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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Deep vein thrombosis and pulmonary embolism, collectively referred to as venous thromboembolic events, are a source of significant morbidity and mortality after gynecologic surgical procedures. In this literature review the advantages and disadvantages of various preventive measures for deep venous thrombosis, including low-molecular-weight heparins, are discussed. The most appropriate prophylactic methods for patients in varying risk categories are recommended. Current methods of diagnosing deep venous thrombosis and pulmonary embolism, including ultrasonography, venography, ventilation-perfusion scan, helical computed tomographic scan, and D -dimer measurement are then discussed. Finally, treatment modalities for deep venous thrombosis and pulmonary embolism, including heparin, low-molecular-weight heparin, warfarin, and thrombolytic therapy, are detailed.
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PMID:Prevention, diagnosis, and treatment of venous thromboembolic complications of gynecologic surgery. 1126 84

A meta-analysis (MA) based on original patient data has been performed comparing low molecular weight heparins (LMWH) with unfractionated heparin (UFH) in thrombosis prophylaxis after major surgical interventions. The analyses have been done for the following prespecified groups of studies: all studies, studies in orthopaedic surgery (OS) and studies in general surgery (GS, with further separation into low-dose studies [GS-LD] and high-dose studies [GS-HD]). Deep vein thrombosis (DVT, all locations) and wound haematoma were used as primary endpoints for efficacy and safety, respectively. The analysis confirms the results of previous publication-based meta-analyses. In GS there is no relevant difference between LMWH and UFH regarding efficacy; the safety results strongly depend on the dosage: under low-dose LMWH the risk of wound haematoma is significantly lower, under high-dose LMWH it is significantly higher than under UFH. However, most of the studies in the last group used regimens of LMWH that are not considered appropriate any more. In OS there is a trend towards a better efficacy and safety of LMWH. In addition, LMWHs are superior to UFH, in OS, with respect to the secondary endpoints proximal DVT and pulmonary embolism. The rates of proximal DVT and pulmonary embolism, respectively, are consistently lower under LMWH than under UFH, whereas slightly smaller rates of distal DVT are observed under UFH.
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PMID:Low molecular weight heparin and unfractionated heparin in thrombosis prophylaxis: meta-analysis based on original patient data. 1136 23

Deep vein thrombosis is a serious complication of oral contraception. The most serious complication, pulmonary embolism, could be lethal. The relative risk of thromboembolic disease is four time higher in women using oral contraception. Both the amount of estrogen and the type of gestagen can increase the relative risk of thromboembolic disease. Oral contraceptives influence procoagulants, fibrinolytic system and inhibitors of coagulation. The choice of oral contraceptive should be very careful. It is advised to use preparations with less then 50 micrograms of ethinyl-estradiol and the type of gestagen that has minimal metabolic side effects, including minimal effect on coagulation. It is not recommended to perform screening of trombophilia before prescribing oral contraception. Family history of thrombosis is indication for more detailed investigation. However in the case of positive history of thromboembolic disease use of oral contraception is contraindicated. Oral contraception users should be informed about increased risk of deep vein trombosis, and what to do to prevent deep vein thrombosis.
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PMID:[Thromboembolic complications in the use of oral estrogen-gestagen contraceptives]. 1150 17

Deep vein thrombosis and pulmonary embolism is a well-recognised major health problem in the West. There is a deep-rooted belief among clinicians that deep vein thrombosis is rare in Asians, particularly in the Chinese population. However, it appears that the incidence of venous thrombosis and pulmonary embolism is increasing in Chinese patients. Prophylaxis reduces the incidence of venous thrombosis by 66% and of pulmonary embolism by 50%--- prophylaxis should therefore be considered for Chinese patients who have a high risk of developing postoperative deep vein thrombosis. This report reviews the current literature on this subject.
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PMID:Deep vein thrombosis and pulmonary embolism in the Chinese population. 1183 Jun 88

Deep vein thrombosis is a serious postoperative complication which can delay recovery and extend hospital stay (Autar 1996). A DVT can be asymptomatic and often precedes a pulmonary embolism (PE), which has been found in 10-25% of hospital deaths (Sandler & Martin 1989). Virchow, a nineteenth century pathologist identified three factors which initiate the formation of a DVT.
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PMID:Deep vein thrombosis. Incidence and physiology. 1189 20

Deep vein thrombosis and pulmonary embolism are common complications after orthopedic and trauma surgery. To prevent these complications, the use of low-molecular-weight heparins (LMWH) as prophylaxis is well proved and accepted. We reviewed 203 patients undergoing geriatric rehabilitation in our hospital after orthopedic and trauma surgery. Despite a prophylaxis with LMWH, 23 (11.3%) of these patients were diagnosed with having a clinically apparent and sonographically confirmed thromboembolic event. The average age of all patients was 81.8 years; the time between surgical or orthopedic intervention and thrombembolic event was on average 29.4 days. Using evidence-based medicine, a search of the literature showed 34 clinical trials concerning the prophylaxis of thrombembolic events with LMWH after orthopedic or trauma surgery. All studies have been reviewed for age of patients and for duration of prophylaxis with LMWH. The average age of all patients involved is 65.8 years. There are only 4 trials with an average age of 75 years or more, with a total number of less than 250 patients. The mean duration of prophylaxis with LMWH is 12.5 days. Only 6 trials concern thromboprophylaxis given longer than 3 weeks after surgical intervention. We conclude that there are no clear data about safety, efficiency and optimal duration of prophylaxis with LMWH in geriatric patients undergoing orthopedic or trauma surgery.
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PMID:[Low molecular weight heparins after orthopedic and traumatologic operations in geriatrics]. 1197 17

The first clinical studies evaluating the safety and efficacy of melagatran, a novel, direct thrombin inhibitor, given subcutaneously as prophylaxis for venous thromboembolism (VTE) following total hip (THR) or total knee replacement (TKR) are reported. In Study I, 66 patients received subcutaneous melagatran (1.5-6 mg bid) in a poloxamer depot formulation, and in Study II, 104 patients received subcutaneous melagatran (2-4 mg bid) in saline or as a depot formulation in cyclodextrin. Treatment was given for 8-11 days, with the first dose administered immediately before surgery. Deep vein thrombosis (DVT) was assessed using mandatory bilateral venography on the last day of treatment, and pulmonary scintigraphy was performed if required. Bleeding complications occurred in the only patient who received melagatran 6 mg, and this dose-arm was discontinued. The frequency of VTE was low (12/129=9%, 95% confidence interval [CI]: 5-16%). Eight patients (6%) had distal DVT, three (2%) had proximal DVT, and in one patient (1%) pulmonary embolism (PE) was verified. In conclusion, subcutaneous melagatran 1.5-4.5 mg bid in saline or depot formulation was well tolerated and resulted in a low frequency of VTE.
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PMID:Prophylaxis of venous thromboembolism with subcutaneous melagatran in total hip or total knee replacement: results from Phase II studies. 1206 37

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are separate but related aspects of the same dynamic disease process known as venous thromboembolism (VTE). Recent community studies have shown that VTE is a major health issue for the developed world, with at least 201,000 new cases each year in the United States, comprising 107,000 with DVT and 94,000 with PE. A quarter of PE cases die within 7 days, some so rapidly that treatment or intervention is impossible. Despite the availability of heparin prophylaxis, the annual incidence of VTE has remained constant at 1 event per 1,000 person-years since 1979 but reaches 1 event per 100 person-years for the over-85-year-olds. The most important risk factors for VTE are hemostatic and environmental. The recent discoveries of factor V Leiden, prothrombin 20210A, and high concentrations of factor VIII have highlighted the increasing importance of a genetic predisposition to thrombophilia. Acquired hemostatic factors include pregnancy and the puerperium, oral contraception, hormone-replacement therapy, malignant tumors, and antiphospholipid syndromes. Important environmental risk factors include hospitalization with previous surgery or trauma, confinement in a care facility, neurologic disease or paraplegia after stroke, current or recent central venous catheter or transvenous pacemaker, and long airplane flights. Internists may be confused about the risk of PE after ventilation/perfusion (VQ) imaging. This may well arise from their use of the relative risk of PE after a low-probability category scan rather than the absolute risk obtained by incorporating the PE prevalence for their particular patient in the risk analysis. Ideally, personal communication with an experienced referring physician provides this clinical information for nuclear medicine. Diagnostic tools or checklists can be used as an alternative. A general knowledge of the natural history of VTE will encourage the nuclear medicine physician to provide an appropriate clinical signal to complement VQ categorical analysis. Combination of these 2 dynamic elements of the art and science of VQ scan reporting-the clinical pretest probability of PE and lung scan category-will permit an accurate prediction of the absolute risk of PE posttest.
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PMID:The natural history of venous thromboembolism: impact on ventilation/perfusion scan reporting. 1210 97

The incidence of deep vein thrombosis in Western World is estimated at about 1 case/1000/year and of pulmonary embolism at 0.5 case/1000/year. Mortality in untreated pulmonary embolism is 30%. With adequate treatment (anticoagulation) it can be decreased to 2-8%. Deep vein thrombosis and pulmonary embolism are frequent complications of various surgical procedures, especially of orthopedic interventions on hip joint. When surgery has to be performed in patient with high risk of pulmonary embolism, anticoagulant prophylaxis should be performed. Venous thromboembolic disease is the most important cause of mortality in trauma patients. We present a case of 46 years old man with bilateral fracture of femoral bone after car accident injury in whom signs of deep venous thrombosis and pulmonary embolism were observed despite the use of anticoagulant prophylaxis.
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PMID:[Pulmonary embolism in course of deep vein thrombosis of lower extremities in patient wit bilateral femoral bone fracture after car accident injuries]. 1227 67

The occurrence of pulmonary embolism, in spite of thromboprophylaxis after a minor elective orthopedic surgery (release of m. rectus femoris tendon) is reported. In case of this severe complication, an early diagnosis is of outmost importance to enable optimal therapy introduction. Deep vein thrombosis and pulmonary embolism are frequent complications after total joint replacement, however, they may also develop after minor surgical orthopedic procedures. The possible causes of pulmonary embolism after release of m. rectus femoris tendon included the history of varicose veins and sclerozation of calf veins, and operative procedure with intraoperative pressure upon large veins of the iliofemoral region, which may and is expected to occur during this procedure. The importance of thrombopropylaxis in orthopedic surgical procedures is emphasized by this case presentation.
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PMID:Pulmonary embolism after minor elective orthopedic procedure. 1239 26


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