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

This article discusses some of the issues raised by development of a new low-dose oral contraceptive (OC) now available in the US after 12 years of clinical use around the world. The principle of using as little of a therapeutic agent as possible to achieve the desired results is the rationale for low-dose OCs. It is very difficult to show a correlation of ambiguous side effects such as depression and mood changes and the dosage level. Some controversy accompanies efforts to reduce grave adverse reactions to OCs, primarily cardiovascular, by lowering the dose: doubts about the underlying epidemiological data result from the probable process of self-selection among women choosing OCs and changing prescription practices by physicians as well as the steady decline in frequency of serious cardiovascular problems, both of which create a shifting baseline. Thrombophlebitis has an even more ambiguous correlation: epidemiologists using clinical and hospital diagnostic records were apparently unaware of the considerable evidence which began to appear in the late 1950s on the unreliability of the clinical diagnosis of deep vein thrombosis. Mechanisms that may be involved in initiating cardiovascular accidents must be considered in the effort to demonstrate the beneficial effects of dosage reduction in a nonepidemiological manner. Little support remains for the notion that coagulation factor changes are important in the genesis of cardiovascular problems attributed to OCs, and the Framingham study, which is attempting to relate information on lipid factors predisposing to myocardial infarction to use of OCs, has not had a single myocardial infarction in a premenopausal woman. The role of lipoproteins among older OC users who smoke cannot however be dismissed and possible risk factors should be minimized even in the absence of detailed information. Other issues discussed are the apparent difference between metabolic transformation of the inactive isomer removed from norgestrel and the metabolism of the active compound, the near impossibility of detecting very small differences in contraceptive effectiveness, the importance of cycle control in determining acceptance of an OC, and the question of whether important beneficial side effects will persist as dosages are lowered.
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PMID:Advances in oral contraception. An international review of levonorgestrel and ethinyl estradiol. 640

Rapid inhibition of tissue-type plasminogen activator (t-PA) in human plasma was measured by addition of 5 IU (50 ng) of purified t-PA per ml plasma and measurement of residual t-PA in the euglobulin precipitate after 5 min incubation at 37 degrees C. The recovery of both t-PA activity and t-PA related antigen in pooled plasma from healthy individuals was approximately 90 percent, indicating that one ml of pooled normal plasma inhibits less than 1 IU or 10 ng of t-PA within 5 min. Of 20 control subjects 13 had less than 1 IU inhibitor activity; 5 subjects inhibited between 1 and 3 IU of t-PA and 2 subjects inhibited around 4.5 IU. The inhibitor titer in the latter two had however decreased to 1.8 and 2.7 IU after two days. Markedly increased rapid inhibition of t-PA (greater than 4 IU per ml) was found in plasma of patients with severe liver disease (3 of 8), pancreatitis (4 of 8), malignancy (5 of 26), but only very occasionally and transiently in that of patients with myocardial infarction (5 of 28) or deep vein thrombosis (2 of 9). Increased inhibition was observed on the first day following coronary bypass (22 of 42) or open heart (16 of 27) surgery but this had disappeared in 15 of 16 patients on the fifth postoperative day. Titration of inhibitor levels revealed maximal amounts of 30 to 50 IU per ml plasma.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Plasma levels of a specific inhibitor of tissue-type plasminogen activator (and urokinase) in normal and pathological conditions. 642 82

Delayed-onset thrombocytopenia developed in 12 patients while they were receiving either prophylactic or therapeutic heparin. Five of the patients had thrombocytopenia alone, and seven had thromboembolic complications which contributed to the death of one patient. These complications included deep venous thrombosis (four patients), pulmonary embolism (three patients), myocardial infarction (one patient), sagittal sinus thrombosis (one patient), and femoral artery occlusion (one patient). The diagnosis of heparin-induced thrombocytopenia was delayed for between one and 13 days after the initial complicating event. All patients had heparin-dependent platelet-aggregating factor in their plasma. The characteristics of the heparin-dependent platelet-aggregating reaction were the same in all patients, but the nadir of thrombocytopenia was lower in patients with delayed-onset heparin-induced thrombocytopenia and complicating thromboembolism. These findings highlight the necessity for early recognition of this syndrome and for the prompt withdrawal of heparin to prevent considerable patient morbidity.
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PMID:Delayed-onset heparin-induced thrombocytopenia. A potentially malignant syndrome. 687 44

Anticoagulant therapy has stood the test to time. Full-dose heparin and warfarin prevent recurring pulmonary embolism and deep venous thrombosis. Their use is indicated in patients who have experienced venous thromboembolism unless contraindications are compelling. Low-dose heparin is successful in preventing the initial episode of venous thrombosis in most patients at high risk for the development of thrombophlebitis. Warfarin reduces the incidence of systemic embolization in patients with heart disease and atrial fibrillation and in patients with artificial heart valves. Evidence is accumulating to suggest that warfarin may still retain an important role in the management of patients with myocardial infarction. However, bleeding remains an inevitable risk in patients receiving anticoagulant therapy. The risk, however, can be diminished when both the physician and patient understand the mechanism of action of the drugs and the factors that predispose to bleeding.
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PMID:Current status of anticoagulant therapy. 707 46

18 out of 137 psoriasis-patients had cardio-vascular complications (myocardial infarction: 3, angina pectoris: 5, deep vein thrombosis: 3, superficial thrombophlebitis: 6, sudden death: 1). Predisposing factors may be found, however, the preliminary results reveal that psoriasis does not predispose to cardio-vascular complications by itself. An exception is psoriatic arthritis.
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PMID:[Correlation between psoriasis and cardiovascular diseases (author's transl)]. 710 23

A study is reported which tries to identify those members of the general population who may be at increased risk of vascular disease. It is probable that patients who have had previous thrombotic episodes are inherently more at risk of further episodes and that a thrombus many months ago will not affect current tests. Accordingly we carried out a number of tests involving platelets on 'controls', and on patients with a past history of either myocardial infarction or deep vein thrombosis (DVT) and patients suffering from intermittent claudication who also are assumed to be at higher risk than the controls. Differences were demonstrated between controls and patient groups and these differences were utilized to develop statistical functions with the ability to discriminate between the groups. The functions were then tested using a second set of data from similar groups. Those designed to discriminate between myocardial infarction patients and controls and between patients with claudication and controls were validated. The heparin thrombin clotting time was found to be the prime predictor variable; the platelet count, platelet volume, platelet factor 3 clotting time and the bleeding time have some predictive value. The antithrombin clotting time, platelet aggregation and platelet adhesiveness tests as measured were not found to have discriminating potential. It is suggested that these appropriate risk functions could be of practical value in identifying members of the general population who may be at greater risk than average. The discriminate functions for DVT patients and controls could not be validated, suggesting differences in platelet involvement in arterial and venous thrombosis.
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PMID:Platelets in the prediction of thrombotic risk. 715 92

14 prospective, randomized trials dealing with non-operated patients were analyzed. In all of them the presence of deep vein thrombosis was measured by the radioactive iodine fibrinogen uptake test. Various prophylactic regimens were tested. 13 studies concern patients after myocardial infarction and one a cerebral hemorrhage patient. Only 2 trials confirm the value of oral couramin administration for the reduction of deep vein thrombosis after myocardial infarction. Two studies show that prophylactic anticoagulation with a full dose of heparin reduces the incidence of deep vein thrombosis after myocardial infarction. In 3 studies, again after myocardial infarction, a statistically significant reduction in the incidence of deep vein thrombosis is found when small doses of heparin are given. In 1 study investigating a few patients no effect could be shown. Low doses of heparin reduce the incidence of deep vein thrombosis after acute cerebral hemorrhage. Early mobilization has reduced the incidence of deep vein thrombosis in 21 patients after myocardial infarction, as compared to 8 patients treated with bed rest. Heavy smokers suffering myocardial infarction show a statistically significant lower incidence of deep vein thrombosis than non-smokers, as 3 papers confirm.
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PMID:[Prevention of deep vein thrombosis in internal medicine]. 725 26

To provide information about long-term outcome after radical prostatectomy for clinically localized prostatic cancer (stage T2c or lower), we undertook a retrospective analysis of 3,170 consecutive patients (mean age 65.3 +/- 6.4 years, range 31 to 81) with a mean followup of 5 years. Complication rates for patients who underwent prostatectomy before 1988 were compared with those who underwent radical prostatectomy more recently. Of the patients 49 (1.5%), 178 (5.6%), 897 (28%) and 2,047 (65%) had clinical stages T1a, T1b, T2a and T2b,c disease, respectively. The Gleason score was 3 or less in 292 patients (9%) and 7 or greater in 782 (25%). Overall, 438 patients (14%) died, 159 (5%) of cancer. The crude 10 and 15-year survival rates for all patients were 75% and 60%, respectively, which is comparable to the expected survival of a control group (67% and 46%). The cause specific survival rates were 90% and 82%, respectively, metastasis-free survival rates 82% and 76%, local recurrence-free survival rates 83% and 75%, overall recurrence-free rates 72% and 61%, and overall recurrence plus prostate specific antigen progression-free (greater than 0.2 ng./ml.) rates 52% and 40%, respectively. Clinical stage did not significantly affect survival but tumor grade was associated: 10 and 15-year cause specific survival rates were 95% and 93%, respectively, for a Gleason score of 3 or less, 90% and 82%, respectively, for a score of 4 to 6, and 82% and 71%, respectively, for a score of 7 or more. Of all patients 26% received adjuvant treatment (hormonal and/or radiation) within 3 months postoperatively because of advanced local pathological stage (pT3 or higher) or margin positive disease. The 30-day mortality rate was 0.3% (0% for 1,728 patients who underwent surgery in 1988 or later). Only 1 patient in the 70 year or older age group died during hospitalization. Complications decreased with time. In a contemporary group the complications were rectal injury in 0.6% of the patients, colostomy in 0.06%, myocardial infarction in 0.4%, deep venous thrombosis in 1.1%, pulmonary embolism in 0.7% and total urinary incontinence (3 or more pads per day) in 0.8%. Recent intraoperative blood loss was a median of 600 ml., and the incidence of recent need for any transfusion was 31% and it is presently less than 5%. In this series patients undergoing radical prostatectomy for clinically localized prostate cancer were usually healthy and, thus, had low co-morbidity. Survival rates at 10 and 15 years compare favorably with those of an age-matched control group.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Long-term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer. 793 40

Ethinyl estradiol is the only estrogen form used in low-dose oral contraceptive (OC) pills. Progestogenic compounds used in OCs include norethindrone, norethindrone acetate, ethynodiol diacetate, norgestrel, levonorgestrel, and norethynodrel. The newest third generation progestins are desogestrel and norgestimate. The most important benefits associated with OC use are a decrease in benign breast disease, less incidence of ovarian and endometrial cancers, and a decrease in the incidence of pelvic inflammatory disease. The most serious risks to OC users who are over age 35 and smoke are deep vein thrombosis, pulmonary embolus, retinal thrombosis, or cardiovascular disease. Other risk factors for cardiovascular disease include obesity, diabetes, hypertension, increased serum cholesterol, and a family history of premature myocardial infarction. All users should have blood pressure checks 3 and 6 months after commencing pill use. OC preparations cause an increase in total cholesterol, triglycerides, low density lipoprotein (LDL), very low density lipoprotein (VLDL), and a decrease in high density lipoprotein (HDL), but norgestimate may actually increase HDL levels. Preparations with levonorgestrel may produce the greatest decrease in glucose tolerance, while those with 35 mcg of ethinyl estradiol and 0.5 mg of norethindrone have the least effect. OCs do not increase the risk of developing breast cancer, but can stimulate the growth of breast cancer once it has occurred. The incidence of gallbladder disease is increased slightly in OC using women who are predisposed. Hepatocellular adenomas are associated with combined OC use. Underweight women are more prone to side effects and need a very low potency preparation. A common problem encountered by patients on OCs is amenorrhea. This usually resolves after 3 cycles. Breakthrough bleeding is also very common. Post-pill amenorrhea is frequently found after stopping OCs. Combined oral contraceptives are a safe and effective contraceptive method for most women throughout their reproductive years.
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PMID:Combined oral contraceptive pills: a brief review. 783 35

Oral anticoagulants were introduced in the late 1940s and remain widely used today. Indications include prevention of thrombosis associated with atrial fibrillation, structural cardiac diseases and following prosthetic valvular replacement. They have been used for both treatment and prophylaxis of deep venous thrombosis and in efforts to decrease the frequency and rate of second myocardial infarction. These compounds include the coumarin derivatives [dicoumarol (bishydroxycoumarin), phenprocoumon, nicoumalone (acenocoumarol)] and the indanedione derivatives (diphenadione, phenindione, anisindione) which, because of adverse reactions, are largely unavailable. The oral anticoagulants, and warfarin in particular, are highly interactive with other drugs. Mechanisms of those interactions include both pharmacokinetic and pharmacodynamic mechanisms and may result in either hyper- or hypoprothrombinaemia. Because their principal adverse reaction is haemorrhage, and interactions are widespread across many therapeutic specialties, it becomes imperative for the practising physician to be aware of the possibility of interaction whenever these agents are coadministered with other drugs.
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PMID:Clinically significant drug interactions with the oral anticoagulants. 803 88


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