Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0149871 (deep vein thrombosis)
 12,364 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Portopulmonary hypertension occurs in 2-8% of liver recipients. However, new onset of pulmonary hypertension following liver transplantation has been reported only once. We report de novo occurrences of portopulmonary hypertension in two liver recipients following successful liver transplantation. Although both patients had recurrent hepatitis C after the transplant, both had excellent clinical graft function. In one patient, upper endoscopy and aortogram showed evidence of persistent venous collaterals in the abdomen. Both patients presented with shortness of breath. Portopulmonary hypertension was diagnosed late, thus contributing directly to their deaths. Autopsy in one patient confirmed the absence of significant liver pathology and failed to demonstrate any source of deep venous thrombosis. This, and our earlier case report, highlights the potential for the occurrence of pulmonary hypertension following liver transplantation. Further studies are needed to determine the scope of the problem and identify patients at risk for this complication.
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PMID:De novo diagnosis of portopulmonary hypertension following liver transplantation. 1239 97

The incidence of acute pulmonary thromboembolism (APTE) in younger patients is extremely low compared with older patients, so the clinical features of these younger patients with APTE is unknown. In the present study, 8 patients with APTE who were less than 40 years old (YG) were compared with 40 patients who were more than 41 years of age (OG). All YG patients had coagulopathy compared with 3 patients in the OG (p<0.01). Deep venous thrombosis (DVT) occurred in all 8 patients in the YG compared with 19 patients in the OG (p<0.01). A higher incidence of patients whose symptoms occurred gradually was noted in the YG (p<0.05). There were no significant differences in clinical characteristics, initial symptoms, past history or other predisposing factors for venous thromboembolism between the 2 groups. Residual pulmonary hypertension was not noted in the YG. However, 1 patient in the YG had recurrent APTE, despite good warfarin control. This study demonstrated the frequency of gradual onset, coagulopathy and clinical signs of DVT in the YG and therefore more careful and long-term observation is necessary in such patients.
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PMID:Clinical features of acute pulmonary thromboembolism in younger patients. 1265 64

Chronic pulmonary thromboembolism is a rare but treatable cause of pulmonary hypertension. We are describing two patients with limited mobility and dyspnoea. Neither of the patients had clinical evidence of deep vein thrombosis. A high level of clinical suspicion is required for the diagnosis. Spiral CT scan establishes the diagnosis avoiding the need for pulmonary angiography. Surgical endarterectomy is the treatment of choice. Life-long anticoagulation therapy is recommended for patients in whom surgery cannot be performed. Untreated, the condition carries a high mortality.
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PMID:Chronic pulmonary thromboembolism. 1297 82

Thromboendarterectomy is performed to treat chronic thromboembolic pulmonary hypertension with obstruction of main, lobar, or segmental pulmonary arteries. The present study evaluated surgical specimens removed between 1990 and 2001. Medical histories and microscopic slides were reviewed in each case. Study slides were stained with hematoxylin and eosin and Verhoeff-van Gieson and evaluated for thrombus, collagen, elastin, atherosclerosis, hemosiderin, calcification, and inflammation. The study group comprised 54 patients (30 women and 24 men), ranging in age from 33 to 77 years (mean, 58 years). Clinically, 28 (52%) had a history of deep leg vein thrombosis and 42 (78%) had a history of pulmonary embolism; 24 (44%) had both events. Coagulation abnormalities were documented in 15 (28%); autoimmune or hematologic disorders, in 8 (15%). Pulmonary thromboendarterectomy was bilateral in 52 patients (96%) and right-sided in 2. Six patients also had obstructions resected from the main pulmonary arteries. Obstruction limited to segmental arteries occurred only in women. Grossly, right-sided specimens were larger than left-sided ones (P = 0.003). Microscopically, ages of thrombi were uniform in 72% and variable in 28%. Intima was thickened in all patients and consisted of collagen (100%), elastin (67%), hemosiderin (56%), inflammation (53%), atherosclerosis (32%), and calcification (15%). We determined that pulmonary thromboendarterectomy was performed most often in middle-aged and elderly patients with a history of deep venous thrombosis or pulmonary embolism. Less than 50% of the patients had an identifiable coagulation, autoimmune, or hematologic abnormality. Most patients had bilateral disease and resections. Right-sided specimens were significantly larger than left-sided specimens, and lower lobe involvement was more common than involvement elsewhere. Resected tissues most commonly exhibited old organized thrombus.
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PMID:Surgical pathology of pulmonary thromboendarterectomy: a study of 54 cases from 1990 to 2001. 1469 15

Treatment goals for deep venous thrombosis include stopping clot propagation and preventing the recurrence of thrombus, the occurrence of pulmonary embolism, and the development of pulmonary hypertension, which can be a complication of multiple recurrent pulmonary emboli. About 30 percent of patients with deep venous thrombosis or pulmonary embolism have a thrombophilia. An extensive evaluation is suggested in patients younger than 50 years with an idiopathic episode of deep venous thrombosis, patients with recurrent thrombosis, and patients with a family history of thromboembolism. Infusion of unfractionated heparin followed by oral administration of warfarin remains the mainstay of treatment for deep venous thrombosis. Subcutaneously administered low-molecular-weight (LMW) heparin is at least as effective as unfractionated heparin given in a continuous infusion. LMW heparin is the agent of choice for treating deep venous thrombosis in pregnant women and patients with cancer. Based on validated protocols, warfarin can be started at a dosage of 5 or 10 mg per day. The intensity and duration of warfarin therapy depends on the individual patient, but treatment of at least three months usually is required. Some patients with thrombophilias require lifetime anticoagulation. Treatment for pulmonary embolism is similar to that for deep venous thrombosis. Because of the risk of hypoxemia and hemodynamic instability, in-hospital management is advised. Unfractionated heparin commonly is used, although LMW heparin is safe and effective. Thrombolysis is used in patients with massive pulmonary embolism. Subcutaneous heparin, LMW heparin, and warfarin have been approved for use in surgical prophylaxis. Elastic compression stockings are useful in patients at lowest risk for thromboembolism. Intermittent pneumatic leg compression is a useful adjunct to anticoagulation and an alternative when anticoagulation is contraindicated.
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PMID:DVT and pulmonary embolism: Part II. Treatment and prevention. 1603 81

The aetiology of chronic thromboembolic pulmonary hypertension (CTEPH) is largely unknown and may be heterogeneous, because there are several ethnic differences in the clinical characteristics of CTEPH. Female predominance and a higher ratio of chronic to acute pulmonary thromboembolism have been reported in Japan as compared with the USA. Because such ethnic differences may be controlled by genetic factors, the current study investigated HLA polymorphisms in Japanese patients with CTEPH. HLA typing by serological and/or DNA typing methods was performed (for HLA-A, B, DPB1, DRB1) in 80 patients and 678 controls, and the association of clinical characteristics with HLA alleles was studied. The frequencies of HLA-B*5201 (40 versus 24%) and DPB1*0202 (19 versus 6%) were significantly higher in the patients. HLA-B*5201 positive patients showed a significant female predominance. Total pulmonary vascular resistance and mixed venous oxygen tension were better in the HLA-B*5201 positive patients. In contrast, cardiac index and gas exchange parameters were worse in the HLA-DPB1*0202 positive patients. In the patients carrying HLA-B*5201 and/or -DPB1*0202, the frequency of deep vein thrombosis was significantly lower than the other patients. These observations suggested that both the susceptibility and clinical characteristics of chronic thromboembolic pulmonary hypertension were controlled in part by the HLA-B and -DPB1 loci.
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PMID:Association of clinical features with HLA in chronic pulmonary thromboembolism. 1564 Mar 34

Temporary interruption of the inferior vena cava (IVC) with a retrievable filter should be considered in patients with objectively verified proximal deep vein thrombosis (DVT) of the legs who have a temporary contraindication to therapeutic anticoagulation, or in patients who experience severe complications from anticoagulation. The risk of the temporary filter being left in place permanently must be considered. Use of a retrievable filter in conjunction with therapeutic anticoagulation during the early phase of therapy for acute DVT in patients whose cardiopulmonary reserve is limited (ie, those with pre-existing pulmonary hypertension) may be a future indication for this intervention. Interruption of the superior vena cava with a retrievable filter has been performed in a small number of cases, but there are insufficient data to guide risk:benefit analysis for this procedure. Thrombolysis, either systemic or local, results in a higher rate of thrombus resolution than anticoagulation alone. However, the long-term benefit of thrombolysis in preventing or improving the post-thrombotic syndrome remains unproven. Due to the substantial risk and cost of thrombolytic therapy, it should not be performed in the routine treatment of DVT. Thrombolytic therapy, in the absence of contraindication, should be considered in highly symptomatic, massive iliofemoral DVT. Catheter-directed thrombolytic therapy has shown promise in case series, but its role remains to be elucidated in randomized trials.
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PMID:Temporary Vena Caval Interruption and Thrombolysis in the Management of Deep Vein Thrombosis. 1593 23

Pulmonary hypertension due to chronic pulmonary thromboembolism is frequently underdiagnosed and has a very poor prognosis if untreated. When the presence of central pulmonary artery thrombus is confirmed, thromboendarterectomy is the treatment of choice, with very good results. We report a 28 years old male with two previous episodes of deep venous thrombosis (DVT) who was admitted due to 8 months of progressive shortness of breath and a syncope. He underwent a CT pulmonary angiogram and an echocardiogram. Severe pulmonary hypertension was confirmed, secondary to a chronic pulmonary thromboembolism with an overlapped acute component. He received systemic thrombolysis with partial thrombus disappearance. Therefore a pulmonary thromboendarterectomy was performed and an inferior vena cava filter was placed. The patient was discharged with marked improvement in his functional capacity.
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PMID:[CT angiography as the diagnostic and decision making method used for surgical indication in pulmonary hypertension due to chronic thromboembolism. Report of one case]. 1597 Sep 81

Massive pulmonary embolism (PE) is surprisingly common and is not necessarily heralded by dramatic symptoms or signs. The death rate from PE remains high, and the most common cause of mortality is recurrent PE, not cancer. Prevention of recurrent embolism with intensive anticoagulation remains the foundation of therapy. The Food and Drug Administration has approved use of the low molecular weight heparin enoxaparin for inpatient treatment of deep venous thrombosis (DVT) with or without PE as a "bridge'' to warfarin. However, in patients with massive PE, anticoagulation alone often does not suffice to prevent death or disability from chronic pulmonary hypertension. Impending hemodynamic instability due to massive PE and its attendant ominous prognosis can be detected by rapid identification of moderate or severe right ventricular failure (usually easily with transthoracic echocardiography). Successful treatment of overt cardiogenic shock, manifested by systemic arterial hypotension and tachycardia, is far more difficult than implementing a strategy that champions early intervention after the onset of right ventricular failure. Among patients with massive PE, thrombolysis and embolectomy (often performed in the interventional angiography laboratory) are being used with increasing skill and improved outcomes. Intensive pharmacologic therapy and mechanical support devices portend a new era of improved intensive and multidisciplinary management of these gravely ill patients.
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PMID:The approach to massive pulmonary embolism. 1608 64

Patients undergoing major lower-extremity orthopedic surgery such as total hip replacement (THR) and total knee replacement (TKR) are at an increased risk of venous thromboembolism (VTE). Routine prophylaxis is necessary to reduce the risk of deep vein thrombosis (DVT), which may progress to potentially fatal pulmonary embolism and secondary complications such as postthrombotic syndrome, recurrent DVT, and chronic pulmonary hypertension. Prophylaxis in patients undergoing TKR, THR, and hip fracture surgery is now standard practice and generally involves anticoagulant treatment with either low-molecular-weight heparin (LMWH) or warfarin for a period of 7 to 10 days, with extended prophylaxis in those with ongoing risk factors such as obesity, cancer, or previous VTE. Data from clinical practice suggest that there is a general trend toward longer postsurgical prophylaxis and shorter hospital stays, making practicality of treatment an important consideration. LMWH is effective for the prophylaxis of VTE, but the parenteral route of administration is not convenient for use in the outpatient setting. Warfarin, on the other hand, can be administered orally but requires the infrastructure for careful patient monitoring and dose adjustments because of its unpredictable dose-response relationship. The development of new anticoagulants has been pursued with the aim of improving efficacy, predictability, consistency of response, safety, and convenience. A recently approved anticoagulant, fondaparinux, has been proven to provide superior efficacy for the prevention of VTE compared with LMWH, but this agent requires parenteral administration and does not overcome the convenience issue. Ximelagatran is the oral form of the direct thrombin inhibitor melagatran, which is available for subcutaneous administration. Ximelagatran has a consistent anticoagulant response allowing fixed oral dosing without the need for coagulation monitoring. The efficacy and safety profile of melagatran/ximelagatran prophylaxis for VTE following THR and TKR has compared favorably with standard LMWH prophylaxis, as seen in the European METHRO II and III trials and EXPRESS trial, and with warfarin prophylaxis, as seen in the North American EXULT A and B trials. Several prophylactic treatment regimens have been evaluated in the European trials to determine the optimal dosing and timing of first dose of melagatran to achieve the best balance of efficacy and safety. Preoperative initiation of melagatran was more effective than when prophylactic treatment was initiated postoperatively, and the lowest rates of bleeding were associated with a postoperative initiation of prophylaxis. Early administration of the first postoperative melagatran dose (4 to 8 hours) was also associated with better prophylactic efficacy relative to a later postoperative start (8 to 12 hours). The results of the comprehensive international clinical trial program and in particular the optimal balance of efficacy/safety data provided by the METHRO III study have led to approval of melagatran/ximelagatran in 2004 in the European Union for the prevention of VTE in patients undergoing elective hip or knee replacement surgery. Ximelagatran has the potential to maximize the use of anticoagulation in patients discharged following major lower-extremity orthopedic surgery.
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PMID:Ximelagatran for the prevention of venous thromboembolism following elective hip or knee replacement surgery. 1612 14


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