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)

There is renewed interest in the use of operative thrombectomy in the management of acute DVT using the adjuncts of heparin infusion through an indwelling catheter and pneumatic segmental compression of the leg. In the absence of phlegmasia cerulea dolens, however, the indication for thrombectomy remains unresolved. For the postthrombotic syndrome, the most widely accepted procedure is the Palma femorofemoral cross-over bypass, which is indicated for relief of persistent unilateral iliac venous obstruction. Venous valvular incompetence is a much more challenging problem for which some limited success has been achieved by direct valvuloplasty, venous transposition, and autologous vein valve transplantation. For the most serious complication of venous thrombosis, pulmonary embolism, the evolution of mechanical devices has eliminated the need for direct approaches to the vena cava, and the long-term results with the Greenfield filter allow it to be placed in either an infrarenal or suprarenal position with assurance of long-term patency.
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PMID:Current status of surgical therapy for deep vein thrombosis. 390 93

A piroxicam-warfarin interaction is presented with a discussion of the possible mechanism of action. A 60-year-old white male on warfarin therapy for recurrent pulmonary embolism and deep venous thrombophlebitis showed a decrease in his previously therapeutic and stable prothrombin time when piroxicam was discontinued from his drug regimen. On two rechallenges over a ten-month period, his prothrombin times showed consistent and clinically significant fluctuations as piroxicam was added and deleted from his drug regimen.
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PMID:A warfarin-piroxicam drug interaction. 402 61

The authors report the case of an active 32 year old man who developed right leg DVT. Before heparinisation, he was discovered to have a low antithrombin III level (biological activity (B) 60%, immunological level (I) 50) and a further inquiry showed the same abnormality in 4 members of the family, leading to a diagnosis of a congenital deficit: a 35 year old sister with a bilateral post-DVT changes had antithrombin III levels of 70% (B) and 45% (I); two nephews, sons of the affected sister: the one aged 5 years was asymptomatic despite antithrombin III levels of 50% (I) and 70% (B); the other had experience DVT at the age of 2 and, on oral anti-vitamin K drugs, had antithrombin III levels of 55% (I) and 67% (B) at the age of 15 years; the patient's brother died at the age of 29 of cerebral vein thrombosis after pulmonary embolism. The recurrence of local signs of DVT after 12 day's heparin therapy with AT III levels (B) of 40%, led to a change in management with infusion of purified AT III concentrate at a dose of 40 U per kg (2 500 U per hour). This induced a rise in AT III activity to over 100% and enabled early introduction of anti-vitamin K therapy. The patient remains asymptomatic after 6 months follow-up. This case illustrates the value of determining AT III activity in all patients who developed DVT without obvious reason.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Treatment of deep venous thrombosis in the presence of a congenital antithrombin III deficiency. Apropos of the use of purified concentrates]. 643 83

A prospective study of thrombo-embolism after total hip replacement in epidural analgesia was carried out in 116 patients, randomly allocated to dextran 70 or low-dose heparin combined with dihydroergotamine (HDHE). Amounts of blood loss and transfused bank blood did not differ significantly between dextran 70 and HDHE prophylaxis. There was a lower incidence of femoral deep vein thromboses in patients given dextran prophylaxis as compared with those on HDHE (P less than 0.05). However, the total frequency of DVT and the frequency of pulmonary embolism did not differ between the two groups. There was no case of fatal pulmonary embolism. The side effects were major bleeding complications in 7 per cent of the HDHE group as compared to none in the dextran group. No anaphylactic reaction was noted from dextran 70 using hapten-dextran prophylaxis.
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PMID:On thrombo-embolism after total hip replacement in epidural analgesia: a controlled study of dextran 70 and low-dose heparin combined with dihydroergotamine. 668 74

The composition and use of oral contraceptives (OCs) have changed since their cardiovascular side-effects were established 20 years ago. This report describes the risk of idiopathic venous thromboembolic (VTE) events (deep vein thrombosis [DVT] and/or pulmonary embolism [PE]) in association with current use of combined OCs among 1143 cases aged 20-44 and 2998 age-matched controls, as evaluated in a hospital-based, case-control study in 21 centres in Africa, Asia, Europe, and Latin America. OC use was associated with an increased risk of VTE in Europe (odds ratio 4.15 [95% CI 3.09-5.57]) and in non-European ("developing") countries (3.25 [2.59-4.08]). Risk estimates were generally higher for DVT than for PE but no consistent trend by certainty of diagnosis (definite, probable, possible) was found. Increased risk was apparent within 4 months of starting OCs, was unaffected by duration of current episode of OC use, and had disappeared within 3 months of stopping OCs. Relative risk estimates of VTE associated with OC use were unaffected by age of user, by history of hypertension (excluding hypertension in pregnancy), or in any consistent way by smoking. However, in both groups of countries increased body mass index (BMI) was an independent risk factor for VTE, and OC-associated odds ratios were higher among those with a BMI above 25 kg/m2 than among those with smaller BMIs. OC-associated risk estimates were high among women in Europe with a history of hypertension in pregnancy. Odds ratios associated with the use of OCs containing a third-generation progestagen were higher than those observed with progestagens of the first (norethindrone type) and second (norgestrel group) generation. Odds ratios associated with first and second generation progestagens tended to be lower, though not significantly, when used in combination with low (< 50 micrograms oestrogen) rather than higher oestrogen doses. This study confirms an association between OC use and VTE in Europe and the developing countries, although overall risk estimates associated with use were lower than demonstrated in most previous studies of non-fatal idiopathic VTE.
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PMID:Venous thromboembolic disease and combined oral contraceptives: results of international multicentre case-control study. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. 1056 Jun 79

Dermatan sulphate catalyses thrombin inhibition by heparin cofactor II; it has a lower haemorrhagic to antithrombotic ratio than that of heparin in animal models. Consecutive patients aged forty years or more, electively undergoing total hip replacement under general anaesthesia, were randomly allocated to one of three dosage regimens of dermatan sulphate (MF701, Mediolanum Farmaceutici) given intramuscularly. These were 200 mg once daily (n = 50), 200 mg twice daily (n = 52) and 300 mg twice daily (n = 51), administered from twenty-four hours pre-operatively until the tenth postoperative day. The overall incidence of DVT assessed by bilateral venography was 53%, 51% and 34% respectively (Chi-square test for trend p = 0.06). The incidence of major proximal DVT was 10.6%, 8.5% and 2.1% respectively. Pulmonary embolism (PE) and bleeding were assessed in all 153 patients. There was one case of PE in each dose group. The incidence of bleeding episodes, volume of blood lost and blood transfusion requirements were low and showed no increase with increasing dose. The patients were followed up 4-8 weeks after discharge. We conclude that the two lower doses were subtherapeutic in this population, however dermatan sulphate given 300 mg twice daily, proved to be efficacious with an incidence of proximal major DVT of 2.1% and a low incidence of bleeding complications. A trial of dermatan sulphate 300 mg twice daily compared to standard prophylactic agents is needed.
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PMID:A dose ranging study to evaluate dermatan sulphate in preventing deep vein thrombosis following total hip arthroplasty. 774 Apr 43

Recognition of the accuracy of CUS for diagnosis of DVT has led to increased requests for bilateral lower extremity CUS studies. Compared to unilateral lower limb CUS studies, these examinations are often requested when the clinical suspicion of DVT is less strong. We undertook a 15 month prospective study of bilateral lower extremity CUS examinations to determine the diagnostic yield of positive studies and any correlation with clinical parameters. Eighty-six patients were studied; six patients (7%) had studies positive for acute DVT, and 78 patients (91%) had negative studies. Positive studies did not correlate with clinical parameters except erythema. Concurrently, 23% of unilateral lower limb sonographic studies were positive. Bilateral lower limb CUS is a low yield investigation, which may be indicated in view of the morbidity and mortality associated with DVT and pulmonary embolism.
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PMID:Bilateral lower extremity evaluation of deep venous thrombosis with color flow and compression sonography. 793 53

Oral anticoagulants are generally accepted as secondary prophylaxis in patients with thromboembolic disease. Long term oral anticoagulant treatment of 24 survivors of clinically acute massive pulmonary embolism (AMPE) was assessed. There were following indications for such a treatment: recurrent PE/DVT in history and/or continuous risk factors. In the group of survivors of AMPE with continuing risk factors or the recurrence of that disaster the long-term oral anticoagulant therapy is effective, relatively safe and therefore justified.
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PMID:[Secondary prevention by using oral anticoagulants in patients with clinically acute massive pulmonary embolism]. 806 40

Trauma patients are at risk for thromboembolic complications, but effective methods of prophylaxis have not been established for this heterogenous population. In this prospective trial, 400 trauma patients were assigned to one of three groups, depending upon their injuries, and randomized within each group to a treatment mode: Group I: sequential gradient pneumatic leg compression (SCD), low-dose subcutaneous heparin (H), or control (C); Group II: H or C; Group III: SCD or C. Venous duplex ultrasound examinations were performed on admission and weekly thereafter. Of the 251 patients who completed the study, 15 (6%) developed lower extremity venous thrombosis and two additional patients developed pulmonary embolism (one fatal). Significant risk factors associated with the development of thromboembolism included immobilization > 3 days, age 30 years or older, and the presence of pelvic or lower extremity fractures. In patients with neurotrauma who cannot receive heparin (Group III), the SCD was more effective than control in preventing DVT (p = 0.057). Neither H nor SCD appeared to offer protection for the other groups of trauma patients, but surveillance with ultrasound examinations allowed for prompt recognition and treatment of occult deep vein thrombosis.
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PMID:Prevention of venous thromboembolism in trauma patients. 808 13

To assess the impact of raised intra-abdominal pressure associated with laparoscopy on venous return, we have used an animal model (pig) to study the effect of progressive increases in insufflation pressure on femoral venous blood outflow. As a second variable, the effect on flow of the reverse Trendelenburg position was also assessed. Evidence of any adaptation in venous blood flow to the increased intra-abdominal pressure was assessed during a prolonged surgical procedure. These studies have shown that femoral venous blood outflow in the pig is markedly depressed at insufflation pressures of 10 to 20 mm Hg. The reverse Trendelenburg position accentuates this reduction in flow, and there was no sign of adaptation to this depressed flow during a laparoscopic Nissen fundoplication. These findings have clear implications for the potential of deep venous thrombosis/pulmonary embolism (DVT/PE) following prolonged therapeutic laparoscopy.
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PMID:Lower limb venous hemodynamics during laparoscopy: an animal study. 816 61


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