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

Propagating illofemoral venous thrombosis that occurs despite adequate anticoagulation can be detected by the serial fibrinogen uptake test. Twenty-three patients who were receiving heparin sodium for confirmed iliofemoral thrombophlebitis underwent the serial fibrinogen uptake test. There was an increasing percentage of isotope uptake at the groin and the upper part of the thigh in eight of these patients, three of whom subsequently developed clinical signs, perfusion, and ventiliation lung scan findings compatible with the occurrence of pulmonary embolism. The remaining 15 patients had decreasing serial fibrinogen uptake during heparin therapy and no sequelas indicative of pulmonary embolism. Progressive thrombosis in adequately heparinized patients indicates failure of anticoagulation therapy and, when this occurs, we believe that interior vena cava interruption should be considered before a first, but potentially lethal, pulmonary embolus develops.
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PMID:Inferior vena cava interruption: a new indication? 116 84

Sodium warfarin was administered to a 59-year-old woman with congestive cardiac failure and deep vein thrombosis. After 3 days of therapy the nipple and areola of the left breast became inflamed; the entire breast then became necrotic. Gangrene spread and a simple mastectomy was performed. The patient died from pulmonary embolism 1 day after operation. Histologic examination of the breast revealed thrombi in some of the arteries and veins. The etiology of this condition is obscure, and there is no known way of preventing or effectively treating the condition. Simple mastectomy or more conservative local excision recommended.
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PMID:Cutaneous gangrene: a rare complication of coumarin therapy. 124 9

An 85-year-old female diabetic was admitted in coma, having been on antidiabetic treatment with the biguanide derivative "Silubin retard", 600 mg/d, for one-and-a-half months. The anion deficiency was 57 mmol/l, pH 6.9, suggesting the diagnosis of lactic acidosis in the absence of other causes of metabolic acidosis. Blood lactic acid levels of more than 16.65 mmol/l (150 mg/100 ml) confirmed the diagnosis. Administration of 875 mmol sodium bicarbonate over 12 hours corrected the deficiency. On admission to hospital there had been slight pre-renal failure. Myocardial infarction developed as a result of tissue hypoxia but did not prove clinically important. On the second day there were signs of a compensated disseminated intravascular coagulopathy with upper gastro intestinal haemorrhage. The woman died suddenly 18 days later of pulmonary embolism.
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PMID:[Lactic acidosis after administration of buformine (author's transl)]. 124 7

Three consecutive patients were treated with heparin sodium administered intravenously for phlebitis and pulmonary embolism following abdominal aortic surgery. After the institution of heparin, hemorrhage in these patients occurred from the suture line 14 days, 18 days, and 31 days after surgery, respectively. the diagnosis was correctly made and control of the bleeding was achieved in each case. The first two patients required exploratory surgery and the third patient was treated successfully without surgical intervention. We propose that the integrity of the clot at the suture line is in dynamic balance. There is a continuous lysis and resorption of old thrombus and replacement with new clot formation until the suture line is sealed by regeneration of the new "intima". If the blood is anticoagulated by heparin, this balance is disrupted and hemorrhage may result.
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PMID:Further hazards of heparin therapy in vascular surgery. 125 16

Three cases of women in the reproductive age group who received warfarin sodium therapy for pulmonary embolism are presented. The therapy was complicated by rupture of ovarian cysts with intraperitoneal hemorrhage necessitating exploratory laparatomy. The possibility of intraperitoneal hemorrhage must be considered in patients who present with abdominal pain and a history of anticoagulant therapy. Lack of awareness of the complication may result in delay in making a correct diagnosis and instituting appropriate therapy.
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PMID:Ovarian hemorrhage complicating warfarin sodium anticoagulant therapy. 125 38

A ten-year analysis of the prevalence of pulmonary embolism found at autopsy examination has been repeated 20 years after a prior study. The frequency of all pulmonary embolism (12.3%) and of "major" pulmonary emboli (7.1%) remains essentially unchanged from that detected 20 years previously (13.6% and 8.6%). Less than 10% of patients had the clinical diagnosis of deep leg vein thrombosis, and only 9.3% had a definitive diagnosis of pulmonary embolism made during life. A sixfold variation in quarterly frequency and a twofold variation in annual prevalence were noted. Since these wide fluctuations in frequency are present, any assumptions regarding a changing disease pattern must be made with great caution. There is no evidence that fatal pulmonary embolism has decreased in frequency in recent years. An effort should be made to increase rate of detection of thromboembolic disease by more widespread use of one or more of the recently developed diagnostic procedures, or a larger segment of the hospital population at risk should receive prophylactic therapy with "low-dose" heparin sodium.
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PMID:The spectrum of pulmonary embolism: twenty years later. 125 77

During a 5 1/2-year period from January 1984 to July 1989, 736 patients between the ages of 50 and 75 with a diagnosis of osteoarthritis had either cemented or uncemented primary total hip arthroplasty. Patients were treated with low-dose sodium warfarin for prophylaxis against pulmonary embolism and had preoperative and postoperative serial lung scanning. The overall incidence of pulmonary embolism was not statistically different between the cemented and uncemented groups (3.87% and 6.19%, respectively; P > .05). Eighty-one percent of the pulmonary emboli were asymptomatic. The incidence of pulmonary embolism was higher in men than in women (7.3% and 2.93%, respectively; P < .05) but did not differ within each individual sex for the cemented and uncemented groups. Of greater significance, when the two initial groups were matched to control for sex and weight differences (564 patients), the incidence of pulmonary embolism narrowed to 4.3% and 5.3% in the cemented and uncemented groups, respectively (P > .55). These data indicate that the use of uncemented total hip arthroplasty does not offer any additional protective value against pulmonary embolism when using low-dose sodium warfarin prophylaxis.
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PMID:Pulmonary embolism. Incidence in primary cemented and uncemented total hip arthroplasty using low-dose sodium warfarin prophylaxis. 147 65

Heparin and warfarin sodium (Coumadin, Panwarfin, Sofarin) are used most often to treat acute and recurrent venous thromboembolic disease, arterial disease, valvular heart disease, and atrial fibrillation. These agents along with dextran, pneumatic compression devices, and gradient stockings are also used to prevent deep venous thrombosis and pulmonary embolism in patients at high risk (eg, those with venous stasis, lower limb or spinal cord trauma, clotting abnormalities). Anticoagulation therapy is monitored by maintaining the activated partial thromboplastin time and the prothrombin time in the therapeutic range.
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PMID:Using anticoagulants safely. Guidelines for therapeutic and prophylactic regimens. 188 10

We reviewed the cases of 10,638 cardiac surgical patients to determine the incidence of deep vein thrombosis (DVT) after open heart surgery (OHS). Seventy-seven patients (0.7 percent) had DVT. Group 1 included 36 patients who had DVT without pulmonary embolism (PE). Occurrence was equal in either leg. Anticoagulation with heparin and warfarin sodium (Coumadin) was employed as treatment. Extension of hospital stay was 10.8 days. Group 2 consisted of 41 patients who experienced PE 9.9 days after OHS. Sixteen patients had known DVT and were receiving heparin. In 25 patients, PE was the first event. Risk factors for PE included perioperative myocardial infarction (16 percent), atrial fibrillation (41 percent); blood type A (70 percent) (p less than 0.05), and coronary artery bypass graft (CABG) (98 percent). Twenty-four patients were treated with anti-coagulation alone. Six died of recurrent PE; mortality was 25 percent. Seventeen patients received anticoagulation plus inferior vena cava (IVC) interruption using a Hunter balloon. There were no recurrent PEs and there was one death from myocardial infarction (6 percent). Deep vein thrombosis and PE are rare complications of OHS. Routine prophylaxis with either heparin or warfarin is unnecessary. Patients with DVT, atrial fibrillation (AF), and perioperative myocardial infarction are at high risk of PE. Aggressive diagnosis to identify major venous thrombi along with anticoagulation and early consideration of IVC interruption are recommended for these patients. Patients who have undergone OHS and who have PE are at an unusually high risk for recurrent PE with death and are more safely treated with IVC interruption and anticoagulation than anticoagulation alone.
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PMID:Deep venous thrombosis. Implications after open heart surgery. 198 84

In a prospective, randomized, double-blind study, the efficacy and safety of a low-molecular-weight heparin were compared with those of unfractionated sodium heparin (standard heparin) in 136 patients who had elective total hip replacement. The patients received subcutaneous injection of either 5000 international units of low-molecular-weight heparin once daily or 5000 international units of standard heparin three times a day. Treatment with low-molecular-weight heparin began twelve hours before the operation, and treatment with standard heparin began two hours preoperatively; both regimens were continued for ten days. Twelve days postoperatively, bilateral ascending phlebography was performed in 122 patients, sixty-three in the treatment group that received low-molecular-weight heparin and fifty-nine in the treatment group that received standard heparin. Pulmonary scintigraphy was performed in 127 patients. Deep-vein thrombosis was diagnosed in forty-four patients: nineteen (30 per cent) of the sixty-three who received low-molecular-weight heparin and twenty-five (42 per cent) of the fifty-nine who received standard heparin. All but four patients, two from each treatment group, were asymptomatic. The difference in the total rate of thrombosis in the two groups was not significant (p = 0.189). However, thrombosis occurred in the thigh in only six (10 per cent) of the patients who received low-molecular-weight heparin but in eighteen (31 per cent) of those who received standard heparin, a significant difference (p = 0.011). Pulmonary embolism was detected in twenty-seven patients: eight (12.3 per cent) of those who received low-molecular-weight heparin and nineteen (30.6 per cent) of those who received standard heparin. Only three patients had clinical signs of embolism. Pulmonary embolism was significantly more frequent in the group that received standard heparin (p = 0.016). Total loss of blood and the total amount of blood that was transfused were significantly reduced in the patients who received low-molecular-weight heparin compared with those who received standard heparin. Prophylaxis was not discontinued because of hemorrhage in any patient. The efficacy of low-molecular-weight heparin was superior to that of standard heparin in the prevention of femoral thrombosis and pulmonary embolism, although the over-all incidence of deep-vein thrombosis was not statistically different.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Prevention of deep-vein thrombosis and pulmonary embolism after total hip replacement. Comparison of low-molecular-weight heparin and unfractionated heparin. 201 87


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