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

To compare contrast venography with noninvasive methods, 353 patients clinically suspected of having deep venous thrombosis were examined with venography and independently with combined Doppler flow sounds and plethysmography. Noninvasive examinations had a sensitivity of 96% and a specificity of 90%. Positive noninvasive tests had a 94% predictive value, and negative noninvasive tests had a 93% predictive value. The overall accuracy of the noninvasive tests was 94% (331 of 353) compared with venography. Since venography itself may be subject to misinterpretation, noninvasive examinations should be the preferred initial method for diagnosing deep venous thrombosis. Venography should be reserved for situations that require additional diagnostic confirmation.
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PMID:Contrast venography: reassessment of its role. 328 98

Venous thromboembolism produces chronic sequelae in the legs and occasional immediate mortality due to pulmonary embolism. Because it occurs in certain high risk situations (for example, after surgery) its prevention is a practical proposition. This has been attempted using many different approaches. Administration of low dose heparin with or without dihydroergotamine to enhance venous return has been one of the most widely tested regimens. There is little doubt that this can prevent, in many patient groups, postoperative deep venous thrombosis and fatal pulmonary embolism, with a low incidence of adverse reactions. Some particularly high risk postoperative patient groups (for example, those undergoing hip surgery) warrant more aggressive measures to prevent thrombosis. Surveys have shown that increasing use is being made of this approach, and it is hoped that all surgeons will adopt a policy that will reduce postoperative venous thrombosis and pulmonary embolism. A reduction in the incidence of venous thromboembolism in large acute myocardial infarction is achieved by low dose heparin, although early mobilization is important. In addition, many of the patients at risk merit full dose anticoagulation to prevent intracardiac thromboembolism. Established venous thrombosis is treated effectively by intravenous heparin, followed by warfarin to keep the prothrombin time at 1.2 to 1.5 times control, as assessed using rabbit thromboplastin; most patients need three months of treatment. Anticoagulation is warranted for pulmonary embolism, with fibrinolytic therapy reserved for patients with massive embolism and hemodynamic compromise. Embolectomy is a heroic measure, which may occasionally be lifesaving.
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PMID:Preventive and therapeutic approach to venous thromboembolic disease and pulmonary embolism--can death from pulmonary embolism be prevented? 353 67

Suspicion of DVT or thromboembolism is critical to early diagnosis and treatment prior to development of severe or life-threatening pathology. Because the consequences of treatment are long-term inconvenience and risk of major complications, objective studies are necessary to confirm the diagnosis. Radiographic procedures such as angiography and lung scanning provide valuable information with low risk to mother and fetus. However, if the clinical situation is strongly suggestive, treatment with intravenous heparin can be immediately initiated followed by definitive diagnosis. When indicated, anticoagulation can be instituted with relative safety, providing there is careful monitoring. Heparin is unquestionably the drug of choice for treatment and prophylaxis during pregnancy. Because warfarin carries a significant risk to the fetus of anomalies and hemorrhage, its use during pregnancy should be reserved for those circumstances in which the benefits of such therapy outweigh the risks. Finally, awareness of the signs and symptoms of thromboembolism, as well as expeditious treatment, remain the mainstays for prevention of maternal and attendant fetal mortality.
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PMID:Thromboembolic disease in pregnancy. 353 47

The optimal role of thrombolytic therapy in clinical practice has not been defined precisely. A review of available information indicates that such therapy may be useful in a small number of carefully selected patients with deep vein thrombosis and/or pulmonary emboli. The superiority of thrombolytic therapy over conventional surgery for arterial thrombi has not been convincingly demonstrated. Available evidence suggests such therapy should be reserved for those conditions in which surgery may be expected to have a poor outcome or be associated with a high incidence of complications. Preliminary information suggests thrombolytic therapy may be of benefit in selected patients with acute myocardial infarction.
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PMID:Current status of thrombolytic therapy. 388 9

Certain non-invasive techniques like Doppler CW and strain gauge plethysmography are highly effective ways of evaluating the natural history of postphlebitic syndrome. 40 patients of both sexes, average age 51.5 +/- 6.9 with a history of deep venous thrombosis (28 documented phlebographically) were subjected to Doppler tests with assessment of venous blood pressure and bilateral strain gauge plethysmography. 34 of the 40 suspected PPS cases were confirmed, though not all cases were at the same stage. Persistent deep venous thrombosis was found in five of the extremities and the last one examined revealed a primary varicose syndrome. A comparison of the Doppler and phlebography results showed both to be highly sensitive techniques (100% accuracy). When the contralateral limbs were examined, the Doppler technique revealed 7 cases of PPS and 21 primary varices. In contrast strain gauge plethysmography identified all 28 cases of increased venous capacitance as primary varices, thus confirming the inability of this technique to distinguish between the various varicose conditions. Assuming the presence of a vascular diagnosis laboratory where both techniques are available, strain gauge plethysmography is recommended as the examination of choice. This technique is simple and fast to perform and can provide extensive information whether at rest (filling and emptying volumes and times; venous tone and distensibility, venous blood pressure at rest) or in movement (venous pressure when standing, muscular pumping index). Hence plethysmography can reveal any canalisation present even in the earliest stages though it cannot pinpoint the precise site of the deep obstruction. The longer, more complex Doppler CW procedure should be reserved for secondary investigations. This technique is preferable to plethysmography when a more accurate assessment of the degree, site and extension of the venous recanalisation is needed. Doppler CW also provides information on any valvar sequelae since it records the direction of the blood flow in the presence of a substitution syndrome (increased venous flow in the surface vessels). Finally if used in a rational manner the two techniques can be combined to eliminate contrast medium techniques, which would only be adopted as a preoperative measure.
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PMID:[Doppler ultrasound and strain gauge plethymography in the diagnosis of the post-phlebitic syndrome]. 390 50

Physiologic changes in clotting parameters and venous flow during pregnancy increase the likelihood of deep venous thrombosis. Conditions that place the pregnant patient at a higher risk include a previous history of thromboembolic disease and surgery or bedrest for any reason during the pregnancy. In the high-risk patient, prophylactic therapy with low-dose heparin is advised beginning around the 34th week of pregnancy and continuing until 4-6 weeks after delivery. The clinical diagnosis of thrombophlebitis or pulmonary embolus is unreliable and should be confirmed objectively before therapy is started. During pregnancy, doppler ultrasound and impedance plethysmography should be the first-line diagnostic tests, but one should seek confirmation with venography if in doubt. The preferred method of therapy for the acute thrombolic event is full anticoagulation with continuous intravenous heparin from 7-10 days, followed by therapy with subcutaneous heparin for the remainder of the pregnancy and the puerperium, although there is considerable controversy regarding long-term therapy. Fibrinolytic agents have little place in pregnancy, and surgical therapy should be reserved for the critically ill patient only.
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PMID:Thromboembolic complications of pregnancy. 666 42

The study was carried out on 234 women who had undergone caesarean sections. Hematoma in the area of the incision represents a major obstacle to the prevention of deep vein thrombosis through systematic subcutaneous heparin therapy. Even though anticoagulant therapy is not 100% effective, complications in this particular treatment appear to be minor. In our opinion, this therapy should be reserved for certain favorable cases and should not be generally used for all women undergoing caesarean sections.
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PMID:[Systematic prevention of deep vein thrombosis with subcutaneous heparin therapy following cesarean section. Advantages and disadvantages]. 685 80

Streptokinase and urokinase are the two thrombolytic agents currently available in the United States. These drugs promote dissolution of thrombi by stimulating the conversion of plasminogen to plasmin, resulting in an overall "lytic state" in the blood. Recent clinical trials in patients with pulmonary emboli, deep vein thrombosis, arterial thrombosis, and arteriovenous cannula occlusions demonstrated significantly greater lysis with thrombolytics than with heparin alone. However, because of the increased risk of bleeding, the use of these agents is reserved for patients in whom the therapeutic advantages outweigh the disadvantages. Contraindications are numerous and include any preexisting condition that may render the patient more susceptible to bleeding.
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PMID:Advances in thrombolytic therapy. 704 63

The high reported incidence of deep venous thrombosis (DVT) in trauma patients has prompted surveillance venous duplex scanning of the lower extremities. We report our retrospective experience with 183 multiple trauma patients who were admitted to the surgical intensive care unit and underwent 261 surveillance venous scans. There were 122 men and 61 women whose average age was 38 years. All patients were treated prophylactically with either extremity pneumatic compression or subcutaneous heparin to prevent DVT. Most (87%) patients suffered blunt trauma and had either head (3%), spinal (3%), intra-abdominal (9%), or lower extremity (17%) injuries or a combination of injuries (68%). Almost two thirds of the patients had no symptoms suggestive of possible DVT. Of the 261 venous scans performed, 239 (92%) were normal, 16 (6%) were positive for proximal lower extremity DVT, and six (2%) showed thrombus limited to the calf veins. Patients with symptoms of lower extremity DVT were significantly more likely to have proximal DVT compared to those without symptoms (15% vs. 5%, p < 0.05). Patients with spinal injuries also had a higher incidence of proximal DVT (18% vs. 6%, p < 0.05). At current hospital charges, the cost to identify each proximal DVT was $6688. If surveillance duplex scans were performed on all trauma patients in the surgical intensive care unit, the national annual expense would be $300,000,000. Routine DVT surveillance is expensive and should be reserved for symptomatic patients or those with spinal injuries.
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PMID:Surveillance venous scans for deep venous thrombosis in multiple trauma patients. 770 54

This study compares the results of a computerized strain-gauge plethysmograph with ascending lower limb venography in 94 patients with clinical deep venous thrombosis, and in 121 patients with asymptomatic legs being screened after total hip replacement. In the symptomatic patients, strain-gauge plethysmography had a sensitivity of 100%, an accuracy of 73%, a specificity of 64% and a negative predictive value of 100% for thrombosis above the popliteal confluence. In the screened patients, the figures were 38.1%, 55.4%, 60.0% and 81.1% respectively. Computerized strain-gauge plethysmography is a safe, non-invasive, reliable and portable method of excluding proximal thrombosis in a symptomatic patient. It avoids the need for urgent venography when anticoagulation therapy is reserved for those with proximal thrombosis. The device was not valuable as a screening tool after total hip replacement, since it had a low specificity and did not reliably detect the non-occlusive mural femoral thrombi which typically follow this procedure.
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PMID:Computerized strain-gauge plethysmography in the diagnosis of symptomatic and asymptomatic venous thrombosis. 800 Aug 35


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