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

Heparin remains the most effective antithrombotic drug. It acts by combining with plasma antithrombin, thereby accelerating the neurtalisation of thrombin and other acitvated coagulation factors. Full-dose intravenous heparin is indicated in all cases of pulmonary embolism and established deep venous thrombosis, unless there exist compelling contraindications. Continuous intravenous infusion of heparin appears to be safer than intermittent injection. Low-dose subcutaneous heparin is effective in preventing the initial occurrence of thigh vein thrombi and in reducing the incidence of fatal pulmonary embolism in general surgical patients over the age of 40. The efficacy of low-dose heparin in preventing pulmonary emboli following hip surgery has not been established. The incidence of severe heparin-induced thrombocytopenia appears to be rising. Platelet counts should be performed in all patients receiving heparin by any mode of administration.
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PMID:Heparin Therapy: regimens and management. 31 90

In a prospective trial, 42 medical patients with a history of deep vein thrombosis of less than five days were allocated at random to treatment with streptokinase or heparin. Only patients with extensive thromboses were included. Streptokinase was given in a loading dose of 250 000 IU and a maintenance dose of 100 000 IU/hour for 4 days as a mean. Heparin was given in a loading dose of 15 000 IU and a maintenance dose of 20 000-50 000 IU/day. The therapeutic results were evaluated by phlebography. Significant thrombolysis occurred in 71.4% of 21 patients treated with streptokinase and in 23.8% of the 21 heparin-treated patients. Using the chi2-test for overall association, this difference was statistically highly significant (p = 0.002). Three patients in each treatment group experienced major bleeding, two in each group requiring blood transfusions. Minor bleeding and slight rise in temperature were encountered more often in the streptokinase than in the heparin group. It is concluded that patients with acute deep vein thrombosis with proximal extension of the thrombus beyond the calf veins should be offered a therapeutic trial with streptokinase.
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PMID:A prospective study of streptokinase and heparin in the treatment of deep vein thrombosis. 35 99

A double-blind controlled clinical trial of the efficacy of the prophylactic subcutaneous administration of calcium heparin in preventing deep vein thrombosis has been conducted in 50 patients with a fractured neck of the femur. Heparin was given every eight hours in a dose of 100 international units per kilogram of body weight and was commenced as soon as possible after the patient's admission to hospital. Treatment was continued for two weeks. In the placebo group, 12 of 25 patients developed a deep venous thrombosis and in five of these patients the thrombosis propagated to the thigh. There were no deep venous thromboses in the heparin-treated group during the two weeks of treatment, but four patients developed a deep venous thrombosis within a week of stopping the heparin. The heparin regime was safe; operative blood loss was not increased, nor was there an increased incidence of wound complications as compared to the placebo group.
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PMID:Heparin prophylaxis of deep vein thrombosis in patients with a fractured neck of the femur. 35 10

The efficacy of a six-month course of low-dose heparin therapy was compared to a conventional warfarin regimen by a prospective, controlled trial in 48 patients with pulmonary embolism or deep venous thrombosis of the legs. All subjects had complicated medical illnesses and a high risk of recurrent thromboembolism. Bleeding complications were virtually negligible during heparin therapy and occurred significantly more frequently in patients receiving warfarin. Heparin was as effective as warfarin in the prevention of recurrent thromboembolism. Patient compliance with the two treatment regimens was comparable. Self-administered, low-dose heparin therapy is a useful alternative to warfarin in the long-term management of complicated thromboembolic disorders.
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PMID:Low-dose heparin therapy in the long-term management of venous thromboembolism. 38 91

The physician frequently encounters the problems of deep vein thrombosis and pulmonary embolism. Recently, a number of studies have been published which are of considerable help in the management of these disorders. It has been shown that in many cases, low-dose heparin is effective in the prevention of both venous thrombosis and pulmonary embolism. However, once venous thrombosis has already occurred, it is necessary to use full-dose heparin, preferably by the continuous intravenous route, with maintenance of the partial thromboplastin time (PTT) at 1 1/2 times the control at all times. Although monitoring the PTT may not prevent hemorrhage, it will help prevent further thrombosis. Heparin is generally continued for seven to ten days. During this time warfarin is generally begun, and it is important to continue the patient on warfarin for five to seven days while the patient is receiving intravenous heparin therapy. After stopping heparin, oral anticoagulation with warfarin should be continued for six weeks. Then, in the absence of a previous history of venous thromboembolism or a known predisposing condition, it is safe to abruptly discontinue anticoagulation in most patients.
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PMID:Heparin and warfarin: use of anticoagulants in the prevention and treatment of venous thrombosis and pulmonary embolism. 43 53

A perspective study by the Royal College of General Practitioners reported that the risk of developing deep venous thrombosis of the legs in women taking oral contraceptives was 5.66 times higher than women not on medication. Estrogen-progestogen compounds are highly potent hormones that produce alterations in metabolic and endocrine functions. Clinical examination of the leg is the most reliable method of determining the earliest indication of thrombophlebitis even with the latest diagnostic tools of venography. The key to diagnosis and treatment of pulmonary embolism, which often occurs with patients with thrombophlebitis, is a patient's complaint of leg pains. Those who have undergone surgery, especially abdominal and pelvic, are bedridden, and those who are taking oral contraceptives are at risk of thrombophlebitis. Deep thrombophlebitis of the leg is not recognized clinically in 50-80% of those with venographically documented thrombophlebitis because the signs and symptoms are so protean. Treatment with heparin and leg bandages is most common. Heparin is often followed with coumarin therapy. Some methods of diagnosis are calf tenderness, edema, skin temperature, Homan's Sign, Lowenberg's Sign, Pratt's Sign, cyanosis, systemic signs, and contrast venogram.
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PMID:A review of the birth control pill and its relationship to thrombophlebitis. 44 35

2136 patients in general surgery, gynaecology and urology were investigated by the 125I-fibrinogen-uptake-test for detection of postoperative deep vein thrombosis (DVT). They received at random one of low-dose heparin, dihydroergotamine, the fixed combination of both drugs (Heparin-Dihydergot), low molecular weight dextran and acetylsalicylic-acid (ASS). When DVT was detected repeated lung perfusion scintigraphies were carried out for diagnosis of embolic pulmonary perfusion defects. Results demonstrate the outstanding effect of Heparin-Dihydergot, which is not only 2-3 times better than the anti-thrombotic standard low-dose heparin but also eliminates almost completely the risk of postoperative embolism. The preventive efficacy of ASS and dextran must be considered to be poor and not comparable to that obtained when using heparin, dihydroergotamine or the combination. Now Heparin-Dihydergot is the new standard with which all prophylactic procedures should be compared.
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PMID:[Quantitative assessment of drug-induced prophylaxis of postoperative thromboembolism. Comparison of frequencies of deep vein thrombosis and pulmonary embolism using acetylsalicylic-acid, dextran, dihydroergotamine, low-dose heparin and the fixed combination of heparin and dihydroergotamine (author's transl)]. 91 47

The standard low dose of heparin for the prevention of deep venous thrombosis in patients who are operated upon is 5,000 units administered subcutaneously two hours before operation and at eight or 12 hourly intervals for the next seven days. Heparin in low doses can at present be recommended as an effective agent in the prevention of deep venous thrombosis in patients over the age of 40 years who are undergoing a major abdominothoracic or gynecologic operation. There is reasonable evidence that heparin in low doses also offers a satisfactory protection against fatal pulmonary embolism for patients at high risk after general abdominothoracic operations. The evidence of the effectiveness of low doses of heparin in the prevention of deep venous thrombosis is less well established in other patients and particularly those at high risk, as after urologic and hip operations. This important distinction is to be made in terms of the population at risk and the efficacy of heparin in low doses. Considering the evidence so far available, it appears that the postoperative state in which dextran has been shown to reduce the incidence of phlebographically confirmed deep venous thrombosis most convincingly is after orthopedic operations. Major orthopedic operations are precisely the type in which the superiority of heparin in low doses is controversial. Unless proved otherwise, dextran 70 in an infusion of 500 to 1,000 milliliters of a 6 per cent solution started before operation and 500 milliliters the following and next three alternate days may be the agent of choice in preventing deep venous thrombosis in major orthopedic operations. Using this scheme, the prophylaxis of postoperative deep venous thrombosis appears equally effective with dextran 70 as with oral anticoagulants. Whether the protection offered by dextran 70 will also prevent fatal and nonfatal pulmonary embolism is still an open question. Low doses of heparin and dextran do not expose patients to serious risks of bleeding after operation, and with the recommended doses of the latter drug, other untoward effects are rare. At the doses recommended, neither of these two drugs requires laboratory monitoring.
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PMID:The prevention of postoperative deep vein thrombosis and pulmonary embolism with low dose subcutaneous heparin and dextran. 99 22

1. The effectiveness of 3 X 5000 IU s. c. heparin daily (starting preoperatively) for the prevention of postoperative deep vein thrombosis was evaluated in a prospective, controlled, randomized study including general surgical and urological patients. 125I-fibrinogen test was performed daily in all patients. 2. 178 patients fulfilled the conditions of the protocol. 35.8% of the 95 patients in the control group developed deep vein thrombosis, but only 13.3% of 83 subjects in the heparin group did so. The difference is statistically highly significant (p less than 0.001). 3. The vast majority of all thrombi in both groups appeared before the 3rd postoperative day. 4. With 1 exception, all deep vein thrombi in the heparin group started in the mid-calf region. In the control group 5 deep thrombi originated in the popliteal vein. 5. Heparin displays a better effect in males (n = 34; p less than 0.01) than in females (n = 49; p less than 0.025). 6. In patients undergoing surgery for malignant disease heparin does not reduce the incidence of deep vein thrombosis. 7. Heparin is far more effective in patients under 60 years of age than in those over 60 (p less than 0.005). 8. Heparin is more effective in obese patients than in those of normal body build. 9. Heparin prophylaxis also reduces the incidence of deep vein thrombosis in patients who exhibit predisposing factors. In patients of the control group with preexisting disease of the venous system, there were significantly more deep vein thrombi (p less than 0.01) than in those without predisposing factors. 10. In the heparin group 29% of all thrombin time determinations show a definite prolongation of more than 26 sec (normal value 15 sec). 11. In 14 patients (=16.9%) of the heparin group, 21 side effects or complications were seen. Bleeding complications were the main problem, comprising 5 wound hematomas and hematomas at the injection site, 4 postoperative bleeding episodes and 2 reoperations. There were no complications in the control group. 12. According to the results of 10 well controlled studies, there is no doubt that in general surgery small doses of subcutaneous heparin, commencing preoperatively, do reduce the incidence of postoperative deep vein thrombosis to a significant degree. However, whether this form of prophylaxis is also effective in patients with fractures of the hip and in elective hip surgery cannot, on the evidence available, be decided. In the fields of gynecological surgery and urology as well, more data are needed before this form of heparin prophylaxis can be recommended.
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PMID:[Subcutaneous small heparin doses for the prevention of thrombosis in general surgery and urology]. 121 80

A total of 1290 patients (Pts) undergoing general surgery were enrolled in a randomized, multicentre double-blind study in order to investigate the efficacy and safety of two different doses of a low molecular weight heparin (LMWH) (Logiparin) for the prevention of deep vein thrombosis. Patients were randomized to either 5,000 IU unfractionated heparin twice daily, 2,500 anti-Xa or 3,500 anti-Xa units of Logiparin once daily. Each treatment was given subcutaneously two hours before surgery and continued for seven to ten days. All coagulation tests were performed blindly in a core laboratory. Blood samples were collected before surgery and then 3 hours after injection on Day 3 and 5 after surgery. Anti-Xa amidolytic activities were significantly higher in the two LMW Heparin groups than in the unfractionated heparin group (mean peak levels +/- s.e.m. on Day 3: 0.097 +/- 0.004; 0.152 +/- 0.004 and 0.034 +/- 0.003 IU respectively). As expected a significant correlation was observed between anti-Xa activity and the dose of LMW Heparin injected. The correlation coefficient was higher when the doses were expressed in anti-Xa units/kg body weight. However, the body weight accounts for only 16% of the interindividual variability of anti-Xa activity. Therefore, there is no clear evidence to suggest that weight-adjusted doses should be recommended when this LMW Heparin is used as prophylactic treatment in general surgery. A weak negative correlation was found between anti-Xa activity and thrombosis as demonstrated by a positive radiolabelled fibrinogen uptake test and confirmed by positive phlebography. No significant correlation was demonstrated between anti-Xa activity and the occurrence of postoperative bleeding.
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PMID:Correlation between anti-Xa and occurrence of thrombosis and haemorrhage in post-surgical patients treated with either Logiparin (LMWH) or unfractionated heparin. Post-surgery Logiparin Study Group. 131 19


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