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)

We report the case of a 22-year-old obese woman with severe protein S deficiency, probably genetic in nature, associated with recurrent venous thrombosis. Protein S deficiency is a rather rare disease: it may be an inherited, either homozygous (purpura fulminans at neonatal age), heterozygous, or acquired disorder. The thrombophilic state may be manifested as deep vein thrombosis or thrombophlebitis of the superficial veins with a high risk of pulmonary embolism in the young, and it is often exacerbated by pregnancy. In our case, the presenting event, bilateral deep venous (iliac-femoral) thrombosis complicated by disseminated intravascular coagulation, had occurred when the patient was 13 years old. We started long-term therapy with oral coagulants, i.e. warfarin even if the latter may cause skin necrosis ("warfarin dermatitis") in some patients with protein S deficiency. The clinician must consider protein S deficiency in cases of recurrent thrombosis, particularly in young patients: the importance of early implementation of long-term preventive therapy should not be underestimated.
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PMID:[Protein S deficiency and thrombophilia: presentation of a clinical case and review of the literature]. 794 92

This report describes a 69-year-old Japanese woman with bilateral forearm thrombophlebitis that developed soon after transvenous permanent pacemaker insertion. Intravenous administration of urokinase and heparin rapidly resolved fever, painful forearm swelling and inflammatory findings. Digital subtraction venograms revealed a brachiocephalic vein thrombosis. A ten-month treatment with warfarin and ticlopidine resulted in the complete restoration of venous flow. Although thrombophlebitis associated with transvenous permanent pacemaker insertion has a relatively low incidence (0.3%), prompt diagnosis and treatment with anticoagulant and/or thrombolytic agents are important for the late clinical outcome in cases with deep venous thrombosis.
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PMID:Recurrent forearm thrombophlebitis after transvenous permanent pacemaker insertion. 816 48

The cases of forty-six patients who were admitted via the Emergency Department (ED) with suspected pulmonary embolism (PE), during a ten-year period, were reviewed. Ventilation perfusion lung scans were done in all patients, and pulmonary angiography was performed in 26. Thirty-six PE patients (78%) were correctly diagnosed by emergency physicians. Ten patients (22%) were erroneously diagnosed at the ED but were proved otherwise after hospitalization. The average age of the patients was 54 years, with males dominantly 67%. Overall mortality rate was 8.7%. Predisposing risk factors for PE were documented in 20 patients (43%). Prior history of thrombophlebitis (17%) or pulmonary embolism (13%), and immobilization (13%) were significant. The most common clinical features were dyspnea (76%), pleuritic pain (74%) and hemoptysis (41%). Thirty patients (65%) had tachypnea and 20 patients (43%) had tachycardia. Chest radiographs were abnormal in 35 cases (76%), and abnormal ECG findings were noted in 27 patients (59%). However, these abnormalities of chest radiographs or ECG were not sufficiently specific to confirm or exclude the diagnosis of PE. Noninvasive or contrast venography for deep vein thrombosis were performed in 31 patients (67%), of whom 17 cases (37%) had positive results. All patient received anticoagulation treatment. And six patients had thrombolytic agents as well.
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PMID:Emergency department recognition of pulmonary embolism. 829 40

Acute arterial occlusions of the extremities present with the classical five P's: pain, pallor, pulselessness, paresthesia, paresis. Loss of sensitivity and motility are symptoms of the most severe grade of ischemia. The occlusions are due to embolism in about 70% of subjects and to local thrombosis in 30%. These patients have to be treated immediately with heparin. In the mildest forms, deobliteration is desirable, but in the more severe cases rapid restoration of flow not only saves limbs but also life. Deobliteration may be performed surgically or by means of catheters (local thrombolysis or thrombus aspiration) if available. Deep vein thrombosis, the other kind of emergency situation, requires immediate anticoagulation as soon as pulmonary embolism is suspected. It should be initiated by heparin and followed by oral anticoagulation. In patients presenting without pulmonary embolism but a swollen leg, ruptured Baker cysts or muscle hematomas should be ruled out before anticoagulation is started. Systemic thrombolysis or surgical thrombectomy is reserved for young patients with acute isolated thromboses. Thrombectomy must also be kept in reserve for the most severe form of deep venous thromboses, the phlegmasia cerulea dolens. In thrombophlebitis, no anticoagulation is indicated except in bedridden patients. The others must remain mobile and may be treated by systemic and local antiinflammatory drugs, incision of thrombosed varices, and bandages.
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PMID:[Emergencies in angiology]. 849 73

Pregnancy and oral contraceptives (OCs) reduce the levels of the natural anticoagulant protein S and about 50% and 20%. respectively. Original work on the link between OCs and development of deep vein thrombosis and pulmonary embolism do not necessarily confirm an association, today since it included cohort studies of women using high estrogen OCs. Also, physicians tended to actively diagnose thrombophlebitis in women they knew were using OCs. Objective diagnostic measures, e.g., venography, were not used in the cohort studies. Decreased estrogen content of current OCs and a case control study design show the likelihood of thrombotic complications of OS use has decreased significantly. Women who have experienced an episode of venous thrombosis and are not on oral anticoagulation therapy should not use OCs, because as many of 30% experience a second episode. Women with a strong family history of thromboembolism and those with antiphospholipid antibodies who have experienced a thrombotic event should also not use OCs. Current or past use of low estrogen Ocs does not significantly increase the risk of myocardial infarction, but smoking does. Physicians doe not know, however, whether women who use an OC with at the most 30 mcg estrogen and who smoke are at greater risk than those who smoke but do not use OCs. Just one study suggests a possible association between OC use and mitral valve prolapse leading to a cerebrovascular accident. The likelihood of developing calf vein clots in women who use low-dose OCs appears to be reduced, if they use sequential compression stockings and subcutaneous low molecular weight heparin following surgery. Since OCs decrease the chance of serious bleeding during ovulation and of heavy menstrual flow, oral anticoagulation is not a contraindication to OC use. The risk of OC-associated thromboembolism is considerably lower than that of pregnancy-associated thromboembolism.
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PMID:Contraceptive choices in women with coagulation disorders. 851 43

The pattern of postoperative pyrexia in Khartoum was prospectively studied in 260 patients who underwent a variety of surgical operations. Ninety four patients (36.1%) developed postoperative pyrexia. The commonest causes of pyrexia encountered were wound sepsis (10%), malaria (9.6%) and respiratory tract infection (7.3%). Less frequent causes were urinary tract infection, thrombophlebitis, intra-abdominal sepsis and deep vein thrombosis. In 14.6% of the patients, the cause of pyrexia was undetermined. The risk factors for postoperative pyrexia were the patient's age, diabetes mellitus, obesity, preoperative chest infection, smoking, duration of surgery, operator's surgical experience and urethral catheterisation. The postoperative pyrexia was associated with 7.4% mortality rate which was due to intra-abdominal sepsis and pulmonary embolism. The incidence of postoperative pyrexia can be minimised by adequate preoperative preparation, meticulous surgical technique and good postoperative care.
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PMID:Pattern of postoperative pyrexia in Khartoum. 862 71

With regard to deep vein thrombosis, superficial thrombophlebitis of lower limbs have a reputation of mildness disease that the experience gained from widely used duplex scanning in their evaluation comes to question. Short superficial thrombophlebitis on non-varicose veins often remain a symptom belonging to or revealing a systemic disease. Superficial thrombophlebitis on varicose veins are of two kinds: short superficial thrombophlebitis remain a common complication of varicose phlebectasia but they must be differenciated from extensive saphenous thrombophlebitis. The first ones are of local symptomatic treatment and of varicose vein surgery. The last ones are associated--with deep vein thrombosis in 10 to 30% of case (either by extension from the saphenous to the deep veins, either without anatomical link), with clinical pulmonary embolism in 5% of cases, and with a cancer in about 10% of cases. Numerous superificial venous thrombosis occur without inflammatory signs and the clinical diagnosis of extensive superficial venous thrombosis is as difficult as the one of deep vein thrombosis. So the diagnosis, the treatment, the etiological investigation of extensive superficial venous thrombosis are in fact not very different from those of deep vein thrombosis.
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PMID:[Superficial venous thrombosis of the lower limbs]. 876 76

Central venous access devices are often essential for the administration of chemotherapy to patients with malignancy, but its use has been associated with a number of complications, mainly thrombosis. The true incidence of upper extremity deep vein thrombosis (DVT) in this setting is difficult to estimate since there are very few studies in which DVT diagnosis was based on objective tests, but its sequelae include septic thrombophlebitis, loss of central venous access and pulmonary embolism. We performed an open, prospective study in which all cancer patients who underwent placement of a long-term Port-a-Cath (Pharmacia Deltec Inc) subclavian venous catheter were randomized to receive or not 2500 IU sc of Fragmin once daily 90 days. Venography was routinely performed 90 days after catheter insertion, or sooner if DVT symptoms had appeared. Our aims were: 1) to investigate the effectiveness of low doses of Fragmin in preventing catheter-related DVT; and 2) to try to confirm if patients with high platelet counts are at a higher risk to develop subclavian DVT, as previously suggested. On the recommendation of the Ethics Committee, patient recruitment was terminated earlier than planned: DVT developed in 1/16 patients (6%) taking Fragmin and 8/13 patients (62%) without prophylaxis (Relative Risk 6.75; 95% CI: 1.05-43.58; p = 0.002, Fisher exact test). No bleeding complications had developed. As for prediction of DVT, there was a tendency towards a higher platelet count in those patients who subsequently developed DVT, but differences failed to reach any statistical significance (286 +/- 145 vs 207 +/- 81 x 10(9)/1; p = 0.067). According to our experience, Fragmin at the dosage used proved to be both effective and safe in these patients.
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PMID:Upper extremity deep venous thrombosis in cancer patients with venous access devices--prophylaxis with a low molecular weight heparin (Fragmin). 881 70

Long-lasting intravenous drug abuse causes sclerosis of the superficial venous system. Many drug abusers thus choose to inject into the major veins of the groin or neck. Such practice may, among various other complications, cause deep venous thrombosis. We describe four patients with venous thrombophlebitis localised at the ileo-femoral junction. All patients were intravenous drug abusers, who for many years had injected various drugs into the groin. Two patients suffered a relapse after the treatment was discontinued. One patient had nonfatal pulmonary embolism. All four patients were treated with low-molecular-weight heparin. Three patients were later treated with warfarin, but, owing to bad compliance, this treatment had to be discontinued quite soon in two cases. We conclude that the management of deep venous thrombosis can be difficult in intravenous drug abusers. This is due mainly to poor venous access, the risk of transmitting blood-borne viruses to health personnel, asocial behaviour, and poor compliance. For most patients, we advocate administration of low-molecular-weight heparin for at least three months. Supporting treatment with metadone should be considered in selected cases.
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PMID:[Deep venous thrombosis in intravenous drug addicts]. 892 24

One hundred and thirty unrelated patients with recurrent deep venous thrombosis were studied over a period of 4 years (1986-1990) in order to determine the possible etiology. Protein C levels were estimated in plasma both by chromogenic substrate assay and by immunoassay. Protein S levels in plasma was determined by immunoassay using antisera to human protein S. Antithrombin III (AT-III) was assayed using monospecific rabbit antiserum to human AT-III. Fifteen patients were found to have hereditary protein C deficiency (11.52%). Family studies revealed autosomal recessive inheritance in one patient and a dominant pattern in the remaining 14 patients. Protein S deficiency was found in eight cases (6.1%), AT-III deficiency was established in five cases (3.8%) and a fibrinolytic defect in 33 cases (25.4%). Thrombosis of visceral and cerebral vessels and a positive family history were more frequently found among patients who had hereditary deficiency of one or the other antithrombotic factor. Thrombophlebitis of superficial veins was found to be very common in patients with protein C and protein S deficiency and virtually absent in AT-III deficiency. The high frequency of protein C and protein S deficiency in this ethnic group is attributed to the high frequency of consanguinity.
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PMID:Thrombophilia in ethnic Arabs in Kuwait. 900 58


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