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

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

In about 50% of the cases of spontaneous deep vein thrombosis a congenital deficiency of an inhibitor of coagulation or an insufficient fibrinolytic mechanism can be detected. In arterial thromboembolism a connection with hyperactive platelets or with a diminished availability of tissue plasminogen activator can be found in about 70%. However, in these cases the defect which provokes thrombosis is mostly acquired and is connected with hyperlipidemia and/or with atherosclerotic alterations of the vessel wall. A study on patients with thromboembolic tendency and detectable risk factors was carried out. A total of 470 patients could be observed for 2 years under an adequate antithrombotic prophylaxis. The occurrence of thromboembolic episodes 2 years prior to prophylaxis and 2 years under prophylaxis was compared. In venous cases thrombosis could be controlled almost completely by coumarins when the underlying cause was a deficient plasmatic inhibitor. In patients with diminished fibrinolysis there was only a partial effect of oral anticoagulants. A better result could be obtained when pentosan polysulfate was administered. In arterial thromboembolism the results of prophylaxis were less convincing. The efficacy of ASA in patients with an increased platelet function was only moderate. In addition, ASA hat to be discontinued in about 20% of the patients because of gastrointestinal problems. Pentosan polysulfate in patients with a diminished fibrinolytic capacity had a fairly good effect and resulted in a 60% reduction of thromboembolic manifestations. It is shown that an exact diagnosis of the underlying deficiency which is likely to cause thrombosis can also improve the efficacy and the specificity of prophylaxis.
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PMID:Antithrombotic therapy in patients with known risk factors for thromboembolism. 248 12

A retrospective study was made to evaluate the effects of two preventive measures on deep venous thrombosis. The first group consists of 147 patients operated upon for biliary tract disease and 118 operative at the hip. The prophylactic measures consisted of dextran and ASA. The second group comprises 52 patients who underwent biliary tract surgery and 40 a hip intervention. During the operation they were submitted to a moderate normovolemic hemodilution (Hemat. 27%) only. During the postoperative period this group received no other prophylactic measures or therapy except for routine physical therapy. This study suggests that moderate normovolemic hemodilution is the best prophylaxis for deep venous thrombosis. Indeed, in the first group 10% of those operated upon for biliary tract disease developed a deep venous thrombosis as detected by the fibrinogen-I 25 test and phlebography (0,68% massive lethal pulmonary embolism). The incidence was 37,2% after hip surgery (1,6% massive lethal pulmonary embolism). Of those operated with moderate normovolemic hemodilution no deep venous thrombosis was detected in the biliary surgery group and only 10% in the hip surgery group. None of them died of a pulmonary embolus. The mechanisms by which normovolemic moderate hemodilution prevents the development of deep venous thrombosis are discussed.
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PMID:[Dextran and hemodilution in the prevention of postoperative venous thrombo-embolism (author's transl)]. 616 3

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.
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PMID:Deep vein thrombosis in spinal cord injury: effect of prophylaxis with calf compression, aspirin, and dipyridamole. 681 14

The introduction of the Gamma nail (GN) as an intramedullar implant for pertrochanteric femoral fractures that allowed full weight bearing decreased the death rate from 17% (methods without full weight bearing) to 6%. The long Gamma nail (LGN) is a logical supplement of the standard version, designed to treat unstable per-, subtrochanteric and segmental fractures. This study evaluated 44 consecutive operations. Seventy percent of the patients had to be classified ASA III and IV, due to their high morbidity. The median age was 73.5 years. Multiple injuries occurred in 30.2%. All fractures were considered unstable. Surgery was usually performed within 24 h. The median duration of the surgical treatment was 120 min. In five cases technical problems were observed. Radiological controls showed a good positioning of the head screw. Early complications consisted of four local wound infections, three of them deep infections with a osteomyelitis. Deep venous thrombosis was observed in four cases, two of which included a pulmonary embolism (conservative treatment). The 30-day death toll was 2.3% (one patient). The median survival time (using Kaplan-Meier) in the study was 46 months, compared to 80 months in a matched population. This difference has to be linked to high premorbidity. The median duration of admission was 15 days. Mobilisation with full weight bearing was theoretically possible in all cases, but additional injuries or preoperatively impaired walking ability prevented full mobilisation in 15 cases. Functional assessment uncovered a decrease in Merle d,Aubigne score of 26.7% due to an impaired walking ability. Seventy-three percent of the patients regained their preoperative social status. In conclusion the long Gamma nail is a universal, less invasive implant with high early weight bearing. It thus allows early remobilization and reduces lethality in the treatment of complex, unstable coxal fractures.
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PMID:[The long gamma nail--indications, technique and results]. 1104 28

Over the past years out-patient operations of varicose veins have become increasingly accepted. In the year 1998 the number of patients treated for long saphenous vein varicosis on an outpatient-basis has risen to 66,922. For the individual risk assessment of the patient the ASA-classification is proven. ASA-class I and II patients may be considered for out-patient treatment. 98.2% of our patients that were operated upon 1995 on an outpatient-basis were classified as ASA I or II. Beside the risk assessment the extension of the disease should determine the indication for outpatient or inpatient treatment. During the year 1995 the majority of operations were performed for long or short saphenous vein varicosis (51.3% in the outpatient group, 61.9% in the inpatient group). But the percentage of isolated treatment of sidebranches and perforating veins was much higher in the outpatient group with 30% in comparison to the inpatient group with 3.4%. Under these conditions outpatient varicose vein surgery can be carried out with good result and a low complication-rate. In our outpatient group a deep vein thrombosis occurred in 0.03%, in other outpatient centers the incidence of deep vein thrombosis was reported with 0.08%. Wound infection was seen in 0.49%, a bleeding complication in 0.16% of the patients.
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PMID:[Ambulatory operation of varicose veins]. 1150 61

Our hypothesis was that, due to its sympatholytic action, epidural anesthesia (EA) administered as part of anesthesia in abdominal surgery would generate a marked venous leg flow enhancement, thus aiding in the prevention of peroperative venous stasis. We studied, and comprehensively quantified the venous haemodynamic changes in the lower limb during and immediately after abdominal surgery performed under EA and general (GA) anesthesia combined, in comparison to GA alone. This is a prospective, randomized, controlled study, stratified for hypertension and smoking, comprising ASA 1-2 patients undergoing elective total abdominal hysterectomy. Those with peripheral vascular or chronic venous disease, prior DVT or BMI>35 were excluded. Eligible recruits received either GA (Group GA) (n = 10; age 36-65, median 50) alone or epidural anesthesia (EA) and GA combined (Group EA/GA) (n = 9; age 32-58, median 46). EA (L(1-2)) was administered using lignocaine 2%. Both groups had GA induced with fentanyl and propofol, maintained with N(2)O and isoflurane; larygoscopy was facilitated with vecuronium; analgesia was provided either with morphine (Group GA) or epidurally with 2% lignocaine boli (Group EA/GA). Hemodynamics were determined at the popliteal vein in the horizontal supine position at baseline (resting prior to anesthesia), post epidural (20 min after delivery of EA), post induction (15 min after laryngeal intubation), surgery (upon uterus removal) and recovery (30 min after extubation). There was no difference in the mean velocity[V(mean)] between the 2 groups at baseline (p = 0.35([Mann-Whitney])), and post induction (p = 0.5([Mann-Whitney])). However V(mean) was significantly higher in Group EA/GA than Group GA, both at surgery (point estimate[PE]: 1.8 cm/s; 95% CI: 0.01, 6.3 cm/s; p <0.05([Mann-Whitney])) and recovery (PE: 2.6 cm/s; 95% CI: 0.4, 5.1 cm/s; p = 0.02([Mann-Whitney])). Volume flow[V(Q)] was similar in the 2 groups at baseline and post induction (both, p >0.1([Mann-Whitney])), but was significantly higher in Group EA/GA at surgery (PE: 54 ml/min; 95% CI: 18, 159 ml/min; p = 0.045([Mann-Whitney])) and recovery (PE: 49 ml/min; 95% CI: 16, 129 ml/min; p=0.0037([Mann-Whitney])). Peak velocity, V(mean) and V(Q) increased significantly post epidural in Group EA/GA. Contrary to the venous leg flow attenuation in elective abdominal surgery under GA and upon its recovery, EA administered as part of GA is associated with a significant enhancement of both V(mean) and V(Q). This beneficial hemodynamic effect of EA at the vulnerable stage of recovery may be critically essential in light of enhanced blood viscosity, fibrinolytic shut-down, endothelial/platelet activation and immobility, acting in synergy with putative cardiorespiratory protection. The results of this study lend support to the preferential selection of combined EA/GA in subjects at high risk for venous thromboembolism, particularly when optimal DVT prophylaxis is practically unattainable due to limitations pertaining to the nature of surgery.
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PMID:Effects of epidural-and-general anesthesia combined versus general anesthesia alone on the venous hemodynamics of the lower limb. A randomized study. 1554 27

We describe a case of a 37-year-old man with active ulcerative colitis complicated by proximal deep vein thrombosis of the left lower limb and subsequent massive pulmonary embolism requiring mechanical ventilation and catecholamine infusion. In spiral CT a large thrombus obturating left pulmonary artery as well as bilateral embolic material in lobar and segmental branches were visible. Haemodynamic status improved after infusion of rtPA. Haemoglobin decrease (7.0-5.6 mmol/L) was corrected with erythrocyte mass transfusion. During subsequent therapy with intravenous full dose of unfractionated heparin and further long-term treatment with subcutaneous enoxaparin (1.5 mg/kg and after 3 months 1.0 mg/kg daily) haemoglobin value was relatively stable. Underlying disease was treated with 5-ASA (mesalazine) and steroids. Due to hyperhomocysteinaemia (16.0 micromol/L) coexisting with a low plasma folic acid (2.1 ng/ml) and cyanocobalamin (137 pg/ml) levels, supplementation with these vitamins was prescribed. The screening tests for familial thrombophilia (including 677C-->T MTHFR mutation) were negative. The authors discuss the pathogenesis of increased thromboembolic risk in inflammatory bowel disease and therapeutic dilemmas connected with treatment of such complications.
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PMID:[Massive pulmonary embolism in a patient with ulcerative colitis and hyperhomocysteinaemia -- a case report]. 1669 88

A 29-year-old man, with no significant past medical history, was in his usual state of health until the afternoon of admission. The patient was seated at work eating lunch when he suddenly noticed that his vision became blurry. He covered his right eye and had no visual difficulty but noted blurry vision upon covering his left eye. At this point, the patient tried to stand up, but had difficulty walking and noticed he was "falling toward his left." Facial asymmetry when smiling was also appreciated. The patient denied any alteration in mental status, confusion, antecedent or current headaches, aura, chest pains, or shortness of breath. He was not taking any prescribed medications and had no known allergies. The patient denied any prior hospitalization or surgery. He denied use of tobacco, alcohol, or illicit drugs, and worked as a maintenance worker in a hotel. His family history is remarkable for his father who died of pancreatic cancer in his 50s and his mother who died of an unknown heart condition in her late 40s. Vital signs on presentation to the emergency department included temperature of 97.6 degrees F; respiratory rate of 18 per minute; pulse of 68 per minute; blood pressure of 124/84 mmHg; pulse oximetry of 99% on ambient air. His body mass index was 24 and he was complaining of no pain. The patient had no carotid bruits and no significant jugular venous distention. Cardiovascular exam revealed a regular rate and rhythm with no murmurs. Neurological exam revealed left-sided facial weakness, dysarthria, and preserved visual fields. He was able to furrow his brow. Gait deviation to the left was present, and Romberg sign was negative. Deep tendon reflexes were 2+ throughout, and no other focal neurological deficit was present. The patient was admitted to the hospital with a diagnosis of stroke. Electrocardiogram, fasting lipid profile, computed tomography (CT) scan of head, magnetic resonance imaging (MRI) of head and neck, and transthoracic echo with bubble study were ordered. The initial head CT did not reveal bleeding. He was started on aspirin (ASA). On the second hospital day, the symptoms improved with resolution of dysarthria. His ataxia had also improved. Fasting lipid profile revealed mildly elevated low-density lipoprotein and total cholesterol. His head MRI revealed an acute right thalamic stroke. Echocardiography was significant only for a patent foramen ovale (PFO) with transit of agitated saline "bubbles" from right atrium to left heart within three cardiac cycles (Figure). Doppler ultrasound of extremities revealed no evidence of deep venous thrombosis. A complete resolution of symptoms occurred by the third hospital day. The patient was discharged on full dose aspirin and a statin and was referred for consideration of enrollment in a PFO closure versus medical management trial.
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PMID:Clinical case of the month. A 29-year-old man with acute onset blurry vision, weakness, and gait abnormality. Stroke. 2010 23

Intracerebral hemorrhage (ICH) is one of the most devastating subtypes of stroke and is characterized by spontaneous extravasation into the parenchymal tissue of the brain. Although advances in critical care have improved, there is no intervention currently available that has shown to alter the outcome of patients who have suffered acute ICH. Therefore, management is largely supportive. Treatment strategies are aimed at limiting hematoma enlargement, seizures, and cerebral edema, as well as other ICU-related complications such as deep venous thrombosis, hyperglycemia, and fever. This review will outline the key pharmacological management strategies in patients with ICH and highlight the most current American Heart Association/American Stroke Association (AHA/ASA) guidelines for management published in 2007.
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PMID:Management of spontaneous nontraumatic intracranial hemorrhage. 2150 45


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