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

From September 1962 to May 1972 145 patients with acute or subacute deep vein thrombosis confirmed by phlebography were treated with streptokinase. During the same period 42 patients considered unfit for thrombolytic therapy were treated with herapin and oral anticoagulants. The results, assessed by repeat phlebography, in 93 of the patients treated with streptokinase were compared with those in 42 patients treated with heparin. The age, sex, and severity of occlusion were roughly similar in both groups. Streptokinase treatment was successful in 42 per cent, partially successful in 25 per cent, and unsuccessful in 32 per cent of the 93 patients compared with none, 10 per cent, and 88 percent respectively in the 42 patients treated with heparin. Streptokinase was more effective when the thrombus was in proximal rather than calf veins. Thrombi of more than six days old were readily lysed. Plasma fibrinogen levels were below 0-8 g/1 (80 mg/100 ml) in nearly all patients successfully treated. The incidence of pulmonary embolism was no greater with streptokinase than with heparin treatment. Only prolonged follow-up would show whether thrombolytic treatment would be effective in preventing late complications of deep vein thrombosis such as chronic venous insufficiency.
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PMID:Treatment of deep vein thrombosis with streptokinase. 12 6

A total of 188 foot phelbograms in 100 patients with suspected venous thrombosis or pulmonary embolism were studied. Thrombus was demonstrated in 59 (31%) of the foot phlebograms. It is concluded that foot vein thrombosis is common, that it may be a source of pulmonary embolism, and that venous thrombus may start in the foot veins and spread into the calf. Foot phlebography should become part of the routine examination of patients with suspected deep venous thrombosis or pulmonary embolism.
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PMID:A phlebographic study of the incidence and significance of venous thrombosis in the foot. 41 90

In a prospective study of 51 patients with fractures of the femoral neck, aspirin was used as a prophylactic measure against thromboembolic disease. Thrombi were detected by cuff impedence plethysmography, Doppler ultrasonography and ascending venography. Thrombi were identified in 20 (39.2%) of the patients. There was no significant difference between the frequency with which thrombi occurred in men and in women. Blood salicylate values were the same for patients who had and who did not have thrombi. There were no instances of pulmonary embolism. The frequency of deep vein thrombosis was comparable to that in a previous series of untreated patients from the same centre. It appears from this study that in these cases prophylaxis against venous thromboembolism using aspirin in a dosage of 600 mg bid is ineffective.
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PMID:Aspirin prophylaxis of venous thromboembolic disease following fracture of the upper femur. 49 17

A series of 952 patients was examined by ascending venography; 812 with clinically diagnosed deep vein thrombosis (DVT) (group 1) and 140 with clinical features suggestive of pulmonary embolism (group 2). Thrombus was demonstrated in 401 (49.4 per cent) of group 1 and in 74 (53 per cent) of group 2 patients. A total of 535 limbs contained thrombus. In 493 (92 per cent) thrombus was present in the calf with either no further clot, or clot in continuity with that in more proximal veins. In the remaining 42 legs (8 per cent) thrombus either originated from multiple discontinuous sites in the legs and pelvis, or in proximal major veins without concomitant calf involvement. The clinical implications of these findings are discussed.
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PMID:The origin of thrombi in the deep veins of the lower limb: a venographic study. 66 37

In a double-blind study a randomized group of 96 patients with abdominal operations received a placebo, dipyridamol/acetylsalicylic acid or ASA alone. Thrombi were verified by the 125-I-fibrinogen test. In 38% of the placebo group deep venous thrombosis (DVT) was found, while only 10% of the dipyridamol/ASA group (P less than 0,05) and 28% of the ASA treated patients (not significant) showed radioactive thrombi. DVT were localized in 83.8% in the calf region. 48.6% of increasend activities were registered up to the end of the first postoperative day, 78.3% up to the third day. The results emphasize the importance of a general antithrombotic prophylaxis. Dipyridamol/ASA seems to be efficient in this regard for abdominal procedures.
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PMID:[Double-blind study for the prevention of postoperative thrombosis]. 100 Nov 31

Thrombotic and thromboembolic occlusions of arteries and veins represent acute and often life threatening complications requiring immediate therapeutic intervention. The most important clinical manifestations of vascular occlusions are myocardial infarction, peripheral arterial occlusion, pulmonary embolism, deep vein thrombosis and ischemic stroke. The logical approach for the treatment in these indications is the early restoration of blood circulation in order to preserve the organ deprived from oxygen supply and to prevent chronic sequelae. Recanalization by surgical intervention is only possible in some indications and is restricted to special clinics. Thrombolysis induced by agents activating plasminogen imitates the physiologic way of dissolving an occlusive clot by shifting the balance of the hemostatic and fibrinolytic system towards fibrinolysis. Streptokinase was the first effective thrombolytic drug used in patients. In the first years of its usage the identification of the appropriate indication and the dosage and application regimens used were based on little pharmacological knowledge and lack of appropriate dose finding. This resulted in suboptimal therapeutic efficacy and severe bleeding. Development of advanced diagnostic methods, more appropriate dose and application regimens and the development of more specific fibrinolytic drugs like rt-PA led to a remarkable improvement of its benefit-risk ratio and made thrombolysis to a widely accepted form of therapy in thrombotic and thromboembolic diseases. Early restoration of blood flow however is only the starting point of a therapeutic strategy, aiming at minimizing the risk of recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Thrombolysis: the logical approach for the treatment of vascular occlusions. 152 9

To determine whether the response to thrombolytic therapy for lower-extremity deep venous thrombosis (DVT) can be predicted from the venographic appearance, 139 thrombosed venous segments were analyzed. Initial and follow-up venograms were obtained in 62 patients randomized to 24-hour infusions of recombinant human-tissue-type plasminogen activator (rTPA) (n = 34), rTPA plus heparin (n = 16), or heparin alone (n = 12). Segmental response to therapy was evaluated by means of blinded review of the paired venograms. The response (50%-100% lysis) to rTPA alone was significantly greater in venous segments involved with nonobstructive thrombi than in those with obstructive thrombi (12 of 23 vs five of 51; P less than .005). Results were similar for the combination of rTPA and heparin (five of six vs six of 30, P less than .01). No significant difference was seen in the response of either obstructive or nonobstructive thrombus to heparin alone. Thrombotic tails responded substantially (greater than 50% decrease in size) to rTPA with or without heparin in 22 of 24 patients. The venographic appearance of DVT appears to help in predicting the therapeutic response to thrombolytic therapy.
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PMID:Short-term response to thrombolytic therapy in deep venous thrombosis: predictive value of venographic appearance. 162 Aug 26

This study describes our experience with 12 patients with white clot syndrome encountered during a recent 36-month period. The diagnosis was based on the following criteria: (1) development of thrombocytopenia of less than 100,000/mm3 during administration of heparin therapy, (2) normalization of the platelet count after an interruption in heparin therapy, (3) exclusion of other causes of thrombocytopenia, (4) a positive heparin-induced platelet aggregation test, (5) detection of white clots on pathologic examination, and (6) the presence of thrombotic complications. Of 2,500 patients who received heparin therapy, 12 (0.48%) developed white clot syndrome. Various indications, routes of administration, and types of heparin were implicated. The mean platelet nadir was 26,900/mm3, and the mean time to onset of heparin-induced thrombocytopenia was 5 days. Thrombotic complications included arterial occlusions of the legs in 11 patients, deep vein thrombosis of the legs in 9 patients (4 had pulmonary embolism), and combined arterial and venous thrombosis in 8 patients. Treatment strategies included discontinuation of heparin in all patients and intravenous infusion of dextran, followed by arterial thrombectomy in four patients, urokinase therapy in two patients for arterial complications, and insertion of Greenfield filters in six patients. All patients were given warfarin. The mortality rate was 25% and the morbidity rate was 50%. An initial platelet count should be obtained on all patients prior to receiving heparin, followed by repeat platelet counts every 2 to 3 days. Once thrombocytopenia or thrombosis is diagnosed, heparin should be discontinued and other methods of therapy considered.
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PMID:Diagnostic and therapeutic strategies of white clot syndrome. 171 45

In a prospective study the value of duplex scanning in the diagnosis of acute femoro-popliteal thrombosis was compared to conventional contrast venography (CV) as a gold standard. A total of 126 legs in 117 patients suspected of having deep vein thrombosis (DVT) or pulmonary embolism (PE) were examined with both methods. CV and duplex scanning were diagnostic in 98.5 and 97%, respectively. Femoro-popliteal thrombosis was present in 64 legs (prevalence 54%). The sensitivity and specificity of duplex scanning were 90.6% and 94.6%, respectively. A marked improvement in sensitivity from 83.3 to 97% and overall accuracy from 88.7 to 96% was noticed between the first and second half of the study period. Of the individual duplex criteria in the diagnosis of DVT, abnormal vessel wall compressibility was the most accurate. The Doppler measurements however allow evaluation of venous areas difficult to assess with B-mode and add discrimination between partial or total vein occlusion. Duplex scanning is more accurate compared to CV in grading the anatomical extent of thrombosis. Agreement between venography and duplex scanning was found in 75% of the vein segments, in about 20% CV suggested more thrombus formation compared to duplex scanning. Thrombus in the deep femoral vein was documented by duplex scanning in 24 patients including two cases of isolated deep femoral vein thrombosis. Venography failed to visualise the deep femoral vein with sufficient diagnostic accuracy in 88% of the patients vs. 8.5% with duplex scanning. Duplex scanning is an accurate non-invasive test in the diagnosis of acute femoro-popliteal thrombosis and superior to CV in the detection of non-occlusive and deep femoral vein thrombosis.
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PMID:Duplex scanning in the diagnosis of acute deep vein thrombosis of the lower extremity. 186 91

Spinal cord injury increases the risk of many life-threatening medical problems, including respiratory failure, pulmonary embolism, and renal failure. Respiratory failure results from paralysis of muscles of inspiration (which impairs oxygen transport to alveoli) and of expiration (which impairs cough and predisposes to pneumonia and atelectasis). Respiratory failure in patients with spinal cord injury can be prevented by proper positioning of the patient, training of ventilatory muscles, pulmonary toilet, and aggressive use of antibiotics and bronchodilators. When respiratory failure occurs, it can be managed by administration of oxygen, intubation, and mechanical ventilation, and in instances of paralysis of the diaphragm, by diaphragmatic pacing. The risk of deep vein thrombosis and pulmonary embolism in acute spinal cord disease is increased by the immobilization of the patient and abnormalities in clotting factors. Thrombotic disease in spinal cord disease can be prevented by intermittent calf compression and heparinization. If pulmonary embolism develops, the patient should be started on a regimen of warfarin for at least 3 months. If anticoagulation is contraindicated, a Greenfield filter can be placed. However, concurrent use of quad cough places the patient at increased risk for complications from the Greenfield filter. Chronic pyelonephritis and systemic amyloidosis are the most common causes of renal failure in the patient with spinal cord disease. Renal failure can be prevented by maintaining a low postvoid residual volume, avoidance of indwelling catheters, use of medications that are not nephrotoxic, and rapid treatment of infection. Hemodialysis and peritoneal dialysis can extend the life of the patient with spinal cord disease in whom renal failure develops, and successful use of renal transplantation has recently been reported.
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PMID:Medical complications of spinal cord disease. 192 58


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