Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0149871 (deep vein thrombosis)
 12,364 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We investigated the efficacy and safety of extended enoxaparin monotherapy in symptomatic patients with acute pulmonary embolism (PE). We randomized 40 patients in a 1:1 allocation to enoxaparin monotherapy (1 mg/kg twice daily for 10-18 days, and then 1.5mg/kg once daily until day 90) (n = 20) or to enoxaparin 1.0 mg/kg twice daily as a bridge to warfarin with a target international normalized ratio of 2.0-3.0 for 90 days (at least 10 doses of enoxaparin overlapping with warfarin for at least 4 days) (n = 20). All patients underwent echocardiography, cardiac troponin I (TnI), and brain natriuretic peptide testing to identify patients with an increased likelihood of adverse clinical outcomes. The end-points were newly diagnosed deep venous thrombosis (DVT) or PE and bleeding events through day 90. In 15 patients on extended enoxaparin therapy, we used repeated measure analysis of variance (ANOVA) to investigate differences in anti-Xa levels obtained at 2, 4, 8 and 12 weeks. The patients' mean age was 52 +/- 17 years; the most common comorbidities were obesity (58%), hypertension (30%), concomitant DVT (30%) and cancer (15%). Twelve (30%) patients had elevated cardiac Tnl >0.1 mg/l and 11 (28%) had moderate or severe right ventricular dysfunction on echocardiography. Ten (25%) patients received thrombolysis with a continuous infusion of 100 mg alteplase prior to randomization. During a 90-day follow-up, one patient from the enoxaparin monotherapy group suffered symptomatic distal DVT; one from the warfarin group had recurrent symptomatic PE (p = 1.0). None of the study patients had major hemorrhage; two warfarin group patients had minor bleeding compared with none in the enoxaparin monotherapy group (p = 0.49). Repeated measure ANOVA did not reveal significant differences in anti-Xa levels over time (p = 0.217). In patients with acute symptomatic PE, extended enoxaparin monotherapy is feasible and warrants further investigation in a large clinical trial.
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PMID:Extended enoxaparin monotherapy for acute symptomatic pulmonary embolism. 1644 53

Pulmonary embolism (PE) is extremely common and is a leading cause of death in all age groups. Unfortunately the diagnosis is most often missed than it is made. Prompt diagnosis and treatment can dramatically reduce the mortality and morbidity. This study was done to evaluate the patients with acute PE, assess the utility of laboratory tests and potential of high resolution spiral computed tomogram angiography of pulmonary arteries (sCTPA) as the confirmatory diagnostic tool. Twenty six consecutive patients with acute PE admitted to CCU of Narayana Hrudayalaya of Banglore were followed prospectively. There were 15 male and 11 female (M:F=1:3:1); age range was 32-58 yrs. (mean 45+/-13 yrs). Pre-testing probability assessment of PE was done by a combined approach of history, physical examination and presence of risk factors. D-dimer and cardiac troponin I (TnI) estimation and sCPTA done by contrast enhanced 64-slice spiral CT scanner in all patients. In addition to the typical findings of PE, sCTPA included and revealed features of cardiac and venous CT imaging. Doppler study of leg veins were done to exclude deep vein thrombosis. Trans-thoracic echocardiography assessed right ventricular dilatation and presence of pulmonary hypertension. Nineteen patients (73.0%) had sub-massive PE, 5 patients (19.2%) had non-massive and 2 patients (7.6%) presented with massive PE. A raised D-dimer (0.5mugm/ml) was found in all the cases (100.0%). An elevated a trponin I (TnI) was found in 18 patients (69.2%). RV dilatation, (i.e. RV/LV>0.9) was found in 21 patients (80.7%). All patients (100.0%) received unfractionated heparin. Thrombolysis with alteplase, without concomittent heparin was administered in 11 patients (42.3%). Inferior venacaval filter were implanted in 9 patients (34.6%) with sub massive PE and recurrent events despite anticoagulation. Embolectomy done in one patients with massive PE, offered satisfactory recovery. Pulmonary endarterectomy were undertaken in 6 patients with acute on chronic thromboembolic pulmonary hypertension. Thus sCTPA detected PE, source of PE and provided prognostic information.
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PMID:Pulmonary embolism: an observational study at Narayana Hrudayalaya Institute of Cardiac Sciences, Bangalore, India. 2063 34

We describe a case of a 90-year-old male admitted to the emergency department with deep vein thrombosis and central acute pulmonary embolism. Despite a remarkably increased value of D-dimer and a modestly elevated concentration of cardiac troponin I, the value of B-type natriuretic peptide was found to be non-diagnostic. Limited to this single case report, our evidence suggests that the measurement of natriuretic peptides is questionable for diagnosing central acute pulmonary embolism in the emergency department.
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PMID:B-type natriuretic peptide may be unsuitable for diagnosing central acute pulmonary embolism. 2596