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

Eight prospective, controlled, randomised studies on the incidence of postoperative thrombosis in gynaecological patients receiving various drugs for prevention of thromboembolism are analysed. In all patients diagnosis had been established by objective means. The rate of thrombosis in patients without drug prophylaxis has been found to vary between 14 and 29%. Infusions of dextran as well as administration of low-dose subcutaneous heparin significantly reduce the incidence of deep vein thrombosis, even as compared to postoperative oral anticoagulation with cumarins. No difference has been found between dextran and oral anticoagulants, when cumarin adminstration was started before operation, nor between dextran and heparin. Aescin did not show any prophylactic effect. High age, severe leg-vein varicosis as well as surgery for malignant disease increase the risk of thrombosis. No significant influence of overweight, previous deep venous thrombosis, epidural anaesthesia or vaginal operation as compared to abdominal approach could be demonstrated. There are no properly controlled, prospective, randomised studies on the incidence of postoperative fatal pulmonary embolism as influenced by drugs in gynaecological surgery.
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PMID:[Prophylaxis of thromboembolic complications in gynecological surgery (author's transl)]. 87 Mar 88

Postoperative thromboembolic complications do present an underestimated problem whenever their detection simply relies upon individual clinical judgement. Major abdominal operations are at increased risk of pulmonary embolism (PE) and deep vein thrombosis (DVT), mostly in advanced age, overweight subject, and in patients with cardiac or malignant diseases, or with previous venous diseases. Such patients may benefit from a peri- and postoperative prophylaxis with chemical or mechanical procedures, as a recent meta-analysis seems to suggest. In our experience, a randomized, multicentric clinical trial with defibrotide (DF) versus calcium-heparin (CH) was realized with the aim of evaluating their effectiveness and side effects in the prophylaxis of PE and DVT after major abdominal surgery; 1296 patients were randomly assigned to i.v. DF (400 mg.) or subcutaneous CH (0.2 ml. = 5000 U.I.) given one hour prior to operation and twice daily for seven days postoperatively. Definitive evaluation was carried out on 1212 patients (610 patients in DF and 602 in CH group, respectively) who completed the prophylaxis and monitoring schedule acceptably. One PE (0.16%) and 38 DVT (6.2%) were detected in DF group while 2 PE (0.33%) and 40 DVT (6.6%) were reported in CH treated patients. Post-operative blood loss was 578 +/- 150 cc. (median +/- S.E.M.) in DF group and 604 +/- 123 in CH group (p = n.s.). Wound hematoma was observed in 69 patients (5.7%): 20 (3.2%) in DF and 49 (8.1%) in CH group of patients (CHI-Square = 12.44; p = 0.0005); a significant post-operative decrease of RBC, WBC, Platelet count, and Fibrinogen was computed in both groups (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The postoperative prevention of deep venous thrombosis and pulmonary embolism with defibrotide versus heparin-calcium: a randomized clinical multicenter study of 1296 patients undergoing major abdominal surgery]. 160 51

The incidence of pulmonary embolism determined by perfusion - ventilation lung scintigraphy was 19% in 108 consecutive patients undergoing elective hip operations. Twelve patients had clinical symptoms. The sensitivity of clinical symptoms was 30 and the specificity 93%. Warfarin was used as prophylactic anticoagulant. The incidence of deep vein thrombosis examined by contrast venography was 43%. Only one patient developed femoral vein thrombosis propagating from the calf region. From the clinical risk factors, overweight had a statistically significant relationship to thromboembolism (p = 0.005). Age over 60 years was positively associated but the difference was not significant. When operation time exceeded 150 min the risk increased significantly (p less than 0.01). A large volume of blood loss at operation showed an increased but statistically insignificant trend towards thromboembolism. There were no fatal emboli. Although prophylactic warfarin treatment is not able to prevent the development of thromboembolism, it probably reduces the incidence of fatal pulmonary emboli. Of clinical and operative risk factors overweight and increasing operation time seem to have the strongest relationship to thromboembolism.
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PMID:Postoperative thromboembolism and risk factors in elective hip surgery. 663 5

A descriptive term nonbacterial thrombotic endocarditis (NBTE) is used currently instead of the former name marantic endocarditis. The study describes 171 cases of NBTE encountered in autopsies over a period of 22 years (an incidence of 0.93% in adults). Malignancy was present in 59% of cases. Tumors relatively most frequently associated with NBTE were carcinomas of the ovaries, biliary system, pancreas, lung, and stomach. The vegetations were located mostly on the left-sided valves (mitral 64%, aortic 24%, both 9%). The involved valves were otherwise normal in 82%, and they were previously damaged in 18%. Systemic emboli from valvular vegetations occurred in 41% of patients, with splenic, cerebral, and renal circulations being most frequently affected. Pulmonary embolism was noted in 43%. The state of nutrition at autopsy was within normal limits in 35%; there was undernourishment or cachexia in 40%, and overweight or obesity in 22% of patients. The main pathogenetic factor in NBTE seems to be a state of hypercoagulation.
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PMID:[Nonbacterial thrombotic endocarditis--a study of 171 case reports]. 833 26

43-year old woman, with considerable overweight had been admitted to Intensive Medical Care Unit with suspicion of pulmonary embolism (PE). The patient had the limb immobilized in gypsum for last several weeks. This episode was tangled with recurrent thrombosis of deep veins in the left limb, treated with heparin and oral anticoagulants irregularly without sufficient control. Taking into consideration the data of anamnesis, clinical picture and the results of ECG, chest X-ray, gasometric and echocardiographic examination we got much closer to the recognition of PE. Our suspicion of PE was confirmed by the result of pulmonary angiography. Indications for thrombolytic treatment (r-tPA) had been established. During the following hours considerable improvement of general state was observed. The therapy was continued with constant drip infusion of heparin. No prolongation of therapeutic PTT was observed. The deficit of AT III was diagnosed. In this situation the patient was given AT III to obtain normalization of its level and therapeutic extension of PTT. Therefore there were settled indications for the operation of uterus with myoma changes. As the rich thrombolytic material in the leg's vein was found the patient was implanted LGM Filter, with excellent prophylactic effect (no PE in perioperative period). The clinical course of our case enabled to present most of diagnostic, therapeutic and preventive methods applied in venous thromboembolism.
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PMID:[Massive pulmonary artery embolism complicated by acute pulmonary heart disease]. 918 93

Morbid obesity causes co-morbidity such as diabetes mellitus, hypertensive heart disease, sleep apnoea, degenerative bone diseases and increased incidence of malignancy. Life expectancy and quality of life are reduced significantly. Without adequate weight loss, treatment of co-morbidity remains symptomatic only. Surgical treatment of morbid obesity is the one therapy promising long-term success, since conservative procedures normally lead to recurrence of overweight. We performed laparoscopic gastric banding on 130 patients between 1.11.95 and 31.10.97. Mean overweight was 63 +/- 12.7 kg (SD), and mean BMI was 46.5 +/- 4.6 kg/m2. The average hospital stay was 5.5 +/- 1.5 days. 4 patients with postoperative pulmonary embolism were treated with oral anticoagulation. We performed 9 (6.9%) reoperations because of pouch dilatation or dorsal slipping with food intolerance in the first series of 70, and none in the second series of 60 patients. Median weight loss after 3 months was 14.7 +/- 4.2 kg, after six months 24.0 +/- 6.6 kg and after 12 months 33.2 +/- 8.5 kg, corresponding to excessive weight loss (EWL) of 55.9 +/- 14.8% in the first year. 14 (70%) of 20 patients with diabetes mellitus normalised and 6 patients with diabetes mellitus normalised and 6 patients showed improved blood sugar levels. All 36 patients with hypertensive heart disease had normalised blood pressure, 60% of them without further medical antihypertensive treatment after median EWL of 36%. Cholesterol levels normalised in 30 (57%) patients and improved in 20 (38%) after 6 months. Laparoscopic gastric banding is a suitable method for reducing weight in morbid obesity patients and provides a better quality of life in a group of patients who are carefully evaluated and followed. Reducing co-morbidity and improving ability to work have a positive economic impact on health care costs.
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PMID:[Morbid obesity: 130 consecutive patients with laparoscopic gastric banding]. 975 89

It has been speculated that hormone replacement therapy (HRT) containing relatively low dose of estrogen would be different from oral contraceptive pills in causing thromboembolism because activation of coagulation depends on the amount of estrogen. In contrast to this knowledge, activation of coagulation pathways has been detected in postmenopausal women treated with HRT in the observational and clinical studies. In this regard, recent studies have reported a 2 to approximately 4 fold risk of venous thromboembolism or pulmonary embolism in postmenopausal women receiving HRT than in non-users of estrogen. On the other hands, HRT has shown to enhance systemic fibrinolysis with decreased plasma plasminogen activator inhibitor-1 (PAI-1) levels. In addition, levels of D-dimer exhibited a significant inverse correlation with PAI-1 levels, suggesting enhanced fibrinolysis potential. However, small doses of estrogen/progestogen induce increases in fibrinolytic capacity via a marked reduction of PAI-1. In other words, HRT at conventional dosages may affect fibrinolytic activity to a greater extent than coagulation activity, whereas the converse trend holds at higher estrogen doses. The increase in fibrinolytic potential was independent of any effect on coagulation of CEE at conventional dosages. However, in contrast to healthy postmenopausal women, we recently reported that HRT did not significantly decrease PAI-1 antigen levels and rather, increased tissue factor activity and prothrombin fragment F(1+2) levels from baseline in hypertensive and/or overweight postmenopausal women. Activation of coagulation following HRT may not be balanced by activation of fibrinolysis in some postmenopausal women. Thrombogenic events are considered more likely in patients with certain heritable conditions, such as platelet antigen-2 (PIA-2) polymorphisms. Further, Factor V Leiden mutation increases the risk of primary and recurrent venous thromboembolic events by three to sixfold and the risk of myocardial infarction. Indeed, HRT may decrease or increase atherothrombosis risk depending on the presence of Factor V Leiden mutation. Thus, HRT should not be initiated in women with established coronary artery disease or the coexistence of other risk factors for hypercoagulability-malignancy, immobility, obesity, diabetes, advanced age, or inherited traits. However, HRT at conventional dosages improves fibrinolysis potential in healthy postmenopausal women.
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PMID:Effects of hormone replacement therapy on coagulation and fibrinolysis in postmenopausal women. 1243 Aug 99

Risk factors for venous thromboembolic disease, during pregnancy and post-partum, can be identified in as much as 75% of pregnant women, who present such an accident. Different risk factors are usually associated in the same women. Risk factors can be attribuated to the pregnant women (age over 35 years, overweight, varicose veins, smoking, previous deep venous thrombosis and/or pulmonary embolism) or to the conditions of the pregnancy (multiparity, immobilisation, hypertension and pre-eclampsia, cesarean delivery). Inherited or acquired biological thrombophilia enhance the risk of thrombosis but the magnitude of this effect in ante-partum, puerperium or post-partum depends on the nature of the abnormality. The analysis of all these risk factors and their cumulative effect enable classifying pregnant women into groups with very high risk, high risk or moderate risk for venous thromboembolism and to propose an adapted strategy to prevent the occurrence of such accidents.
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PMID:[The risk of maternal venous thromboembolism disease. Synopsis and definition of high-risk groups]. 1502 83

(1) The reference drug for prophylaxis against venous thromboembolism after hip or knee replacement surgery is a low-molecular-weight heparin (LMWH), given subcutaneously for 1 to 5 weeks. Vitamin K antagonists, including warfarin, have similar risk-benefit balances. (2) Subcutaneous melagatran and its oral metabolic precursor ximelagatran have recently been granted marketing authorisation in France for use as prophylaxis after hip or knee replacement surgery. Melagatran, unlike LMWH, is a specific thrombin inhibitor. (3) There are four randomised double-blind trials in more than 9000 patients comparing these agents with a LMWH (enoxaparin in three trials, dalteparin in one). Melagatran was given subcutaneously for one or two days before being replaced with ximelagatran (as soon as oral feeding was possible) for 6 to 9 days. These trials showed no advantage of melagatran-ximelagatran in terms of clinical endpoints such as symptomatic deep venous thrombosis, pulmonary embolism, and death from all causes. (4) Three randomised double-blind trials have compared ximelagatran with warfarin in more than 5000 patients. Treatment lasted 7 to 12 days. Ximelagatran was no better than warfarin when assessed using clinical endpoints. (5) In these trials melagatran-ximelagatran did not increase the risk of bleeding compared with LMWH or warfarin. (6) Melagatran-ximelagatran can cause an increase in serum transaminase activity, and is contraindicated if pretreatment serum transaminase activity is more than twice the upper limit of normal. (7) Trials versus warfarin showed a higher risk of myocardial infarction in patients taking ximelagatran (0.7% versus 0.16%). (8) There are few data on the patient subgroups most likely to receive melagatran-ximelagatran, namely patients over 75, underweight and overweight patients, and patients with renal failure. (9) There is currently no clotting test that allows the melagatran-ximelagatran dose regimen to be adjusted in patients who have an increased risk of adverse effects due to overdosing. There is no available antidote if overdose occurs. (10) Erythromycin increases melagatran bioavailability, thereby increasing the bleeding risk. Melagatran and ximelagatran must not be combined with other anticoagulants, thrombolytic agents or antiplatelet drugs because of a increased bleeding risk. (11) In practice, low-molecular-weight heparin remains the reference prophylactic treatment for venous thromboembolism after hip or knee replacement surgery.
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PMID:Melagatran and ximelagatran: new drug. No real simplification of anticoagulant therapy. 1610 94

Pulmonary embolism (PE) and deep venous thrombosis (DVT) are clinical manifestations of the same entity, venous thromboembolic disease (VTD). In approximately 25% of patients, the first manifestation of PE is sudden-unexpected death. We carried out a prospective study at the forensic pathology service of the Institute of Legal Medicine in Seville with the aim to know the incidence of PE as well as to describe the epidemiological, pathological and clinical characteristics of these deaths and associated risk factors. In the study period (32 months) 32 cases of PE were registered from a total of 2447 completed autopsies. Three cases were considered accidental deaths and the remaining 29 cases were sudden natural deaths, which represents 1.3% of the total autopsies, 2.6% of natural deaths and 4.3% of sudden deaths. Nineteen cases (59%) were men (mean age 50.3+/-13.8, range 22-74 years) and 13 cases (41%) were women (mean age 50.3+/-13.8, range 18-87 years). In 78% of cases death occurred at home or during transfer to a health care centre, mainly during the fall or winter (69%) and between 8a.m. and 4p.m. (47%). Pulmonary infarction was associated only in two cases (6%). Nine cases (28%) had been immobilized but only three (9%) received anticoagulant therapy. Surgical interventions had occurred in seven cases (22%). A history of psychiatric pathology was found in 31%. Overweight or obesity was found in 75%. The most frequent symptoms prior to death were dyspnea (31%) and chest pain (19%), and 19% of patients were examined in an Emergencies Department for symptoms compatible with deep vein thrombosis and/or PE, but this diagnosis was not suspected in any case. PE frequently makes its first appearance as sudden death. In addition to the classic risk factors, this study highlights that 75% of the cases were overweight/obese as well as 31% having had a history of psychiatric disorders and treatment as to support that this association should be considered as a risk factor. PE continues to be under diagnosed in Emergencies Department patients, which hinders the application of adequate therapeutic measures to prevent these deaths.
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PMID:Pulmonary embolism and sudden-unexpected death: prospective study on 2477 forensic autopsies performed at the Institute of Legal Medicine in Seville. 1932 75


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