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

Conventional treatment of deep venous thrombosis (DVT) has been based, until recently, on non-fractionated heparin by continuous intravenous infusion in hospital until effective anticoagulation could be obtained by oral anticoagulants introduced early. Low molecular weight heparin (LMWH) seems to be as effective and has a better bio-availability, which means that there are fewer adverse effects. This usage has logically led to the increase in the possibilities of treatment of DVT at home. However, certain precautions are necessary, especially the evaluation of the individual patient's risk with this strategy. This requires multidisciplinary collaboration and the respect of strict rules (precise diagnostic objective, hospital admission at the slightest doubt of pulmonary embolism) to demonstrate the value of ambulatory LMWH therapy which would improve patient comfort and allow early mobilisation.
Arch Mal Coeur Vaiss 2001 Nov
PMID:[Ambulatory treatment of deep venous thrombosis]. 1179 78

Between January 1987 and December 1991, 68 consecutive patients aged 71.5 +/- 12.0 years underwent percutaneous implantation of a vena caval filter, mainly the LGM (N = 64). Fifty seven patients had pulmonary embolism, 61 had deep vein thrombosis of the lower limbs. The average follow-up interval was 4.9 +/- 3.3 years (7.0 +/- 2.7 years for the patients still alive). The follow-up included a telephonic enquiry to determine the date and cause of death, recurrent deep vein thrombosis and/or pulmonary embolism; surviving patients underwent clinical examination, plain abdominal X-ray with a lateral decubitus view and duplex ultrasonography of the lower limb veins to assess the patency of the filter. Fifty three per cent of the patients died. Four predictive factors for mortality were identified: a contra-indication to anticoagulant therapy, chronic post-embolic cor pulmonale, an indication of prophylactic implantation in the elderly and the presence of underlying malignant disease. There were 5.8% recurrences of pulmonary embolism, 26.1% of lower limb deep vein thrombosis and 25% of filter thrombosis. The only predictive factor of thrombosis was a proximal venous thrombus and was associated in 50% of filter thrombosis. Seventy per cent of the plain abdominal X-rays were abnormal with 9 displacements. 9 migrations and 10 closures of the filters. There was a significant correlation between closure on plain abdominal X-ray and caval thrombosis and between recurrent deep vein thrombosis and caval thrombosis. The frequency of long-term complications after implantation of a caval filter in this study suggests that interruption of the vena cava should be reserved for the only validated indications in the presence of a formal contra-indication to or failure of anticoagulant therapy. Other indications require evaluation with prospective randomised trials.
Arch Mal Coeur Vaiss 2002 Jan
PMID:[Very long-term outcome of 68 vena cava filters percutaneously implanted]. 1190 86

Vascular involvement in Behcet's disease is common, especially in deep vein thrombosis. Aneurysmal or occlusive arterial disease is, however, rare. The authors report five cases of vascular Behcet's disease reviewed over a period of 4 years (1996-1999). All these patients were men and the mean age was 38 years. The arterial disease was the presenting symptom of Behcet's disease in 3 cases. The other patients had been followed up for Behcet's disease for 4 years. The average time of onset of arterial disease was 7.2 years with respect to the presenting symptom, the range being 2 to 20 years. In all, seven arteries were involved, two patients having two arterial sites at the same time. The femoral artery was involved in 3 cases. The iliac artery was involved twice. One patient had a coronary thrombosis and the last case was of a pseudoaneurysm of the infra-renal abdominal aorta which ruptured into the retroperitoneal space. Six lesions were aneurysmal. All patients underwent surgery. The histological analysis of the resected lesions showed non-specific panvasculitis. The postoperative period was marked by short and medium term complications: four prosthetic thromboses and two anastomotic pseudo-aneurysms which required several surgical procedures and which led to two deaths. These results and a review of the literature underline the need to search for Behcet's disease in all cases of aneurysmal or occlusive arterial disease in young patients, especially those born in the Mediterranean regions. Surgical treatment should not be delayed. In these inflammatory conditions with pronounced perivascular involvement, the surgery is difficult and postoperative complications are common, especially anastomotic disunion. Medical treatment has no surgical implication, but does not prevent progression of the disease.
Arch Mal Coeur Vaiss 2002 Feb
PMID:[Arterial manifestations of Behcet's disease. A report of five operated cases]. 1193 37

Despite standardized tests (PT-INR) and better definition of therapeutic objectives, oral anticoagulation still leads to a significant number of hemorrhagic events. The risk is higher during the initial phase of treatment and for arterial indications, but must also be considered for other situations, including deep vein thrombosis, where the risk is less well defined. This risk can now be quantified on the basis of recent data used to identify at risk populations. The risk scores account for age, gender, associated cancer, weight, history of digestive tract bleeding or stroke, and comorbidity (recent myocardial infarction, hematocrit<30%, serum creatinine > 15 mg/l, diabetes). A high score is associated with higher risk of hemorrhagic events. Besides the patient's clinical status, the risk of hemorrhage is related to compliance, the level of anticoagulation, and drug interactions. Specialized monitoring centers provide a means of reducing the risk of morbidity and mortality. New anticoagulation agents must be developed to reduce the risk of hemorrhage which remains an important cause of morbidity and mortality, particularly in the elderly and patients at risk.
J Mal Vasc 2002 Jun
PMID:[Risk of hemorrhage with oral anticoagulants for deep vein thrombosis]. 1223 29

Pulmonary Embolism (PE) poses an important diagnostic problem in patients with chronic obstructive pulmonary disease (COPD). Indeed PE may aggravate the already precarious respiratory state of these fragile patients. Moreover, these two conditions share common symptoms: dyspnoea, wheezing, pleural pain, haemoptysis, palpitations and signs of right cardiac insufficiency. In two studies, one retrospective and the other prospective, we investigated the incidence of PE in patients with non-infective exacerbations of their COPD. The retrospective study was carried out over two years and involved 50 COPD patients with non-infective respiratory exacerbations. In this population, 10 patients out of 50 (20%) had a documented PE. No predictive factor was identified. The prospective study was conducted over one year and COPD patients admitted to hospital with exacerbations were included in the study if they had a positive D-dimer blood test and no evidence of acute respiratory infection. 31 patients were studied with Doppler ultra-sound examination of the legs and a lung perfusion scan. The presence or absence of PE was determined and the two groups were compared. 9 patients out of 31 (29%) had a documented PE. Six of these nine patients had a deep venous thrombosis (DVT). Two predictive factors of PE were identified: existence of a DVT and a significant fall in PaO(2) from baseline state (DeltaPaO(2) > 22 mmHg). We conclude that PE is a frequent (20 to 30%) of non-infective respiratory decompensation in COPD patients. Faced with an unexplained respiratory exacerbation in these patients, a lung perfusion scan should be routinely undertaken to rule out a PE when the D-dimers are positive.
Rev Mal Respir 2002 Sep
PMID:[Pulmonary embolism and sibilant types of chronic obstructive pulmonary disease decompensations]. 1241 52

During this year, cellular therapy with bone mononuclear cells of critical leg ischemia was demonstrated to be a new therapeutic approach in critical leg ischemia. This treatment, as well as gene therapy, is an important step forward in this pathology when there is no other therapeutic option. In venous thromboembolism, the usefulness of fibrinolytic therapy in severe pulmonary embolism associated with right ventricular dysfunction or pulmonary-artery hypertension was demonstrated. Fondaparinux appears also to be a promising agent for prophylaxis of deep vein thrombosis. Finally, the publication of the WHI trial (Women Health Initiative) confirms the absence of any benefit of hormone replacement therapy in primary cardiovascular prevention.
Arch Mal Coeur Vaiss 2003 Jan
PMID:[The best of vascular medicine in 2002]. 1261 66

The antiphospholipid antibody syndrome (APS) may present with serious cardiovascular complications which should be recognised by the cardiologist. The authors report a series of 6 cases of APS diagnosed after thrombotic events and the finding of antiphospholipid antibodies. The APS was primary in 5 cases and associated with tuberculous lymphadenitis in 1 case. There was cardiac involvement in 5 patients with pericardial effusion in 3 cases, complicated by tamponade as the presenting sign of primary APS in the other 2, valvular disease in one case (moderate mitral stenosis with aortic valve disease) and pulmonary embolism in one case. Five patients developed recurrent deep vein thrombosis of the legs. One patient had a transient ischaemic cerebral attack.
Arch Mal Coeur Vaiss 2003 Apr
PMID:[Cardiovascular abnormalities of the antiphospholipid antibody syndrome]. 1274 9

Educ'AVK is an education program designed for patients starting an oral anticoagulant treatment following a thromboembolic event (deep venous thrombosis or pulmonary embolism). Patients enrolled are judged capable of self-management of their drug treatment. The intervention, adapted to a short-term treatment, consists in an 3-step one-on-one teaching session conducted by a trained pharmacist. 1) Identification of the patient's needs--or educational diagnosis. 2) Definition of educational objectives adapted, first, to the patient's cognition: to be able to describe indications for therapy and potential risks factors for anticoagulant bleeding, to interpret INR lab tests and to solve a problematic treatment situation related second, to the patient's behaviour: to be able to anticipate the risk (how to enhance compliance, how to deal with a missed dose.), to take relevant decisions when dealing a therapeutic incident (bleeding, INR outside of the targeted range). 3) Choice of appropriate teaching contents and methods to reach the objectives. We used the "individual guidance" technique associated with original tools: a picture book to describe the pathology and the treatment; a booklet synthesizing all the information given by the educator during the consultation. This booklet presents 3 key-points: the information is specifically targeted to thromboembolic venous disease; the information integrates the risk-level of the patient (3 different booklets according to the patient's level of risk, of bleeding, of thromboemboly, no specific risk); there is a section where the patient writes down his/her INR results in a table specifically adapted to his/her risk level--bleeding, thromboemboly, no specific risk--and giving recommendations for the management of INR out of the targeted range.
J Mal Vasc 2004 Jul
PMID:[Therapeutic education of patients receiving anticoagulants for thromboembolic venous disease: description of the Educ'AVK program]. 1534 9

Thromboembolic events are an increasingly commonly recognized secondary complications in children treated for serious, life-threatening primary diseases. Nevertheless the incidence of venous thromboembolic disease remains 100 times less frequent in hospitalized children than hospitalized adults, as recent data suggest an incidence of 5,3/10.000 pediatric patients compared to an incidence of 2,5-5/100 in adult patients. Diseases usually associated with thromboembolic events in children are neoplasia, autoimmune or cardiac malformative disease. Contrarily to what is observed in the adult, the majority of deep vein thrombosis events occur at the upper limbs veins, usually at the place where devices for venous access like port-a-cath or central venous lines are inserted. Because of the relatively low incidence of venous thromboembolic events in children, the diagnostic approach used are largely extrapolated from guidelines obtained from adult studies. However, the diagnostic performances of some diagnostic tools like Doppler-Ultrasound are probably diminished in children. Moreover, the concept of developmental hemostasis, which stresses the point that the hemostatic system in children is quite different from the adult one, is widely accepted and clearly suggests that the diagnostic and therapeutic approach in pediatric patients may not be simply extrapolated from data obtained in adult studies. From a more practical point of view, the fact that the hemostatic system in children is a dynamic and evolving system, renders the therapeutic approach quite complex. In particular, doses of anticoagulants vary markedly across the pediatric age. The absence of adapted formulations of commonly used anticoagulants, for example the absence of liquid formulations of anti-vitamin K drugs, further complicates the administration and the correct monitoring of anticoagulation in children, and may diminish observance in adolescent patients. Even though the concept that "children are not little adults" is nowadays widely accepted, there is an urgent need for prospective studies to better assess the modalities of diagnosis and treatment of venous thromboembolic disease in this particular population.
J Mal Vasc 2006 Jul
PMID:[Diagnosis and treatment of thromboembolic events in pediatrics]. 1684 Sep 50

We report the case of 74 years-old female patient hospitalized for a ST+ acute coronary syndrome with normal coronary angiography. The association of a patent foramen ovale, a deep venous thrombosis and a pulmonary embolism led us to conclude the diagnosis of paradoxical coronary embolism. This case allows us to remind different etiologies to be considered in case of myocardial infarction with normal coronary arteries, and the interest of transesophageal echocardiography for the diagnosis of its etiology.
Arch Mal Coeur Vaiss 2007 Jan
PMID:[Myocardial infarction with normal coronary arteries: role of transesophageal echocardiography]. 1740 58


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