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

The non-invasive diagnosis of pulmonary emboli is based, in part, on evidencing a deep venous thrombosis (TVP-DVT); one of the principal features of thromboembolic disease with pulmonary emboli. Ultrasonic venograms have been introduced as the best non-invasive morphological examination for the diagnosis of DVT. Its sensitivity in subjects suspected of having pulmonary emboli (but having no frank signs of DVT) is inferior to that observed in cases where there is a clinical suspicion of DVT. On the other hand, only 70 per cent of subjects having pulmonary emboli have a DVT of the lower limbs on phlebography. For these reasons, only a positive ultrasonogram has any value in the diagnostic process as a negative ultrasonic venogram does not allow a pulmonary embolus to be excluded with certainty. A search for a DVT of the lower limbs should thus be integrated into the diagnostic approach which is both reasoned and rigorous in a search for pulmonary emboli.
Rev Mal Respir 1999 Nov
PMID:[Pulmonary embolism: the techniques, indications and diagnostic impact of lower limb investigations]. 1090 41

Caval interruption has been, historically, the first "treatment" of venous thromboembolic disease. Following ligation, plication, then clips, and finally intracaval filters constituted the successive improvements of this procedure, which can now be considered reasonably safe. However, reliable and clinically relevant data regarding long-term safety are lacking; recent data suggest that caval filters might increase the risk of recurrent deep venous thrombosis. As almost no controlled trials are available, indications for caval interruption are based on fragile grounds: contraindications to and failure of anticoagulant treatment in patients with recent proximal deep venous thrombosis remain the only two widely accepted indications. Although the PREPIC study, first prospective controlled trial on caval filters, confirmed their efficacy for preventing pulmonary embolism, the addition of caval filters to preventive or curative anticoagulant treatment in high-risk patients is still a matter of debate, because "very high-risk" settings despite anticoagulant treatment remain poorly defined. Finally, the risk-benefit ratio of caval interruption in addition to medical thrombolysis, or as an alternative to preventive or curative anticoagulant treatment appears unfavorable. The relevance of debatable indications, the precise identification of "very high-risk" patients, and the determination of the "best" filter should be assessed in specific prospective clinical trials.
Rev Mal Respir 1999 Nov
PMID:[Inferior vena cava interruption. How and when?]. 1090 46

The limitations of conventional treatment using nonfractionated heparin have stimulated research in new anticoagulants which act at different levels of the coagulation pathways. New natural or synthetic compounds have been developed to improve current treatments. Included among these compounds are indirect thrombin inhibitors such as dermatan sulfate, heparanoids and low-molecular weight heparin. Low-molecular weight heparins are particularly interesting for venous thromboembolism and acute coronary syndromes. Several studies have demonstrated their efficacy in unstable angina and myocardial infarction without Q wave. In comparison with nonfractionated heparin, administration of enoxaparin offers a supplementary benefit. Indirect thrombin inhibitors such as hirudin and its derivatives are also being evaluated and have shown a certain efficacy in the prevention of postoperative deep vein thrombosis although no superior effect compared with nonfractionated heparin has been demonstrated in thrombotic coronary disease. Finally, indirect anti-Xa agents and physiological coagulation inhibitors are also being assessed.
Rev Mal Respir 1999 Nov
PMID:[New medical anticoagulants]. 1090 47

Deep venous thrombosis is 50 times less frequent in upper than in lower limbs. Data remain poor in the literature. Forty consecutive patients (24 males, 16 females, mean age: 54.5 years) were retrospectively analysed from 161 subjects who underwent venous explorations of the upper extremity for a 3.5 year period in the same center. Diagnosis of thrombosis was made by duplex ultrasonography (n =37) or phlebography (n =3). Main clinical manifestations were edema (n =36) and pain (n =29). Location of thrombosis was humeral (n =1), axillary (n =2), or sub-clavian (n =37, 2 bilateral). The majority of thrombosis (n =29) were secondary to cancer and venous catheter (n =19, 15 implanted ports), to central catheter alone (n =3) or cancer alone (n =7). The 11 others were associated with thoracic outlet syndrome (n =6) or apparent primary thrombosis (n =5). Thrombophilia was identified in 6 out of these 11. During follow up [mean of 9 months (0,5-36)], two patients developed pulmonary embolism, 14 a post-thrombotic syndrome and 16 patients died. Initial therapy included heparin (n =36) or fibrinolysis (n =4). Upper extremity deep venous thrombosis are mostly associated with cancers and venous catheters. Thrombophilia is frequent in the other cases. Heparin followed by oral anticoagulation is the optimal therapy whose duration depends upon underlying condition. Fibrinolysis has not been useful for preventing post-thrombotic syndrome in our study.
J Mal Vasc 2000 Oct
PMID:[Upper extremity deep venous thrombosis. 40 hospitalized patients]. 1106 Apr 19

The incidence and the nature of medium-term complications of automatic implantable cardiac defibrillators (AICD) were studied. Seventy-nine AICD were implanted in 50 consecutive patients (42 men, aged 54.5 +/- 13.7 years). Forty-six patients had spontaneous ventricular arrhythmia. These arrhythmias were resistant to treatment (N = 9), reproducible with treatment (N = 28). In 4 patients, the indication was prophylactic, in 2 a Brugada syndrome, in 2 syncope with reinducible ventricular tachycardia and in 1 patient, torsades with a short coupling interval. Forty-six patients had underlying cardiac disease (ischaemic, N = 28, primary dilated cardiomyopathy, N = 10, others, N = 8). The ejection fraction was > 40% in 32 patients. The average follow-up was 41.3 +/- 34.9 months. Eight patients died, 2 from cardiac failure. Twenty-one patients (42%) had 1 or more complications related to their AICD. These occurred: in the operative period (N = 3): 1 post-shock atrioventricular block, 1 ruptured electrode and 1 increased threshold with amiodarone; in the postoperative period (N = 6): infection in 3 cases, cerebrovascular accident in 1 case, deep venous thrombosis of the left arm in 1 case, pneumothorax in 1 case. In the medium-term, the complications were mainly inappropriate electrical shocks observed in 14 patients related to atrial arrhythmias in 7 cases, sinus tachycardia in 1 case, over-detection of myopotentials in 2 cases and electrode dysfunction in 4 cases. In addition, the authors observed complications related to the material: AICD failure in 1 case, electrode displacement in 1 case, and electrode rupture in 3 cases. The authors conclude that AICD are effective for the treatment of malignant ventricular arrhythmias which justify strict specialist follow-up given the incidence and diversity of their complications.
Arch Mal Coeur Vaiss 2000 Nov
PMID:[Mid-term complications of automatic implantable cardiac defibrillators]. 1119 Apr 54

The generalisation of the use of transthoracic echocardiography in the investigation of pulmonary embolism leads to the diagnosis of mobile right heart thrombus in about 5% of cases. A review of the literature shows that this association is mainly observed in clinically severe pulmonary embolism. The presence of a mobile right heart thrombus is associated with a poor prognosis and emergency treatment is based on thrombolytic therapy or surgical embolectomy. In minimal or infraclinical pulmonary embolism, the finding of a mobile right heart thrombus is rare and there is no consensus about its treatment. The authors report the case of a 61 year old man admitted to hospital for bilateral deep vein thrombosis with no symptoms of pulmonary embolism in whom investigations revealed a mobile right heart thrombus with minimal pulmonary embolism. The outcome was favourable with progressive resolution of the right heart thrombus with oral anticoagulation after three weeks of heparin therapy.
Arch Mal Coeur Vaiss 2001 Sep
PMID:[Mobile right heart thrombus with minimal pulmonary embolism. A case report]. 1160 65

Deep venous thrombosis (DVT) of upper limbs is extremely rare. DVT related to physical stress is a less known form. The purpose of this study was to outline the clinical pattern and laboratory features as well as the clinical course and outcome of this disease. The authors report 5 documented cases of upper limb DVT related to physical stress: 4 patients were hand workers and 1 was a young athletic man. None of the patients developed pulmonary embolism. Two patients had late sequelae. Treatment is based on prompt and early anticoagulation. Prevention can be achieved by contention, active physiotherapy and professional rehabilitation.
J Mal Vasc 2001 Oct
PMID:[Effort phlebitis of the upper limb. Report of 5 cases]. 1207 Aug 41

The necessity of anticoagulant treatment after a pulmonary embolus or a deep venous thrombosis has been demonstrated. The modalities of this treatment have been well established, especially the usefulness of initial heparin therapy followed by a period of antivitamin K treatment with an "ideal target INR" between 2 and 3. One of the last questions in this therapeutic protocol is the duration of antivitamin K treatment. The choice of duration of treatment must be made on numerous criteria. It is necessary to distinguish the circumstances of the occurrence of the DVT or the PE and the context. It is thus possible for less than 3 months treatment in secondary venous thrombo-embolic disease, which occurs in precise, recognised circumstances for which the cause will have been controlled. Otherwise, in so-called idiopathic venous thrombo-embolic disease, which is distinguished by a higher prevalence of recurrences, it is known that long-term antivitamin K treatment is effective for the thrombo-embolic recurrences but at the price of a risk of haemorrhage. Finally thrombo-embolic recurrences also benefit from a long treatment. These circumstances of occurrence are thus important in order to decide the choice of treatment duration. But, in our opinion, the compliance to antivitamin K treatment remains the primary criterion to consider. The dilemma facing the prescriber is to evaluate the risk-benefit ratio of each patient, asking especially if the antivitamin K treatment surveillance of a particular patient will be done as well as in the randomised studies. For the future, long-term antivitamin K does not perhaps represent the only therapeutic option. The results of studies evaluating the durations of long-term treatment with less intense levels of anticoagulation (INR < 2) as well as therapeutic alternatives to antivitamin K (antiaggregants or other antithrombins) are awaited.
Arch Mal Coeur Vaiss 2001 Nov
PMID:[Duration of antivitamin K therapy in venous thromboembolic disease. Certainties and uncertainties]. 1179 73

Malignant disease predisposes to deep venous thrombosis (DVT) or pulmonary embolism (PE) in several ways. One classical situation is that of DVT or PE with no apparent cause which may be the first sign of an occult cancer. In this domain, although the epidemiological data is well known, it is important to recognise the limitations of "blind" investigations. Another situation is more common. The patients have a diagnosed malignancy and thromboembolic disease is the main extra-cancer complication. The approach to this problem is changing, both in primary prevention where many trials have already reported encouraging results, and in the treatment after the event where classical therapeutic protocols are not always well adapted. Ancestral fears of the prescription of anticoagulants in cancer patients must cede to a more objective benefit/risk analysis which seems to be very favourable in some situations. Moreover, some publications have demonstrated a chance finding of a possible anticancer effect of antithrombotic agents.
Arch Mal Coeur Vaiss 2001 Nov
PMID:[Venous thromboembolism and cancer]. 1179 74

Thromboembolic venous disease includes deep vein thrombosis of the lower limbs and pulmonary embolism, a common acute complication. The usual treatment is anticoagulation. Thrombolytic drugs are only used in severe cases. Of the thrombolytic agents and therapeutic protocols in use, alteplase 100 mg/2 hours seems to be the best compromise between the risk of bleeding and efficacy in reducing pulmonary resistances by 30 to 40% and relatively early pulmonary revascularisation of 40-50%. As in myocardial infarction, cerebral haemorrhage is the main complication and the risk is higher in elderly (over 70 years of age) patients who have undergone invasive procedures. Massive pulmonary embolism, defined by clinical criteria, is presently the only formal indication of thrombolysis in this context. In non-massive embolism with right ventricular dysfunction, thrombolysis could also be indicated in the absence of haemorrhagic risk. In deep vein thrombosis of the lower limbs, the role of thrombolysis is limited and controversial; in many cases, the risk of haemorrhage is greater than the potential benefits.
Arch Mal Coeur Vaiss 2001 Nov
PMID:[Fibrinolytics in venous thromboembolic disease]. 1179 77


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