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

To determine the natural history of calf deep venous thrombosis (C-DVT), an analytic review of the 20 relevant English-language papers published since 1942 was performed. Remarkably little methodologically sound research on this subject was found. However, available evidence suggests that C-DVT propagates to the thigh in up to 20% of cases and that propagation invariably occurs before embolization. No fatal emboli were reported in patients presenting with isolated C-DVT. Traditional anticoagulation treatment with heparin sodium and warfarin sodium of symptomatic patients with C-DVT appears to prevent extension, embolization, and early recurrence. There is no convincing evidence that C-DVT leads to chronic venous insufficiency or whether the risks of anticoagulation exceed the risks of no treatment. As an option to anticoagulation, physicians may choose to follow patients with C-DVT with serial impedance plethysmography, treating only if there is evidence of proximal extension.
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PMID:Calf deep venous thrombosis. A wolf in sheep's clothing? 305 45

During the past decade, we have learned a great deal about the etiology, pathogenesis, diagnosis, and treatment of thromboembolic disease. Subcutaneous heparin has emerged as a major deterrent worldwide for thrombosis prevention but is associated with the potential risk of bleeding and cannot be used in certain patient situations. External compression modalities have emerged as major alternate forms of prophylaxis. We have learned that these devices stimulate the fibrinolytic system, prevent stasis and the endothelial injury that can accompany extreme venous distention. Since they are not associated with bleeding or other serious complications, they are attractive methods for most surgeons, including those performing delicate or complex surgical procedures. Independent studies worldwide have demonstrated their effectiveness in reducing deep vein thrombosis, as recognized by the NIH Consensus Development Panel, and the evidence is compelling that DVT efficacy is a valid marker for PE efficacy. Since these devices reduce the incidence of deep vein thrombosis, they almost certainly must prevent pulmonary emboli; however, a properly designed protocol should be conducted to validate these assumptions. Evidence suggests that full-leg sequential compression is superior to calf compression, but further study is necessary. We believe that a hospital-wide plan, including risk-factor assessment and application of clinical management guidelines, including all available modalities, is important to provide the maximum protection of patients with the lowest risk of side effects. Such a program has been very successful in our community.
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PMID:Role of compression modalities in a prophylactic program for deep vein thrombosis. 305 39

Although the exact cause of DVT is not known, venous thrombosis and its sequelae remain important clinical problems. Pulmonary embolism is a significant cause of morbidity and mortality in the hospitalized population, and the postthrombotic syndrome affects a large portion of the general population. While specific screening tests are not readily available to detect those patients who are likely to develop DVT, certain clinical risk factors have been identified that predispose to thrombosis. These groups include patients undergoing a wide variety of surgical procedures, patients with cardiac disease or cancer, pregnant or postpartum women, and individuals with previous history of DVT. The diagnosis of thrombosis is based on clinical findings and must be confirmed with appropriate laboratory tests. While contrast venography remains the gold standard, noninvasive tests have become increasingly more accurate. The recent use of real-time B-mode ultrasonic imaging and duplex sonography for the diagnoses of DVT has been shown to be efficacious. The postthrombotic syndrome with its associated chronic pain and ulcerations remains a significant clinical problem. The general diagnosis of this condition is readily made on clinical grounds in the advanced state. However, exact knowledge of the location and cause of the venous pathology can only be obtained using objective diagnostic tests. Older noninvasive and invasive tests may diagnose the presence of venous obstruction, valvular incompetence, and also may document venous hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Venous thrombosis: the clinical problem. 307 72

Using affinity chromatography on lysine Sepharose 4B, a fast-acting tissue plasminogen activator inhibitor (t-PAI) was partially purified from t-PAI-rich plasma from patients with recurrent DVT. Its inhibition of tissue plasminogen activator (t-PA) was demonstrated in functional assays and its reaction with 125I-t-PA was analyzed by autoradiography following SDS-PAGE (sodium dodecyl sulfate polyacrylamide gel electrophoresis). When the t-PAI was mixed with an equimolar concentration of t-PA at 37 degrees C, the half-life of free one-chain and two-chain 125I-t-PA was 1.8 and 0.8 min, respectively. The rate of complex formation between 125I-t-PA and t-PAI was similar both in patient plasma, pregnancy plasma and platelet lysates made from platelet-rich normal, patient and pregnancy plasma. The molecular weights of the complexes between t-PA and the inhibitors in patient plasma and in the different platelet lysates were identical, while that of the inhibitor complex formed in pregnancy plasma was found slightly higher by SDS-PAGE indicating that the pregnancy plasma t-PAI differs from the fast-acting t-PAI found in plasma from thrombotic patients and in platelet lysates.
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PMID:Plasminogen activator inhibitors in plasma and platelets from patients with recurrent venous thrombosis and pregnant women. 308 15

The purpose of this study was to analyze the various factors that influence the anatomical site of occurrence of DVT and to determine if the clinical course differed in patients afflicted with DVT at different anatomical sites in the lower extremity. Forty four of 92 patients undergoing venography during a 4-1/2 year period had positive venograms for DVT. Patients were grouped into one of three categories: iliofemoral thrombosis (IFT) n = 9, superficial femoral vein thrombosis with or without distal thrombosis (SFV) n = 21, and popliteal/calf thrombosis (clot limited to below the knee) (PCT) n = 14. Patients in the IFT group had a significantly prolonged hospital stay (p less than .05) and a significantly lower mean weight (129 lbs) when compared to the PCT group (173 lbs) (p less than .05). Pain was present equally among the three groups. Swelling was much more common in the SFV group, whereas tenderness was most frequent in the PCT group. Of those patients with swelling, 70% were in the SFV group and of those patients with tenderness, 60% were in the PCT group. DVT as the primary diagnosis was seen in 39% of cases of which half had disease limited to the PCT region. Post-op DVT occurred equally among the groups. DVT occurred much more frequently in the PCT region after myocardial infarctions and after orthopedic procedures, whereas in patients with malignancies, the most common site was the SFV region. Pulmonary embolism developed in 11% of patients and occurred in the IFT and SFV groups only. No patient with DVT of the calf/popliteal developed a pulmonary embolism.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Regional anatomical differences in the venographic occurrence of deep venous thrombosis and long-term follow-up. 318 22

The authors report their preliminary results using an external electric stimulator in hip surgery. One group received electric stimulation and the control group did not. There were 75 patients in each group and each patient underwent a total hip replacement. In the non-stimulated group, there were 15 DVT's (20%) and in the stimulated group 3 (4%). These results are discussed.
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PMID:[The prevention of thromboembolic disease by physical means. Use of an external electric stimulator. Initial results obtained during hip surgery]. 326 98

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.
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PMID:Axillo-subclavian deep venous thrombosis in quadriplegia: a case report. 337 90

A total of 564 patients undergoing laparotomy entered a prospective 10-year study to determine the influence of postoperative DVT relative to other thrombotic episodes on the subsequent development of post-thrombotic syndrome (PTS). Pre-existing venous thrombotic disease and postoperative thromboses were assessed at the initial hospitalisation. Subsequent thrombotic episodes and signs of PTS have been monitored at biennial review. Thirty-five patients had PTS by the tenth year but it was already present in 16 before the index operation. Twenty-six patients without previous thrombotic episodes developed spontaneous DVT or phlebitis during the 10-year follow-up. New leg ulcers developed in six patients. Although all thrombotic episodes, irrespective of the relation to the index operation, increased the risk of PTS, most PTS occurred in patients without recognised DVT, although most had lesser venous problems prior to operation. PTS should be seen as resulting from the summation of a number of incidents of damage to the leg veins rather than one postoperative incident. Direction of prophylactic effort to patients with pre-existing venous problems may best reduce PTS among patients undergoing abdominal surgery, but will not make a major impact on the total population incidence of PTS.
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PMID:A prospective 10-year study of the post-thrombotic syndrome in a surgical population. 341 75

A simple assay method of heparin cofactor II (HC II) activity is described. The procedure is based on the following principle: Antithrombin III (AT III) in plasma is inactivated by addition of an IgG fraction of goat serum after immunization of the animals against human AT III. Complete inactivation of AT III could be shown by absence of an anti Xa-effect of heparinized plasma treated with this antibody. Thrombin was only partially inhibited after inactivation of AT III. The characteristics of this inhibition were typical for the action of HC II. This method was applied for an assay of HC II activity. After optimizing of the method practical application in clinical routine screening was carried out. A diminution of HC II was observed in liver cirrhosis and in DIC but not in AT III deficiency. In 15 out of 269 cases of recurrent DVT there were HC II activities below 70% of normal. In 4 out of these patients activities of HC II were repeatedly between 44% and 52%. In arterial obstructive disease there was an HC II activity of less than 60% in 18 out of 583 patients and in 11 of them the HC II levels were repeatedly between 45% and 54%.
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PMID:Heparin cofactor II: a simple assay method and results of its clinical application. 342 87

Suspicion of DVT or thromboembolism is critical to early diagnosis and treatment prior to development of severe or life-threatening pathology. Because the consequences of treatment are long-term inconvenience and risk of major complications, objective studies are necessary to confirm the diagnosis. Radiographic procedures such as angiography and lung scanning provide valuable information with low risk to mother and fetus. However, if the clinical situation is strongly suggestive, treatment with intravenous heparin can be immediately initiated followed by definitive diagnosis. When indicated, anticoagulation can be instituted with relative safety, providing there is careful monitoring. Heparin is unquestionably the drug of choice for treatment and prophylaxis during pregnancy. Because warfarin carries a significant risk to the fetus of anomalies and hemorrhage, its use during pregnancy should be reserved for those circumstances in which the benefits of such therapy outweigh the risks. Finally, awareness of the signs and symptoms of thromboembolism, as well as expeditious treatment, remain the mainstays for prevention of maternal and attendant fetal mortality.
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PMID:Thromboembolic disease in pregnancy. 353 47


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