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)

Morbidity and mortality after hip fractures is often a result of deep vein thrombosis and pulmonary embolism. Therefore, prophylaxis for venous thrombosis is recommended in patients undergoing osteosynthesis of upper end of lower extremity or arthroplasty of the hip. Study compared efficacy of UFH and LMWH in prevention of thromboembolic disease. The most important part of the study is the prospective trial, which describe group of 81 patients, undergoing operation for hip fracture. These patients suffered fracture of the neck of femur (35) or intertrochanteric fracture (46). For prevention of DVT was used UFH or LMWH. The evaluation was exercised by laboratory tests, Doppler test and by phlebography in cases, where was suspicion of phlebothrombosis. All patients were controlled for two months after operation. Died eleven patients; in every case was PE or cause of death or main complication. Nine of dead was operated for pertrochanteric fracture, another two for fracture of the neck. Prevention drug was UFH in nine dead patients; eight of them suffered pertrochanteric fracture. The most often death sated in fourth and fifth weeks after operation. It means, that the risk of PE continue for a several weeks. It appears, that the prevention use of UFH is not sufficient.
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PMID:[Prevention of thromboembolism in surgery of fractures of the upper end of the femur]. 1268 43

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are a major cause of morbidity and mortality, affecting approximately 4 million people each year in the United States. The identification of risk factors for the development of DVT and PE helped to develop a system for risk stratification. The risk to develop a deep vein thrombosis has been estimated to be up to 80% in some populations without prophylaxis. In multiple studies LMWHs demonstrated to be efficient and safe for reduction of DVT of patients in general and visceral surgery, orthopedic surgery, and trauma. Three compounds have been studied best, e.g., dalteparin, enoxaparin, nadroparin, which may help to decide which type of LMWH to use. There is clearly an expanding role for LMWHs in gynecology, cancer, intensive care, patients with acute medical illness and bedridden patients. In summary, LMWHs have chemical, physical, and clinical similarities. They have greater bioavailability, longer half-lifes, more predictable pharmacological response, possible improved safety, and similar or greater efficacy compared with UH. However, the evaluation of clinical trials does not allow the determination of therapeutic equivalence due to different diagnostic methods, drug administration times, dose equivalencies, and outcome measurements The scoring of the quality of clinical trials for meta-analysis is problematic and it has been recommended to assess the methodological aspects individually. Despite clear evidence of effectiveness, deep vein thrombosis prophylaxis is underused. This has been recognized by law firms as evidenced by internet advertisement where patients are informed on the prevention of venous thromboembolism or economy class syndrome. "If you or a family member has been injured, contact a personal injury attorney today. Just fill out Injury.Board.com's on-line questionnaire and have a personal injury lawyer review your potential personal injury claim -- free of charge.". The medico legal implications of antithrombotic prophylaxis and treatment are well recognized.
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PMID:Prophylaxis of thrombosis with low-molecular-weight heparin (LMWH). 1509 26

Venous thromboembolism VTE remains a common but preventable disease. The last decade has witnessed major advances in VTE treatment and prophylaxis. Low molecular weight heparins LMWH became the agents of choice in the treatment of deep venous thrombosis DVT and are increasingly used in the treatment of stable pulmonary embolism PE. Increasing focus on simplicity and efficacy has led to the discovery of the synthetic pentasaccharides, substances that specifically inhibit factor Xa activity, producing an antithrombotic effect without affecting other coagulation factors or platelets. Fondaparinux, the first pentasaccharide introduced into the market, was first tried as a prophylactic agent against VTE in patients undergoing major orthopedic procedures, such as hip fracture, total hip and knee replacements, such approach appeared to be more effective than LMWH. Fondaparinux was also used, with promising results, in prophylaxis in patients undergoing major abdominal surgery and high risk medical patients. Pentasaccharides were recently tried in the treatment of both DVT and PE. The largest clinical investigation program ever undertaken in this therapeutic area, has shown that pentasaccharides are as safe and as effective as either unfractionated heparin UFH or LMWH, with the added convenience of once daily injection, no need for monitoring the anticoagulant effect and no major side effects such as thrombocytopenia. Therefore, the efficacy, the safety profile and the added convenience for both patients and physicians alike, will probably keep pentasaccharides as the front runner among new anticoagulants of the future. This article focuses on the use of fondaparinux as a prophylactic agent against VTE in patients undergoing major orthopedic and abdominal surgery along with high risk medical patients; it will also discuss the recent promising data on its use to treat active DVT and PE.
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PMID:Pentasaccharides. The new anticoagulants. 1532 84

Deep vein thrombosis and its potentially fatal complication, PE, accounts for more than 250,000 hospitalizations annually in the United States. Pulmonary embolism is the most serious complication and has a 3-month mortality of 17%. Two million people each year are affected by VTE, and the prevalence is rising because of the aging population. Deep vein thrombosis and its potential complication, PE, is preventable. However, there still is widespread failure to screen, diagnose, and initiate prophylactic therapy in patients at risk. This failure can be corrected by development of a heightened awareness of risk factors among emergency department physicians and nurses and by similar personnel caring for bedridden hospitalized patients. A recent landmark study Prophylaxis in Medical Patients With Enoxaparin Study (MEDENOX) revealed the risk factors of VTE in order of frequency: (1) previous VTE, (2) acute infectious disease, (3) cancer, (4) age greater than 75 years, and (5) chronic respiratory disease. This study confirmed the effectiveness of a LMWH, enoxaparin, in the prevention of VTE.
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PMID:A silent killer--often preventable. 1547 Aug 61

The association between cancer and thromboembolic disease is a well-known phenomenon and can contribute significantly to the morbidity and mortality of cancer patients. The spectrum of thromboembolic manifestations in cancer patients includes deep vein thrombosis, pulmonary embolism, but also intravascular disseminated coagulation and abnormalities in the clotting system in the absence of clinical manifestations. Unfractionated heparin (UFH) and particularly low molecular weight heparins (LMWH-s) are widely used for the prevention and treatment of thromboembolic manifestations that commonly accompany malignancies. Malignant growth has also been linked to the activity of heparin-like glycosaminoglycans, to neoangiogenesis, to protease activity, to immune function and gene expression. All these factors contribute in the proliferation and dissemination of malignancies. Heparins may play a role in tumour cell growth and in cancer dissemination. The aims of the study are to review the efficiency of heparins in the prevention and treatment of cancer-related thromboembolic complications, and review the biological effects of heparins. Heparins are effective in reducing the frequency of thromboembolic complications in cancer patients. Meta-analyses comparing unfractionated heparins and LMWH-s for the treatment of deep vein thrombosis have shown better outcome with a reduction of major bleeding complications in patients treated with LMWH-s. LMWH have antitumour effects in animal models of malignancy: heparin oligosaccharides containing less than 10 saccharide residues have been found to inhibit the biological activity of basic fibroblast growth factor (bFGF), whereas heparin fragments with less than 18 saccharide residues have been reported to inhibit the binding of vascular endothelial growth factor (VEGF) to its receptors on endothelial cells. It has been shown that LMWH, in contrast with UFH, can hinder the binding of growth factors to their high-affinity receptors as a result of its smaller size. In vitro heparin fragments of less than 18 saccharide residues reduce the activity of VEGF, and fragments of less than 10 saccharide residues inhibit the activity of bFGF. Small molecular heparin fractions have also been shown to inhibit VEGF- and bFGF-mediated angiogenesis in vivo, in contrast with UFH. Moreover, heparin may influence malignant cell growth through other different interrelated mechanisms: inhibition of (1) heparin-binding growth factors that drive malignant cell growth; (2) tumour cell heparinases that mediate tumour cell invasion and metastasis; (3) cell surface selectin-mediated tumour cell metastasis and blood coagulation. The above evidence, together with favourable pharmaco-properties and with a reduction in major bleeding complications, suggests an important role for LMWH-s in thromboprophylaxis and in the therapy of venous thromboembolism in cancer patients. There is sufficient experimental data to suggest that heparins may interfere with various aspects of cancer proliferation, angiogenesis, and metastasis formation. Large-scale clinical trials are required to determine the clinical impact of the above activities on the natural history of the disease.
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PMID:The heparins and cancer: review of clinical trials and biological properties. 1567 86

The optimal pharmacological antithrombotic treatment for interventional coronary procedures is a controversial subject. The ISAR-REACT trial investigated the necessity of a IIb/IIIa glycoprotein inhibitor in procedures not considered at high risk, that is to say excluding acute coronary syndromes, and concluded that there was no additional gain with this treatment compared with placebo when the patient was pre-treated with 600 mg of clopidogrel. The REPLACE-2 trial proposed an alternative to a treatment with NFH and IIb/IIIa glycoprotein inhibitor with the use of a direct antithrombin, bivalirudine. Heparin therapy of acute coronary syndromes and the eventual ensuing interventional coronary procedure may employ NFH or LMWH. New large scale trials (SYNERGY and phase A of the so-called A to Z trial) compared the two approaches and are reported later on. If facilitated angioplasty is a seductive concept, the best antithrombotic association remains to be determined (BRAVE trial). Bitherapy with a platelet inhibitor and an antithrombotic, ximegalatran, was tested in the ESTEEM trial and in the post-infarct period. Bitherapy with platelet inhibitors clopidogrel and aspirin versus clopidogrel alone was tested in patients with "ischaemic" stroke but does not seem to be more effective than monotherapy. In pulmonary embolism, the fondaparinux seems to be an alternative to NFH. Finally, the concept of resistance to platelet inhibitors is in vogue and is the subject of some interesting trials.
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PMID:[The best of thrombosis in 2004]. 1571 67

Reviparin sodium (clivarine) is a second generation LMWH, developed with the aim of maximising the antithrombotic action while minimising the risk of haemorrhage. Clivarine has been extensively studied in acute coronary syndrome. Various clinical studies in unstable angina and acute coronary syndrome have proved that clivarine in a dosage of 3436anti-Xa units twice daily is an effective antithrombotic agent. Clivarine has been shown to be as effective as unfractionated heparin (UFH) in thromboprophylaxis and it has less incidence of local haematoma at injection site. At a daily dose of 1432 IU anti-Xa it was found to be as effective as UFH in preventing deep vein thrombosis (DVT) in moderate risk surgery (general and abdominal) and reducing to a significant extent DVT in patients with brace immobilisation of the legs. At a daily dose of 3436 IU anti-Xa reviparin was as effective as UFH or enoxaparin in preventing DVT in high risk orthopaedic surgery and as effective as UFH in prevention of DVT and/or pulmonary embolism (PE) and/or mortality in high risk orthopaedic surgery. In patients with acute venous thrombo-embolism (VTE), reviparin was more effective than UFH in thrombus reduction and at least as effective as UFH in the prevention of clinical recurrence of DVT and/or PE. The use of reviparin is associated with a similar or lower incidence of bleeding complications than UFH. The benefits of reviparin sodium have been demonstrated in a number of clinical trials.
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PMID:Reviparin sodium clivarine: a review of its therapeutic use. 1588 30

The use of heparin as the most potent anticoagulant for the prevention of deep vein thrombosis and pulmonary embolism is nevertheless limited, because it is available to patients only by parenteral administration. Toward overcoming this limitation in the use of heparin, we have previously developed an orally active heparin-deoxycholic acid conjugate (LMWH-DOCA) in 10% DMSO formulation. The present study evaluates the anti-thrombogenic effect of this orally active LMWH-DOCA using a venous thrombosis animal model with Sprague-Dawley rats. When 5 mg/kg of LMWH-DOCA was orally administered in rats, the maximum anti-FXa activity in plasma was 0.35 +/- 0.02, and anti-FXa activity in plasma was maintained above 0.1 IU/ml [the minimum effective anti-FXa activity for the prevention of deep venous thrombosis (DVT) and pulmonary embolism (PE)] for five hours. LMWH-DOCA (5 mg/kg, 430 IU/kg) that was orally administered reduced the thrombus formation by 56.3 +/- 19.8%;on the other hand, subcutaneously administered enoxaparin (100 IU/kg) reduced the thrombus formation by 36.4 +/- 14.5%. Also, LMWH-DOCA was effectively neutralized by protamine that was used as an antidote. Therefore, orally active LMWH-DOCA could be proposed as a new drug that is effective for the longterm prevention of DVT and PE.
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PMID:Prevention effect of orally active heparin derivative on deep vein thrombosis. 1689 57

A total of 290 consecutive patients who underwent total hip and total knee arthroplasty were prospectively entered into a clinical anticoagulation trial using a 10-day course of Lovenox with the American College of Chest Physicians-1A guidelines. Major complications occurred in 9% of patients; symptomatic deep vein thrombosis occurred in 9 (3.8%) patients, and nonfatal pulmonary embolism in 3 (1.3%) patients. Complications included 4.7% readmissions, 3.4% return to the operating room for wound incision and drainage, 5.1% prolonged hospitalization (wound drainage), and 3.4% injection site complications. Wound drainage of more than 7 days was predictive of readmission and wound reoperation. A body mass index of more than 35 was predictive of prolonged wound drainage. Return to the operating room for wound complications occurred 3x more frequently with the use of Lovenox than in our previous study using warfarin. Surgical site complications requiring readmission or reoperation should be considered "major" complications.
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PMID:Failure of the American College of Chest Physicians-1A protocol for lovenox in clinical outcomes for thromboembolic prophylaxis. 1740 85

Postoperative thromboembolic risk depends on both the patient's predisposing factors and on the surgical procedure. Patients with an objective history of venous thromboembolism who require orthopedic surgery are considered to be at very high postoperative risk. However, no specific prophylactic guidelines have been established for this group. Surgeons and patients have to choose between deciding against surgery or accepting a very high possibility of thromboembolic complications. We believe that this group of patients should be treated with an intensive prophylactic protocol combining physical (impulsion foot pump), pharmacological treatment (low molecular weight heparin [LMWH] administered at therapeutic doses from the third postoperative day) and eventually mechanical methods (removable vena caval filter). This intensive prophylactic protocol has been employed in our hospital since 2003, when we initiated an observational, prospective study in 20 patients with a history of venous thromboembolism (VTE) undergoing major pelvic or lower limb orthopedic surgery. Eighteen patients received postoperative physical prophylaxis and 1 month of therapeutic doses of LMWH. Two patients also received mechanical prophylaxis with a removable vena caval filter. Systematic venography and pulmonary scintigraphy performed 1 month after surgery allowed the diagnosis and treatment of one asymptomatic deep venous thrombosis (DVT) and one asymptomatic pulmonary embolism (PE). Moreover, a massive thrombi retained by the removable vena caval filter was detected in another patient. There were no bleeding events leading to reoperation or deaths. Systematic application of our intensive prophylactic protocol for patients with a history of VTE was safe and effective in preventing thromboembolic recurrence after major orthopedic surgery.
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PMID:[Thromboprophylaxis in patients with previous thromboembolic disease who require major orthopedic surgery]. 1908 47


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