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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 study was concluded on paraplegic and tetraplegic patients of all aetiologies except neoplasic, where paralysis developed within 48 hours. All patients were admitted to the rehabilitation department within 90 days after the onset of paralysis. In a preliminary review of 328 files, there were 27 cases of clinical deep vein thrombosis (DVT) and 10 with pulmonary embolism (PE), 6 of which were fatal. A prospective study was conducted, based on systematic detection of asymptomatic DVT with phlebography. Among the 147 patients, 20 previously presented with DVT. The 127 others underwent phlebography which showed 39 DVT in 29 patients. Eighty seven patients with negative phlebography underwent a second study a month later which showed 14 DVT in 12 patients. Only one minor pulmonary embolism occurred in these 147 patients. The incidence of DVT after acute spinal cord injury and the frequent absence of clinical manifestations were confirmed. Prophylactic anticoagulant therapy is useful but insufficient. This study demonstrates that systematic and repeated detection of DVT by phlebography may reduce the incidence of PE.
Paraplegia 1991 May
PMID:Systematic lower limb phlebography in acute spinal cord injury in 147 patients. 187 Aug 90

A detailed analysis was undertaken to study the incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), and death during the initial hospitalisation after traumatic spinal cord injury (SCI). The National Spinal Cord Injury Statistical Center supplied data on 1419 subjects with acute injuries hospitalised between October 1, 1986 and June 9, 1989. The incidence of PE was 4.6% (4.3% for paraplegia and 4.8% for quadriplegia) and 14.5% for DVT (15.9% for paraplegia and 12.5% for quadriplegia). Fifty two patients (3.7%) died during their initial hospitalisation. Age, gender, and quadriplegia were not statistically significantly correlated with the development of DVT, while motor complete lesion was a better predictor of DVT than a complete lesion. The highest incidence of DVT was 22.9% in patients with motor complete paraplegia, while the lowest incidence was 9.3% in patients with motor incomplete quadriplegia. The only significant predictor for PE was age. Mortality was associated with increased age, PE, quadriplegia, and complete lesions. The highest incidence of death was 14.0% in patients greater than or equal to 40 years of age with quadriplegia and the lowest incidence of death was 0.37% in patients less than 40 years of age with paraplegia. This study emphasises the need for careful analysis and detailed stratification when designing or interpreting SCI research with DVT, PE, and mortality. Completeness of lesion, age, and category of impairment, whether quadriplegia or paraplegia, are appropriate strata to select.
Paraplegia 1991 Jan
PMID:Acute spinal cord injuries and the incidence of clinically occurring thromboembolic disease. 202 73

The authors report 21 cases of heparin-induced thrombocytopenia with ischemic vascular complications. The clinical presentations were peripheral arterial ischemia (16 cases), hemiplegia (1 case) and deep vein thrombosis (4 cases). The vascular surgeon confronted by these complications in an emergency situation should recognise the difficulties of clinical diagnosis (atypical forms) and biological investigations (problems of tests of platelet aggregation). Arterial occlusions are usually accessible to disobliteration with a Fogarty catheter without peroperative heparinisation. Delayed diagnosis explains the seriousness of these complications; in our series of 21 patients, there were 2 deaths, 1 paraplegia, 4 amputations due to arterial problems, 4 severe post-deep vein thrombosis conditions, two of which followed trans-metatarsal amputation. The diagnosis of heparin-induced thrombocytopenia implies immediate withdrawal of heparin therapy. A relay with a low molecular weight heparin is not without risk and should only be undertaken after a negative platelet aggregation test (with the low molecular weight heparin). These tests are rarely practicable in emergency situations and a relay using oral anti-vitamin K antagonists with a rapid onset of action is probably the safest option.
 ...
PMID:[Ischemic vascular complications following thrombopenia induced by heparin. Diagnostic and therapeutic problems]. 212 62

In a patient with traumatic neuropathy at C6, a delayed DVT was observed in the left axillary-subclavian veins with consequent neurological symptoms, loss of brachioradialis and wrist extensor functions. Anticoagulation therapy for 12 weeks did not correct the occlusion of the veins. It is stressed that anticoagulation treatment should be started as early as possible, preferably within a few days after development of the DVT.
J Am Paraplegia Soc
PMID:Axillo-subclavian deep venous thrombosis in quadriplegia: a case report. 337 90

The centrally active, alpha-2 adrenergic receptor agonist clonidine was given to 12 spinal cord injury patients with problematic spasticity not adequately controlled by recognized spasmolytic drug therapy. Five patients had an excellent reduction and 2 patients had some reduction in clinical spasticity (average dose 0.39 mg daily). Four of the 7 responders discontinued clonidine because of adverse reactions after an average of ten weeks of therapy. Three responders have continued to tolerate the drug well with excellent control of spasticity for 18 to 34 months. Five patients had no change in clinical spasticity (average dose of 0.24 mg daily). Three of the non-responders discontinued clonidine because of adverse reactions after an average of three weeks of therapy. Significant associated adverse reactions included syncopal seizures (3), cerebrovascular accident (1), deep vein thrombosis (1), autonomic hyperreflexia (3), lethargy/drowsiness (3), and nausea/vomiting (1). Possible mechanisms of action for clonidine to affect spasticity and the unstable cardiovascular system of quadriplegics is discussed. While spinal cord injured patients with severe spasticity may benefit from clonidine, great caution is recommended during its use until further study establishes safe parameters of administration and efficacy is confirmed on controlled studies.
Paraplegia 1986 Jun
PMID:Early clinical experience with clonidine in spinal spasticity. 374 98

We have analysed 11 studies dealing with thrombo-embolic complications and their prevention in paraplegics. The incidence of deep vein thrombosis in a total of 1316 hospitalized patients (not receiving any sort of specific prevention), lies between 13 per cent when the diagnosis is made on clinical grounds alone, and reaches 84 per cent when a fibrinogen test and phlebography are carried out routinely. In 904 patients not receiving prevention pulmonary emboli occur in 4-15 per cent, but in only two studies were autopsies carried out. It is most likely that thrombo-embolic complications in paraplegics are even more common than in orthopaedic patients. Five studies dealt with prevention of thrombo-embolic complications; three with oral anticoagulation, two using physical methods, one dealing with subcutaneous heparin and one testing platelet inhibitors. None of the studies published so far is controlled, prospective and randomized at the same time, and uses objective diagnostic methods. Since all studies show one or more methodological problems, it is impossible to make clear statements regarding the relative effectiveness of various prophylactic methods in this type of patient. The apparently extremely high risk for thrombo-embolic complications, however, would make routine prevention in paraplegics mandatory.
Paraplegia 1985 Apr
PMID:Prevention of thrombo-embolic complications in paraplegics. 400 Jun 93

Ergot derivatives are widely used for migraine headaches. However, ergotamine tartrate may cause intoxication which may even become fatal. A case of ergot poisoning in a paraplegic patient is reported, where deep vein thrombosis and ischaemia of the lower limbs were the presenting signs.
Paraplegia 1984 Feb
PMID:Ergot poisoning in paraplegia. 642 86

Twenty-eight consecutive patients with acute spinal cord injury were randomised to one of two regimens for the prevention of deep vein thrombosis (DVT): external pneumatic calf compression (EPCC, 15), or EPCC combined with aspirin, 300 mg bid, and dipyridamole, 75 mg tid (ASA/dip, 13). DVT, detected by the 125I-fibrinogen test and impedence plethysmography, was confirmed by contrast venography. The incidence of DVT in the total group was 33 per cent, significantly less than the 78 per cent observed in 37 untreated patients studied previously (p less than 0.001). DVT developed in six of 15 patients receiving only EPCC, and three of 12 on ASA/dip as well as EPCC (p less than 0.1). The untreated patients studied earlier had significantly increased circulating platelet aggregates, increased platelet affinity for collagen, and elevated factor VIII activities, which generally coincided with the development of DVT (usually 7-9 days after injury). Prophylaxis partially prevented these coagulation abnormalities and delayed the onset of thrombosis. While the differences in the haemostatic parameters between those not treated with ASA/dip and those receiving these agents were not statistically significant (except for the platelet-collagen affinity), there was a trend toward less elevated values in the drug-treated patients. We conclude that spinal cord injury patients are at extreme risk for DVT, and have abnormal platelet and factor VIII activities. Prophylaxis with EPCC significantly and safely reduces the risk of DVT in these patients.
Paraplegia 1982 Aug
PMID:Deep vein thrombosis in spinal cord injury: effect of prophylaxis with calf compression, aspirin, and dipyridamole. 681 14

Eight acute spinal injury patients with deep vein thrombosis and/or pulmonary emboli are presented witn an in-depth analysis and management of anticoagulation therapy. Special considerations for acute spinal cord injury patients with regards to prophylactic and therapeutic anticoagulation by heparin and coumadin are discussed. There was a wide variation in the requirement of heparin and/or coumadin to maintain effective coagulability which could only be elicited by frequent laboratory monitoring. Inadequate dose and shorter duration of administration of anticoagulant resulted in recurrence of thromboembolism in three out of eight patients in the present series. Haemorrhagic complications were minor and easily manageable. Co-trimoxazole potentiation of coumadin action occurred in two of our patients and it requires special mention as the drug is used increasingly in the treatment of urinary tract infections.
Paraplegia 1980 Feb
PMID:Experience with the management of deep vein thrombosis in patients with spinal cord injury. Part II: a critical evaluation of the anticoagulant therapy. 696 87

Based on morphological features of the lymphatic microcirculation of the skin from healthy subjects, and from paraplegic patients who had no evidence of ilio-femoral venous thrombosis (thromboembolic disease: TED), the leg terminal lymphatic vessels from skin biopsies of five male paraplegic patients with acute traumatic spinal cord lesions and with documented TED were studied. Paraplegic patients with TED had lymph vessels with a dilated lumen surrounded by a rarefacted perivascular connective tissue characterized by dissociation and disruption of collagen and elastic fibres. The lymphatic wall was generally attenuated and some open junctions and channels delimited by endothelial protrusions were observed. The venous outflow obstruction caused by deep venous thrombosis accompanied by the absence of ambulatory venous pressure in the paretic leg determines skin microlymphatic dilatation, lymph stasis and changes in the interstitial connective tissues. These alterations may be considered to be the morphological aspect of the dystrophic alterations seen in the skin of legs from paraplegic patients with TED. The results are discussed in view of the correct rehabilitative medical treatment necessary, and adequate prophylaxis of TED.
Paraplegia 1995 Aug
PMID:Morphological changes in the skin microlymphatics in recently injured paraplegic patients with ilio-femoral venous thrombosis. 747 43


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