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

Pulmonary revascularization after submassive pulmonary embolism can be achieved within 14 days in 50% of the patients treated with intravenous heparin then oral anticoagulants. Recurrence is estimated at 5% and risk of severe haemorrhage at 5 to 6%. For deep vein thrombosis, low-molecular weight heparins are at least as effective as unfractionated heparin and have a comparable or lower rate of complications. For submassive pulmonary embolism, two low-molecular weight heparins (calcium nadroparin and sodium dalteparin) have been compared with unfractionated heparin. Pulmonary revascularization on day 8 was about 68% for all treatment regimens. No cases of recurrent embolism were recorded and no severe haemorrhage occurred in patients given low-molecular weight heparin but did occur in 6% of those given unfractionated heparin. These early results, together with easy subcutaneous administration and the absence of daily dose adaptation requirement, suggest that low-molecular weight heparins could play a major role in treating submassive pulmonary embolism and thromboembolism in general.
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PMID:[Role of low molecular weight heparins for treating non-massive pulmonary embolism]. 789 6

In general surgery the incidence of deep vein thrombosis is between 10 and 40% according to age, the length and type of operation and the pathology "risk" associated. Prevention is undoubtedly the best way to avoid this complication. The aim of this study was to confirm, in 160 patients split in two groups, the clinical effectiveness and the usefulness of a low molecular weight heparin (parnaparin) versus calcium heparin. Both drugs demonstrated high effectiveness in prevention of deep vein thrombosis and or pulmonary embolism. In our opinion, however, parnaparin has a more protective and a less hemorrhagic inter-operation effect than calcium heparin and, not last, the advantage of a single daily administration.
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PMID:[Low molecular weight heparin (parnaparin) versus calcium heparin in the prevention of thromboembolic disease in general surgery]. 797 64

We performed a randomised controlled study to compare heparin with the A-V Impulse System in the prevention of deep-vein thrombosis (DVT) in 132 consecutive patients undergoing total hip replacement. After the operation, all patients had compression stockings, 65 were treated with calcium heparin and 67 with the intermittent plantar pump. DVT was diagnosed by Doppler ultrasound and thermography, followed by phlebography. There were 23 cases of DVT (35.4%) in the heparin group, with 16 major and seven minor thromboses. In the impulse pump group there were nine cases (13.4%) with three major and six minor thromboses. The differences for all thromboses and for major thromboses were both significant at p < 0.005. In the heparin group there was one fatal pulmonary embolism and nine patients (13.8%) had excessive bleeding or wound haematomas, as against none in the impulse pump group.
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PMID:Prophylaxis against deep-vein thrombosis in total hip replacement. Comparison of heparin and foot impulse pump. 770 63

DVT is a very frequent complication of general surgery. Heparin and, more recently, LMWHs can successfully prevent post surgical thromboembolism. One thousand one hundred and twenty-two patients (533 males and 589 females; mean age 62.2 +/- 11.4 yrs) were enrolled in a multicentre controlled study, to evaluate the efficacy and safety of enoxaparin in comparison to calcium heparin in the prevention of deep venous thrombosis (DVT) following general surgery. Patients assigned to the enoxaparin and the calcium heparin groups received 1 daily dose of 20 mg (2000 I.U.) and 2 daily doses of 0.2 ml (5000 I.U.), respectively starting 2 hours before the operation. Both drugs were given by subcutaneous route. A Doppler or Duplex Scan diagnosis of DVT was made in 3 (0.5%) patients in the enoxaparin group (2 cases during treatment and 1 patient at the end of treatment) and in 6 (1.1%) patients in the calcium heparin group (5 cases during treatment and 1, bilateral, after the end of treatment). Pulmonary embolism (PE) was ascertained by angiography in 1 patient (0.18%) in the enoxaparin group and in 2 patients (0.36%) in the calcium heparin one. Hemorrhagic complications occurred in 29 patients (5.2%) in the enoxaparin group and in 34 (6.1%) in the calcium heparin group. Haematomas located in the injection site were reported in 16.1% and 25.3% in the enoxaparin and calcium heparin groups respectively (p = 0.0001). Local pain in the injection site at the 5th day of treatment was reported in 8.4% and 16.6% in the enoxaparin and calcium heparin groups respectively (p = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Enoxaparin in the prevention of deep venous thrombosis after major surgery: multicentric study. The Italian Study Group. 827 57

The authors describe a rare case of pulmonary thromboembolism with unusual clinical findings and emphasized the large difficulty encountered in formuling a correct diagnosis in a reasonable time. A man, 60 years old, was admitted to a Medical Division of our hospital for the appearance of chest pain and epigastric pain during effort in the last year. He smoked 20 cigarettes a day and drank wine (1 or 2 litres a day). He was affected by hypercholesterolemia and in the past reported relapsed thrombophlebitis in the left leg. Four years before admission to our hospital he underwent large and small left saphenectomy. He had no cardiac events in the past. After a non significant exercise stress test the patient was treated with nitrates and asa and was discharged from the hospital. At home the symptoms increased and after 8 months the patient was admitted again to the Cardiologic Division of the hospital. At admission he reported dyspnea and chest pain at rest, not only during effort and the ECG showed negative T waves in anterior and inferior leads. Intravenous heparine, nitrates and calcium antagonists stabilized the clinical picture. The following examinations revealed: reduction of the T wave negativity at the ECG registered during chest pain; mild enlargement of the heart at the chest roentgenogram; normal value of the left ventricle and apical and midseptal by ipokinesia at the transthoracic echocardiogram; normal coronary artery at the coronary arteriography. "Vasospastic angina" was diagnosed and the patient was discharged after 20 days, asymptomatic. After 15 days he returned to the hospital again for chest pain, dyspnea, hypotension and syncope despite therapy. At physical examination he showed a painful left tibio-tarsal tumefaction, an increased and splitting second heart sound in the pulmonary area and a systolic murmur in the third and fourth left interspace. The ECG showed a severe anterior ischemia, while a new transthoracic echocardiogram revealed a considerable dilatation of the right atrium, right ventricle and the main pulmonary artery with severe tricuspid regurgitation and pulmonary hypertension (mean PAP about 50 mmHg). The following pulmonary perfusion scintigraphy confirmed the diagnosis of pulmonary embolism and the selective right and left pulmonary arteriography exhibited multiple thrombi and large intravascular filling defects. The right heart catheterization confirmed a chronic precapillary pulmonary hypertension (mean PAP = 55 mmHg). About 24 hours after these examinations the patient died because of a cardiac arrest with electromechanical dissociation. Pulmonary thromboembolism is a potentially fatal disease characterized by a largely variable clinical presentation. Frequently pulmonary embolism diagnosis is difficult especially when clinical findings are unusual. In the case observed the "typical" chest and epigastric pains associated with the electrocardiographic findings directed diagnosis towards myocardial ischemia. Also after the coronary arteriography that showed normal coronary artery, the erroneous diagnosis persisted. Pulmonary embolism was correctly diagnosed too late to begin an effective therapy. These unusual clinical findings and diagnostic mistakes are stressed and critically reviewed in the article.
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PMID:[Pulmonary thromboembolism. A clinical case with unusual presentation]. 871 Jan 39

Sixteen patients (6 women, 10 men; mean age: 52.5 years) suffering from spontaneous subarachnoid haemorrhage (SAH) of unknown origin underwent a protocol of initial and then weekly computed tomography (CT), initial four-vessel digital subtraction angiography (DSA) and at least one control pancerebral DSA. Fourteen patients had magnetic resonance imaging before undergoing first control DSA. All patients had calcium-antagonists (Nimodipine) via a central venous catheter, were kept on the neurosurgical intensive care unit and followed daily with transcranial Doppler ultrasonography (TCD). One patient (6.3%) developed moderate and 5 (31.1%) developed severe cerebral vasospasm as documented with TCD and exhibited deterioration of their level of consciousness. These 6 patients were treated with induced hypertension, hypervolaemia and haemodilution. Their blood flow velocities were elevated for a mean of 8 (5-17) days with a peak after 12.5 (9-17) days following SAH. No complications due to treatment were noted. One patient of the non-vasospastic group died of pulmonary embolism, another patient had an ischaemic incident during angiography, which has led to permanent disability. On follow-up 2-24 months after SAH 14 patients had returned to their premorbid state. It is concluded that patients suffering from SAH of unknown origin should undergo repeated angiographic investigation and subsequent daily monitoring of their neurologic status including daily TCD recordings so that haemodynamic treatment can be established in the event of cerebral vasospasm, which may occur in up to one third of these patients.
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PMID:Cerebral vasospasm after subarachnoid haemorrhage of unknown aetiology: a clinical and transcranial Doppler study. 880 Mar 32

In a prospective, randomized multicentre trial the safety and efficacy of two regimens of a low molecular weight heparin (nadroparin calcium) were compared for the prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE) in orthopaedic trauma patients. Two hundred and eighty-three patients with a spinal fracture, a pelvic fracture, or a lower limb injury were randomized to receive either a fixed dose (7500 anti-Xa IC units = 3075 anti-Xa IU) or a variable dose depending on body weight and time since operation (100 to 150 anti-Xa IC units/kg approximately equal to 40 to 60 anti-Xa IU/kg). The patients continued the prophylactic regimen for 6 weeks, but were withdrawn from the study medication in the presence of a major complication or if they were completely cured from their injury. To assess the rate of DVT, a B-mode ultrasound scan of both legs was performed. Positive results were confirmed by phlebography. If signs or symptoms of PE were present, a ventilation-perfusion scan was performed. Both prophylactic regimens were equally safe. In each group, five patients developed major haemorrhagic complications. In each group, one case of reversible thrombocytopenia was seen. DVT was confirmed by phlebography in one patient given the fixed dose and in four patients given the variable dose. PE was confirmed by ventilation-perfusion scans in one patient with the fixed dose and in two patients with the variable dose. An intention-to-treat analysis was performed on the overall randomized population, with the assumption that all patients who were lost to follow-up had DVT. A therapeutic efficacy analysis was performed on those patients, who completed the course of the prophylactic regimen and in whom B-mode ultrasound scanning was performed 10 days and also 6 weeks after injury. These two modes of analysis showed no significant differences in the incidence of DVT or PE between both prophylactic regimens. In conclusion, both regimens were equally safe following a spinal fracture, a pelvic fracture or a lower limb injury. The risk of DVT and PE was similar with both regimens.
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PMID:Thromboembolic prophylaxis in orthopaedic trauma patients: a comparison between a fixed dose and an individually adjusted dose of a low molecular weight heparin (nadroparin calcium) 927 47

Severe congestive heart failure and cardiogenic shock don't resemble a homogeneous clinical picture, but a syndrome that is based on very different etiologies. What all the etiologies have in common is the inadequate peripheral O2-supply to essential organs with or without signs of severe pulmonary congestion up to pulmonary edema. For prognosis and therapy is a fast diagnostical clarification of the causes crucial. The therapeutical procedure for the various etiologies may be diametrically opposed. For the therapy is it also dicisive to distinguish between acute myocardial failure, e.g. acute myocardial infarction, and the development of myocardial failure from a longer existing consistent congestive heart failure (cardiomyopathy). Whenever possible, next to symptomatically therapy of cardiogenic shock the basic conditions of the disease should be cured (e.g., PTCA, lysis with acute myocardial infarction, lysis in acute pulmonary embolism). In myogenic cardiogenic shock the use of positive-inotropic substances with and without simultaneous vasodilatory effects, if necessary in combination with other vasodilators, may be life-saving. Up until now there still doesn't exist an alternative to the catecholamines in the acute phase, initially they should be used as a first-line-therapy to stabilize the hemodynamics. The insertion of a Swan-Ganz-catheter for invasive therapy-monitoring, especially for the regulation of the therapy is a "condition sine qua non" for every patient with unstable hemodynamics. Because of the prompt beta-receptor-down-regulation during shock, caused by endogenous catecholamines, successful therapy with exogenous catecholamines is limited (adrenaline, dopamine, dobutamine), on account of the acceleration and intensification of the beta-receptor-down-regulation process. Possible beta-receptor independent alternatives are beta 2-agonists (dopexamine), PDE-III-inhibitors (amrinone, milrinone, enoximone) as well as H2-receptor agonists (impromidine, arpromidine) and finally the calcium-sensitisers (pimobendane). First results give rise to optimism to effectively reduce the mortality of congestive heart failure. The combination of these new pharmacological possibilities with interventional transcutaneous applicable assist-systems (aortic counterpulsationpump IABP, hemopump, transcutaneous heart-lung-machine) as well as the transitory application of an artificial heart (Novacor) can possibly increase the success of these therapeutic strategies. So far there are no convincing results shown in the world literature.
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PMID:[Pharmacotherapy of severe heart failure with inodilators--new approaches]. 902 10

In the last 20 years within the clinical research on venous thromboembolism a major objective was to identify and develop increasingly effective and safe methods of prevention. This trend is justified by the high incidence of thromboembolism as well as by the relevant mortality for acute pulmonary embolism and postphlebitic sequels of difficult treatment. A significant contribution to the rational application of methods of prevention was given by the knowledge of risk factors. Together with acquired risks, as surgery, age, malignant tumors, in the last 30 years some conditions of thrombophilia were identified. They are caused by deficiencies in coagulation inhibitors (antithrombin III, protein C, protein S) or other alteration of the anticoagulation system as resistance to activated protein C or antiphospholipid antibodies. The primary prophylaxis of venous thromboembolism is aimed at the prevention of thrombosis by pharmacologic methods able to oppose the procoagulant alterations while avoiding hemorrhagic complications. The physical methods tend to reduce the stasis in the veins of the lower extremities. Subcutaneous calcium heparin at the dose of 5000 U twice or three times a day is the most common pharmacologic method used. It was shown to be safe and effective especially in postoperative prophylaxis of venous thromboembolism in general surgery. More recently, low molecular weight heparin fractions have been introduced. As compared to standard heparin they have the advantage of a single daily dose and a better efficacy in some groups of patients, as those undergoing hip replacement. Among the substances under clinical experimentation, dermatan sulfate seems promising. Most common physical prevention methods consist in the use of elastic graduated compression stockings and systems of intermittent pneumatic calf compression. The former can be used also in presence of a hemorrhagic risk as in neurosurgery. The latter have shown a good efficacy in increasing flow velocity and probably also in enhancing the fibrinolytic activity. The combination of physical and pharmacologic methods seems to be able of enhancing the efficacy of prophylaxis.
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PMID:Risk factors and prevention of venous thromboembolism. 906 62

Nadroparin (nadroparin calcium) is a low molecular weight heparin with a mean molecular weight of 4.5 kD. Compared with unfractionated heparin (UFH), nadroparin has a greater ratio of anti-factor Xa to anti-factor Ha activity, greater bioavailability and a longer duration of action, allowing it to be administered by subcutaneous injection for prophylaxis or treatment of thromboembolic disorders. In clinical trials conducted in older patients (mean age usually > 60 years), nadroparin was at least as effective as UFH in preventing deep vein thrombosis (DVT) and pulmonary embolism after major general or orthopaedic surgery, and in bedridden medical patients. Nadroparin was also at least as effective as dalteparin or oral acenocoumarol in preventing thromboembolic events following general and orthopaedic surgery, respectively. When used for treatment of established DVT, nadroparin was at least as effective as intravenous UFH. Subcutaneous nadroparin, at dosages similar to those used for the treatment of DVT, produced promising results in older patients with pulmonary embolism, acute ischaemic stroke or unstable angina. In 1 study, 75% of nadroparin-treated patients were able to complete their treatment at home and 36% did not require admission to hospital; the potential pharmacoeconomic implications of these results deserve further evaluation. Overall treatment costs (drug acquisition and monitoring costs) were similar for nadroparin and UFH in a French study, but nadroparin was associated with significantly less nursing time spent on treatment delivery. Nadroparin is well tolerated by older patients. The most frequently reported adverse events in a large (n approximately 4500) placebo-controlled study in general surgical patients were wound and injection site haematoma (11.8 and 10.2%, respectively, vs approximately 6.5% for placebo). When used as prophylaxis, no significant differences in bleeding complications were noted between nadroparin and UFH or acenocoumarol recipients. Prophylactic nadroparin was associated with significantly fewer withdrawals because of adverse events than UFH in elderly bedridden medical patients. When used as treatment for DVT, nadroparin was generally associated with lower occurrences of major bleeding than intravenous UFH (0.5 to 2.3% vs 2 to 5%); however, trials were not large enough to demonstrate any significant differences between the 2 agents. Similarly, the incidence of thrombocytopenia was slightly, but generally not significantly, lower in nadroparin (< 1%) than in UFH (< or = 3.5%) recipients. Thus, nadroparin should be considered an effective and well tolerated alternative to UFH for prophylaxis and treatment of DVT in older patients, with the advantage of more convenient administration and decreased monitoring requirements.
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PMID:Nadroparin calcium. A review of its pharmacology and clinical use in the prevention and treatment of thromboembolic disorders. 910 90


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