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

Venous thromboembolism is a frequent major complication in patients with gynecologic cancer. Risk factors include being elderly and nonwhite, having an advanced stage of malignancy, a past history of deep venous thrombosis, previous venous disease as evidenced by lower extremity edema, venous stasis changes, or varicose veins. Patients who have had pelvic radiation therapy, or who are more than ten percent over their ideal body weight are also at increased risk. Thromboembolism in gyn cancer patients most often occurs in the perioperative period. Prevention is dependent upon the recognition of the patient at risk and institution of effective prophylactic methods, prior to surgery, and continuing until the patient is fully ambulatory. Low-dose heparin postoperatively is ineffective, but more intense regimens of heparin and intermittent leg compression in the operating room and postoperatively are effective.
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PMID:Thromboembolism in patients with Gyn tumors: risk factors, natural history, and prophylaxis. 270 2

In eighty-three patients with confirmed deep vein thrombosis, the fibrinolytic system was studied before and after a 10-minute venous occlusion. Blood was collected at least 3 months after the last acute episode, and PAI-1 antigen and activity, as well as tissue-type plasminogen activator (t-PA) antigen, urokinase-type plasminogen activator (u-PA) antigen, and fibrinolytic activity were measured in these samples. During venous stasis, plasminogen activator inhibitor (PAI) activity decreased in almost all patients (81 of 83), from a median value of 8.2 to 2.9 U/mL (P less than .001, Wilcoxon signed-rank test). Because PAI-1 antigen augmented from a median value of 16 to 19.2 ng/mL (P less than .001), the decline in PAI activity was attributed to an increase in t-PA antigen from a median value of 10 to 21.7 ng/mL (P less than .001). Neutralization of PAI activity thus reflects the patient's capacity to overcome basal inhibitory potential through t-PA release. Based on residual PAI activity after 10-minute stasis, patients were classified as good or bad responders (PAI activity below detection limit, ie, less than or equal to 1.0 and greater than 1.0 U/ml, respectively). Good responders had a significantly higher fibrinolytic response after stasis than bad responders (median euglobulin clot lysis time 60 v 180 minutes; dilute whole blood clot lysis time 60 v 120 minutes; fibrinolytic activity on fibrin plates 7.7 v 0 U/mL). Furthermore, good responders, as compared with bad responders, had higher t-PA release (median 16.5 v 11.5 ng/mL), lower basal PAI activity (median 4.8 v 11.2 U/mL), and lower basal PAI-1 (median 11 v 21 ng/mL) and u-PA antigen (median 7.9 v 9.0 ng/mL, P less than .02). Hypofibrinolysis, as defined by the inability of released t-PA to overcome PAI-1 basal inhibitory potential, was observed in 45 of 83 patients (54%) and resulted either from an insufficient release of t-PA or from an increased basal PAI activity.
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PMID:Residual plasminogen activator inhibitor activity after venous stasis as a criterion for hypofibrinolysis: a study in 83 patients with confirmed deep vein thrombosis. 313 60

Preventive effect of intermittent sequential pneumatic compression of the legs (ISPC) on the postoperative deep venous thrombosis (DVT) was studied by 125I-fibrinogen uptake test in 64 surgical patients. Furthermore the mechanism of preventive effect by ISPC was analysed from the point of view of coagulation and fibrinolytic activity in 78 patients. Following results were obtained. 1) The incidence of DVT in control group was 18.0 percent, while it was 6.3 percent in ISPC group (p less than 0.01). 2) The euglobulin lysis time in ISPC group was significantly shorter than that of control group on the first postoperative day (p less than 0.01). 3) There were no definite changes in plasminogen and B beta 15-42 peptide between control group and ISPC group. 4) There were no complications in using of ISPC. This study demonstrates that ISPC has a dual action; (1) mechanical prevention of venous stasis and (2) fibrinolytic acceleration. ISPC are effective for prevention of postoperative DVT.
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PMID:[Study on postoperative deep venous thrombosis with reference to prevention]. 336 30

Dihydroergotamine(DHE)-heparin combination offers a unique treatment modality for the prevention of deep vein thrombosis. The combination appears to affect all 3 limbs of Virchow's triad: hypercoagulability, venous stasis, and endothelial damage. In most efficacy studies, data indicated that the combination of DHE 0.5 mg and heparin 5000 IU was superior to low-dose heparin alone. Even when the efficacy of DHE-heparin was the same as that of heparin alone, the use of the combination allowed for a decrease in the heparin dose required.
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PMID:Combination dihydroergotamine mesylate and heparin sodium with lidocaine HCl. Pharmacokinetics, mechanism of action, clinical efficacy, and adverse effects. 353 4

We study by 81mKr radionuclide phlebography 13 normal lower limbs and 22 limbs suffering from sequelae of deep vein thrombosis. We assess the spontaneous venous return and the effect of an intravenous injection of 0.5 mg dihydroergotamine (DHE), a powerful venoconstrictor agent. The phlebograms are analysed on a morphological basis. Dynamic data are also collected: the delay of arrival of the radioactivity at the groin and the regional radioactivity level at steady state (during the steady 81mKr perfusion). This segmental radioactivity is a positive marker of the venous stasis because it increases when the venous system dilates and when the flow goes down. It is normalized with regard to the radioactivity measured in the proximal segment (lower vena cava and proximal iliac vein). The influence of DHE on the delay of arrival of the radioactivity in the groin is variable: it is regularly and significantly shortened in the normal limbs (mean decrease of 6.5 s, table II). The segmental radioactivity is relatively low among these limbs (2.76 at the pelvic level, 9.68 at the high, tables IV and V). It drops significantly with DHE in all segments (tables IV and V: -44% in the pelvic veins, -57% in the great saphenous vein and -46% in the femoral tract). The post-thrombotic limbs showing spontaneously an abnormal deep network are characterized by a high radioactivity level (total in the high: 14.25, deep system 5.70 and 8.55 in the saphenous vein, table V). This segmental total radioactivity does not decrease significantly under the influence of DHE; even more it increases in the deep tract (+24%, table V).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Scintigraphic study (81mKr) of venous return activation using intravenous dihydroergotamine]. 355 9

The amount and rate of blood expelled with different modes of intermittent external pneumatic compression applied to the lower leg were studied on a regional basis in a series of experiments on healthy human volunteers. Radionuclide imaging of the labelled blood pool, with acquisition of counts synchronised to the pressurisation cycle, provided data on regional blood volumes in the leg in relation to time. To determine the changes in blood volume of the lower leg resulting from external pneumatic compression labelled red blood cell counts were determined during 10 different types of compression cycle. Since venous stasis is considered to be a major cause of venous thrombosis the red blood cell counts were used to calculate regional values of the fraction of blood ejected as well as comparative indices proportional to regional flow rate, regional velocity, and regional wall shear stress. All these indices should be maximised for optimal prophylaxis against deep vein thrombosis. The four compartment cuff in each compression mode applied a mean pressure of 45 mm Hg, but different combinations of values were used for intercompartmental pressure gradation (delta p) and for intercompartmental time sequencing to the onset of compression (delta t). Uniform compression (delta p = 0; delta t = 0) was substantially inferior to cycles with gradation and sequencing. The optimal values of delta p were in the range 5-10 mm Hg and of delta t in the range 0-0.5 seconds.
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PMID:Optimisation of indices of external pneumatic compression for prophylaxis against deep vein thrombosis: radionuclide gated imaging studies. 379 48

Surgical prophylaxis of pulmonary embolism by implantation of Vena-cava-filter (Greenfield) or Vena cava clip (Adams de Weese) was performed in 24 patients. The following indications were used: Recurrent pulmonary embolism under adequate anticoagulation, Pulmonary embolism in cases of contraindications to anticoagulation, Floating thrombus occurring late following deep vein thrombosis, After pulmonary embolectomy. In a retrospective study we recognized 0% recurrent pulmonary embolism, a vena cava occlusion rate of 4% and no clinically relevant signs of bilateral venous stasis in the lower limbs.
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PMID:[Prevention of pulmonary embolism using a vena cava filter and cava clip]. 380 67

Deep venous thrombosis is a major complication following gynecologic surgery. Assessing a patient's risk of developing deep venous thrombosis is important for patient selection and in choosing appropriate prophylactic methods. Four hundred eleven patients undergoing major gynecologic surgery were evaluated prospectively. All known variables associated with deep venous thrombosis were recorded. Deep venous thrombosis was diagnosed by 125I fibrinogen leg counting of all patients. Univariate analysis of all variables identified the following to be significantly related (P less than .05) to postoperative deep venous thrombosis: a prior history of deep venous thrombosis, leg edema or venous stasis changes, venous varicosities, degree of preoperative ambulation, type of surgery, nonwhite race, recurrent malignancy, prior pelvic radiation therapy, age above 45 years, excessive body weight, intraoperative blood loss, and duration of anesthesia. A stepwise logistic regression analysis of these variables was performed. The following preoperative prognostic factors remained significant: type of surgery, age, leg edema, nonwhite patients, severity of venous varicosities, prior radiation therapy, and prior history of deep venous thrombosis. Duration of anesthesia was also important when intraoperative factors were considered in the analysis. Using these factors, a prognostic model was created and tested. The model resulted in a degree of concordance of 0.82 and allows one to evaluate the risks of postoperative deep venous thrombosis for an individual patient.
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PMID:Variables associated with postoperative deep venous thrombosis: a prospective study of 411 gynecology patients and creation of a prognostic model. 380

Does a normal leg phlebogram exclude deep venous thrombosis (DVT)? Is it safe not to anticoagulate patients with suspected DVT and a normal phlebogram? To answer these questions a retrospective study was undertaken of 71 outpatients with clinically suspected DVT and a normal phlebogram. Patients were followed for 5 months on the average; data were obtained from conversations with referring physicians and interviews with patients. Nine patients were excluded from the study because of incomplete follow-up data; four others were excluded because they were treated with coumadin "on clinical grounds". Five patients continued having symptoms subsequently attributed to arthritis, cellulitis and/or venous stasis. Fifty-three patients had no venous thromboembolic problems during the follow-up period and their symptoms subsided without therapy. We conclude that a properly performed normal leg phlebogram excludes a diagnosis of clinically significant DVT. No patient in this study developed problems because anticoagulant therapy was withheld based on a negative phlebogram.
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PMID:The normal leg venogram: significance in suspected vein thrombosis. 383 Nov 59

The aim of this study is to demonstrate the importance of the fight against venous stasis in the prevention of post-operative deep venous thrombosis. The study is based on two perfectly matched groups of 75 patients undergoing surgery for the complete replacement of the hip. As well as the usual preventive methods, one group was given external electric stimulus of the muscles of the lower limbs during the operation, in the immediate post-operative period and for the ten days following, achieving maximum venous drainage which was virtually permanent. The results make it apparent that external electric stimulus meant that 16% of deep venous thromboses were avoided in the group on which it was used.
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PMID:[Prevention of deep venous thrombosis by physical methods. Use of an external electrical stimulator. Initial results in surgery of the hip]. 387 12


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