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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In this review of cardiovascular effects of oral contraceptives (OCs), the risks are identified from 2 prospective cohort studies as 19/10,000 woman years for the risk of thrombosis or thromboembolism. 11 of 19 were superficial thrombosis and 8 were deep vein thrombosis or pulmonary embolism. For women with no risk factors, the risk was 2.0 for superficial thrombosis and 4.0 for deep vein thrombosis. Myocardial infarction (MI) risk is estimated at 7/100,000 current users/year for women 30-39 years and 67/100,000/year for women 40-44 years based on combined British and American studies. 37/100,000/year is the estimated risk for women 30-44 years for either thrombotic or hemorrhagic stroke. 50% of the MIs and 10% of the strokes were fatal. The total annual risk of death from any circulatory disease was estimated at 22-24 deaths/100,000 women years based on 2 British cohort studies. Other predisposing factors also contribute to cardiovascular disease, and separating out the effects has been controversial. In 1985, a study refuted that OCs were responsible for any effect on cardiovascular risk, because of flawed case control studies. One such study is cited which shows that only 16.7% of OC users were confirmed by Doppler ultrasound for deep vein thrombosis compared with 30.7% for nonusers. The general trend in the UK is one of reduced death rates from circulatory disease for women in spite of widespread contraceptive use. This relationship between OC use and cardiovascular disease was evidenced in another study of vital statistics from 21 countries. The pathological mechanisms for the association between OC use and vascular disease are discussed for blood clotting with the importance of predisposing factors highlighted, MI and lipid metabolism and other risk factors, stroke, and breakthrough bleeding. The risk is very low for vascular disease with available low- dose preparations. Risk is further reduced with careful screening of high risk women. The side effects of low-dose pills such as breakthrough bleeding can be treated with cautious use of alternative high-dose formulations and patient education. Low-dose OCs with 30-35 mg of estrogen combined with a low-dose and low androgenic progestin are recommended.
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PMID:Cardiovascular effects of oral contraceptives: a review. 257 58

Blood echogenicity was measured in four patient groups with circulatory disturbances (myocardial infarction, stroke, claudication, and deep venous thrombosis) at hospital admission and one week later. The recording was done by an A-mode ultrasonic method at three shear rates down to 4.1 s-1. The rheological effects of adding an anti-aggregatory drug, naftidrofuryl, was tested in vitro at concentrations ranging from 10(-8)-10(-6) M. Echogenicity was lowest in blood from healthy volunteers and significantly greater in blood from patients with claudication. The in vitro addition of naftidrofuryl significantly lowered the echogenicity of blood samples taken from patients with venous thrombosis in the lower extremities. The authors suggest that increased blood echogenicity, which can be pharmacologically manipulated, may be a nonspecific indicator of disease.
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PMID:The in vitro echogenicity of flowing blood in patients with vascular disease and the effect of naftidrofuryl. 267 60

Clinical experience with thrombolytics in non-coronary disorders is limited to the plasminogen activators streptokinase, urokinase and alteplase; therapeutic trials with anistreplase (APSAC) are almost, and with saruplase completely, limited to acute myocardial infarction. In terms of thrombus clearance, thrombolytic drugs are superior to heparin in patients with recent deep vein thrombosis in the pelvis or lower limbs. In aggregate, thrombi younger than 8 days are lysed in approximately 60% of patients treated with streptokinase, urokinase or alteplase. The results of studies assessing the subsequent development of the postphlebitic syndrome are conflicting, but most suggest that thrombolytic therapy can reduce symptoms of chronic venous insufficiency. Currently, the combination of systemic thrombolytic drugs followed by heparin is recommended for patients with acute major pulmonary embolism who are haemodynamically unstable. Streptokinase, urokinase and alteplase have all been shown to accelerate the lysis of pulmonary emboli and to decrease pulmonary vascular obstruction and pulmonary hypertension. Systemic venous or intrapulmonary infusions of alteplase offers the same benefit in terms of angiographic and haemodynamic improvement. A short infusion of 100 mg alteplase over 2 hours seems to be superior to a 24-hour infusion of urokinase. None of the thrombolytic trials in pulmonary embolism have been large enough to demonstrate a reduction in mortality. It is now generally accepted that, unless contraindicated, thrombolytic therapy is the front-line treatment for patients with massive pulmonary embolism and major haemodynamic disturbance. The local treatment of acute arterial occlusion in limb arteries results in rapid clearing of the artery in 67% of patients treated with streptokinase; the corresponding success rates for urokinase and alteplase are 81% and 88 to 94%, respectively. The main question appears to be the identification of patients in whom local thrombolysis is the treatment of choice, as opposed to established therapeutic modalities. Thrombolytic treatment following a major ischaemic stroke is hazardous, although clinical improvement has been noted in a minority of patients with recanalised cerebral arteries. The safety and efficacy of thrombolytic treatment remains unproven for this indication, and its use must be restricted to experimental protocols. Thrombolytic treatment in retinal artery or vein occlusion has, in practice, been abandoned.
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PMID:Use of thrombolytic drugs in non-coronary disorders. 268 38

Over a period of 18 years, 191 consecutive patients had interruption of the inferior vena cava with the Hunter-Sessions balloon for complications of deep venous thrombosis and pulmonary embolism. Causes of deep venous thrombosis and pulmonary embolism included the postoperative state (33%), cancer (32%), and stroke (11%). There were 93 females and 98 males; ages ranged from 17 to 90 years (average, 57 years). Indications for placement of the Hunter-Sessions balloon were as follows: contraindication to anticoagulants (33%), anticoagulant complications (24%), pulmonary embolism despite anticoagulants (45%), and others including inferior vena cava thrombus (12%). Sixty-eight percent had clinical phlebitis and 36% had positive venography results. Pulmonary embolism had occurred in 165 patients (86%). It was diagnosed by ventilation-perfusion scanning (75%), angiography (23%), or on clinical grounds (2%) in patients with confirmed deep venous thrombosis. At the time of the procedure 52% were in significant cardiopulmonary distress, and 10% were intubated and on respirators. Transjugular placement was done in 188 patients, and transfemoral placement was performed in three. All All tolerated inferior vena cava interruption. Thirty patients (15%) died while in the hospital an average of 21 days after balloon placement, which was unrelated to the deaths. Follow-up was 45 months. Ninety-four patients are dead, 95 are alive, and the status of two patients is unknown. Twenty-nine of 64 patients (45%) who died after they left the hospital died of cancer. At last follow-up, 75% of patients had legs free of edema and 25% had need for elastic stockings. No malfunction or migration has occurred with the device. No patient had a pulmonary embolism while in the hospital after insertion of the Hunter-Sessions balloon, and no patient died of pulmonary embolism. Late minor pulmonary embolism occurred in three patients.
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PMID:Inferior vena cava interruption with the Hunter-Sessions balloon: eighteen years' experience in 191 cases. 279 70

Deep venous thrombosis (DVT) in the legs occurs in 23% to 75% of patients with acute ischemic stroke, and pulmonary embolism accounts for about 5% of deaths. New heparinoid substances, lacking the hazards of more established anticoagulants, raise the question of DVT prophylaxis for these patients. Two hundred fifty consecutive acute ischemic stroke patients were evaluated for the presence of DVT of the legs in a feasibility study for a trial of low-molecular-weight heparin prophylaxis. Forty-nine patients were found suitable for the study, of whom 11 (22.5%) developed DVT. All patients underwent clinical examination, I-125 fibrinogen leg scanning, and impedance plethysmography. Five patients were sufficiently alert and without serious neurologic deficits to justify DVT prophylaxis. Recent advances in noninvasive diagnostic techniques to detect DVT early and the development of relatively safe heparinoid compounds increase the need for a prophylactic study in patients with ischemic stroke.
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PMID:Deep vein thrombosis after ischemic stroke: rationale for a therapeutic trial. 284 84

Ancrod has been used in Europe for over 15 years for peripheral vascular disease, deep vein thrombosis, and central retinal venous thrombosis, and in patients at risk for thromboembolism. In a double-blind, randomized, placebo-controlled study at University Hospitals in Cincinnati, 20 acute cerebral infarction patients received a series of IV infusions of ancrod (ten) or placebo (ten) for seven days. Early fibrinolysis with a small decrease in fibrinogen was observed, and d-dimers were elevated at four hours, indicating early clot lysis. At three months, patients with moderate to severe strokes (less than 40 on the Scandinavian Stroke Scale) in the ancrod group showed average improvement by a factor of 3 over the placebo group. No bleeding, abnormal laboratory results, or deaths occurred, but ancrod was discontinued in one patient who had seizures. As a result of this study, a double-blind multicenter international clinical trial to further assess the safety and effectiveness of ancrod is being planned.
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PMID:Use of ancrod in acute or progressing ischemic cerebral infarction. 305 31

There are 2 striking differences in the practice of medicine in the US and in the UK: 1) in the former, there is a great emphasis on private medicine, and 2) in the US there is a much higher incidence of litigation, whereas in the UK, family planning services are free, and litigation in this area is almost unknown. British medical opinion agrees with the US on the following oral contraceptive contraindications: 1) cancer of the breast, ovary, uterus, vagina, or cervix; 2) coronary thrombosis, pulmonary embolism, deep vein thrombosis, angina pectoris, or stroke; and 3) unusual or unexplained vaginal bleeding. Both countries agree that it is inadvisable to give the combined pill over the age of 45, and over the age of 35 in smokers. The UK agrees with 75% of the routines adopted by US doctors on a patient's 1st visit for oral contraceptives. However, a patient who becomes amenorrheic while taking the pill is not regarded as lightly in the UK as she would be in the US; she is closely monitored. If 1 of 4 risk factors (age 35 or over, hypertension, obesity, or smoking) is evident, a patient in the UK is closely supervised while taking the pill. If more than 2 risk factors are present, a UK doctor may advise against the pill. Since the 1960s the media have both praisd and condemned the pill. There is no doubt that, in the field of contraceptive advice, the US and the UK lead the way, and a closer liaison between the 2 medical professions is essential to reassure patients.
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PMID:Contraceptive advice: how the English differ from the Americans. 309 Feb 54

Recent reviews have suggested a higher frequency of the lupus anticoagulant or related antiphospholipid antibodies in patients with systemic lupus erythematosus (21% to 65%) than was found in earlier studies (6% to 18%). In our study of 60 consecutive patients, we found the frequency of the lupus anticoagulant by Russell viper venom time was 6.7% (95% confidence interval, 16.2 to 1.8) and by anticardiolipin antibody assay was 25% (95% Cl, 37.0 to 15.7), compared with 0% (p = not significant) and 2.5% (p = 0.002), respectively, in the normal control population. The Russell viper venom time (p = 0.0001 by t-test) and anticardiolipin antibody levels (p = 0.01) were significantly associated with presumed thrombotic events (stroke, deep venous thrombosis, and digital gangrene). No association with miscarriage or pulmonary hypertension was detected. The Russell viper venom time was more specific than the anticardiolipin antibody level in the prediction of past presumed thrombotic events, miscarriage, or pulmonary hypertension (100% compared with 84%, p = 0.01).
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PMID:The frequency of lupus anticoagulant in systemic lupus erythematosus. A study of sixty consecutive patients by activated partial thromboplastin time, Russell viper venom time, and anticardiolipin antibody level. 310 10

A 16-year-old girl developed right middle cerebral artery infarction and deep venous thrombosis of the lower extremities in association with circulating lupus-like anticoagulant. Currently, she is functionally independent with no further vascular insults and is being treated with sodium warfarin. This patient illustrates that cerebral ischemia can occur in association with lupus anticoagulant in the pediatric population. This entity should be considered and appropriate screening tests performed in young patients with unexplained ischemic stroke or transient ischemic attack.
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PMID:Ischemic stroke in a girl with lupus anticoagulant. 314 70

This study was designed first to determine the prevalence of occult proximal deep vein thrombosis (DVT) in stroke patients admitted to rehabilitation hospital using the technique of impedance plethysmography (IPG), and second, to identify clinical findings which may be indicators of an increased risk for the development of proximal DVT. Impedance plethysmography was performed on 105 consecutive stroke patients within one week of admission to our hospital. It was found that 34 out of 100 patients with adequate studies had abnormal IPG, two out of the 34 had known DVT, leaving 32 out of 98 with undiagnosed DVT (19 on the paretic side alone, nine bilateral, and four on the nonparetic side). Using logistic regression analysis, it was determined that profound weakness, male gender, interval between the stroke and IPG, edema, and leg hyperpigmentation were independently associated with positive IPG. Since IPG has a high positive predictive value for proximal DVT, one must assume that most of our patients with positive IPG have proximal DVT. Routine screening of stroke patients for DVT seems indicated and probably should include noninvasive venous studies such as serial IPG. The most efficient screening protocol needs to be determined.
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PMID:Occult proximal deep vein thrombosis: its prevalence among patients admitted to a rehabilitation hospital. 334 16


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