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

The clinical picture of pulmonary embolism (PE) ist remarkably unspecific and one has to rely mainly on imaging techniques to obtain a reliable diagnosis. PE is not a primary disease but the complication of deep venous thrombosis (DVT), and thus there is a strong correlation between pulmonary embolism and venous thrombosis. Radiologic screening of these diseases is based on invasive and noninvasive tests. Chest X-ray has a low predictive value of 63% and helps mainly in ruling out other diagnoses such as pneumothorax or pneumonia. Chest computed tomography scanning with contrast may occasionally be useful in detecting large central emboli. Magnetic resonance imaging in PE has not yet been shown to be of great clinical value. Digital subtraction angiography has the potential advantage of allowing injections of smaller contrast volumes and is particularly useful in pulmonary hypertension. Cardiac and respiratory motion blur images and render interpretation difficult. Conventional pulmonary angiography is required for definitive diagnosis in a significant number of patients, especially when V/Q scan is non-diagnostic. Its morbidity and mortality is nowadays negligible. If these facilities are not available, they can often be obviated by venous studies searching for the presence of venous thromboses. Alternative modalities include contrast phlebography and venous ultrasound imaging. This last, newly developed technique combined with compression Doppler is safe and accurate, at least in the femoral and popliteal veins. Contrast phlebography remains the standard imaging method, is widely available, and demonstrates floating clots or thromboses with minor complications using non-ionic contrast media.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Diagnostic and interventional radiology in pulmonary embolism]. 194 62

The ability of streptokinase and urokinase to lyse intravascular fibrin-based clots is firmly established. However, there is a lack of enthusiasm for these agents because of serious haemorrhagic complications and a lack of controlled randomized studies indicating their efficacy. Thrombolytic therapy is suitable in only 15 per cent of patients with acute deep venous thrombosis. It restores the venous circulation to normal in up to 95 per cent of these patients if therapy is instituted within 5 days of the onset of symptoms. These patients have significantly fewer symptoms on follow-up than patients treated with heparin although the ability of thrombolytic therapy to preserve venous valvular function and to prevent the post-phlebitic syndrome is now in question. Thrombolytic therapy is as effective as heparin in preventing pulmonary embolism and may be superior in its treatment. Pulmonary haemodynamics are rapidly improved, diffusion capacity is restored and, although the evidence is inconclusive, long-term pulmonary hypertension may be prevented. Although the mortality rate is not decreased, controlled studies show that thrombolytic therapy may be beneficial in massive pulmonary embolism with clinical shock. Thrombolytic therapy is indicated for acute arterial and acute bypass graft occlusion when the surgical alternative is associated with a higher morbidity and mortality. Partial thrombolysis is achieved in up to 90 per cent of cases and the need for further therapeutic intervention is eliminated in one-third of the patients treated. New thrombolytic agents with greater specificity and potentially greater efficacy and fewer complications are being developed. Tissue plasminogen activator has been successfully used. Prourokinase, fibrin-seeking urokinase and acetylated streptokinase-plasminogen complex may expand the role of thrombolytic therapy in surgical practice.
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PMID:The role of thrombolytic therapy in surgical practice. 265 13

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

Between October 1982 and July 1984 systemic thrombolysis was carried out in 10 patients (5 males and 5 females aged 19 to 66 years) with massive pulmonary embolism (PE). Mean thrombolytic treatment duration was 77 hours. The main fibrinolytic agent used (9 cases) was streptokinase. Sequential treatment with streptokinase and urokinase was given to 2 patients and urokinase alone to one. 5 patients received porcine plasmin additionally, and one patient BRL 26921 (streptokinase-plasminogen complex) and human plasminogen. Pulmonary arterial pressures were recorded serially. Pulmonary angiograms were obtained before, occasionally during and after thrombolysis. Pulmonary arterial pressures (systolic: p less than 0.01, diastolic: p less than 0.05, mean: p less than 0.01, paired t-test, two tailed) and pulmonary angiograms (p less than 0.001, paired t-test, two tailed) all showed significant improvement. Thrombolytic treatment had to be discontinued in two patients due to side effects. Patients with the most recent PE showed the best response. Patients with recurrent PE and preexisting pulmonary hypertension showed no improvement. In PE without deep vein thrombosis (DVT), treatment duration of up to three days seems to be appropriate. In PE with concomitant DVT the treatment should be prolonged to achieve complete lysis of thrombi.
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PMID:[Fibrinolysis therapy in massive lung embolism. Experiences in 10 patients 1982-1984]. 293

Two patients with the lupus anticoagulant exhibited unusual cutaneous manifestations. They both fulfilled four criteria for systemic lupus erythematosus and had experienced deep venous thrombosis. The first patient suffered from a leg ulcer that resembled a pyoderma gangrenosum. The second patient presented erythematous and purplish macules on the fingertips. The histologic studies showed only microthrombosis in the dermal vessels without vasculitis, although such lesions in systemic lupus erythematosus are usually attributed to vasculitis. The association of these cutaneous lesions with lupus anticoagulant has never been reported. It is likely that this association is not fortuitous. After a review of the literature, it seems possible to individualize a new syndrome characterized by the presence of a subgroup of antiphospholipid antibodies. Thrombosis, spontaneous abortions, neurologic manifestations, pulmonary hypertension, positive results of a Coombs' test, and thrombocytopenia can be included in this syndrome, which overlaps with systemic lupus erythematosus. Certain cutaneous symptoms are associated with the presence of lupus anticoagulant or other antiphospholipid antibodies: leg ulcers, distal cutaneous ischemia, widespread cutaneous necrosis, and livedo. They can be considered as the dermatologic manifestations of this syndrome.
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PMID:Cutaneous manifestations associated with the presence of the lupus anticoagulant. A report of two cases and a review of the literature. 309 56

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

Thrombolytic therapy is an effective, rapid method in treatment of massive lung embolism and major deep venous thrombosis extending to the caval vein. Besides resolution of the thrombus and improving hemodynamics, it prevents evolution to chronic pulmonary hypertension or postphlebitic syndrome. To have a beneficial effect in the early course of acute myocardial infarction, thrombolytic therapy should be instored within about three hours after the onset of pain; a real brief time limit. Intracoronary or systemic fibrinolysis later than the three hours period does not improve cardiac wall motion and hemodynamics and cannot assure infarct size reduction in spite of reestablished coronary flow. In peripheral arterial disease, fibrinolytic therapy of thrombosed grafts or vessels facilitates detection and unmasking of the underlying anatomical lesion permitting definite therapy (graft revision, percutaneous transluminal angioplasty). Selective intraarterial infusion has given encouraging results. Thrombolysis is a reasonably safe therapeutic method, on the condition of respecting all contraindications and avoiding unnecessary punctions. Allergy and hyperthermia are mostly benign and responsive to medical treatment. Cost-effectiveness renders streptokinase the most applicated thrombolytic agent.
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PMID:[Current status of fibrinolysis--a literature review of 25 years of fibrinolytic treatment]. 330 73

A 75-year-old woman presented with deep venous thrombosis and multiple pulmonary emboli. Course was complicated by pulmonary hypertension which caused central shunting of blood through an abnormal patent foramen ovale. Paradoxical embolus to the right coronary artery was demonstrated premorbidly and at autopsy.
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PMID:Paradoxical coronary embolism associated with an unusual interatrial flap valve. 337 97

A 39-years-old male patient with chronic venous insufficiency, deep venous thrombosis and recurrent pulmonary embolism in the past medical history. After syncopal event was diagnosed of bilateral chronic pulmonary embolism, pulmonary hypertension and right ventricular failure. Fibrinolytic treatment was no effective therapeutic modality. Under cardiopulmonary bypass, bilateral pulmonary thromboendarterectomy with extension into lobe arteries, plus insertion of caval filter was performed. We present our experience with this case and a review of the literature.
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PMID:[Bilateral pulmonary thromboendarterectomy in chronic pulmonary thromboembolism. A case report and review of the literature]. 748 Oct 40

In 10 patients with thromboembolic disease 1 Gunther filter and 9 LGM filters were inserted. Indications for filter placement were: pulmonary hypertension caused by recurrent pulmonary embolism in 3 cases; planned surgery in 2 patients with pulmonary embolism and deep venous thrombosis; recurrent pulmonary embolism despite of anticoagulant treatment in 2 cases, previously performed thrombo-endarterectomy in 1 case; contraindications for anticoagulant treatment in 1 case and complications of anticoagulant therapy also in 1 case. No serious complications after filter placement were observed.
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PMID:[Indications for prophylactic vena cava filters introduced subcutaneously in patients with thromboembolic disease--preliminary report]. 758 Oct 62


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