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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 audit was performed to examine the time of administration of heparin and antibiotic prophylaxis to patients at risk of deep vein thrombosis, pulmonary embolism and post-operative wound infection. The records of 648 consecutive patients undergoing major surgery within a 12-month period were reviewed retrospectively. Heparin prophylaxis was given before surgery to only 30.9 per cent of patients undergoing elective procedures and in only 22.7 per cent of emergencies. Antibiotic prophylaxis was given before operation or at induction of anaesthesia to 82.1 per cent of patients undergoing elective procedures and in only 72.1 per cent of emergencies. It is concluded that administration of heparin and antibiotic prophylaxis is inadequate despite the provision of a written protocol.
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PMID:Administration of heparin and antibiotic prophylaxis. 782 48

Enoxaparin, a low-molecular-weigth heparin, has recently been approved for use in the prevention of deep venous thrombosis following elective hip replacement surgery. Clinical trials have demonstrated enoxaparin to be superior to placebo, dextran and unfractionated heparin in deep venous thrombosis prophylaxis. However, no published studies have compared the efficacy of enoxaparin with that of warfarin in the prevention of deep venous thrombosis. Advantages of enoxaparin include less frequent dosing, reduced need for laboratory monitoring and a lower incidence of adverse effects, including hemorrhage. Although enoxaparin is more expensive than unfractionated heparin, its potential benefits may offset its higher cost.
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PMID:Enoxaparin in the prevention of deep venous thrombosis. 770 82

Prevention of deep venous thrombosis is fundamental in the prevention of pulmonary embolism. Deep venous thrombosis is common after all surgical procedures, but the frequency differs, as does the effectiveness of various methods of prevention. Low-dose heparin, low molecular weight heparin, graduated compression elastic stockings, intermittent pneumatic compression, and oral anticoagulants have a role in the prevention of deep venous thrombosis, depending on the risks of deep venous thrombosis and their demonstrated effectiveness (or lack of effectiveness) in the particular circumstance. The optimal method of prophylaxis is specific to the predisposing condition. Heparin continues to be a mainstay of anticoagulant therapy. Major bleeding is rare in patients treated with low doses of heparin to prevent deep venous thrombosis. With therapeutic doses, however, major bleeding occurs in about 5% of patients. The optimal dose of warfarin and the method of evaluating the anticoagulant effect of warfarin have undergone modifications in recent years. It is now recognized that the prothrombin time ratio depends on the activity of the thromboplastin used for measuring the prothrombin time. An International Normalized Ratio, which relates to a standardized thromboplastin, has been developed, thus avoiding differences of the prothrombin time ratio that occur from batch to batch of thromboplastin reagent from the same manufacturer and that occur with different thromboplastin reagents from different animal sources and different manufacturers. The bedside diagnosis of pulmonary embolism is useful in helping a physician determine the extent to which diagnostic tests should be pursued. A sound bedside impression also contributes strongly to the formulation of a noninvasive diagnosis of pulmonary embolism. The clinical manifestations of pulmonary embolism form a recognizable constellation of findings that often lead to a correct diagnosis or exclusion of pulmonary embolism. Important clues to the diagnosis of pulmonary embolism relate to the initial syndrome. The presentation of pulmonary embolism is most often in the form of the pulmonary hemorrhage-pulmonary infarction syndrome. The next most common presentation is unexplained dyspnea, unaccompanied by pulmonary hemorrhage or infarction. Least common, but most severe, is the syndrome of circulatory collapse. Immobilization, usually caused by surgery, is the most frequent predisposing factor. Most patients with clinically recognizable pulmonary embolism have dyspnea or tachypnea. Dyspnea or tachypnea or pleuritic pain occurs in nearly all patients who have clinically apparent pulmonary embolism (97%). Ordinary tests such as the electrocardiogram and chest radiograph are helpful if the physician is attentive to nonspecific abnormalities.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Acute pulmonary embolism. 807

Fibrin D-Dimer (D-Di), prothrombin activation fragment (F 1+2) and thrombin-antithrombin III complexes (TAT) were measured using ELISA procedures in the plasma of patients with an acute deep venous thrombosis (DVT), at presentation and on days 2, 6 and 10 after initiation of heparin treatment. Patients were randomly allocated into two treatment groups: 44 patients received adapted doses of continuous intravenous unfractionated heparin (UH) whereas 47 received 1 mg/kg every twelve hours of a low molecular weight heparin (enoxaparin) subcutaneously. A phlebography and a perfusion lung scan were performed before inclusion and on day 10. Failure of therapy (n = 9) was defined by venogram worsening or confirmed pulmonary embolism. Improvement (n = 44) or stationary state (n = 38) were defined by venogram evolution in the absence of new leg scan defects. At presentation, D-Di, F 1+2 and TAT were above cut-off values in 97, 66 and 89% of patients respectively. D-Di levels correlated with the extent of venous thrombosis whereas TAT and F 1+2 did not. Mean levels of D-Di decreased sharply during the first days of treatment but were still abnormal on day 10. A secondary increase of D-Di on days 6 or 10 by more than 3 micrograms/ml occurred in 4 of the 9 patients who developed a thromboembolic recurrence but in none of the 72 patients who had a more favorable outcome. F 1+2 and TAT time-courses were not related to clinical evolution. In the Enoxaparin group, there was no relationship between antifactor Xa activities and any biological markers.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Markers of hemostatic system activation in acute deep venous thrombosis-evolution during the first days of heparin treatment. The DVTENOX Study Group. 816 10

The incidence of deep venous thrombosis (DVT) in the trauma population and those risk factors which affect its development remain an enigma. We prospectively studied 100 trauma patients admitted to a Level I trauma center with duplex scans throughout their hospitalization. Fifteen patients (15%) developed DVT. The remaining 85 patients (85%) had no evidence of DVT during their hospitalization. The two groups were similar in sex ratio, Glasgow coma scale, trauma score, and type of injury. Fourteen patients (93%) with DVT had been given prophylactic treatment with 5,000 units of Heparin subcutaneously q12h, and 36 patients (42%) without DVT were similarly treated. The data in this study describe the incidence of DVT (15%) in the trauma population and those patients at most risk for its development. Patients admitted with high Injury Severity Scores and extremity injuries are at most risk for development of DVT.
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PMID:Deep venous thrombosis in the trauma patient. 819 28

DVT is a very frequent complication of general surgery. Heparin and, more recently, LMWHs can successfully prevent post surgical thromboembolism. One thousand one hundred and twenty-two patients (533 males and 589 females; mean age 62.2 +/- 11.4 yrs) were enrolled in a multicentre controlled study, to evaluate the efficacy and safety of enoxaparin in comparison to calcium heparin in the prevention of deep venous thrombosis (DVT) following general surgery. Patients assigned to the enoxaparin and the calcium heparin groups received 1 daily dose of 20 mg (2000 I.U.) and 2 daily doses of 0.2 ml (5000 I.U.), respectively starting 2 hours before the operation. Both drugs were given by subcutaneous route. A Doppler or Duplex Scan diagnosis of DVT was made in 3 (0.5%) patients in the enoxaparin group (2 cases during treatment and 1 patient at the end of treatment) and in 6 (1.1%) patients in the calcium heparin group (5 cases during treatment and 1, bilateral, after the end of treatment). Pulmonary embolism (PE) was ascertained by angiography in 1 patient (0.18%) in the enoxaparin group and in 2 patients (0.36%) in the calcium heparin one. Hemorrhagic complications occurred in 29 patients (5.2%) in the enoxaparin group and in 34 (6.1%) in the calcium heparin group. Haematomas located in the injection site were reported in 16.1% and 25.3% in the enoxaparin and calcium heparin groups respectively (p = 0.0001). Local pain in the injection site at the 5th day of treatment was reported in 8.4% and 16.6% in the enoxaparin and calcium heparin groups respectively (p = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Enoxaparin in the prevention of deep venous thrombosis after major surgery: multicentric study. The Italian Study Group. 827 57

The antithromboembolic efficacy and safety of Enoxaparin, a low molecular weight heparin preparation, has been studied in a multicenter prospective randomized trial in 10,032 patients scheduled for a variety of elective general surgical, gynecologic, and urologic procedures. There were 9919 patients operated on and who received Enoxaparin, of whom 9907 patients were randomized into two groups. The morning group, composed of 4987 patients, received a subcutaneous injection of 20 mg Enoxaparin 2 hours before surgery and each morning for 7 postoperative days. The evening group, composed of 4920 patients, received the identical injection the evening before surgery and postsurgically for 7 days in the evening. Both groups were comparable in age, gender, weight, surgical category, anesthesia, and any risk factors that could predispose to the development of DVT or PE. The objective of this study was to detect efficacy and safety of Enoxaparin 20 mg under typical clinical conditions. The results were the following: PE was reported in 24 patients, leading to an incidence of PE under Enoxaparin prophylaxis of 0.24% in total, 0.21% for nonfatal and 0.03% for fatal PE. There were no differences in the incidence between the morning and evening groups. The incidence of DVT diagnosed by clinical signs was found to be 0.11%, with six cases in the morning group and five cases in the evening group. An analysis of operative and postoperative bleeding showed no difference between the groups in terms of blood transfusion requirements and drainage volumes, excessive bleeding in the wound area, or other bleeding complications. There was a slight postoperative decrease in haemoglobin and hematocrit in both groups. However, no severe Enoxaparin-induced thrombocytopenia was observed. Only 71 patients (0.72%) reported adverse drug reactions, most of which were local reactions. The results from this study indicate that a single daily injection of 20 mg Enoxaparin is a safe and efficient prophylaxis for thromboembolic complications in patients undergoing any of a variety of general surgical procedures. This study indicates that prevention of thromboembolism is not strictly limited to a 2-hour interval between start of prophylaxis and onset of surgery but may also be provided by starting prophylaxis with 20 mg Enoxaparin during the evening before surgery and continuing treatment postoperatively.
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PMID:Prevention of postoperative thromboembolism with Enoxaparin in general surgery: a German multicenter trial. 839 21

The incidence of postoperative deep vein thrombosis (PDVT) after aortic surgery and lower limb revascularisation has not been assessed by a large prospective study. In a prospective randomised trial the effect of a low-molecular-weight heparin fragment, Enoxaparin (ENX) 4200 anti factor Xa IU once daily was compared to that of unfractionated heparin (UFH) 7500 IU twice daily. Two hundred and thirty-three consecutive patients were classified into three groups, aortic or aortoiliac and aneurysmectomy (n = 75), aorto-femoral bypass for atherosclerotic disease (n = 71), and femoropopliteal or femorodistal bypass (n = 87). Patients were analysed for development of deep vein thrombosis by Duplex scanning and, if positive, by venography between the seventh and tenth postoperative day. PDVT was present in 10 patients in the ENX group and in four patients in the UFH group (8.2 and 3.6% respectively, NS). The incidence of PDVT was 8% after aortic or aortoiliac aneurysmectomy, 7% after aortofemoral revascularisation, and 3.4% after femoropopliteal or femorodistal bypass. The overall incidence of PDVT after aortic surgery was 7.5% (95% CI 5.4-9.7). There was no pulmonary embolism. Intra-operative blood loss and postoperative bleeding events did not differ significantly between the ENX and UFH groups. After 1 month follow-up, no clinical event or death could be related to PDVT or pulmonary embolism. In conclusion, in vascular surgery ENX is as safe and effective in the prevention of PDVT as is UFH.
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PMID:A randomised controlled trial of a low-molecular-weight heparin (Enoxaparin) to prevent deep-vein thrombosis in patients undergoing vascular surgery. 840 1

A formal statistical overview of all truly randomised trials was undertaken to determine whether antithrombotic therapy is effective and safe in the early treatment of patients with acute stroke. There were 15 completed randomised controlled trials of the value of early antithrombotic treatment in patients with acute stroke. The regimes tested in acute presumed or confirmed ischaemic stroke were: heparin, 10 trials with 1047 patients: oral anticoagulants, one trial with 51 patients: antiplatelet therapy, three trials with 103 patients. Heparin was tested in one trial with 46 patients with acute haemorrhagic stroke. Outcome measures were deep venous thrombosis (confirmed by I125 scanning or venography), pulmonary embolism, death from all causes, haemorrhagic transformation of cerebral infarction, level of disability in survivors. In patients with acute ischaemic stroke, allocation to heparin was associated with a highly significant 81% (SD 8, 2p < 0.00001) reduction in deep venous thrombosis detected by I125 fibrinogen scanning or venogram. Only three trials systematically identified pulmonary emboli, which occurred in 6/106 (5.7%) allocated control vs 3/132 (2.3%) allocated heparin, a non-significant 58% reduction (SD 45.7, 2p > 0.1). There were relatively few deaths in the trials in patients with presumed ischaemic stroke: 94/485 (19.4%) among patients allocated to the control group vs 79/497 (15.9%) among patients who were allocated heparin. The observed 18% (SD 16) reduction in the odds of death was not statistically significant. The least biased estimated of the effect of treatment on haemorrhagic transformation of the cerebral infarct (HTI) comes from trials where all patients were scanned at the end of treatment, irrespective of clinical deterioration; using this analysis, haemorrhagic transformation occurred in 7/102 (6.9%) control vs 8/106 (7.5%) treated, a non-significant 12% increase (SD 56, 2p > 0.1). These data cannot exclude the possibility that heparin substantially increases the risks of HTI. No data on disability in survivors could be obtained. Early heparin treatment might be associated with substantial reductions in deep venous thrombosis (and probably also pulmonary embolism) and possibly a one fifth reduction in mortality (equivalent to the avoidance of 20-40 early deaths per thousand patients treated.) However, the data were wholly inadequate on safety, particularly on the risk of haemorrhagic transformation of the infarct and on the hazards of heparin therapy in patients with known intracerebral haemorrhage. The trials of oral anticoagulants (15 deaths among 57 patients) and antiplatelet therapy (two deaths among 103 patients) were too small to be informative. Much larger randomized trials-comparing aspirin, heparin and the combination of both drugs against control-in patients with acute ischaemic stroke are justified (and several are now planned or underway).
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PMID:Antithrombotic therapy in acute ischaemic stroke: an overview of the completed randomised trials. 812 24

Three cases of lower limb, deep venous thrombosis that progressed to ischemia in patients with advanced ovarian cancer are reported. One patient developed frank gangrene of the extremity. Venous stasis, secondary to venous compression from metastatic disease, was the predisposing factor in all cases. Heparin therapy was uniformly unsuccessful in halting progression of thrombosis. Ischemic thrombosis originating from extrinsic venous compression is unlikely to respond to conventional therapy alone. Local external radiation to metastatic sites, given early and possibly in conjunction with conventional treatment methods, may achieve a clinical response by causing a reduction in tumor size and thus relief of venous compression.
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PMID:Lower limb ischemic venous thrombosis in patients with advanced ovarian carcinoma. 850 98


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