the various factors that influence the anatomical site of occurrence of DVT and to determine if the clinical course differed in patients afflicted with DVT at different anatomical sites in the lower extremity. Forty four of 92 patients undergoing venography during a 4-1/2 year period had positive venograms for DVT. Patients were grouped into one of three categories: iliofemoral thrombosis (IFT) n = 9, superficial femoral vein thrombosis with or without distal thrombosis (SFV) n = 21, and popliteal/calf thrombosis (clot limited to below the knee) (PCT) n = 14. Patients in the IFT group had a significantly prolonged hospital stay (p less than .05) and a significantly lower mean weight (129 lbs) when compared to the PCT group (173 lbs) (p less than .05). Pain was present equally among the three groups. Swelling was much more common in the SFV group, whereas tenderness was most frequent in the PCT group. Of those patients with swelling, 70% were in the SFV group and of those patients with tenderness, 60% were in the PCT group. DVT as the primary diagnosis was seen in 39% of cases of which half had disease limited to the PCT region. Post-op DVT occurred equally among the groups. DVT occurred much more frequently in the PCT region after myocardial infarctions and after orthopedic procedures, whereas in patients with malignancies, the most common site was the SFV region. Pulmonary embolism developed in 11% of patients and occurred in the IFT and SFV groups only. No patient with DVT of the calf/popliteal developed a pulmonary embolism.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Regional anatomical differences in the venographic occurrence of deep venous thrombosis and long-term follow-up. 318 22

To study the incidence of deep venous thrombophlebitis (DVT) and pulmonary embolism (PE) in patients with multiple sclerosis (MS), charts of 228 subjects with multiple sclerosis who constituted 1986 hospital admissions to the Milwaukee Regional Medical Center were reviewed, covering a 3 1/2-year period. The records were investigated for any other hospitalization for deep venous thrombophlebitis and pulmonary embolism. No case of pulmonary embolism or deep venous thrombophlebitis was found. There were over 57,416 non-MS-related admissions during the same interval. Among these patients there were 175 with PE and 258 with DVT. The presence of lower extremity spastic disease may have prevented clotting. This statistically low incidence of thromboembolic events in MS is less than expected, and further studies are warranted.
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PMID:Are patients with multiple sclerosis protected from thrombophlebitis and pulmonary embolism? 326 61

Chromogenic substrate (CS) assay of heparin may be performed with or without addition of antithrombin (AT) to the test plasma. Both types of assay are used for monitoring of heparin therapy, reflecting either heparin activity (heparin act), or heparin concentration (heparin conc) when AT is added. In plasma samples from 43 patients treated with intravenous heparin for DVT, the ratio between heparin act and heparin conc varied from 0.36 in patients with AT plasma concentration below 0.50 U/ml, to 0.85 in patients with AT above 1.00 U/ml (mean ratio 0.61). A formula expressing heparin act as a function of AT and heparin concentration in the test plasmas of the patients was used to calculate heparin act of the total material comprising 280 patients. Mean heparin act and heparin conc were both significantly correlated to clinical outcomes (bleeding complications, pulmonary embolism and phlebography score). For monitoring heparin therapy, guidelines for plasma heparin activity or concentration ("therapeutic ranges") are requested. When using a heparin act assay, the heparin dose needed in patients with low plasma AT concentration to reach a fixed therapeutic range, may imply undue risk of bleeding. On the other hand, when a heparin conc assay indicate plasma heparin conc within therapeutic range, antithrombotic activity may still be inadequate in patients with low plasma AT concentration.
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PMID:Monitoring of heparin therapy: should heparin assays also reflect the patient's antithrombin concentration? 362 42

The efficacy and safety of a low-molecular-weight (LMW) heparin fraction in preventing postoperative venous thrombo-embolism, was assessed in a double blind, randomly allocated trial, and in an 'open' study. Of 395 patients included in the double blind trial, 199 received unfractionated (UF) calcium heparin, and 196 the LMW heparin fraction. The data were analysed on an 'intention to treat' basis. The two groups were well matched for risk factors which could predispose to the development of venous thrombosis. Fifteen (7.5 per cent) of one hundred and ninety-nine patients receiving UF heparin, and five (2.5 per cent) of one hundred and ninety-six patients in the LMW heparin group developed DVT (P less than 0.05). There was no significant difference between the two groups in terms of excessive incisional or total blood loss during surgery, postoperative drainage or wound haematoma formation. Of 910 patients included in the 'open' study who received a single injection of LMW heparin every day, 30 (3.2 per cent) died during the postoperative period; in none of the autopsied patients were pulmonary emboli detected. Thirty-one (3.4 per cent) patients developed isotopic DVT; twenty-seven (2.9 per cent) were receiving prophylaxis at the time the DVT was diagnosed. Thirty-six (3.9 per cent) patients developed wound haematoma; twenty-five (12.4 per cent) of those were in the two hundred and one undergoing surgery for gynaecological conditions, and eleven (1.5 per cent) in the seven hundred and nine patients having general abdominal surgery. This difference is statistically significant (P less than 0.001). The results of a double blind trial indicate that a single daily injection of 1850 APTT units (7500 antifactor Xa units) of a LMW heparin is more effective than 10 000 APTT units of commercially available UF heparin in preventing postoperative DVT. The findings of the 'open' study suggest that this regimen also provides an effective prophylaxis against post-operative major pulmonary embolism.
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PMID:Efficacy and safety of low-molecular-weight heparin (CY216) in preventing postoperative venous thrombo-embolism: a co-operative study. 389 40


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