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)

Prophylaxis for DVT unequivocally is beneficial in patients identified to be at high risk. Heparin prophylaxis with subcutaneous low-dose UFH is adequate in some clinical settings but less effective in others. LMWH preparations are effective and safe as prophylaxis in certain medical patients as well as in general surgery and elective hip replacement. Efficacy and safety are demonstrated in the therapy of established venous thromboembolism. Subcutaneous administration of LMWH once or twice daily may prove more convenient from both the patient and nursing viewpoint, particularly in the treatment of established DVT. Monitoring is not necessary when using LMWH preparations as prophylaxis, and a fixed-dose without weight adjustment has been used in most prophylaxis trials. When treating established DVT, less monitoring is likely to be required than currently is the case with UFH. Although the cost of LMWH preparations is greater than that of UFH, the decrease in the occurrence or recurrence of thromboses that has been demonstrated in some trials might prove an effective balance. Future avenues to explore include discovery of better means to standardize the LMWH preparations and determination of the efficacy and safety of LMWH in specific populations, such as those in intensive care units, cancer patients, nursing home patients, and outpatients in general. Although cost-benefit is favorable thus far, meticulous assessment in other settings may enhance the acceptance of these agents. Long-term follow-up could be helpful in determining the relative effect of different heparin preparations on the frequency of postphlebitic syndrome. Comparison of different LMWH fractions may follow, as well as further investigations of newer ultra-low-molecular-weight agents. One LMWH preparation (enoxaparin) already has been approved in the United States for prophylaxis in the setting of elective hip replacement; and dalteparin has been approved here for use as DVT prophylaxis in patients undergoing abdominal surgery when there appears to be a significant risk of thromboembolism. It is likely that LMWH preparations will become even more widely used in North America and that the approved indications will expand to include prophylaxis in numerous settings and the treatment of established venous thromboembolism.
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PMID:Management of venous thromboembolic disease. The impact of low-molecular-weight heparin. 765 40

We reviewed 43 patients using clinical scoring for evidence of postphlebitic syndrome at least 5 years after hip replacement. All had had a venogram as part of a screening study at the time of surgery. The postphlebitic syndrome was identified in 13 patients and was disabling in 6. The syndrome was present in 9 of the 11 patients with a venographically proven deep vein thrombosis (DVT) and in 4 of the 32 without DVT. Postphlebitic sequelae had developed despite anticoagulant therapy for the acute DVT. The postphlebitic syndrome following asymptomatic deep vein thrombosis is an important long-term complication of total hip replacement.
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PMID:Postphlebitic syndrome after hip arthroplasty. 43 patients followed at least 5 years. 783 42

As many as two thirds of patients with new symptoms after documented DVT have postphlebitic syndrome, not DVT. Noninvasive imaging is central to the differentiation so that unnecessary anticoagulation therapy can be avoided. Recent changes in heparin and warfarin protocols for DVT are also outlined.
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PMID:Deep vein thrombosis: recovery or recurrence? 788 11

The severity of post-thrombotic symptoms in 111 limbs (107 patients) with previous phlebographically proven deep vein thrombosis (DVT) was correlated with superficial and deep venous function as determined by foot volumetry (n = 90) and duplex ultrasonography (n = 62). The median delay between DVT and assessment was 8 (range 1-34) years. Symptoms were mild (group 1) in 31 limbs (28 per cent), moderate (group 2) in 41 (37 per cent) and severe (group 3) in 39 (35 per cent). There was no significant relationship between the site of DVT, or the time since DVT, and the severity of symptoms. Without tourniquet occlusion of superficial veins, limbs in group 3 had a significantly shorter half-refilling time than those in groups 1 and 2 (P = 0.01). Although a similar trend was observed after tourniquet occlusion of superficial veins, this was not statistically significant. There was no significant difference in the expelled volumes between the three clinical groups. On duplex scanning, deep and superficial venous reflux was detected in just over half of the limbs in each group. Eight patients had entirely normal scans and none of them had severe symptoms (P = 0.04). This study identifies a strong association between severe postphlebitic syndrome and venous reflux, such that it may be considered that venous reflux is necessary for the development of severe post-thrombotic symptoms. However, many patients with severe reflux have only mild symptoms and additional factors must therefore contribute to the development of severe postphlebitic syndrome.
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PMID:Venous function and clinical outcome following deep vein thrombosis. 804 99

Deep vein thrombosis (DVT) and pulmonary embolism (PE) occur in pediatric patients; however, the incidence, associated morbidity, and mortality are unknown. A Canadian registry of DVT and PE in children (ages 1 month to 18 years) was established July 1, 1990 in 15 tertiary-care pediatric centers. One-hundred thirty-seven patients were identified prospectively and are the subject of this report. The incidence of DVT/PE was 5.3/10,000 hospital admissions or 0.07/10,000 children in Canada. Infants under 1 year old and teenagers predominated with equal numbers of both sexes. DVT were located in the upper (n = 50) and lower (n = 79) venous system, or as PE alone (n = 8). Central venous lines (CVLs) were present in approximately 33% of children with DVT (n = 45). Associated conditions were present in 96% of children and 90% of children had two or more associated conditions for DVT. DVT was diagnosed by venography (n = 83), duplex ultrasound (n = 37), and other combinations (n = 17). Twenty-two of the 31 ventilation/perfusion scans performed were interpreted as high-probability scans for PE. Therapy consisted of heparin (n = 115), thrombolysis (n = 15), surgical removal of a CVL or thrombus (n = 22), and oral anticoagulant therapy (n = 103). Significant bleeding complications did not occur. However, three (2.2%) children died as a direct consequence of their thromboembolic disease; DVT reoccurred in 23 children and postphlebitic syndrome (PPS) occurred in 26. In conclusion, DVTs occur in a significant number of hospitalized children with a mortality of 2.2%. Complications are not hemorrhagic, but thrombotic, and characterized by PE, recurrent disease, and PPS. In contrast to adults, the upper venous system is frequently affected because of the use of CVLs. The frequency of DVT/PE justifies controlled trials of primary prophylaxis in high-risk groups, and therapeutic trials to determine optimal treatment.
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PMID:Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. 811 29

Epidemiologic studies over the past 30 years have provided much of the basis for the understanding of venous thromboembolic disease. There has been an evolution from simple descriptive studies using clinical diagnosis to various forms of comparative studies using objective diagnoses. Identification of high-risk cases in the hospitalized population has led to the development of both general and specific antithrombotic prophylactic regimens. This has occurred against a background of an increased understanding of the pathophysiology of venous thrombosis. Inhospital case interventions have allowed direct questions concerning pathophysiology to be addressed. Examples would include the use of certain types and dosages of anticoagulants and the use of mechanical devices to avoid stasis. Despite these advances, there are still areas that require further attention. One aspect of importance is to evaluate the thrombotic risk of new procedures. The possibility that a new procedure may be either less or more thrombotic than its predecessor should be addressed. In the case of the former, additional antithrombotic measures are needed. An example of this is the relatively disappointing results of regular low-dose heparin treatment in some orthopedic procedures. In the case of the latter, less severe measures may be indicated. Current antithrombotic methods are not without risks and may not be necessary with some of the new endoscopic surgical procedures. Another area of importance relates to the monitoring of compliance. The information on antithrombotic methods has been available for two decades, yet surveys of the application of these methods consistently show that antithrombotic protocols are used less in North America relative to their use in equivalent institutions in Europe. A third area that still needs further epidemiologic study is the incidence and effects of venous thrombosis in the general community. Despite the two recent descriptive studies cited above, relatively little, as compared with the in-patient perspective, is known about community risk factors and their prevention. With respect to the natural history of hospital-based cases it seems unlikely that much is to be gained from surveying the efficacy of heparin or heparin-like treatment for mortality end points. However, a large and still unsatisfactorily examined area is the true frequency and impact of the postphlebitic syndrome. This aspect is germane to both hospital- and community-acquired DVT and, with an aging population, clearly deserves a lot more attention.
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PMID:The natural history and epidemiology of venous thrombosis. 818 96

Deep venous thrombosis (DVT) and its complications, pulmonary embolism (PE), and postphlebitic syndrome (PPS) affect millions of Americans. The risk is especially high in surgical patients in general, and orthopaedic patients in particular. Virchow's triad describes the three factors that affect coagulation within a blood vessel: stasis, vessel injury, and coagulation factors. Risk factors, which relate to these factors, can predict which patients will be most likely to develop DVT. Prophylactic regimens should be tailored to patient risk. Nursing care is the key to implementation, maintenance, and compliance with any prophylactic program and its ultimate success.
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PMID:Deep venous thrombosis: implications for orthopaedic nursing. 832 63

Deep vein thrombosis (DVT) is a ubiquitous process that in the acute setting can lead to pulmonary embolism. Chronically, permanent changes that develop within the venous system following an episode of DVT can produce the postphlebitic syndrome, which is associated with pain, swelling, and ulceration. The postphlebitis syndrome can often mimic acute DVT or coexist with it. The clinical evaluation of DVT is ineffective and necessitates a reliable noninvasive diagnostic technique. Compression ultrasound (US) has proved to be the diagnostic method of choice for detection of extremity clot. Femoral and popliteal veins are routinely evaluated for acute clot, but uncertainty exists concerning the need to evaluate the calf veins similarly. US also can be used to diagnose chronic venous changes, which are indicated by the presence of incompetent valves and retrograde blood flow. Upper-extremity venous thrombosis, often induced by indwelling catheters, can also be diagnosed with US.
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PMID:Venous thromboembolic disease: the role of US. 843 Jan 64

Venous thrombectomy as a treatment of deep venous thrombosis is discussed extremely controversial. Occasionally, however, surgical technique, goal of the therapy, indications and limitations are not really known. Indication for surgical treatment is an extensive acute deep vein thrombosis with clinical symptoms of less than 7 days. Goal of the therapy is the preservation of valve function and prevention of a postphlebitic syndrome. Further indications are an embolizing venous thrombosis, a floating thrombus and an ischemic thrombosis. In these cases the single goal of the treatment is to reduce the individual risk of the patient. The best long term results can be achieved in young patients (below 40 years of age) with no preexisting venous lesion and an acute iliofemoral thrombosis. Advantages, drawbacks and results of venous thrombectomy are discussed.
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PMID:[Surgical treatment of deep venous thrombosis--indications, possibilities and limitations in venous thrombectomy]. 865 50

The combination of catheter-directed thrombolytic therapy and endovascular stenting is a new and promising approach for treating acute and chronic thrombotic iliofemoral venous occlusions on the basis of the authors' initial experience in a small group of patients. In acute DVT, catheter-directed techniques provide more complete lysis than systemic infusions and early, aggressive interventional therapy may spare the patient from the life-long disability associated with the postphlebitic syndrome, by preserving valve function and eliminating the venous outflow obstruction. Immediate postthrombolysis venography can evaluate the underlying vein and assess the need for adjunctive treatment with angioplasty and/or stents. Urokinase has a high degree of safety with few complications when a catheter-directed approach rather than systemic infusion is used. Even patients with chronic DVT can benefit by reducing the obstruction to venous outflow if the occlusion is limited to the iliac vein and/or the inferior vena cava. Long-term follow-up studies are necessary to evaluate patency rates of the treated veins, determine whether successfully treated limbs have a lower frequency of recurrent DVT, and ascertain the frequency of chronic venous insufficiency compared with that in patients treated with anticoagulation alone. Based on our initial experience, a National Venous Thrombosis Registry was established in October 1994. The purpose of this multidisciplinary Registry is to prospectively document the long-term results of catheter-directed thrombolytic therapy for patients with iliofemoral DVT, with data now being collected from 40 leading medical centers around the United States. We hope that endovascular techniques for iliofemoral DVT will significantly reduce the immediate and long-term complications commonly associated with this difficult and often misunderstood clinical problem.
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PMID:Catheter-directed thrombolysis for iliofemoral venous thrombosis. 866 23


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