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

Mechanical methods of preventing deep vein thrombosis have been surveyed. The best means of preventing venous stasis has been shown to be by intermittent compression of the legs. Use of intermittent compression will prevent isotopically detectable deep venous thrombosis in 82 percent of patients and in malignancy in 90 percent of patients. The only other prophylactic measure of comparable effectiveness is administration of low-dose subcutaneous heparin. Intermittent compression need only be applied during the operation and is cheap, foolproof, and safe. Intermittent compression acts by squeezing empty the soleal sinuses and large valve pockets in the major veins in which thrombi form while venous flow is slowed during operation. A combination of intermittent compression and administration of low-dose subcutaneous heparin has been found to be no more effective than is intermittent compression alone.
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PMID:The prevention of deep vein thrombosis, with particular reference to mechanical methods of prevention. 31 52

This animal study investigated the fibrinolytic activity in the vein wall of the pig following venous stasis, which was induced artificially using an intermittently inflated pneumatic cuff. The method used to measure the fibrinolytic activity was modified from Todd's original technique. The area of lysis and the area of the vein wall were measured and expressed as a ratio, called the fibrinolytic index. After 3 h of intermittent venous stasis the fibrinolytic index was reduced by 68 per cent, significantly lower than the control group. The reduction of the fibrinolytic index by venous stasis could play an important part in the development of deep vein thrombosis.
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PMID:The fibrinolytic activity of the vein following venous stasis. 49 52

A prospective double-blind study was instituted in a group of 150 general surgical patients to test the effectiveness of mini-dose heparinization in the pre- and postoperative periods. There was a 21 per cent reduction in the incidence of deep venous thrombosis in the heparin treated group. A radiopharmaceutical imaging technique with 99m-technetium macroaggregated albumin was used to evaluate the deep venous system. The procedure proved to be simple, safe, and painless; however, it was difficult to differentiate venous stasis from deep venous thrombosis. A negative study was good evidence that deep venous thrombosis did not exist. An additional benefit of this procedure was that a perfusion lung study could be obtained which provided additional information regarding pulmonary embolism without injecting additional radiopharmaceutical. Again, the negative perfusion lung study provided more information.
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PMID:Evaluation of mini-dose heparin administration as a prophylaxis against postoperative pulmonary embolism: a prospective double-blind study. 109 61

The possible benefits of adding a low-dose heparin regimen to the technique of peroperative intermittent calf compression for preventing deep vein thrombosis (D.V.T.) were assessed in a randomized trial in 84 surgical patients. The efficacy of peroperative intermittent calf compression was not enhanced by a low-dose heparin regimen, but neither was it worsened. Age, weight, duration, operation, and malignant disease did not affect the relative effectiveness of the two regimens of prophylaxis. The results confirmed that venous stasis is the principal cause of D.V.T.
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PMID:Failure of low-dose heparin to improve efficacy of peroperative intermittent calf compression in preventing postoperative deep vein thrombosis. 109 26

The aim of this study was to determine the incidence and severity of popliteal vein compression by full knee extension in the normal population. The popliteal veins in 100 healthy volunteers (200 limbs) with no history of previous deep vein thrombosis (DVT) or venous obstruction were examined using duplex scanning with the knee slightly flexed and then fully extended. Knee extension produced complete obstruction in 17 subjects and severe obstruction (< 50% decrease in diameter) in a further 10 subjects. Thirteen subjects had unilateral compression and 14 bilateral. The 27 subjects were tested for functional venous outflow obstruction with air plethysmography. In flexion, the outflow fraction was normal (> 40%) in all subjects. With the knee fully extended, severe or complete venous obstruction (outflow fraction < 10%) was found in eight subjects. Moderate obstruction (outflow fraction 10-40%) was found in all the remaining 19 subjects. When digital compression of the long saphenous vein was performed, these subjects also demonstrated severe outflow obstruction. Although the incidence of symptoms of functional venous obstruction is rare in the general population, these findings have important implications for venous stasis for patients on the operating table and in those having prolonged bed rest. Studies investigating the association between popliteal vein compression and postoperative deep venous thrombosis are needed.
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PMID:Popliteal vein entrapment in the normal population. 145 18

Eighteen subfascial ligations of deep venous perforators were performed on 17 patients with refractory venous stasis ulceration. Thirteen patients also required concomitant or subsequent split thickness skin grafting. Primary indications included: (1) recurrence of ulceration during adequate support therapy with failure to heal using conservative measures (10 cases--55%) and (2) failure to heal with support therapy alone (eight cases 45%). Five limbs had ulcers greater than 30 cm2 and two had giant ulcers (greater than 50 cm2). Most extremities had evidence of venous reflux by photoplethysmography or Doppler ultrasound (10 of 11) or chronic deep venous thrombosis by venography (six of seven). Mean hospital stay was 23 days +/- 17, range six to 68 days. Early complications, including incisional breakdown or partial skin graft loss, were common and occurred in 10 patients. With a mean follow-up interval of 28 months (range nine to 49 months), most limbs (N = 10) were judged cured, including both with giant ulcers, and three significantly improved. By life table analysis, 63% were free from significant ulcer recurrence at 42 months. Four limbs were not significantly improved following surgery. Most patients with refractory venous ulceration will benefit from subfascial ligation of deep venous perforators and skin grafting, although recurrent or persistent ulceration remains problematic for a significant number of patients.
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PMID:Limitations of subfascial ligation for refractory chronic venous stasis ulceration. 154 84

Pulmonary embolism is a potentially lethal complication among patients with acetabular fractures requiring surgery. The reliability, safety, and extent of efficacy of pharmacologic as well as existing nonpharmacologic anticoagulation prophylaxis in this patient group has not been determined. A careful analysis of the myriad factors acting on these patients who have had major trauma and have undergone a major surgical procedure about the hip prompted a change in our approach to prophylaxis in this patient group. In the period from March 1984 through October 1987, 51 patients having 52 acetabular fractures underwent osteosynthesis at the Wake Forest University Medical Center. Twenty-four patients had two or more identifiable risk factors and underwent insertion of a Greenfield filter for prevention of pulmonary emboli. Filters were inserted at the time of acetabular surgery with C-arm guidance via the internal jugular vein approach. The average time for insertion was 57 min. Placements were verified by plain roentgenograms. There were no complications during filter insertion. Four patients with filters (17%) developed leg edema; in three the edema was minor, and in one the filter trapped what could have been a fatal embolus but caused lower extremity venous stasis severe enough to result in peripheral lower extremity tissue loss. There were no pulmonary emboli (by clinical criteria). The remaining 27 patients had routine medical prophylaxis and no filters. In this group, two patients had a clinically evident pulmonary embolus (7%), and one of these patients died. Two other patients (7%) had minor chronic leg edema. In one of them, a proximal deep venous thrombosis in the lower extremity was documented with venography, requiring rehospitalization and anticoagulant therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Greenfield filter prophylaxis of pulmonary embolism in patients undergoing surgery for acetabular fracture. 160 32

Heparin and warfarin sodium (Coumadin, Panwarfin, Sofarin) are used most often to treat acute and recurrent venous thromboembolic disease, arterial disease, valvular heart disease, and atrial fibrillation. These agents along with dextran, pneumatic compression devices, and gradient stockings are also used to prevent deep venous thrombosis and pulmonary embolism in patients at high risk (eg, those with venous stasis, lower limb or spinal cord trauma, clotting abnormalities). Anticoagulation therapy is monitored by maintaining the activated partial thromboplastin time and the prothrombin time in the therapeutic range.
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PMID:Using anticoagulants safely. Guidelines for therapeutic and prophylactic regimens. 188 10

Experimental models of deep venous thrombosis, heretofore, have not been available for laboratory studies. This investigation establishes a novel model of venous thrombosis by inhibiting the protein C system combined with venous stasis and subtle venous injury. Ten adolescent baboons were studied in pairs, with one animal receiving saline solution (B2, B4, B6, B8, B10) and one being exposed to thrombogenic reagents (B1, B3, B5, B7, B9). These reagents represented a combination of a monoclonal antibody (HPC4) to protein C, 1 to 4 mg/kg administered over 5 minutes, and tumor necrosis factor administered over 3 minutes at a dose of 150 micrograms/kg through a catheter placed into the left superficial femoral vein with distal ligation. To encourage stasis, a pediatric size blood pressure cuff was inflated to 40 mm Hg on the right thigh for 50 minutes of every hour during the first experimental day (day 1) in B5 to B10. The animals were observed for a 6-hour period on day 1 and then for an 11- to 15-day period until sacrifice. Hemodynamic and hematologic parameters were recorded along with duplex imaging of the iliac veins and inferior vena cava on a daily basis. Venography was performed on day 1, day 4, and the day of sacrifice. At sacrifice the entire iliac and vena caval system was carefully dissected, opened, and photographed. Experimental animals given the HPC4 and tumor necrosis factor developed left iliac vein thrombosis extending into the inferior vena cava. Duplex imaging, venography, and autopsy revealed that control animals receiving saline solution never developed comparable thrombus. Experimental subjects exhibited thrombus on duplex imaging by day 4 (B1), day 3 (B3), day 2 (B5), 120 minutes (B7), and 360 minutes (B9) after receiving HPC4 and tumor necrosis factor. Venograms performed on day 1 exhibited thrombus in B5, B7, and B9. The extent of thrombus, the timing of its occurrence, and its effect on the animals' left leg followed a dose-dependent relationship for the animals in which the occlusive blood pressure cuff was used. Significantly greater declines in blood pressure, white blood cell count, and platelet count were found in affected animals given HPC4 and tumor necrosis factor reagents as compared to control subjects. All affected animals demonstrated the appearance of fibrin split products and a markedly prolonged prothrombin time. This investigation, for the first time, establishes a reproducible model of deep venous thrombosis involving inhibition of protein C that will facilitate further laboratory studies on venous thrombosis.
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PMID:Deep venous thrombosis in the baboon: an experimental model. 194 66

During a five year period at Akron City Hospital, 165 Greenfield filters were placed in 165 patients. Of this group, 78 patients were available for long term analysis, and of these, 42 did not receive anticoagulation treatment for venous thromboembolic diseases, either acutely or on an outpatient basis. An analysis of the outcome for these 42 patients who had the Greenfield filter only as the primary mode of therapy for the disease included chart review and asking each person a standard set of questions. Leg swelling was the most common complaint, occurring in 33 per cent of patients. Venous stasis ulceration occurred in two patients and recurrent deep venous thrombosis occurred in one patient. When compared with a historical control group with venous thromboembolic disease that was treated with anticoagulation alone, the incidence of these sequelae in Greenfield-treated patients was not significantly different. Finally, in this review, the Greenfield filter is better than 95 per cent effective in the prevention of pulmonary embolism. This is no less effective than anticoagulation alone, the efficacy of which is 95 to 98 per cent. The placement of a Greenfield filter is a safe procedure that can usually be done after a local anesthetic was administered to the patient with a complication rate of less than 10 per cent. Unfortunately, major complications of anticoagulation (usually hemorrhage) are relatively common at a rate of 2 to 15 per cent, and occur more frequently in the older population. It is for reasons of safety of therapy and of an equal or better efficacy that the Greenfield filter is recommended in a broader range of clinical circumstances. In particular, it is concluded that the Greenfield filter should be used as a primary means of therapy in venous thromboembolic disease, particularly in those patients who are more than 65 years of age, when the risks of anticoagulation are most threatening.
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PMID:The Greenfield filter as the primary means of therapy in venous thromboembolic disease. 200 47


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