Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: 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 a randomized series of patients who underwent gynaecological operations, the prophylactic effect on thrombophlebitis of low dose Heparin was compared to that of oral anti-coagulants. One group (n = 221) received Heparin (Liquemin Roche) subcutaneously in a dosage of 5000 units 2 hours pre-operatively and every 12 hours until the eighth post-operative day. The control group (n = 237) continued to receive the conventional prophylactic medication with Sintrom by mouth from the second post-operative day to complete ambulation keeping the quick test between 20 and 30%. The two groups were more or less identical regarding several risk factors and the following results were obtained: 1. The number of cases of deep thrombophlebitis diagnosed by the I-125-Fibrinogen test was significantly less in the group receiving Heparin than in the group receiving Sintrom. Clinical examination showed the same correlation but only detected 30% of all cases of deep thrombophlebitis. 2. The clinical suspicion of pulmonary embolism was more frequent in the group of patients receiving low dosage Heparin. Most of the symptoms were mild and none of the patients died. 3. During the anti-coagulant treatment the incidence of secondary bleeding was the same in both groups. The prevention of deep thrombophlebitis by low dosage Heparin is a very effective and simple method with few side effects and is superior to the post-operative prophylaxis with oral anti-coagulants.
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PMID:[A comparison of low dose heparin and oral anticoagulants in the prevention ot thrombo-phlebitis following gynaecological operations (author's transl)]. 118 92

A randomized open trial was undertaken to compare the antithrombotic efficacy of a low molecular weight heparin (LMWH; Sandoparin) with that of dextran 70 in patients undergoing surgery for hip fracture. One hundred thirteen patients received LMWH once daily subcutaneously at a fixed dosage while 103 patients received intravenous dextran 70. Postoperative deep vein thrombosis (DVT) was assessed by a diagnostic algorithm using the 125Iodine fibrinogen uptake test as screening and Duplex ultrasonography and/or ascending venography as confirming techniques for suspected DVT. The frequency of DVT was significantly lower in the LMWH group than in the dextran group (15.5 versus 32.6%, p less than 0.005). Proximal DVT was rare in both groups (LMWH: 2%, Dextran: 1%). Only one case of fatal fat pulmonary embolism was observed during the 10 day prophylaxis period in a patient receiving Dextran. Three cases of pulmonary embolism occurred later; one fatal event in the dextran group on day 14, and two cases in the LMWH group (one fatal and one non-fatal event) on day 14 and 17, respectively. There was no major bleeding complication in either group. We conclude that the LMWH we used is safe, was well tolerated, and has a significantly better thromboprophylactic effect than dextran 70.
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PMID:Prevention of deep vein thrombosis in patients with hip fractures: low molecular weight heparin versus dextran. 128 62

In a randomized, prospective, double-blind trial, the effect of conventional low-dose heparin (5,000 units every 8 hours) was compared with that of a low molecular weight fragment (2165 LMWH, Kabi Vitrum AB, starting 2,500 units 2 hr before surgery, and then 5,000 units subcutaneously every morning for 9 days). A total of 90 patients admitted because of hip fracture fulfilled the inclusion criteria and were analyzed for development of pulmonary embolism and deep vein thrombosis: 46 patients were included in the low molecular weight heparin (LMWH) group, and 44 in the conventional heparin group. Two and three, respectively, died before diagnostic tests were performed. In the remaining patients a ventilation-perfusion lung scan was performed 8 days after intervention. In the first 57 patients studied a bilateral ascending venography was performed on the ninth day only if clinical symptoms suggested a deep venous thrombosis. Because of the rate of venous thrombosis detected in those patients was unexpectedly low, venography was requested in the remaining 33 patients, even if the screening tests were negative. Pulmonary embolism occurred in six patients, all in the LMWH group. Deep vein thrombosis occurred in 14 patients in the LMWH group and in six patients in the conventional heparin group. Both differences are statistically significant. Mortality did not differ between the groups, nor did haemorrhagic complications. Our findings suggest that, in patients with hip fracture, LMWH is not useful at the dosage used.
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PMID:A prospective double-blind trial of a low molecular weight heparin once daily compared with conventional low-dose heparin three times daily to prevent pulmonary embolism and venous thrombosis in patients with hip fracture. 216 34

A multicentric study was carried out involving six italian departments of general surgery to assess the efficacy of a low molecular weight (LMW) heparin called Fluxum compared to standard calcium heparin in low doses for prevention of postoperative thromboembolic complications (deep vein thrombosis and pulmonary embolism). 610 patients were treated; 308 (50.5%) of whom were treated with Fluxum at doses of 4,000 or 8,000 I.U. Axa once a day by subcutaneous injection and 302 (49.5%) with heparin calcium at doses of 5,000 I.U. two or three times a day by subcutaneous injection. We observed a total of 29 deep vein thrombosis (4.7%); 10 (3.2%) from the group treated with LMW heparin and 19 (6.3%) from the comparative group. During the study 4 (0.65%) pulmonary embolism were found, 1 (0.32%) in the group treated with LMW heparin and 3 (1%) in the group treated with calcium heparin. None serious hemorrhagic accident was reported during the study. The antithrombotic prophy laxis carried out with Fluxum was on the whole better tolerated than the treatment of the other group, registering a lower frequency of hematomas at the injection and surgical wound sites.
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PMID:A multicentre study on LMW-heparin effectiveness in preventing postsurgical thrombosis. 285 Mar 22

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

In a prospective, randomized multicentre trial the efficacy and safety of the low molecular weight heparin (LMWH) fraction Fraxiparin and unfractionated calcium heparin (Calciparin) were compared for the prevention of postoperative deep vein thrombosis. Of 1909 patients included in the trial 1896 underwent abdominal surgery and received either one daily subcutaneous injection of 7500 anti-Xa units Fraxiparin or 5000 units calcium heparin three times a day subcutaneously. Elastic compression stockings were worn by both groups of patients in the postoperative period. Before randomization the patients were stratified in two subgroups with or without malignant disease. To assess the rate of deep vein thrombosis (DVT), 125I-labelled fibrinogen leg scanning was performed daily for 7 postoperative days. Positive results were confirmed by phlebography whenever possible. Venous thrombosis occurred in 27 of 960 patients (2.8 per cent) given Fraxiparin and in 42 of 936 patients (4.5 per cent) given calcium heparin (P = 0.034). The rates of proximal vein thrombosis were 0.4 per cent (4 patients) and 1.4 per cent (13 patients) respectively (P less than 0.05). Pulmonary embolism occurred in 2 of 960 patients (0.2 per cent) treated with Fraxiparin and in 5 of 936 patients (0.5 per cent) treated with calcium heparin. The two treatments were equally well tolerated. Intra- and postoperative blood loss, the number of wound haematomas as well as frequency and volume of transfusions were similar in both groups. The present trial demonstrates that a single daily subcutaneous injection of Fraxiparin is more effective than the established low dose subcutaneous heparin prophylaxis with 5000 units three times per day in preventing postoperative DVT after abdominal surgery in patients wearing compression stockings.
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PMID:Comparison of a low molecular weight heparin and unfractionated heparin for the prevention of deep vein thrombosis in patients undergoing abdominal surgery. The European Fraxiparin Study (EFS) Group. 290 87

Heparin (Lipo-Hepin, Liquaemin Sodium) and warfarin sodium (Coumadin, Panwarfin) are the classic anticoagulants in use for venous thromboembolic disease. They work by modifying the coagulation mechanism, heparin having an immediate effect and warfarin having a more delayed effect. The most common adverse effects of anticoagulation therapy are hemorrhagic complications. Thrombolytic therapy should be considered in all patients with massive pulmonary embolism with hypotension and in patients with deep venous thrombosis in the popliteal area or higher. Such therapy has been shown to help preserve the pulmonary microcirculation after pulmonary embolism and to decrease the incidence of the postthrombotic syndrome following deep venous thrombosis. If certain clinical guidelines are followed rigidly, the incidence of significant bleeding complications is low. Although the use of tissue plasminogen activator in venoocclusive disease has been limited to isolated cases, results have been very promising.
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PMID:Treatment of venous thromboembolic disease. A pragmatic approach to anticoagulation and thrombolysis. 370 54

In a prospective, controlled clinical study prevention of postoperative deep venous thrombosis by low-dose heparin (Heparin Leo 5 000 I.U. subcutaneously twice daily) was compared with graded compression stockings (TED stockings, Kendall Co.). One hundred and twelve patients, admitted during a period of one year for elective major surgery, were allocated to one of the two treatment groups. In order to detect deep venous thrombosis the 99mTc-plasmin test was performed before the operative procedure and again 5 days later. Ninety-seven patients completed the study (45 patients in the heparin group and 52 patients in the stocking group). Venous thromboembolism was detected in 4 patients (8.9%) in the heparin group and in 3 patients (5.8%) in the stocking group (p greater than 0.05). In 6 patients the plasmin test was positive and one patient in the heparin group died following pulmonary embolism. It is concluded that graded compression stockings can be used as an alternative to low-dose heparin for prophylaxis against deep venous thrombosis in elective general surgery.
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PMID:Prevention of postoperative deep venous thrombosis. Low-dose heparin versus graded pressure stockings. 389 94

The optimal administration regimens of low molecular weight heparins (LMWHs) have not yet been established. The aim of this study was to compare the efficacy and safety of 2500 and 5000 XaI units of the LMWH dalteparin in patients undergoing elective general surgery for malignant and benign abdominal disease. Prophylaxis was started in the evening before surgery and given once-daily every evening thereafter. The study was designed as a prospective, randomized, double-blind, multicentre trial. Some 66.4 per cent of patients were operated on for a malignant disorder. The primary endpoint was deep vein thrombosis (DVT) detected with the fibrinogen uptake test. Bleeding complications were recorded and classified. Analysis was made both on an intention to treat basis and in patients given correct prophylaxis (86.3 per cent). A total of 2097 patients were randomized and 27 excluded after randomization. A technically correct fibrinogen uptake test was obtained in 1957 patients. The incidence of DVT was significantly lower in patients given 5000 XaI units, this being true for both correct prophylaxis (6.8 versus 13.1 per cent, P < 0.001), on an intention to treat basis (6.6 versus 12.7 per cent, P < 0.001), and in patients with malignant disease (8.5 versus 14.9 per cent, P < 0.001). Sixty-seven patients (3.2 per cent) died within 30 days with no difference between the groups. There were two cases of fatal pulmonary embolism. The frequency of bleeding complications in the whole series was higher in patients randomized to 5000 XaI units (4.7 versus 2.7 per cent, P = 0.02), although this was not the case in those operated on for malignant disease (4.6 versus 3.6 per cent, P not significant). Dalteparin in the dose of 5000 XaI units started in the evening before surgery has a good thromboprophylactic effect in high-risk general surgery at the cost of a small bleeding risk. In patients with malignant disease there was no increased risk of bleeding. The overall frequency of fatal pulmonary embolism with dalteparin is extremely low, even in this high-risk group of patients.
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PMID:Low molecular weight heparin started before surgery as prophylaxis against deep vein thrombosis: 2500 versus 5000 XaI units in 2070 patients. 755 26

A randomized multicentre double-blind study was organized to evaluate the efficacy and the safety of Clivarin (reviparin-sodium) (anti-Xa/anti-IIa ratio: 3-5 International units) for the prevention of post-operative thromboembolism in patients undergoing general surgery. 1,351 patients were randomly allocated to receive subcutaneously either 5,000 U of unfractionated heparin (UFH) twice a day or 1,750 anti-Xa IU of reviparin-sodium once a day (morning) followed by a placebo injection (evening) for at least 6 days. Deep vein thrombosis (DVT) was detected with the 125I-fibrinogen technique confirmed by phlebography if necessary. After randomization thrombotic risk factors were equally distributed in each group. More than 50% of the patients had a cancer. The incidence of DVT and of pulmonary embolism was 4.8% (CI 95%: 3.3-6.7%) in the reviparin-sodium group and 4.4% (CI 95%: 2.9-6.2%) in the UFH group, a non-significant difference. The number of transfusions required was equivalent in the two groups. However, post-operative bleeding complications, including wound haematomas and internal bleeding, were less frequent in the reviparin-sodium group (P < 0.01). Therefore, for the first time, this study demonstrates that an unusual low dose of a low molecular weight heparin retains its antithrombotic efficacy by comparison with UFH and that the tolerance of this low dose is better.
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PMID:An international multicentre study: Clivarin in the prevention of venous thromboembolism in patients undergoing general surgery. Report of the International Clivarin Assessment Group. 818 Mar 25


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