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

In a randomized controlled clinical trial, the efficacy and safety of two low molecular weight heparin ( LMWH ) fractions in the prophylaxis of deep vein thrombosis (DVT) were assessed. One hundred twenty-six patients undergoing major abdominal surgery received alternatively 2,500 APTT units b.i.d. of two LMWH fractions or 5,000 APTT units b.i.d. of an unfractionated sodium mucosal heparin ( UFH ). LMWH 2 differed from LMWH 1 by presenting a lower mean molecular weight and a higher anti-Xa/APTT ratio in vitro. Patients were randomly allocated to the three groups, and the development of DVT was studied with the 125I-fibrinogen uptake test ( RFUT ). The study was interrupted and the code broken prematurely because of otherwise unexplainable bleeding events. While no thrombosis and no severe bleeding were detected in the UFH group, three (7%) RFUT -positive DVT and two (5%) hemorrhagic complications occurred in the LMWH 1 group. No thrombosis and nine (22%) cases of severe bleeding were observed in the LMWH 2 group. Thus, the latter group differed significantly from the control group with regard to subjective and objective criteria for postoperative bleeding. Although these results do not allow general conclusions as to the value of LMWH fractions in the prevention of DVT, they indicate that these preparations just as ordinary heparin have a limited therapeutic range.
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PMID:Clinical efficacy of low molecular weight heparin in postoperative thrombosis prophylaxis. 637 78

Postoperative pulmonary embolism continues to be a problem in patient care, especially in high-risk patients. This study was designed to evaluate a combined pharmacologic approach to the prophylaxis of postoperative deep venous thrombosis (DVT) by mediating at least two and probably three of Virchow's predisposing factors. Patients 40 years of age and older undergoing operations greater than 45 minutes under general anesthesia were placed in one of five treatment groups and studied by a prospective randomized, double-blind protocol. Study drugs were the following: (1) 0.5 mg of dihydroergotamine plus 5000 IU of sodium heparin (DHE 5000), (2) 0.5 mg DHE plus 2500 IU heparin (DHE 2500), (3) 5000 IU of HEP (HEP 5000), (4) 0.5 mg of DHE (DHE 0.5), and (5) a placebo. Study medications were administered 2 hours preoperatively and continuously thereafter every 12 hours postoperatively subcutaneously in the anterior abdominal wall for 5 to 7 days or until a positive radiofibrinogen uptake test (RFUT). The RFUT was performed according to standardized technique and was used to establish the presence or absence of DVT. This report is an analysis of the major subgroup of patients undergoing intra-abdominal operations. Results showed a highly statistically significant prophylactic benefit from DHE 5000 compared with the placebo (p less than 0.003) and all other treatment groups (p less than 0.05). There was no significant benefit from DHE 2500, HEP 5000 (p greater than 0.13), and DHE 0.5 (p greater than 0.3). All patients who entered the study had two or more risk factors for postoperative DVT, and high-risk patients were distributed equally throughout all treatment groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prophylactic efficacy of low-dose dihydroergotamine and heparin in postoperative deep venous thrombosis following intra-abdominal operations. 638 9

The prophylactic effect of a semisynthetic heparin analogue (SSHA) on deep vein thrombosis was investigated in a prospective double-blind multicentre trial. 440 major general surgical and gynaecological patients were randomized to one of three treatment groups: 50 mg SSHA, 37.5 mg SSHA and 5000 units sodium heparin subcutaneously 12-hourly. Deep venous thrombosis (DVT) was diagnosed with the fibrinogen uptake test and verified with phlebography. Bleeding complications and other side-effects were carefully monitored. There were no significant differences between the three treatment groups of patients in age, sex, type of operation or risk factors. A DVT was diagnosed in 16 patients (12 per cent) in the SSHA 50 mg group, in 21 patients (15 per cent) in the SSHA 37.5 mg group and 21 patients (14 per cent) in the heparin-treated group. No significant differences were found in the number of patients who bled unexpectedly in the postoperative period, required transfusion or developed wound haematomas. Blood loss at operation was similar in all three groups. Three pulmonary emboli were diagnosed by pulmonary scintigraphy, one in each group.
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PMID:A randomized study of a semisynthetic heparin analogue and heparin in prophylaxis of deep vein thrombosis. 643 67

Impedance plethysmography (IPG) and the Doppler ultrasonographic probe were used to assess whether thrombophlebitis, initiated by injection of a sclerosant into superficial varicose veins, extended to involve the deep veins of the leg. Sixty-seven legs were treated with compression sclerotherapy in 50 patients (26 men, 24 women) whose mean age was 53 years. Indications for this therapy were unacceptable appearance (n = 37), pain (n = 13), cramps (n = 11), and stasis ulcer (n = 6). Each leg received an average of six injections (range, three to 11) of 0.5 mL of sodium tetradecyl sulfate. Blood flow in the deep veins was studied immediately before injection of the sclerosant and one week and two weeks afterward. In each leg, no change in either of these studies was found at one and two weeks following injection treatment. In nine extremities, delayed venous emptying was found on IPG. This persisted after sclerosis and was interpreted as evidence of a previous deep vein thrombosis.
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PMID:Sclerosant treatment of varicose veins and deep vein thrombosis. 649 33

The efficacy of heparin, sodium warfarin, and elastic stockings in preventing the late leg sequelae of deep venous thrombosis was evaluated by reexamining 15 patients with previous acute deep venous thrombosis so treated. All 5 patients with iliocommon femoral disease and only 5 of 10 patients with distal disease had evidence of postphlebitic syndrome. Venous Doppler and strain gauge plethysmography confirmed these clinical findings. The most striking and consistent laboratory abnormalities were in the patients with proximal disease. Treatment of acute deep venous thrombosis by traditional means does not prevent the clinical and laboratory late leg sequelae. In light of these findings, serious investigation of new therapeutic modalities is strongly suggested.
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PMID:Late sequelae of deep venous thrombosis. Diagnostic and therapeutic considerations. 669 94

A case of skin necrosis caused by subcutaneously administered heparin is reported. A 76-year-old woman received subcutaneous injections of porcine sodium heparin twice a day to prevent deep vein thrombosis. Nineteen days after heparin therapy began, black necrotic areas were noted on her abdomen, and heparin injections were discontinued. The patient received small amounts of heparin intravenously for three additionally days without apparent complications. Proposed mechanisms for heparin-induced skin necrosis include allergic vasculitis and localized platelet aggregation with intravascular thrombosis. Heparin therapy should be stopped if necrosis develops. Intravenous administration of heparin to sensitive patients may be followed by life-threatening reactions. Necrotic areas may heal spontaneously, but often require debridement and skin grafting. Various agents, including steroids, may be useful in preventing the development of necrotic lesions.
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PMID:Heparin-induced skin necrosis. 671 77

Patients who underwent radiographic phlebography were studied to determine the frequency of postphlebographic venous thrombosis. In a group of 23 patients who had negative phlebograms performed with standard contrast agent (60% sodium methylglucamine diatrizoate), nine had positive 125I-fibrinogen leg scans. On repeat phlebography, three had confirmed deep vein thrombosis, six overall developed deep or superficial thrombosis, and three had positive scans without demonstrable thrombi. In a second group of 34 patients studied with the contrast material diluted to 45%, only three developed positive scans, one due to deep venous thrombosis and two to superficial thrombosis. There was also a reduction in the incidence of postphlebographic symptoms of pain, tenderness, and erythema, but no apparent sacrifice in diagnostic accuracy.
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PMID:Reduction of venous thrombosis complicating phlebography. 677 Jun 25

Coagulation studies and the J-125-fibrinogen-uptake-test for diagnosis of deep vein thrombosis were carried out in 244 and 288 patients resp. undergoing vaginal or abdominal hysterectomy. They were given a prophylaxis with 2 X 5000 IU calcium heparin (Calciparin) or 2 X 5000 IU sodium heparin with 0.5 mg dihydroergotamine (Heparin-Dihydergot). Control patients received acenocoumarol (Sintrom). The incidence of deep vein thrombosis was lowest in the heparin/dihydroergotamine group and was 5.9%. With calcium heparin prophylaxis it was 15.5%, and with acenocoumarol 12.2%. Plasma heparin levels and parameters of coagulation, fibrinolysis and platelet function showed that after 8 days of heparin prophylaxis with or without dihydroergotamine there is no change in hemostasis towards an increasing hypo- or hypercoagulability. Coagulation changes and the incidence of postoperative wound hematoma were identical using heparin alone or in combination with dihydroergotamine. Thus the improved effectiveness of heparin/dihydroergotamine in prevention of deep vein thrombosis which has been shown in the fibrinogen test cannot be explained by an effect onto the coagulation parameters studied. It is pointed out that a peridural anesthesia can be carried out in low-dose heparin and heparin/dihydroergotamine prophylaxis without the risk of bleeding and that the incidence of wound hematoma can be reduced by correct choice of the site of injection.
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PMID:[Postoperative changes in hemostasis by heparin/dihydroergotamine prevention]. 686 45

Renal transplant patients in whom deep vein thrombosis and pulmonary embolism (PE) develop usually respond to heparin sodium treatment. A small percentage of transplant patients will require vena caval filter placement to prevent recurrent PE, and this report details our experience with two patients. In one patient there was contraindication to heparin, and in the other, a massive recurrent PE. Greenfield filters were inserted transvenously in these patients and found to be well tolerated. There was no evidence of renal compromise, recurrent PE, or other complications. Follow-up venograms confirmed the presence of patent vena cavas with properly positioned filtered. Autopsy studies subsequently performed confirmed the clinical assessment of each patient's course, and neither patient died of recurrent embolism.
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PMID:Greenfield filter in renal transplant patients. 725 96

In a randomised double-blind controlled trial 24 patients undergoing elective aortic bifurcation graft surgery received subcutaneous calcium heparin (2,500 u pre-operatively then 5,000 u 12-hourly for 7 days) and 25 control patients received saline injections. All patients received a routine dose of intravenous sodium heparin intra-operatively. The trial was terminated because of excess bleeding complications in patients receiving subcutaneous heparin (8 vs. 1, p less than 0.05). Deep vein thrombosis occurred in 6 control patients and 2 patients on heparin (p less than 0.05). In this group of patients undergoing major vascular surgery the risk of bleeding due to heparin outweighed the potential benefit of thrombotic prophylaxis.
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PMID:Low dose heparin in the prevention of deep-vein thrombosis after aortic bifurcation graft surgery. 736 49


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