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)

Thrombolytic therapy is being used with increasing frequency in myocardial infarction (MI), pulmonary embolism, deep venous thrombosis (DVT), and peripheral arterial occlusion. Use of these agents, however, is hampered by concerns regarding safety and efficacy. Numerous laboratory parameters have been evaluated for monitoring the risk of bleeding complications, with levels of fibrinogen (and percentage of decrease) and fibrin/fibrinogen degradation products (FDPs) correlating to a variable extent with clinical bleeding. The bleeding time (BT) test has also been proposed as a potential predictor of bleeding during thrombolytic therapy. With respect to efficacy, the D-dimer fragment of FDPs, when corrected for soluble fibrin polymers, has been shown to correlate with clot lysis in venous thromboembolism but not MI. The BT also is being considered as a marker of lysis in patients with DVT. Given the increasing concomitant use of antiplatelet agents during thrombolytic therapy, the BT, as an in vivo test of hemostasis and platelet function, has potential utility as a noninvasive, adjunctive marker of thrombolytic efficacy.
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PMID:Laboratory parameters to monitor safety and efficacy during thrombolytic therapy. 200 7

An inadequate efficiency of the fibrinolytic system was revealed in 50-60% of subjects suffering young age from venous thrombosis or myocardial infarction. In a group of 27 patients with the history of deep venous thrombosis of the idiopathic type the authors revealed a significant relationship between the elevated body weight and inadequate fibrinolysis manifested by a reduced fibrinolytic capacity and excess inhibitor of plasminogen activator and its inadequate decline after desmopressin infusion (DDAVP). In a group of 29 patients, who had suffered a myocardial infarction when young, the authors revealed a significant association between reduced fibrinolytic capacity and elevated body weight, hypertriglyceridaemia and increased immunoreactive insulin secretion after a glucose load. In half the investigated subjects it proved possible to improve the reduced fibrinolytic capacity by a low energy diet.
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PMID:[Disorders of fibrinolysis and thrombophilic states, risk factors and possibilities of dietary effects]. 205 93

Autologous 111In oxine-labelled platelet scintigraphy was used to detect left ventricular thrombi in 20 patients with anterior and 18 patients with inferior Q wave myocardial infarction within 48-72 h. Left ventricular thrombi were found in 8/20 patients with anterior myocardial infarction and in 1/18 patients with inferior myocardial infarction, giving a total incidence of 24%. Patients with left ventricular thrombi were older (64.3 versus 58.2 years), had higher peak creatinine kinase (CK) levels (4523 versus 2749 IU 1-1), lower ejection fraction (19.5 versus 37.8%, P less than 0.005) and were more likely to have an enlarged left ventricle than those without left ventricular thrombi (87.5 versus 54.5%, P less than 0.001). Left ventricular thrombi were found overlying sites of myocardial infarction in 8 out of 9 patients. Apical left ventricular thrombi were 1.7 times more common than septal left ventricular thrombi. All patients received minidose heparin for prevention of deep venous thrombosis. This technique is complementary to echocardiography and may provide additional information in the difficult cases where the decision about full-dose anticoagulation is in doubt.
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PMID:Early detection of left ventricular mural thrombi after acute Q wave myocardial infarction using 111In oxine-labelled autologous platelets. 212 15

Percutaneous transluminal angioplasty was performed in 39 consecutive patients with atheromatous renal artery stenosis associated with hypertension. The mean blood pressure before angioplasty was 191/107 mmHg and this had dropped to a mean of 167/90 mmHg at the patient's most recent visit, representing a significant fall in both systolic (p less than 0.01) and diastolic pressures (p less than 0.001). The mean serum creatinine was 166.7 mumol/l before percutaneous transluminal angioplasty and 155.3 mumol/l at the most recent visit (not statistically significant). The mean number of anti-hypertensive drugs fell from 2.4 to 1.9 after percutaneous transluminal angioplasty (p less than 0.05). Three patients (eight per cent) were 'cured' (diastolic blood pressure less than 90 mmHg without medication), 25 (64 per cent) had 'improved' (diastolic blood pressure less than 109 mmHg, with a fall of more than 15 per cent) and 11 (28 per cent) had not improved. Logistic discriminant analysis showed that pre-percutaneous transluminal angioplasty diastolic blood pressure, age, serum creatinine and smoking habit together correctly predicted the outcome of percutaneous transluminal angioplasty in 90 per cent of patients, with four 'false positives' and no 'false negatives'. Ten patients suffered a total of 12 serious complications related to the procedure: one death in acute renal failure, one myocardial infarction, one severe hypotension just after the procedure, one deep vein thrombosis, one episode of transient ischaemia of the toes and seven groin haematomas. Thus percutaneous transluminal angioplasty for atheromatous renal artery stenosis rarely 'cures' hypertension, but improved blood pressure control is often achieved, albeit at the expense of troublesome complications. A prospective, randomized trial is needed to establish whether or not the improvement is due directly to percutaneous transluminal angioplasty.
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PMID:Percutaneous transluminal angioplasty for atheromatous renal artery stenosis--blood pressure response and discriminant analysis of outcome predictors. 214 39

We developed an ELISA to quantitate complexes of activated protein C (APC) with a major plasma APC inhibitor, alpha 1-antitrypsin (alpha 1AT) in human plasma based on the sandwich principle using two different antibodies directed towards protein C and alpha 1AT, respectively. This ELISA test was specific for APC:alpha 1AT complexes and sensitive to greater than or equal to 150 pg complex. Fifty-one of 56 healthy donors had APC:alpha 1AT complex levels above the detection limit (3 ng/ml) ranging from 4 to 14 ng/ml (mean value +/- SD: 7.6 +/- 2.5 ng/ml). Patients (n = 10) with disseminated intravascular coagulation (DIC) had detectable levels of APC:alpha 1AT complex ranging from 21 to 125 ng/ml (median: 69 ng/ml). Complexes of APC with plasma protein C inhibitor (PCI) were also measured using an ELISA sandwich assay. None of the 30 healthy donors had detectable levels (greater than or equal to 5 ng/ml) of APC:PCI complex, and plasma samples from 9 of 10 DIC patients had detectable concentrations of APC:PCI complex ranging from 10 to 63 ng/ml (median: 22 ng/ml). APC:alpha 1AT complex was detected in 25 of 26 patients with deep venous thrombosis (DVT), with levels ranging from 5 to 136 ng/ml (median: 23 ng/ml), whereas APC:PCI was detected in only 6 DVT patients, with levels between 11 and 105 ng/ml. PCI antigen levels in 70 normals ranged from 56 to 175% (mean +/- SD: 99.1% +/- 24.2%). PCI antigen levels were decreased in DIC patients, in patients with cerebral arterial thrombosis, and in DVT patients undergoing heparin therapy, but not in patients with myocardial infarction. PCI antigen levels were decreased much further in DVT patients receiving heparin compared to those not receiving heparin, showing that heparin therapy is associated with a decrease in PCI levels. The detection in normal subjects and in thrombotic patients of circulating APC:inhibitor complexes supports the view that the protein C pathway is activated during DIC and DVT. Moreover, it emphasizes that both PCI and alpha 1AT are physiologic inhibitors of APC. Thus, measurement of APC complexes may provide sensitive parameters for specific detection of activation of the clotting and protein C pathways.
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PMID:Determination of plasma protein C inhibitor and of two activated protein C-inhibitor complexes in normals and in patients with intravascular coagulation and thrombotic disease. 217 67

Broad spectrum assays which measure a range of fibrinogen/fibrin derivatives (FDPs) in serum have become an established means of identifying activation of blood coagulation and/or fibrinolysis, such as occurs in disseminated intravascular coagulation (DIC). There is considerable interest in the application of these assays to the diagnosis of other hypercoagulable states, such as recurrent deep venous thrombosis and myocardial infarction. In recent years, more sensitive and specific FDP assays (e.g. for fragment E, fragment E neoantigen, D-dimer, fragment D neoantigen, fibrinopeptide A and fibrin fragment beta 15-42) have been devised, some of which allow measurement in plasma of FDPs without interference from fibrinogen or certain of its derivatives. It was predicted that these assays would both avoid the possibility of artifacts introduced as a consequence of serum preparation and improve detection of hypercoagulable states. In the light of these expectations we have reviewed data published on the use of assays to detect clinical hypercoagulability, giving prominence to assays of crosslinked fibrin derivatives and nothing particularly certain studies that have compared the performance of different assays on the same samples. The accumulating evidence indicates that all of the assays are adequate for detection of DIC. The same cannot be said for other hypercoagulable states. Here much variation is evident between different studies of similar patients in the ability of a particular marker to discriminate between a normal control group and patients determined to be hypercoagulable by an independent method. This variability would seem to be a function of patient group heterogeneity and selection, as assays that detect different antigenic determinants produce results on the same plasma samples that are well correlated. It appears that the precise antigenic determinant does not critically affect detection of hypercoagulability. Additionally, some studies have indicated that use of serum need not introduce artifacts. Despite there being no other obvious advantage, the convenience of some of the plasma assays may well encourage their widespread use. Assays have also been developed for measuring activation fragments of coagulation proteins (e.g. prothrombin fragment F1 + 2 and protein C activation peptide) and for proteinase inhibitor complexes (e.g. thrombin-antithrombin complex) generated during activation of coagulation. The latter assays have been useful in providing a biochemical definition of a 'prethrombotic state'.
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PMID:Assessment of hypercoagulable states by measurement of activation fragments and peptides. 218 46

Measurements were made of levels of D-dimer in plasma and serum, thrombin-antithrombin complex (TAT) in plasma and fibrinogen/fibrin fragment E antigen (FgE) in serum in a normal healthy control group and in patients with a range of disorders associated with hypercoagulability. Levels were determined in 31 normal healthy controls, 30 patients with disseminated intravascular coagulation (DIC), 21 patients with deep venous thrombosis (DVT), 27 patients with myocardial infarction (MI), 26 patients with acute leukaemia and 56 patients with liver disease. Considering all subjects, significant correlations were established between the results of all assays. Notably high correlations (r greater than 0.9) were established between plasma and serum levels of D-dimer, between plasma levels of D-dimer and serum levels of FgE, and between serum levels of D-dimer and FgE. All assays showed very high discrimination (sensitivity) between the normal control group and patients with DIC (97-100%), but there were marked differences between the assays in sensitivity for DVT and MI. In general, the FgE assay was more sensitive than the D-dimer assay, whilst both the FgE and D-dimer assays were more sensitive than the TAT assay. The same trends were apparent in the capability of the assays to discriminate between the normal control group and patients with acute leukaemia and liver disease: disorders with an unknown prevalence of activation of coagulation/fibrinolysis. Our results indicated that measurements of fibrinogen/fibrin degradation products (FDPs) in serum were almost unaffected by artefacts. The data further suggested that the broad-spectrum FgE assay was better than the more specific D-dimer assay in detecting clinical hypercoagulability. Our study showed that, in the clinical conditions examined, FDPs were more effective markers of hypercoagulability than TAT.
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PMID:A comparative evaluation of assays for markers of activated coagulation and/or fibrinolysis: thrombin-antithrombin complex, D-dimer and fibrinogen/fibrin fragment E antigen. 218 90

5 cases of vascular complications--hemorrhagic stroke, myocardial infarction, retinal vein thrombosis, thrombotic stroke and deep vein thrombosis--in young women taking low dose oral contraceptives are described from the Department of Obstetrics and Gynecology, University of the Witwatersrand, Johannesburg, South Africa. The hemorrhagic stroke occurred in 1987 in a 24-year old heavy smoker taking Triphasil (Wyeth) for 12 months. She recovered fully. A 34-year old woman had an anteroseptal infarction while on Minovlar ED (Schering, 50 mcg ethinyl estradiol and 1 mg norethisterone acetate) for 2 years. She had no risk factors other than smoking 5 cigarettes daily. The woman with retinal vein thrombosis had 2 episodes, the 1st while taking Restovar 28 (Organon, 37.5 mcg ethinyl estradiol and 0.75 mg lynestrenol) for 7 years. 19 months later she began Diane (Schering AG, 50 mcg ethinyl estradiol and 2 mg cyproterone acetate) and had a bilateral retinal vein thrombosis leaving her partially blind. The woman with thrombotic stroke was 24 when she was struck in 1986, after 1 year of taking Logynon ED (Schering AG, 6/5/7 days, 30,40/40 mcg ethinyl estradiol and o.5/0.75/0.125 mg levonorgestrel). The patient with deep vein thrombosis was 19, smoked, and had used Triphasil for 2.5 years.
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PMID:Vascular complications in women using the low steroid content combined oral contraceptive pills: case reports and review of the literature. 220 50

The study was carried out of 53 patients with acute myocardial infarction receiving no anticoagulant treatment. Changes were traced in certain indices of the blood clotting system and fibrinolysis in plasma in the first 14 days of the disease, with particular attention given to patients in whom during the hospitalization signs of deep vein thrombosis in the lower extremities appeared or a positive result was obtained of the test with 125I-fibrinogen. In a group of 9 patients with deep vein thrombosis developing during the observation, on the first day of myocardial infarction shortening of the kaolin-cephalin clotting time and considerable rise of the level of fibrinogen-fibrin (FDP) degradation products were noted in serum, and on the 14th day raised fibrinogen level and reduced exogenous fibrinolytic activity of the plasma were noted. Increased level of fibrinogen and FDP and exogenous and endogenous plasma fibrinolytic activity observed on the 7th day of the disease were not related to the development of thrombotic complications. The thrombin clotting time, platelet count, factor X level, protein C concentration and antithrombin III activity in the plasma were not significantly changed during myocardial infarction. The obtained results suggest a limited usefulness of the basic tests of the clotting and fibrinolytic systems for early diagnosis of deep vein thrombosis in acute myocardial infarction.
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PMID:[Assessment of hemostasis in patients with myocardial infarction complicated by deep venous thrombosis]. 227 86

The overall risk of oral contraceptive (OC) use is minimal when women over 35 years of age, smokers, and those with multiple risk factors (thromboembolic disorders, cerebrovascular or coronary artery disease, liver tumors, breast cancer, estrogen-dependent neoplasms, undiagnosed abnormal genital bleeding, and congenital hyperlipidemia) are excluded. OC use increases the risk of hypertension by 1-5%, depending on age, parity, and duration of use, but even this small risk is decreased when multiphasic OCs are prescribed. Deep venous thrombosis in the leg is 4 times more prevalent in OC users than nonusers and the risk of superficial thrombosis is doubled. Again, fewer thromboembolic complications occur when the estrogen dosage is low. The risk of myocardial infarction is not believed to increase with OC use as long as other risk factors--smoking, obesity, hypertension, age over 35 years, hypercholesterolemia--are not present. Studies involving the original high-dose OCs revealed a 3-fold increase in the risk of thrombotic stroke and a 2-fold increase in the risk of hemorrhagic stroke, but low-dose OCs appear to have no effect on the potential for stroke. The impact of OC use on breast cancer cannot yet be determined given the very long latency period of this cancer. In terms of benign breast disease, OC users have been shown to be at substantially reduced risk of lesions, fibroadenomas, and fibrocystic changes. OCs also protect women from endometrial and ovarian cancer, although the pill seems to accelerate the progression of cervical dysplasia. Other beneficial effects of OC use include reductions in the incidence of pelvic inflammatory disease, endometriosis, ectopic pregnancy, and ovarian cysts.
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PMID:Oral contraceptive pills. Part II: Potential complications and health benefits. 228 19


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