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

By the use of 125I-labeled fibrinogen test, the incidence of postoperative deep vein thrombosis (DVT) and the effectiveness of prophylactic low-dose heparin treatment were investigated in 110 patients who underwent elective neurosurgical procedures. Fifty patients were appointed randomly to a control group and 50 to a heparin group (10 patients were excluded since they had DVT before surgery). The incidence of DVT was reduced from 34% in the control group to 6% in the heparin group (p less than 0.005). No statistically significant differences were observed in transfusion requirements, postoperative hemoglobin concentration, and the occurrence of postoperative hematomas between the two groups. Positive correlation was observed between DVT and motor deficit (p less than 0.05). Preoperative assessment of patients' sensitivity to the standard 5000-unit dose of heparin was performed in all treated patients and is thought an important factor in improving the safety of heparin prophylaxis.
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PMID:Deep vein thrombosis and low-dose heparin prophylaxis in neurosurgical patients. 68 99

Fibrinolytic therapy was carried out in 59 patients suffering from a total of 60 deep venous thromboses of the iliac segment (n = 24), the femoropopliteal segment (n = 18), the deep calf veins (n = 2), or the subclavian vein (n = 16). 46 patients received streptokinase (SK), 4 were given urokinase (UK), and 10 were treated with streptokinase followed by urokinase (SK + UK). The duration of fibrinolytic therapy was between 19 and 596 hours (x = 166 +/- 111 hrs). Phlebographic examination was used to determine the location of the thrombotic occlusion as well as to evaluate therapeutic results. To assure sufficient anticoagulatory protection during therapy with streptokinase the dose of streptokinase was either reduced by steps of 20,000 U/hr to a minimum of 40,000 U/hr or heparin was added as a continuous infusion. Urokinase was administered with a mean loading dose of 75,000 IU followed by an average maintenance dose of 40,000 IU/hr; it was always given in combination with heparin. When therapeutic success was graded as complete/partial/no recanalisation, the following results were obtained: thrombotic occlusion up to 1 week old 35%/48%/17%; up to 2 weeks old 57%/14%/29%; 3 or 4 weeks old 12%/38%/50%; older than 4 weeks 13%/37%/50%. The two most common side effects were a fall of the hemoglobin and a rise of body temperature. Treatment with SK had to be interrupted for bleeding in two cases. One patient diet after rupture of the liver and of the spleen following development of subcapsular hematoma in these organs, 3 patients survived pulmonary embolism without major long-term impairment. Considering medical and social aspects (preservation of capability for working in young adults) it appears justified to administer fibrinolytic agents up to a thrombus age of 14 days, in some cases even up to a thrombus age of 28 days. Good results in cases of deep vein thrombosis of the lower limbs are often obtained only when fibrinolytic therapy is extended beyond 96 hours. It should be performed in intensive care units only. Follow-up examinations of the venous drainage capacity up to 2 years after fibrinolytic therapy document the good therapeutic effect that is warrented by streptokinase or urokinase induced complete recanalisation.
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PMID:[Fibrinolytic therapy in deep venous thrombosis of the upper and lower extremity]. 84 72

Consecutive patients undergoing knee arthroplasty or tibial osteotomy at four participating hospitals received either enoxaparin, 30 mg subcutaneously every 12 h (n = 66) or an identical-appearing placebo (n = 65). All study medications started the morning after the operation and were continued up to a maximum of 14 days. Patients underwent surveillance with 125I-fibrinogen leg scanning and impedance plethysmography. Bilateral contrast venography was performed routinely at Day 14 or at time of discharge, if sooner. Deep vein thrombosis was detected by venography in 35 of 54 patients (65%) in the placebo group and in 8 of 41 patients in the enoxaparin group (19%), a risk reduction of 71%, P less than 0.0001. For the entire study group, deep vein thrombosis was detected by either venography of non-invasive tests in 37 of 64 patients (58%) in the placebo group and in 11 of 65 patients (17%) in the enoxaparin group, a risk reduction of 71%, P less than 0.0001. Proximal vein thrombosis was found in 19% of the placebo patients and in none of the enoxaparin patients, a risk reduction of 100%, P less than 0.001. Bleeding complications occurred in 5 of 65 patients (8%) in the placebo group and in 4 of 66 patients (6%) in the enoxaparin group, P = 0.71. There were no differences in the amount of blood loss, minimum hemoglobin levels and number of units of packed red cells given between the two treatment groups. We conclude that a fixed dose regimen of enoxaparin, started post-operatively, is an effective and safe regimen for reducing the frequency of deep vein thrombosis after major knee surgery.
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PMID:Prevention of deep vein thrombosis after major knee surgery--a randomized, double-blind trial comparing a low molecular weight heparin fragment (enoxaparin) to placebo. 132 9

A prospective, randomized trial has been undertaken to evaluate the prophylactic effects of low molecular weight heparin (LMWH) and dextran-70 in 216 patients with hip fracture during a postoperative period of ten days. Deep vein thrombosis (DVT) was diagnosed using the 125Iodine fibrinogen uptake test, confirmed by ascending venography. 113 patients received LMWH and 103 dextran-70. The frequency of DTV of 14.2% in the LMWH group was significantly lower compared with the 30.1% in the dextran group (p less than 0.003). During the first 10 days postoperative there were no fatal pulmonary embolism (PE). After this period PE occurred in 2 patients (1.8%) in the LMWH group and 1 patient (1.0%) in the dextran group. In each group one patient died from PE. There was no major bleeding in either group. The frequency of local complications was slightly higher in the dextran group (10.7%) compared with the LMWH group (3.5%). The postoperative hemoglobin level was significantly lower in dextran treated patients than in patients receiving LMWH (p less than 0.0001).
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PMID:[Prevention of thromboembolism in hip traumatology: low molecular weight heparin versus dextran]. 137 76

The ability to produce a large increase in plasma volume is one of the hallmarks of a successful pregnancy. Data from Garn et al. (5), Knottnerus et al. (14) and Murphy et al. (15) have shown, that hemoglobin levels above 13 g/dl or hematocrit 38% before admittance to hospital are associated with a high incidence of IUGR (intrauterine growth retardation), gestational hypertension and with a greater perinatal mortality. Patients with an elevated viscosity and hematocrit have increased perinatal risks. In these cases the hemodilution with hydroxy- ethylstarch (HES) improves the blood flow and decreases the incidence of dysmature babies and pregnancy complications. The effect of HES on certain coagulation assays seems qualitatively similar to those of Dextran. In a prospective trial we evaluated the effect of HES in the incidence of thrombosis after cesarean section and we found a 5.9% incidence of thrombosis in patients treated with 6% HES 0.62 compared with a 7.8% incidence in heparin treated patients. Treatment with 1500 ml 6% HES 0.62 before and after cesarean section is similarly effective in preventing deep vein thrombosis as heparin prophylaxis.
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PMID:[Value of hemodilution therapy in pregnancy]. 171 33

To determine the etiology of the increased incidence of postoperative deep venous thrombosis (DVT) in patients with carcinoma of the colon, serum levels of protein C were measured preoperatively in 65 patients with colorectal adenocarcinoma. Noninvasive lower-extremity Doppler studies were performed on all patients prior to discharge to assess patency of the deep veins. Six patients (9%) were found to have DVT. The protein C level was considered elevated if it was greater than 125% of control values and reduced if less than 75% of control values. The development of DVT was found to be independent of the serum carcinoembryonic antigen, albumin, total protein, hemoglobin, hematocrit, platelet count, prothrombin time, partial thromboplastin time, and the patient's age and percentage of ideal body weight. There was an inverse relationship between the protein C level (p less than 0.001), Dukes stage of the tumor (p less than 0.001), and the development of DVT. Linear regression analysis revealed that only the tumor stage and the protein C level could be used to predict the development of DVT. The data show that for these patients with colorectal malignancy, the development of DVT may be related to decreased levels of protein C.
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PMID:Protein C activity, stage of disease, and vascular thrombosis in colon carcinoma. 173 77

In order to determine the efficacy and safety of ancrod, a rapid acting defibrinogenating drug, for patients with heparin-induced thrombocytopenia, 11 consecutive patients who required anticoagulant therapy because of venous thromboembolism and who developed acute heparin-induced thrombocytopenia or had a history of heparin-induced thrombocytopenia were treated with ancrod. Heparin therapy was discontinued (in patients receiving heparin) and ancrod started at a dose of 1 to 2 U/kg every 24 hours with subsequent daily doses adjusted to maintain fibrinogen levels between 0.5 and 1.0 g/L. Ancrod was continued until warfarin had become effective. The platelet count increased to more than 150 x 10(9)/L within 2 to 10 days in all thrombocytopenic patients. Two patients with a history of heparin-induced thrombocytopenia maintained normal platelet counts while receiving ancrod. Two patients had recurrent venous thrombosis while receiving warfarin, 10 days after ancrod was discontinued: one of these patients had metastatic pancreatic carcinoma and developed phlegmasia cerulea dolens and the other patient developed a venographically proven extension of her deep venous thrombosis. One patient suffered a bleeding episode into the thigh with a 16-g/L decrease in her hemoglobin level while receiving ancrod therapy. No other side effects were noted. Our experience indicates that ancrod therapy is a reasonable approach for patients with heparin-induced thrombocytopenia who require anticoagulant therapy.
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PMID:Rapid anticoagulation using ancrod for heparin-induced thrombocytopenia. 157 63

Recent studies have demonstrated an increased incidence in the diagnosis of malignancy subsequent to the diagnosis of deep venous thrombosis or pulmonary embolus. We reviewed 237 patients with venographically proven deep venous thrombosis over eight years. Of these, 216 had at least one predisposing cause for deep venous thrombosis; of the remaining 21 patients, three had hemoglobin determinations revealing anemia and were subsequently shown to have a malignant disease. One patient had two chief complaints and was shown to have deep venous thrombosis and malignant disease. The 17 remaining patients underwent computed tomographic scan of the abdomen and seven (41%) had abnormalities which proved to be malignant in origin. One further patient was diagnosed with carcinoma of the cervix two months following the onset of deep venous thrombosis. The remaining 10 patients continued free of malignant disease. Five have died of circulatory causes in the follow-up period. Seven of the nine patients diagnosed with malignancy succumbed within six months of the diagnosis. We conclude that only a small group of patients with deep venous thrombosis will have no identifiable cause for deep venous thrombosis and be asymptomatic for malignancy. Complete blood count, physical examination and computed tomographic scan of the abdomen at the time of venographic diagnosis of deep venous thrombosis is useful in diagnosis of "occult" malignancy. The number of gynecologic tumors would suggest the need for pelvic examination as well as radiographic examination. The presence of deep venous thrombosis and malignant disease is an ominous prognostic sign.
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PMID:"Idiopathic" deep venous thrombosis: the value of routine abdominal and pelvic computed tomographic scanning. 206 13

Once daily dosing of Enoxaparin to prevent deep vein thrombosis (DVT) after total hip replacement has been defined through two double-blind prospective, randomized multicentric trials. A previous prospective study including 228 consecutive patients had determined optimal dose to be 40 mg daily (4000 anti Xa U) begun 12 hours pre-operatively. The first trial (118 patients) compared two modes of administration of the dose of 40 mg--either 40 mg once daily or 20 mg twice daily, every twelve hours. Results were a figure of 6% for total DVT detected by ascending bilateral phlebography, 5% of wound hematoma and did not shown a statistically significant difference between the two modes of administration as regard tolerance. The second trial (237 patients) compared unfractionated calcic Heparin (5000 U.I. every eight hourly begun two hours before surgery) with Enoxaparin, 40 mg/day begun twelve hours before surgery. In the unfractionated Heparin group, we observed 27 total DVT (25%) 20 proximal DVT (12.5%) and one case of non fatal pulmonary embolism. In the Enoxaparin group, we observed 15 total DVT (12.5%), 9 proximal DVT (7.5%) no case pulmonary embolism. Red-cell transfusion requirements and hemoglobin levels on the third post-operative day shown a significant better tolerance in the Enoxaparin group. Theses results are coherent with those observed in the placebo controlled trial of Turpie, Levine, et al (1986). They used a dose of 30 mg twice daily (6000 anti Xa IU) begun 12/24 hours post-operatively, and observed a figure of 12% for total DVT and 4% for proximal DVT. Tolerance was the same than in the placebo group.
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PMID:[Prevention of deep vein thrombosis by enoxaparin after total hip prosthesis]. 217 35

A prospective, double-blind, randomized, controlled clinical trial compared the efficacy and safety of fixed combinations of low-molecular weight heparin or standard unfractionated heparin plus dihydroergotamine mesylate in the prevention of deep vein thrombosis in high-risk patients undergoing elective major abdominal surgery. Two hundred patients, with a mean age of 66.6 years and almost half with malignancy, were allocated to receive either 5,000 IU unfractionated heparin plus 0.5 mg dihydroergotamine mesylate twice daily or 1,500 IU low-molecular weight heparin plus 0.5 mg dihydroergotamine mesylate once daily together with one placebo injection per day. Treatment was commenced 2 hours preoperatively and continued for at least 7 days. The incidence of deep vein thrombosis, determined by radiolabelled fibrinogen uptake and phlebography, was 11 percent in the unfractionated heparin plus dihydroergotamine mesylate group and 11.4 percent in the low-molecular weight heparin and dihydroergotamine mesylate group. Neither these figures nor those for major proximal thrombi proved significantly different. Of the four parameters used to assess hemorrhagic complications, only the decrease in postoperative hemoglobin levels in the low-molecular weight and dihydroergotamine mesylate group reached statistical significance. These results indicate that once-daily prophylaxis with a combination of low-molecular weight heparin and dihydroergotamine is safe, effective, and convenient in high-risk patients undergoing major abdominal surgery.
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PMID:Fixed combinations of low-molecular weight or unfractionated heparin plus dihydroergotamine in the prevention of postoperative deep vein thrombosis. 253 25


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