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Query: UMLS:C0149871 (deep vein thrombosis)
 12,364 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 16 year old teenager with chest pain came to the emergency room at Children's Hospital in Charleston, South Carolina. Her sharp, constant midsternal pain and breathing difficulties began the morning of admission. 1 week before admission, she experienced a similar but less intense pain which resolved spontaneously. She was taking low-dose, triphasic oral contraceptives (OCs) as treatment for severe dysmenorrhea and dysfunctional uterine bleeding. She had no family history of elevated lipids, blood or clotting disorders, and cardiovascular disease. She did not smoke. She was obese (137.3 kg). She had elevated blood pressure (147/33 mm Hg), a high low-density lipoprotein count (140 mg/dL), and a high total cholesterol count (237 mg/dL). Her tender right calf was larger than the left calf. She had decreased perfusion of the entire left lung and right lower lobe. A pulmonary angiogram revealed emboli, and ultrasound of the legs revealed a thrombus behind the right knee. The physicians discontinued the OCs. They administered 2 anticoagulants--intravenous heparin followed by oral sodium warfarin for 6 months. Her respiratory distress ended within several days. Her right calf was no longer tender after 1 week. The physicians discharged her on a low-cholesterol, low-fat diet. They suggested she reduce her weight and exercise more often. She did not experience another venous thrombosis or pulmonary embolus. It appeared that the OCs contributed to her thromboembolism; yet, she did lead a sedentary lifestyle and was considerably overweight. Even though thromboembolism is rare in adolescents with no underlying predisposition for cardiovascular disease and who do not smoke, physicians should watch for sizeable changes in blood pressure, lipids, and cholesterol level as well as symptoms of deep venous thrombosis and cardiovascular disease.
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PMID:Pulmonary embolus in an adolescent on oral contraceptives. 129 Jul 74

The Heparin Study in Internal Medicine (HESIM) compares the efficacy and safety of an unfractionated (UF) heparin with a low molecular weight (LMW) heparin (CY 216 D) for prevention of proximal deep vein thrombosis (DVT) and pulmonary embolism (PE) in medical inpatients with a high risk for development of thromboembolism. Patients are randomized and receive three times daily 5000 IU UF heparin or once daily 3100 IU LMW heparin and two placebo injections subcutaneously for 10 days. All patients are screened for the presence of proximal DVT at day 1 and 10 by real-time B-mode compression sonography and for PE by repeated clinical examinations. Perfusion scintigraphy is used for confirmation of the clinical diagnosis of PE. The study protocol includes a stratified randomization of patients on admission to the hospital according to one of the following main diagnoses: malignant disease, cardiovascular disease, bronchopulmonary disease, neurologic disease, and other diseases. The present study may serve as a model for further clinical trials in medical inpatients using the biometric approach of statistical analysis for proving equivalence of drug efficacy, and to adopt less sensitive but noninvasive methods for the detection of primary endpoints.
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PMID:Heparin Study in Internal Medicine (HESIM): design and preliminary results. 133 5

Oral contraceptives (OCs) containing a fixed dose of estrogen and progestogen in a 21-day regimen initially were approved for unrestricted use in the 1960s in the United States. OCs have been used and studied extensively for more than 30 years. They have always been seen as providing excellent efficacy. However, estrogens were associated with major risks in the use of OCs. In the early 1960s, case reports of thromboembolism in women using OCs led to epidemiological studies suggesting a correlation between deep vein thrombosis and the estrogen content of the pill. Research focused on decreasing the estrogen dose. In the evolution process, the combination monophasics of the early 1960s gave way to the sequential pill and the "mini pill" of the 1970s. Sex steroids given in the form of OCs were shown to alter lipoprotein and carbohydrate metabolism. This, together with the increased risk of thromboembolism, led to increased risk of cardiovascular disease, e.g., myocardial infarction. Little consideration (in the early 1960s) was given to the effects of potent progestogens and their interaction with estrogens. Hence, the recent focus of clinical research is the development of new and improved progestational agents. These third-generation gonane types appear to have little impact on carbohydrate or lipoprotein metabolism while maintaining excellent efficacy and cycle control. They should reduce the risk of serious side effects. However, to understand how and why these agents evolved, tracing the history of OC development is valuable. It might allow us to determine the baseline dose where we will begin to lose some of the OCs' benefits.
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PMID:Oral contraceptives: an epidemiological perspective. 136 86

We conducted a survey of all 926 active members of the British Orthopaedic Association using a postal questionnaire to find out their current attitude to thromboprophylaxis in total hip replacement surgery. Previous surveys have been performed, and with all the recent literature on the subject we wanted to see if the attitude of British orthopaedic surgeons has changed. There were 676 replies, a response rate of 73%. Fifty-five replies were excluded, those from surgeons who had retired from practice or whose practice did not include total hip replacement surgery. Of the remaining 621 surgeons, 466 (75%) use some method of thromboprophylaxis, with 367 (59%) routinely using prophylactic pharmacological agents and 99 (16%) using mechanical methods of thromboprophylaxis. Twenty-five per cent (155) of surgeons used no routine method of thromboprophylaxis. Eight-six per cent (534) of surgeons used a pharmacological method of prophylaxis in those patients thought to have a high risk of developing a deep vein thrombosis (DVT) (eg previous DVT, cardiovascular disease, obesity). Thirty-two different methods of thromboprophylaxis were used. Low molecular weight heparin is now being used by 19% of surgeons routinely and by 25% of surgeons in high risk cases, whereas 3 years ago it was not used at all. Our survey shows that although there is still a great reluctance for British orthopaedic surgeons to use pharmacological agents routinely in thromboprophylaxis. Amongst those that do, low molecular weight heparin is being increasingly used. More surgeons may want to use low molecular weight heparin routinely, but in some hospitals it is not currently available.
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PMID:The use of thromboprophylaxis in total hip replacement surgery: are the attitudes of orthopaedic surgeons changing? 147 52

The clinical findings relating to 11 patients in Hong Kong (HK) and to 43 patients described elsewhere, all with Streptococcus zooepidemicus septicaemia, are reviewed. There was a particular association with cardiovascular disease (27%) with seven cases of endocarditis, three of abdominal aortic aneurysm and two of deep venous thrombosis. Associations not previously reported included two cases of pharyngitis and two patients with persistent post-operative fever. The overall mortality was 22%. Both human and porcine strains of S. zooepidemicus from HK did not hydrolyse aesculin in contrast to the aesculin-positive biotypes reported previously. HK strains also had very mucoid colonies and capsules of hyaluronic acid were seen in electron micrographs. Samples of chromosomal DNA, extracted by means of HindIII restriction endonuclease, of strains from human beings and pigs were identical. The MIC of penicillin for all strains was less than or equal to 0.03 mg/l but the MBC for all was greater than 32 mg/l. Penicillin alone is generally sufficient for cure but combination with an aminoglycoside may be indicated in seriously ill patients. In our locality, pigs were incriminated as a possible source of human infection whereas consumption of contaminated dairy products is important elsewhere.
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PMID:Streptococcus zooepidemicus (Lancefield group C) septicaemia in Hong Kong. 227 71

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

This report reviews the present status of cardiovascular surgery in West Africa and highlights some of the constraints of development in this field.Rheumatic heart disease is still endemic in the tropics, where it constitutes about 20 percent of all cases of cardiovascular disease (CVD) in Nigeria. Endomyocardial fibrosis is a disease of unknown etiology accounting for 10 to 20 percent of cases. Purulent pericarditis is a common complication of pyomyositis and osteomyelitis found in 5 percent of patients. Chronic constrictive pericarditis is a sequela of infective pericarditis found in 5 percent of all cases of CVD. Calcification is found in 30 percent of cases and pericardiectomy can be performed successfully without cardiopulmonary bypass. Infective endocarditis is equally rare, occurring in 2.5 percent of cases; it is a common source of septic emboli to coronary artery and a very difficult disease to treat in the West African environment.Ischemic heart disease is relatively uncommon, accounting for less than 0.5 percent of patients. The rarity of the disease in black Africans has been attributed to dietary habits and environment rather than to racial and psychosocial factors. Congenital heart disease accounts for 5 percent of all cases of CVD in this review. Ventricular septal defect and patent ductus arteriosus are the most common acyanotic defects, while tetralogy of Fallot and transposition of the great arteries are the most common cyanotic defects.Vascular diseases are uncommon in this series, with traumatic injuries accounting for most of the cases. Abdominal aortic aneurysms, peripheral occlusive vascular disease, and atherosclerotic aortic aneurysms are quite rare. This review further confirms the rarity of deep venous thrombosis and pulmonary embolism in Africans.
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PMID:The status of cardiovascular surgery in West Africa. 331 74

In a prospective multicenter study, 244 men with highly or moderately differentiated prostatic cancer in stage I, II or III (VACURG) were consecutively randomized to three groups of treatment: Group A (77 patients) received polyestradiol phosphate (Estradurin, Leo) 80 mg i.m. every fourth week + ethinyl estradiol (Etivex, Leo) 150 micrograms daily, group B (72 patients) estramustine phosphate (Estracyt, Leo) 280 mg twice daily, and group C (76 patients) no therapy. Only men without current or previous other malignancy and without cardiovascular disease were admitted to the study. After 4 1/2 years 125 of the 244 patients had left the study, 9 because of cancer progression (stage IV, VACURG). The most serious complications were cardiovascular, including ischemic heart disease, cardiac decompensation, cerebral ischemia and venous thromboembolism, which occurred in 24 patients from group A and 9 from group B as compared to only one patient in group C. The subgroup superficial or deep venous thrombosis comprised 11 group A and 2 group B patients. Estrogens (E + e) offered as palliative treatment to patients with non-generalized prostatic carcinoma is burdened with a high incidence of serious cardiovascular complications.
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PMID:Cardiovascular complications of estrogen therapy for nondisseminated prostatic carcinoma. A preliminary report from a randomized multicenter study. 352 68

Focus in this discussion of pulmonary embolism is on the following: risk factors (age, heredity and blood type, obesity, estrogen and oral contraceptive use/pregnancy, cardiovascular disease, cancer, and other risk factors); pathophysiology and presenting symptoms; laboratory procedures and findings (radiography, electrocardiography, lung scanning, and evaluation of lower extremity veins); treatment modalities (heparin therapy, thrombolysis, and surgery); and prevention. Pulmonary embolism may be the primary cause or a major contributory cause in as many as 200,000 deaths per year in the US. Most of these deaths occur in patients in whom the diagnosis is not suspected and, thus, not treated. The mortality rate for untreated pulmonary embolism is approximately 30%. 90% of patients survive the initial embolic event, but the correct diagnosis is made in no more than 2/3 of cases. Risk factors for the development of deep venous thrombosis are based upon the Virchow-Aschoff postulates, which include: trauma or disruption of the vein wall; stasis of blood flow in the veins; and increased coagulability of the blood. More than 85-90% of all pulmonary emboli originate from deep venous thromboses in the popliteal and femoral deep veins. Other important, although less frequent, sites of origin of venous thromboembolism include the pelvic veins, the renal and hepatic veins, the axillary veins in the upper extremities, and the right atrium. Accurate diagnosis and effective prevention and treatment depend on the clinician's awareness of risk factors for development of deep vein thrombosis. Estrogen may accelerate intimal proliferation in arteries and veins, and it may also increase permeability of venous vascular endothelium. The risk of thromboembolism increases as the dose of estrogen increases. Both pregnancy and oral contraceptive use significantly decrease venous tone and the velocity of blood flow in the calf of the leg. Appropriate treatment includes thrombolytic therapy for patients with massive pulmonary embolism, which results in hypotension or shock. Anticoagulant therapy with herapin followed by an oral anticoagulant is the primary treatment for most patients with submassive emboli in which there is less cardiovascular compromise. When thrombolytic therapy is used, it should always be followed by anticoagulant therapy. Prevention of primary or recurrent deep vein thrombosis is directed toward improving venous blood flow and reducing hypercoagulability.
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PMID:Pulmonary embolism: incidence, diagnosis, prevention, and treatment. 398 Feb 63

The scientific basis for the statement that cigarette smoking increases the risk of serious cardiovascular side effects from oral contraceptive (OC) use is reviewed. The published literature and the new statistical analyses of the data are examined. Attention is directed to 3 broad categories of relevant vascular disease--deep vein thrombosis and pulmonary embolism, stroke--both occlusive and hemorrhagic, and ischemic heart disease. Within each category, the epidemiologic relationship of cigarette smoking alone, of OC use, and of a combination of the 2 is addressed. This review of smoking and OC use as risk factors for major classes of cardiovascular disease reveals little convincing evidence for an interaction of the smoking and OC use. Essentially all of the data have been interpreted to indicate that OC use is a risk factor for cardiovascular disorders derive from retrospective case-control studies, which continue to be a subject of controversy. The role of smoking as a risk factor appears to be little questioned in the case of myocardial infarction, and the evidence suggests that it may also be a factor in hemorrhagic stroke. There is little evidence to implicate smoking in the pathogenesis of thrombotic stroke in young women, and several publications suggest that it has a protective effect for deep vein thrombosis. In sum, evidence for an interaction of smoking and OC use has been reported but is deemed to be weak. A major existing difficulty is the methodological problems that are inherent in epidemiologic investigations, both retrospective and prospective. While conservatism could thus withhold needed and effective contraception, the recommendation is for the OC user to forego smoking.
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PMID:Smoking, oral contraceptives, and thromboembolic disease. 612 53


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