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

An infusion of dextran (mean molecular weight 70000) in normal saline (either 1 litre or 500 ml) was given to patients undergoing hysterectomy. The infusion was started at induction of anaesthesia and continued throughout the operation and for up to 5 h thereafter. The rate of elimination of dextran was independent of the dose given. The time to eliminate half the dose was nearly two days and up to 10% was still present in the circulation after one week. The persistence of dextran in the plasma in these amounts and for this length of time may have considerable implications in the prophylaxis of postoperative deep venous thrombosis.
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PMID:The persistence of dextran 70 in blood plasma following its infusion, during surgery, for prophylaxis against thromboembolism. 0 46

In a study of 112 patients undergoing elective major surgery clinical and haemostatic data was followed in connection with a double-blind investigation on the effect of subcutaneous low-dose heparin prophylaxis. None of the patients developed severe thromboembolism but according to lung photoscanning and leg scanning 41 of the patients had deep vein thrombosis and/or pulmonary embolism. Clinically thromboembolism appeared within 4 days after operation. In 22 patients with epidural anaesthesia the incidence of thromboembolism was lower than in the patients with general anaesthesia. The extension of the operation was positively correlated to a higher incidence of thromboembolism. The surgical trauma was reflected in most of the routine haemostatic laboratory parameters, hiding possible minor changes caused by subclinical thromboembolic complications. The low doses of heparin could only be detected with more sensitive methods. A comparison of sodium and calcium heparin administered subcutaneously revealed no significant differences.
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PMID:Clinical and haemostatic parameters related to thromboembolism and low-dose heparin prophylaxis in major surgery. 5 29

The antithrombotic effect of dextran 70 and dextran 40 was studied by a double blind trial in 235 patients with major or medium sized elective procedures. 6% dextran 70 (Macrodex) or 10% dextran 40 (Rhemacrodex) or 5% dextrose in 0.9% saline were given in a double blind manner in 500 ml quantities over 30 minutes starting with the induction of anaesthesia. The diagnosis of deep venous thrombosis was confirmed objectively by the I-125-labelled fibrinogen uptake method. Statistically significant differences in the incidence of deep venous thrombosis between the controls and the dextran groups were not found.
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PMID:Peroperative infusion of dextran 70 and dextran 40 in the prevention of postoperative deep venous thrombosis as confirmed by the I-125-labelled fibrinogen uptake method. 32 33

Two hundred and forty-seven phlebograms (113 bilateral and 21 unilateral) were performed in 134 patients 10--14 days after total hip replacement. Fifty-eight per cent of the patients were found to have deep vein thrombosis. The patients with DVT were significantly older than patients without DVT, but there was no difference regarding sex, type of hip prosthesis, side of operation or day of mobilization. No difference was found in the duration of operation and anaesthesia, the operative haemorrhage and the amount of bank blood transfused in patients with and without DVT. Fifty per cent of the thrombi were confined to the calf veins. Ninety-seven per cent of these thrombi were asymptomatic and were as frequent on the operated as on the non-operated side. The remaining 50 per cent of the thrombi engaged the thigh with or without simultaneous calf vein involvement. These thrombi produced symptoms in 23 per cent of the cases and were significantly more common on the operated than on the non-operated side. It is concluded that DVT after hip replacement can be of two different types: thrombosis caused by stasis and the general effects of trauma and thrombosis caused by local factors involving the thigh veins of the operated leg.
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PMID:Deep vein thrombosis after total hip replacement: a clinical and phlebographic study. 44 49

Several studies have suggested that events which initiate deep venous thrombosis (DVT) occur in the early postoperative or interoperative period. Since DVT is a complication of many surgical procedures, an understanding of the early events which initiate DVT would be highly desirable. We have studied these events in a canine surgical model. The early response of the endothelium and the adhesion of blood elements to the luminal surface of veins was compared following three types of surgical trauma. Sixteen dogs were divided into four groups (control, splenectomy, hysterectomy, intestinal anastomoses) of four animals each. Blood was removed by perfusion 4 hours after anesthesia alone (control dogs) or anesthesia and surgery (experimental dogs). Jugular veins were removed for scanning and transmission electron microscopy. Veins from control dogs were covered by a continuous sheet of endothelial cells with some pseudopod formation and minor deposition and adhesion of cellular and noncellular material on the luminal surface. The response of veins from experimental animals varied considerably in the three types of surgery studied. The least-affected veins were those from splenectomized animals. These veins had patchy areas of cellular and noncellular material (10 veins) and occasional microthrombi deposited on the luminal surface (one vein). The veins from dogs subjected to hysterectomy exhibited greater endothelial alteration, including crater formation (two veins) and more cellular adhesion, particularly erythrocytes (eight veins). The veins from intestinal anastomoses animals exhibited the greatest response. In these animals there was considerable cellular and noncellular material deposited on the luminal surface of six veins from three of the four animals. The cellular material consisted primarily of erythrocytes and leukocytes, and the noncellular material was an amorphous granular substance. The other two veins were similar in appearance to the control veins. These findings would support the concept that deep venous thrombosis can begin in the interoperative or early postoperative period and that therapeutic intervention in the preoperative and interoperative periods might help prevent subsequent DVT.
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PMID:The response of canine veins to three types of abdominal surgery: a scanning and transmission electron microscopic study. 63 77

Experiences with the anaesthetic management of 248 patients undergoing total hip replacement are presented. Blood loss does not appear to be influenced by hypertension, the method of venting or the type of anaesthetic, with the exception of neurolept-analgesia. The importance of oxygen therapy in the treatment of the pulmonary embolic syndrome is stressed and the prevention of deep venous thrombosis is discussed. Mortality and morbidity figures are given.
Anaesthesia 1978 Sep
PMID:Clinical considerations in anaesthesia for hip arthroplasty. 71 19

Presently available data indicate that low-dose heparin will significantly diminish postoperative deep venous thrombosis and pulmonary embolism in patients over the age of 40 subjected to major elective abdomino-thoracic surgery. The schedule is 5,000 USP units of heparin subcutaneously beginning two hours before operation and continued every twelve hours (10,000 units per day) until the patient is discharged. Whether anticoagulent therapy should be continued after discharge should be decided on an individual basis. Preoperative tests for patients on this regimen should include an hematocrit, prothrombin time, partial thromboplastic time, and a platelet count. They should also not be receiving aspirin or other platelet anti-aggregating agents for five days before operation. The efficacy of this regimen is complemented by the fact that it is well tolerated by the patient and requires no laboratory monitoring. However, it does produce a definite but acceptably low frequency of minor intraoperative and postoperative bleeding. This low-dose regimen has not proved effective in open prostatectomy or major orthopedic operations. Data are not available concerning the drug's safety in patients receiving spinal or epidural anesthesia. Nor is it recommended for operations on the eye, brain or in patients who are experiencing an active thrombotic process. More than five million individuals over the age of 40 undergo major general surgical operations annually in this country. One or two out of each thousand of these patients will die postoperatively from pulmonary embolism. If low dose heparin prophylaxis in 80% effective, then the possibility exists of saving 4,000 to 8,000 lives annually. Such an impact might be realized if physicians are prepared to recommend the low-dose heparin regimen as primary prophylaxis for all hemostatically competent patients over the age of 40 who undergo abdomino-thoracic surgery.
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PMID:Prevention of venous thromboembolism in surgical patients by low-dose heparin: prepared by the Council on Thrombosis of the American Heart Association. 83 57

Eight prospective, controlled, randomised studies on the incidence of postoperative thrombosis in gynaecological patients receiving various drugs for prevention of thromboembolism are analysed. In all patients diagnosis had been established by objective means. The rate of thrombosis in patients without drug prophylaxis has been found to vary between 14 and 29%. Infusions of dextran as well as administration of low-dose subcutaneous heparin significantly reduce the incidence of deep vein thrombosis, even as compared to postoperative oral anticoagulation with cumarins. No difference has been found between dextran and oral anticoagulants, when cumarin adminstration was started before operation, nor between dextran and heparin. Aescin did not show any prophylactic effect. High age, severe leg-vein varicosis as well as surgery for malignant disease increase the risk of thrombosis. No significant influence of overweight, previous deep venous thrombosis, epidural anaesthesia or vaginal operation as compared to abdominal approach could be demonstrated. There are no properly controlled, prospective, randomised studies on the incidence of postoperative fatal pulmonary embolism as influenced by drugs in gynaecological surgery.
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PMID:[Prophylaxis of thromboembolic complications in gynecological surgery (author's transl)]. 87 Mar 88

Presently available data indicate that low-dose heparin prophylaxis will significantly diminish massive postoperative pulmonary emboli in patients more than 40 years of age subjected to major elective abdominothoracic surgery. The schedule is 5,000 USP units of heparin sodium subcutaneously, beginning two hours before surgery and continued every 12 hours (10,000 units/day) until the patient is discharged. Patients receiving this therapy should have a preoperative screening that includes a hematocrit reading, prothrombin time, partial thromboplastin time, and a platelet count. They should also not be receiving aspirin or other platelet antiaggregating agents for five days prior to surgery. The efficacy of this regimen is complemented by the fact that it is well tolerated by the patient, free of side effects, requires no laboratory monitoring, and produces minimal intraoperative or postoperative bleeding. This low-dose regimen has not proved effective in open prostatectomy or major orthopedic surgery. Data are not available concerning the drug's safety in spinal or epidural anesthesia, nor is it recommended for eye or brain surgery or in patients with an active thrombotic process. Other data are suggestive but still inconclusive that the regimen may reduce the incidence of postoperative acute myocardial infarction. In non-surgical patients hospitalized with acute myocardial infarction and receiving a low-dose heparin regimen, the findings reflect a significant decrease in deep venous thrombosis, though no observations are yet available concerning reductions in pulmonary emboli, mural thrombi, or systemic emboli.
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PMID:Heparin as an antithrombotic agent. Low-dose prophylaxis. 94 59

The natural history diagnosis and immediate treatment of patients suffering from pulmonary embolism has been discussed. Anaesthetists should use their influence to bring about a high standard of prophylactic care against deep venous thrombosis and consequently of pulmonary embolism. They are likely to be involved in the resuscitation and treatment in intensive care units of those cases who suffer from major symptoms and massive emboli and some of them will rarely be involved in anaesthetising for pulmonary embolectomy aided by cardiopulmonary by-pass and, less rarely, for IVC ligation or plication and venous disobliteration. Anticoagulant drugs appear to limit the mortality of pulmonary embolism to 5%. The mortality of IVC ligation or plication varies in different reports from 2 to 50%; it should therefore be reserved for the special indications which have been discussed. There is also an incidence of recurrent pulmonary embolism after IVC ligation and plication and leg troubles from stasis in about 30% of cases. Streptokinase is usually indicated in the immediate treatment of major pulmonary emboli which cause shock and severe distress with an immediate threat to life. In hospitals having access to cardiopulmonary by-pass, pulmonary embolectomy has a small role to play in major emboli with cardiovascular collapse, if surgery can start within 2 hours and pulmonary angiography is available. Cardiopulmonary by-pass on its own may be life-saving in supporting the circulation while the clot fragments. If cardiac arrest occurs, external cardiac massage should be undertaken as it is sometimes successful and disseminates and fragments the clot in the pulmonary artery.
Anaesthesia 1976 Sep
PMID:Pulmonary embolism. Prophylaxis diagnosis and treatment. 97 May 90


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