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Sample records for acute venous thromboembolism

  1. Acute on Chronic Venous Thromboembolism on Therapeutic Anticoagulation

    Directory of Open Access Journals (Sweden)

    Byron Bassi

    2013-01-01

    Full Text Available A case of proximal venous thromboembolism in a patient who presented to the ED with lower extremity pain is presented. Making this diagnosis is very important as fifty percent of patients with symptomatic proximal DVTs will go on to develop PE without treatment. This report underscores the utility of bedside ultrasonography in the emergency department.

  2. Venous thromboembolism in adults treated for acute lymphoblastic leukaemia: Effect of fresh frozen plasma supplementation

    NARCIS (Netherlands)

    I. Lauw (Ivoune); B. van der Holt (Bronno); S. Middeldorp (Saskia); J.C.M. Meijers; J.J. Cornelissen (Jan); B.J. Biemond (Bart)

    2013-01-01

    textabstractTreatment of acute lymphoblastic leukaemia (ALL) is frequently complicated by venous thromboembolism (VTE). The efficacy and optimal approach of VTE prevention are unclear, particularly in adult patients. We assessed the effect of thromboprophylaxis on symptomatic VTE incidence in cycle

  3. Venous Thromboembolism in China

    Institute of Scientific and Technical Information of China (English)

    赵永强

    2005-01-01

    @@ Deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) are two manifesttions of venous thromboembolism (VTE) . Although the controversy remained,it has been widely accepted for many years that Chinese people have lower incidence of VTE than Caucasians with the different etiology and clinical features.

  4. Idiopathic venous thromboembolism and thrombophilia

    OpenAIRE

    Sinescu, C; Hostiuc, M; Bartos, D.

    2011-01-01

    During the past decade idiopathic venous thromboembolism has become a separate entity, a chronic illness which has required prolonged anticoagulation and other prevention strategies to avoid recurrences. This article reviews recent developments regarding unprovoked venous thromboembolism and its relation with thrombophilia. In the beginning, the latest definition of idiopathic venous thromboembolism is presented. The article continues with statistics about thrombophilia, related venous thromb...

  5. [Homocysteine and venous thromboembolism].

    Science.gov (United States)

    Monnerat, C; Hayoz, D

    1997-09-06

    Congenital homocysteinuria is a rare inherited metabolic disorder with early onset atherosclerosis and arterial and venous trombosis. Moderate hyperhomocysteinemia is more frequently encountered and is recognized as an independent cardiovascular risk factor. Several case-control studies demonstrate an association between venous thromboembolism and moderate hyperhomocysteinemia. A patient with moderate hyperhomocysteinemia has a 2-3 relative risk of developing an episode of venous thromboembolism. The occurrence of mild hyperhomocysteinemia in heterozygotes for the mutation of Leiden factor V involves a 10-fold increase in the risk of venous thromboembolism. The biochemical mechanism by which homocysteine may promote thrombosis is not fully recognized. Homocysteine inhibits the expression of thrombomodulin, the thrombin cofactor responsible for protein C activation, and inhibits antithrombin-III binding. Treatment with folic acid reduces the plasma level of homocysteinemia, but no study has demonstrated its efficacy in reducing the incidence of venous thromboembolism or atherosclerosis. Hyperhomocysteinemia should be included in the screening of abnormalities of hemostasis and thrombosis in patients with idiopathic thromboembolism, and mild hyperhomocysteinemia may justify a trial of folic acid.

  6. Hormonal contraception and venous thromboembolism

    DEFF Research Database (Denmark)

    Lidegaard, Øjvind; Milsom, Ian; Geirsson, Reynir Tomas;

    2012-01-01

    New studies about the influence of hormonal contraception on the risk of venous thromboembolism (VTE) have been published.......New studies about the influence of hormonal contraception on the risk of venous thromboembolism (VTE) have been published....

  7. Venous thromboembolism and pregnancy

    Directory of Open Access Journals (Sweden)

    Maristella D’Uva

    2010-03-01

    Full Text Available Maristella D’Uva1, Pierpaolo Di Micco2, Ida Strina1, Giuseppe De Placido1Department of Obstetrics and Gynecology and Human Reproduction, “Federico II” University of Naples, Naples, Italy; 2Internal Medicine Division, Buonconsiglio Fatebenefratelli Hospital of Naples, Naples, ItalyAbstract: In recent decades, the association between a hypercoagulable state and its causes and adverse pregnancy outcome, in particular recurrent pregnancy loss (RPL has been studied extensively. Although the first studies were focused only on the association between thrombophilia and RPL, subsequent studies underlined also a potential role of antithrombotic treatment to prevent vascular complication such as venous thromboembolism (VTE during pregnancy. Thromboprophylaxis should be considered also for pregnant subjects carriers of molecular thrombophilia or that previously experienced VTE, in order to prevent VTE during pregnancy, while antithrombotic treatment for VTE should be performed during all pregnant periods.Keywords: thrombophilia, venous thromboembolism, recurrent pregnancy loss, factor V Leiden

  8. Venous thromboembolism: The intricacies

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    Dutta T

    2009-01-01

    Full Text Available Venous thromboembolism (VTE has been a subject of great interest of late. Since Rudolph Virchow described the famous Virchow′s triad in 1856, there have been rapid strides in the understanding of the pathogenesis and factors responsible for it. Discovery of various thrombophilic factors, both primary and acquired, in the last 40 years has revolutionized prognostication and management of this potentially life-threatening condition due to its associated complication of pulmonary thromboembolism. Detailed genetic mapping and linkage analyses have been underlining the fact that VTE is a multifactorial disorder and a complex one. There are many gene-gene and gene-environment interactions that alter and magnify the clinical picture in this disorder. Point in case is pregnancy, where the risk of VTE is 100-150 times increased in the presence of Factor V Leiden, prothrombin mutation (Prothrombin 20210A and antithrombin deficiency. Risk of VTE associated with long-haul air flight has now been well recognized. Thrombotic events associated with antiphospholipid syndrome (APS are 70% venous and 30% arterial. Deep venous thrombosis and pulmonary embolism are the most common venous events, though unusual cases of catastrophes due to central vein thrombosis like renal vein thrombosis and Budd-Chiari syndrome (catastrophic APS may occur.

  9. Venous thromboembolism and subsequent hospitalisation due to acute arterial cardiovascular events: a 20-year cohort study

    DEFF Research Database (Denmark)

    Sørensen, Henrik Toft; Horvath-Puho, Erzsebet; Pedersen, Lars

    2007-01-01

    of myocardial infarction and stroke in 25,199 patients with deep venous thrombosis, 16,925 patients with pulmonary embolism, and 163,566 population controls. FINDINGS: For patients with deep venous thrombosis, the relative risks varied from 1.60 for myocardial infarction (95% CI 1.35-1.91) to 2.19 (1......-up, with 20-40% increases in risk for arterial cardiovascular events. Relative risks were similar for those with provoked and unprovoked deep venous thrombosis and pulmonary embolism. INTERPRETATION: Patients with venous thromboembolism have a substantially increased long-term risk of subsequent arterial......BACKGROUND: In some studies, venous thromboembolism has been associated with atherosclerosis and with the risk of arterial cardiovascular events such as myocardial infarction and stroke. Other studies, however, do not show this association. To help clarify these discrepant findings, we aimed...

  10. Overview of venous thromboembolism.

    Science.gov (United States)

    Abad Rico, José Ignacio; Llau Pitarch, Juan Vicente; Rocha, Eduardo

    2010-12-14

    Thrombosis occurs at sites of injury to the vessel wall, by inflammatory processes leading to activation of platelets, platelet adherence to the vessel wall and the formation of a fibrin network. A thrombus that goes on to occlude a blood vessel is known as a thromboembolism. Venous thromboembolism begins with deep vein thrombosis (DVT), which forms in the deep veins of the leg (calf) or pelvis. In some cases, the DVT becomes detached from the vein and is transported to the right-hand side of the heart, and from there to the pulmonary arteries, giving rise to a pulmonary embolism (PE). Certain factors predispose patients toward the development of venous thromboembolism (VTE), including surgery, trauma, hospitalization, immobilization, cancer, long-haul travel, increased age, obesity, major medical illness and previous VTE; in addition, there may also be a genetic component to VTE. VTE is responsible for a substantial number of deaths per annum in Europe. Anticoagulants are the mainstay of both VTE treatment and VTE prevention, and many professional organizations have published guidelines on the appropriate use of anticoagulant therapies for VTE. Treatment of VTE aims to prevent morbidity and mortality associated with the disease, and any long-term complications such as VTE recurrence or post-thrombotic syndrome. Generally, guidelines recommend the use of low molecular weight heparins (LMWH), unfractionated heparin (UFH) or fondaparinux for the pharmacological prevention and treatment of VTE, with the duration of therapy varying according to the baseline characteristics and risk profile of the individual. Despite evidence showing that the use of anticoagulation prevents VTE, the availability of several convenient, effective anticoagulant therapies and the existence of clear guideline recommendations, thromboprophylaxis is underused, particularly in patients not undergoing surgery. Greater adherence to guideline-recommended therapies, such as LMWH, which can be

  11. Incidence and prevention of venous thromboembolism in acutely ill hospitalized elderly Chinese

    Institute of Scientific and Technical Information of China (English)

    LI Xiao-ying; FAN Jin; CHENG You-qin; WANG Yan; YAO Chen; ZHONG Nan-shan

    2011-01-01

    Background As the third most frequent cardiovascular disease, venous thromboembolism (VTE) remains a major cause of morbidity and mortality in hospitalized patients. The aim of this study was to determine the incidence of VTE and steps for its prevention in acutely ill hospitalized elderly Chinese patients.Methods A prospective multi-center study was conducted from June 2006 to November 2007. A total of 607 patientsfrom 40 research centers in China were enrolled. Data of the patients' baseline characteristics, VTE events and prophylaxis/therapy methods were collected.Results Fifty-nine patients (9.7%) had an objectively confirmed VTE during the 90-day follow-up, of which, 59.3%occurred during the first week and 75% within 14 days. Forty-one patients died (6.6%) during the follow-up, 36.6% died within three weeks. We also found that medical disorders including respiratory failure (16.4%), acute brain infarction (15.6%), acute infectious diseases (14.3%), acute coronary artery syndrome (8.7%) and heart failure (7.6%) play a role in provoking VTE. Only 13.0% of the elderly patients with high risk of VTE used low dose unfractionated heparin, 7.1% used low molecular weight heparin, 5.4% used warfarin,0.3% used graduated compression stockings and none of them used intermittent pneumatic compression.Conclusions Our study showed similar results between our study and western countries in the VTE incidence by day 90 in elderly hospitalized patients with acute medical illness. Great caution must be applied in the care of acutely ill elderly hospitalized patients to deal with the complications of VTE. Application of safe and effective prophylaxes against embolism remains a critical challenge.

  12. Venous thromboembolism risk and prophylaxis in the acute hospital care setting: the Irish results of the ENDORSE study.

    LENUS (Irish Health Repository)

    Murphy, O

    2012-05-01

    ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting), is a multinational, cross-sectional survey of venous thromboembolism (VTE) risk prevalence and effective prophylaxis in the acute hospital care setting. Three Irish hospitals enrolled in the study. The American College of Chest Physicians (ACCP) guidelines were employed to evaluate VTE risk and prophylaxis. Of 552 patients, 297 (53.8%) and 255 (46.2%) were categorised as surgical or medical, respectively, with 175 (59%) surgical and 109 (43%) medical patients deemed to be at risk for VTE. Of these, only 112 (64%) and 51 (47%) received recommended VTE prophylaxis, respectively. The results are consistent with those observed in other countries and demonstrate a high prevalence of risk for VTE and a low rate of prophylaxis use, particularly in medical patients. Awareness of VTE guidelines should be an integral component of health policy.

  13. Management of venous thromboembolism in patients with acute leukemia at high bleeding risk: a multi-center study.

    Science.gov (United States)

    Napolitano, Mariasanta; Valore, Luca; Malato, Alessandra; Saccullo, Giorgia; Vetro, Calogero; Mitra, Maria Enza; Fabbiano, Francesco; Mannina, Donato; Casuccio, Alessandra; Lucchesi, Alessandro; Del Principe, Maria Ilaria; Candoni, Anna; Di Raimondo, Francesco; Siragusa, Sergio

    2016-01-01

    In the last decades, evaluation of clinically relevant thrombotic complications in patients with acute leukemia (AL) has been poorly investigated. The authors performed a multi-center study to evaluate the management of symptomatic venous thromboembolism (VTE) in adult patients with AL. The intention was to find as clinically relevant the following: symptomatic Venous Thrombosis (VT) occurred in typical (lower limbs) and atypical (cerebral, upper limbs, abdominal, etc) sites with or without pulmonary embolism (PE). Over a population of 1461 patients with AL, 22 cases of symptomatic VTE were recorded in hospitalized patients with a mean age of 54.6 years. The absolute incidence of VTE was 1.5%. VTE occurred during chemotherapy in 17/22 (77.2%) cases, mainly (14/17, 82.3%) during the induction phase. Treatment of acute VTE was based on Low Molecular Weight Heparin (LMWH) at full dosage for the first month from diagnosis and reduced dosage (75%) for the following months.

  14. Characteristics and risk factors of major and clinically relevant non-major bleeding in cancer patients receiving anticoagulant treatment for acute venous thromboembolism-the CATCH study

    NARCIS (Netherlands)

    Kamphuisen, P.W.; Lee, A.Y.Y.; Meyer, Guy; Bauersachs, R.; Janas, M.S.; Jarner, M.F.; Khorana, A.A.

    2015-01-01

    Background: Cancer patients with acute venous thromboembolism (VTE) receiving anticoagulant treatment have a substantial risk of bleeding complications. Aims: To assess the rate, site and risk factors of clinically relevant bleeding (CRB; major or clinically relevant non-major bleeding) in cancer pa

  15. Prevention of venous thromboembolism in hospitalized acutely ill medical patients: focus on the clinical utility of (low-dose fondaparinux

    Directory of Open Access Journals (Sweden)

    Di Nisio M

    2013-09-01

    Full Text Available Marcello Di Nisio,1,2 Ettore Porreca3 1Department of Medical, Oral and Biotechnological Sciences, University G D'Annunzio of Chieti-Pescara, Chieti, Italy; 2Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands; 3Department of Medicine and Aging, Centre for Aging Sciences, Internal Medicine Unit, University G D'Annunzio Foundation, Chieti, Italy Abstract: Venous thromboembolism (VTE is a frequent complication among acutely ill medical patients hospitalized for congestive heart failure, acute respiratory insufficiency, rheumatologic disorders, and acute infectious and/or inflammatory diseases. Based on robust data from randomized controlled studies and meta-analyses showing a reduced incidence of VTE by 40% to about 60% with pharmacologic thromboprophylaxis, prevention of VTE with low molecular weight heparin (LMWH, unfractionated heparin (UFH, or fondaparinux is currently recommended in all at-risk hospitalized acutely ill medical patients. In patients who are bleeding or are at high risk for major bleeding, mechanical prophylaxis with graduated compression stockings or intermittent pneumatic compression may be suggested. Thromboprophylaxis is generally continued for 6 to 14 days or for the duration of hospitalization. Selected cases could benefit from extended thromboprophylaxis beyond this period, although the risk of major bleeding remains a concern, and additional studies are needed to identify patients who may benefit from prolonged prophylaxis. For hospitalized acutely ill medical patients with renal insufficiency, a low dose (1.5 mg once daily of fondaparinux or prophylactic LMWH subcutaneously appears to have a safe profile, although proper evaluation in randomized studies is lacking. The evidence on the use of prophylaxis for VTE in this latter group of patients, as well as in those at higher risk of bleeding complications, such as patients with thrombocytopenia, remains scarce. For critically ill patients

  16. Risk factors for venous thromboembolism during pregnancy

    DEFF Research Database (Denmark)

    Jensen, Thomas Bo; Gerds, Thomas Alexander; Grøn, Randi;

    2013-01-01

    Pregnant women are at an increased risk of venous thromboembolism (VTE). Risk factors for VTE among pregnant women are not sufficiently investigated.......Pregnant women are at an increased risk of venous thromboembolism (VTE). Risk factors for VTE among pregnant women are not sufficiently investigated....

  17. Chronic Infection and Venous Thromboembolic Disease.

    Science.gov (United States)

    Epaulard, Olivier; Foote, Alison; Bosson, Jean-Luc

    2015-09-01

    Venous thromboembolic disease often arises as a complication of another pathological condition and/or triggering event. Infectious diseases result from both the direct action of the pathogens themselves and their effect on the immune system. The resulting inflammatory process and the coagulation and fibrinolysis processes share common pathways, explaining why infection is associated with thrombosis. In this brief overview, besides certain chronic infectious diseases, we also consider some acute infections, as the mechanisms are likely to be similar, particularly in the initial infective stage or the more acute episodes of a chronic infection. The infectious agent can be viral, bacterial, fungal, or parasitic. However, the literature on the link between infections and venous thromboembolism (VTE) is uneven, favoring infections that are found in more developed countries where physicians have access to VTE diagnostic tools. Thus, large epidemiological studies in this field are restricted to a limited number of the common chronic infectious diseases such as tuberculosis, while for other infections, particularly parasitic and fungal infections, the link with VTE is only evoked in a few scattered case reports.

  18. Venous thromboembolism in cancer patients

    Directory of Open Access Journals (Sweden)

    Mehmet Fuat Eren

    2013-09-01

    Full Text Available Venous thromboembolism (VTE is a major complication of cancer and represents an important cause of morbidity and mortality. The incidence of VTE is 0.6-7.8% in patients with cancer more than double the incidence of VTE in patients without cancer. The risk of VTE which includes deep venous thrombosis (DVT and pulmonary embolism (PE is increased two to seven fold in patients with cancer. VTE risk is especially high among certain groups such as hospitalized patients with cancer and those receiving active antineoplastic therapy. Also cancer patients, who undergoing major surgery, are increased risk of VTE. Trauma, long-haul travel, increased age, obesity, previous VTE and genetic component are also predisposing factors for VTE. Patients with cancer who develop VTE should be managed multidisciplinary treatment guidelines. The primary goal of thromboprophylaxis in patients with cancer is to prevent VTE. The large majority of cancer patients should be treated with therapeutic doses of unfractioned heparin (UFH or low molecular weight heparin (LMWH. Prophylaxis should include cancer patients who underwent major surgery for cancer and patients with a history of VTE.

  19. Microalbuminuria and Risk of Venous Thromboembolism

    NARCIS (Netherlands)

    Mahmoodi, Bakhtawar K.; Gansevoort, Ron T.; Veeger, Nic J. G. M.; Matthews, Abigail G.; Navis, Gerjan; Hillege, Hans L.; van der Meer, Jan

    2009-01-01

    Context Microalbuminuria (albuminuria 30-300 mg per 24-hour urine collection) is a well-known risk marker for arterial thromboembolism. It is assumed that microalbuminuria reflects generalized endothelial dysfunction. Hence, microalbuminuria may also predispose for venous thromboembolism (VTE). Obje

  20. Venous thromboembolism risk and prophylaxis in the acute hospital care setting: report from the ENDORSE study in Egypt

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    Goubran Hadi A

    2012-09-01

    Full Text Available Abstract Background Venous thromboembolism (VTE is a leading cause of hospital-related deaths worldwide. However, the proportion of patients at risk of VTE who receive appropriate prophylaxis in Egypt is unknown. The ENDORSE study in Egypt is part of a global initiative to uncover the incidence of high-risk surgical and medical patients and determine what proportion of these patients receive appropriate VTE prophylaxis. Methods Ten Egyptian hospitals participated in this observational study, enrolling all surgical and medical patients that met the study criteria. This resulted in a cohort of 1,008 patients in acute care facilities who underwent a retrospective chart review. Each patient’s VTE risk status and the presence or absence of appropriate prophylactic care was assessed according to the American College of Chest Physicians (ACCP guidelines 2004. Results Of the 1,008 patients enrolled, 395 (39.2% were found to be at high-risk for VTE. Overall, 227 surgical patients were at high-risk, although only 80 (35.2% received ACCP-recommended prophylaxis. Similarly, 55/268 (32.75% of high-risk medical patients received appropriate VTE prophylaxis. Low molecular weight heparin was the most commonly used anticoagulant, while mechanical prophylactic use was quite low (1.5% in high-risk patients. Conclusions In Egypt, more than one-third of all patients hospitalized for surgery or acute medical conditions are at high risk for developing VTE. However, only a small fraction of these patients receive appropriate VTE prophylaxis. Corrective measures are necessary for preventing VTE morbidity and mortality in these high risk patients.

  1. Effect of the time of diagnosis on outcome in patients with acute venous thromboembolism. Findings from the RIETE Registry.

    Science.gov (United States)

    Lecumberri, Ramón; Soler, Silvia; Del Toro, Jorge; Barba, Raquel; Rosa, Vladimir; Ciammaichella, Maurizio M; Monreal, Manuel

    2011-01-01

    The influence of the day of diagnosis (weekends vs. weekdays) on outcome in patients with acute venous thromboembolism (VTE) has not been thoroughly studied. We used the RIETE database to compare the clinical characteristics, treatment details, and mortality rate at 7 and 30 days, of all patients diagnosed with acute VTE on weekends versus those diagnosed on weekdays. Up to January 2010, 30,394 patients were included in RIETE, of whom 5,479 (18%) were diagnosed on weekends. Most clinical characteristics were similar in both groups, but patients diagnosed on weekends had less often cancer (20% vs. 22%; p=0.004), and presented more likely with pulmonary embolism (PE) than those diagnosed on weekdays (52% vs. 47%; p <0.001). Most patients in both groups received initial therapy with low-molecular-weight heparin (90% and 91%, respectively; p=0.01), then switched to vitamin K antagonists (72% and 71%, respectively; p=0.007). The 7-day mortality rate in patients presenting with PE was 2.75% in those diagnosed on weekends versus 3.00% in those diagnosed on weekdays (p=0.49). At 30 days, the mortality rate was 6.51% versus 6.06%, respectively (p=0.38). In patients presenting with deep vein thrombosis alone, the 7-day mortality rate in those diagnosed on weekends was 1.04% versuss 0.66% in those diagnosed on weekdays (p=0.053). The mortality rate at 30 days was of 3.41% versus 2.88% (p=0.14), respectively. In RIETE, the clinical characteristics, treatment strategies, and 7- and 30-day mortality rates of patients diagnosed on weekends were similar to those in patients diagnosed on weekdays.

  2. What happens after venous thromboembolism?

    Science.gov (United States)

    Baglin, T

    2009-07-01

    Venous thromboembolism (VTE) comprises deep vein thrombosis (DVT) with or without symptomatic pulmonary embolus (PE). The incidence of a first episode of VTE is 1.5 per 1000 person-years [1] (J Thromb Haemost, 2007;5:692-9) with a per-person lifetime incidence of 5% [2] (Arch Intern Med 1998;158:585-93). The risk of recurrence after DVT and PE is similar but the pattern of recurrence tends to reflect the initial event, for example recurrence with PE is more common in patients with previous PE [3] (Circulation 2003;107:122-30). At least 50% of patients, who present with symptomatic DVT, have asymptomatic PE and conversely, a majority presenting with symptomatic PE have asymptomatic DVT [3] (Circulation 2003;107:122-30). This suggests that whilst DVT and PE are manifestations of the same pathology, the phenotypic expression of the disease is predetermined. This may be an important consideration for long-term anticoagulant therapy as the risk of fatal PE is the greatest in patients with previous PE [4] (Ann Intern Med 2007;147:766-74). At present, the only factor reported to be associated with the pattern of VTE is the factor V Leiden mutation [5] (Thromb Haemost 1999;81:345-8). This suggests that the kinetics of thrombin generation and the resulting fibrinolytic response may influence clot structure and likelihood of embolization.

  3. Dabigatran for the treatment of venous thromboembolism.

    Science.gov (United States)

    Schellong, Sebastian M

    2015-08-01

    Venous thromboembolism (VTE) is a major cause of morbidity and mortality, and individuals with a first VTE are at risk of recurrent VTE. VTE treatment is divided into three phases: a first short phase of acute (traditionally parenteral) anticoagulation, followed by a second maintenance phase with an oral anticoagulant, which may be continued into a third extended maintenance phase in patients considered to be at increased risk of recurrent VTE. Vitamin K antagonists are effective oral anticoagulants but have well-known limitations; non-vitamin K oral anticoagulants including dabigatran etexilate (DE) were therefore developed. DE was approved for VTE treatment on the basis of an extensive clinical trial program that evaluated DE during both the maintenance phase and the extended maintenance phase of VTE treatment. This article provides a comprehensive overview of DE in VTE treatment, from its preclinical characteristics and pharmacokinetic properties to its efficacy and safety in major clinical trials.

  4. Multifaceted Intervention to Prevent Venous Thromboembolism in Patients Hospitalized for Acute Medical Illness: A Multicenter Cluster-Randomized Trial.

    Directory of Open Access Journals (Sweden)

    Pierre-Marie Roy

    Full Text Available Misuse of thromboprophylaxis may increase preventable complications for hospitalized medical patients.To assess the net clinical benefit of a multifaceted intervention in emergency wards (educational lectures, posters, pocket cards, computerized clinical decision support systems and, where feasible, electronic reminders for the prevention of venous thromboembolism.Prospective cluster-randomized trial in 27 hospitals. After a pre-intervention period, centers were randomized as either intervention (n = 13 or control (n = 14. All patients over 40 years old, admitted to the emergency room, and hospitalized in a medical ward were included, totaling 1,402 (712 intervention and 690 control and 15,351 (8,359 intervention and 6,992 control in the pre-intervention and intervention periods, respectively.Symptomatic venous thromboembolism or major bleeding (primary outcome occurred at 3 months in 3.1% and 3.2% of patients in the intervention and control groups, respectively (adjusted odds ratio: 1.02 [95% confidence interval: 0.78-1.34]. The rates of thromboembolism (1.9% vs. 1.9%, major bleedings (1.2% vs. 1.3%, and mortality (11.3% vs. 11.1% did not differ between the groups. Between the pre-intervention and intervention periods, the proportion of patients who received prophylactic anticoagulant treatment more steeply increased in the intervention group (from 35.0% to 48.2%: +13.2% than the control (40.7% to 44.1%: +3.4%, while the rate of adequate thromboprophylaxis remained stable in both groups (52.4% to 50.9%: -1.5%; 49.1% to 48.8%: -0.3%.Our intervention neither improved adequate prophylaxis nor reduced the rates of clinical events. New strategies are required to improve thromboembolism prevention for hospitalized medical patients.ClinicalTrials.gov NCT01212393.

  5. Familial risk of venous thromboembolism: a nationwide cohort study

    DEFF Research Database (Denmark)

    Sørensen, H T; Riis, A H; Diaz, L J

    2011-01-01

    Background: Venous thromboembolism has genetic determinants, but population-based data on familial risks are limited. Objectives: To examine the familial risk of venous thromboembolism. Methods: We undertook a nationwide study of a cohort of patients with deep venous thrombosis or pulmonary...... and expected number of venous thromboembolism cases among siblings, using population-specific, gender-specific and age-specific incidence rates. Results: We identified 30 179 siblings of 19 599 cases of venous thromboembolism. The incidence among siblings was 2.2 cases per 1000 person-years, representing...... with pulmonary embolism. Conclusion: Venous thromboembolism has a strong familial component....

  6. Recent research on venous thromboembolism in China: a brief report from China Venous Thromboembolism Study Group

    Institute of Scientific and Technical Information of China (English)

    ZHAI Zhen-guo; ZHAN Xi; YANG Yuan-hua; WANG Chen

    2010-01-01

    @@ Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary thrombo-embolism (PTE), carries significant mortality and morbidity. As a result of the increasing awareness and improvement in diagnostic facilities, the hospital admissions have increased dramatically in China. Recent publications have reported the increasing incidences of PTE and DVT in hospitalized patients.~(1-3)

  7. MRA for diagnosis of venous thromboembolism

    Energy Technology Data Exchange (ETDEWEB)

    Sostman, H. D. [Cornell University, Weill Medical College, Chair of Radiology, New York (United States)

    2001-12-01

    Direct imaging of pulmonary embolism (PE) and deep vein thrombosis (DVT) with CT, and potentially with MR, will continue to replace V/Q scintigraphy. Venous imaging with MR far detecting DVT is used in a few centers, and their published accuracy figures are impressive. Recent studies of MR pulmonary angiography for PE reported that sensitivity of MRA was 85-100%, specificity 95-96%, but this data must be confirmed in other centers and patient populations. MR has advantages compared with CT, which make it worthwhile to continue MR development. Ionizing radiation and iodinated contrast material are not used. Imaging the pulmonary arteries and then imaging whichever venous region is of clinical interest is practical in a single examination. Repeated examinations can be performed safely. New contrast materials will facilitate the practically and accuracy of the MR technique and perfusion imaging may increase sensitivity. MR also has disadvantages compared with CT. It does not image effectively the non-vascular compartment of the lungs. It is more expensive, patient monitoring is more cumbersome, and a routine technique, which embodies all of MR's potential advantages, has not been packaged and tested. Accordingly, helical CT is a realistic option in clinical management of patients with suspected PE in most centers, while clinical application of MR is limited to centers with appropriate MR expertise and technology. However, MR has a number of fundamental characteristics that make it potentially ideal modality for evaluating patients with suspected acute venous thromboembolic disease and further clinical research with MRA is warranted.

  8. Complement C3 and High Risk of Venous Thromboembolism

    DEFF Research Database (Denmark)

    Nørgaard, Ina; Nielsen, Sune Fallgaard; Nordestgaard, Børge Grønne

    2016-01-01

    BACKGROUND: Complement activation may contribute to venous thromboembolism, including deep venous thrombosis and pulmonary embolism. We tested the hypothesis that high complement C3 concentrations are associated with high risk of venous thromboembolism in the general population. METHODS: We...... similar for deep venous thrombosis and pulmonary embolism separately. The multivariable-adjusted hazard ratio for venous thromboembolism for a 1-g/L increase in complement C3 was 2.43 (1.74-3.40). CONCLUSIONS: High concentrations of complement C3 were associated with high risk of venous thromboembolism...... included 80 517 individuals without venous thromboembolism from the Copenhagen General Population Study recruited in 2003-2012. Plasma complement C3 concentrations were measured at baseline, and venous thromboembolism (n = 1176) was ascertained through April 2013 in nationwide registries. No individuals...

  9. Venous Thromboembolism and Atherosclerosis link

    Institute of Scientific and Technical Information of China (English)

    刘泽霖

    2011-01-01

    @@ Past always venous thrombosis and arterial thrombo-sis as a separate system to be discussed, the main reason is because there is between the anatomical and pathologi-cal physiological differences, the clinical manifestations are very different.

  10. [Prevention of venous thromboembolism in musculoskeletal surgery].

    Science.gov (United States)

    Pabinger-Fasching, Ingrid; Eichinger-Hasenauer, Sabine; Grohs, Josef; Hochreiter, Josef; Kastner, Norbert; Korninger, Hans Christian; Kozek-Langenecker, Sibylle; Marlovits, Stefan; Niessner, Herwig; Rachbauer, Franz; Ritschl, Peter; Wurnig, Christian; Windhager, Reinhard

    2014-05-01

    Musculoskeletal surgery is associated with a high risk of venous thrombosis and pulmonary embolism. The introduction of direct oral anticoagulants (DOAK) has broadened the possibilities for prevention of venous thromboembolism in the course of orthopedic and trauma surgery. Addressing this recent development, the Austrian Societies of Orthopedics and Orthopedic Surgery (ÖGO), Trauma Surgery (ÖGU), Hematology and Oncology (OeGHO) and of Anaesthesiology, Reanimation und Intensive Care Medicine (ÖGARI) have taken the initiative to create Austrian guidelines for the prevention of thromboembolism after total hip and knee replacement, hip fracture surgery, interventions at the spine and cases of minor orthopedic and traumatic surgery. Furthermore, the pharmacology of the DOAK and the pivotal trial data for each of the three currently available substances - apixaban, dabigatran, and rivaroxaban - are briefly presented. Separate chapters are dedicated to "anticoagulation and neuroaxial anesthesia" and "bridging".

  11. Venous thromboembolic disease. CT evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Goodman, L. R. [Medical College of Wisconsin, Pulmonary Medicine and Intensive Care, Dept. of Diagnostic Radiology, Milwaukee, WI (United States)

    2001-12-01

    Helical and multidetector CT has proven to be a valuable imaging modality for both pulmonary embolism and deep venous thrombosis. This paper will review the sensitivity and specificity of CT and discuss diagnostic algorithms utilizing CT and more established imaging technologies.

  12. Lay Stress on Study of Venous Thromboembolism

    Institute of Scientific and Technical Information of China (English)

    刘泽霖

    2002-01-01

    @@ Venous thromboembolism (VTE) including deep vein thrombosis(DVT) and pulmonary embolism(PE).Its occurs in about 1 per 1 000 individuals per years.Thrombosis is a serious disorder. It may be fatal by PE (case fatality rate of venous thrombosis is estimated at 1% to 2%)(Figure 1 ). A substantial proportion of these deaths occur in the postoperative period, and many events are fatal before diagnosis can be made and therapy initiated. Just as well, the prophylactic treatment of thrombosis is focused on preventing first events and recurrences through adequate knowledge about risks and risk factors.

  13. Venous thromboembolism with inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Hugh James Freeman

    2008-01-01

    Venous thrombosis and thromboembolism appear to be increased in patients with inflammatory bowel disease.Although several acquired and genetic risk factors are known,about half that develop a thromboembolic event have no identifiable risk factor.Control of the inflammatory process is thought to be the key factor in risk reduction for thrombotic events.Prophylactic use of anticoagulants is not universally recommended,but possible use should be reviewed in an individual patient after evaluation of the risks,such as hemorrhage,compared to potential benefits.Particular consideration should be given if there has been a prior thrombotic event,if hospitalization will require surgery,or if an underlying coagulation disorder is present.

  14. Direct oral anticoagulants and venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Massimo Franchini

    2016-09-01

    Full Text Available Venous thromboembolism (VTE, consisting of deep vein thrombosis and pulmonary embolism, is a major clinical concern associated with significant morbidity and mortality. The cornerstone of management of VTE is anticoagulation, and traditional anticoagulants include parenteral heparins and oral vitamin K antagonists. Recently, new oral anticoagulant drugs have been developed and licensed, including direct factor Xa inhibitors (e.g. rivaroxaban, apixaban and edoxaban and thrombin inhibitors (e.g. dabigatran etexilate. This narrative review focusses on the characteristics of these direct anticoagulants and the main results of published clinical studies on their use in the prevention and treatment of VTE.

  15. Venous Thromboembolism in Patients With Thrombocytopenia

    DEFF Research Database (Denmark)

    Baelum, Jens Kristian; Moe, Espen Ellingsen; Nybo, Mads

    2017-01-01

    . OBJECTIVES: To identify VTE risk factors and describe treatment and outcome (bleeding episodes and mortality) in patients with thrombocytopenia. PATIENTS/METHODS: Patients with thrombocytopenia (platelet count ... with anticoagulants. There was no difference in bleeding incidence between cases and controls. CONCLUSIONS: Several known VTE risk factors also seems to apply in patients with thrombocytopenia. Also, patients with thrombocytopenia may be VTE risk stratified based on platelet count and comorbidities. Finally, patients......BACKGROUND: Venous thromboembolism (VTE) is a frequent and potentially lethal condition. Venous thrombi are mainly constituted of fibrin and red blood cells, but platelets also play an important role in VTE formation. Information about VTE in patients with thrombocytopenia is, however, missing...

  16. [Venous thromboembolism in patients with cancer].

    Science.gov (United States)

    Lecumberri, Ramón; Feliu, Jesús; Rocha, Eduardo

    2006-06-03

    The association between neoplastic diseases and venous thromboembolism (VTE) is known since long time ago. The nature of this association is bidirectional. On one hand, cancer increases the incidence of venous thrombosis and, on the other hand, the hemostatic system does play a key role in the tumorigenesis process. However, despite recent advances in the field, prophylaxis and treatment of VTE in cancer patients is still a challenge, due to the complexity of this type of patients. This review is focused on some important points regarding management of VTE in cancer patients such as physiopathology, epidemiology, search for hidden malignancy, prognostic impact, prophylaxis in the medical and surgical setting, or initial and long-term treatment.

  17. Antithrombotic Agents in the Prevention and Treatment of Venous Thromboembolism

    Institute of Scientific and Technical Information of China (English)

    包承鑫

    2004-01-01

    @@ Venous thromboembolism is a major health problem,carrying significant morbidity and mortality, with an incidence that exceeds I per 1 000. Independent risk factors for venous thromboembolism include increasing age, male gender, surgery, trauma, hospital or nursing home confinement, neurologic disease with extremity paresis, central venous catheter/transvenous pacemaker, prior superficial vein thrombosis, and varicose, among women, the risk factors include pregnancy, oral contraceptives, and hormone replacement therapy.

  18. Characterizing the Risk Factors Associated With Venous Thromboembolism in Pediatric Patients After Central Venous Line Placement

    OpenAIRE

    Wisecup, Sarah; Eades, Shannan; Turiy, Yuliya

    2015-01-01

    OBJECTIVES: With the apparent increase in venous thromboembolism noted in the pediatric population, it is important to define which children are at risk for clots and to determine optimal preventative therapy. The purpose of this study was to determine the risk factors for venous thromboembolism in pediatric patients with central venous line placement.

  19. Controversies in the diagnosis of venous thromboembolism.

    Science.gov (United States)

    Le Gal, G; Righini, M

    2015-06-01

    Over the last decades, important advances have been made in the diagnosis of venous thromboembolism (VTE). Current diagnostic strategies rely on the sequential use of non-invasive diagnostic tests, based on the pretest clinical probability of disease. Diagnostic tests include D-dimer measurement, leg vein compression ultrasonography, chest computed tomography pulmonary angiography, or ventilation perfusion (V/Q) lung scan. The safety and cost-effectiveness of these strategies have been extensively validated. They have been widely implemented in clinical practice and have replaced the historical gold standard diagnostic tests (venography and pulmonary angiography). However, new challenges arise, including a lower clinical suspicion threshold and concerns on potential over-diagnosis of VTE. Moreover, the diagnostic management remains suboptimal in many subgroups of patients with suspected VTE: patients with prior VTE, pregnant women, or elderly patients.

  20. [Prophylaxis of venous thromboembolism after severe stroke].

    Science.gov (United States)

    Riabinkina, Iu V; Gnedovskaia, E V; Piradov, M A; Kuntsevich, G I

    2010-01-01

    Venous thromboembolism (VTE), a deep and superficial thrombosis and pulmonary embolism, is a very important problem of severe stroke. Pulmonary embolism (PE) significantly influences the course and outcome of severe stroke. The cause of this effect lies not only in severe patient's condition, high risk of VTE and difficulties in diagnosis of VTE but in still common limits in prophylaxis and treatment of PE in severe stroke, first of all, in brain hemorrhages and large brain infarctions with secondary hemorrhage. The paper presents the main principles and methods of prophylaxis of VTE in severe stroke. The suggested approach allows to decrease the frequency of VTE and fatal outcomes in severe stroke in the modern neuro-intensive care units.

  1. Contraception-related venous thromboembolism in adolescents.

    Science.gov (United States)

    O'Brien, Sarah H

    2014-02-01

    Venous thromboembolism (VTE) is a rare but serious complication of combined hormonal contraception. While the absolute risk of VTE is low in adolescents, thrombotic events in contraception users younger than the age of 20 years account for 5 to 10% of total contraception-related VTE events in population studies, because of the high frequency of contraception use in adolescents. An increased risk of VTE exists not only with oral contraceptives, but also the contraceptive patch and vaginal ring. Most adolescents who experience contraception-related VTE have additional transient or inherited thrombotic risk factors at the time of VTE. Although the presence of inherited thrombophilia impacts the risk of contraception-related VTE, thrombophilia screening before contraception prescribing should be targeted only to high-risk populations. Pediatric institutions, caregivers, and young women need to be aware of the risk of VTE with estrogen-containing contraception, and maintain a high index of suspicion for this complication in women using these agents.

  2. Inflammation as a cause of venous thromboembolism.

    Science.gov (United States)

    Saghazadeh, Amene; Rezaei, Nima

    2016-03-01

    Inflammatory markers are highly amenable to appraise and adjust and could already serve as a diagnostic indicator and also as a predictor of prognosis over the management of many health problems. Inflammation is implicated in venous thromboembolism (VTE). However there is still an intense curiosity about whether it is a cause or only a consequence of the thromboembolic process. The more likely scenario is that some inflammatory mediators contribute to the development of VTE, which per se induces an inflammatory reaction. Here we will review evidences supporting the role of inflammation as a cause of VTE. Genetic association studies have provided possible links between inflammation-related genetic variants, especially cytokines (e.g. IL-1, IL-4, IL-6, IL-10, and IL-13), and VTE, leading to establish the fundamental role of genetic background in predisposition to VTE and variable inflammatory processes in individuals. Additionally, several inflammation-related conditions including aging, autoimmune disease, cancer, cardiovascular diseases, hormone replacement therapy, infectious diseases, metabolic diseases, overweight or obesity, pregnancy or postpartum, respiratory diseases, and trauma have been associated with an increased risk of VTE. At this moment, despite their theoretical potential, to achieve the implementation of the inflammation-related laboratory tests in practice is a long task and future studies with larger sample sizes are required to address whether the properties of the inflammatory process, particularly intensity and duration, are useful in determining the risk of VTE and following outcomes.

  3. Statins and prevention of venous thromboembolism: Myth or reality?

    Science.gov (United States)

    Gaertner, Sébastien; Cordeanu, Eléna-Mihaela; Nouri, Salah; Mirea, Corina; Stephan, Dominique

    2016-03-01

    The pleiotropic effects of statins, beyond their cholesterol-lowering properties, are much debated. In primary prevention, several observational cohort and case-control studies appear to show that statins reduce the incidence of venous thromboembolism by about 30%. In a single randomized placebo-controlled clinical trial (JUPITER), which included 17,000 patients, rosuvastatin 20mg/day reduced the risk of venous thromboembolism by 43%. However, these patients were at low risk of venous thromboembolism, and the frequency of the event was, in principle, low. In secondary prevention, several observational studies and post-hoc analyses of randomized clinical trials have suggested that statins may prevent recurrence of venous thromboembolism. However, none of these studies had enough scientific weight to form the basis of a recommendation to use statins for secondary prevention. The putative preventive effect of statins appears to be independent of plasma cholesterol concentration and could be a pharmacological property of the statin class, although a dose-effect relationship has not been demonstrated. The mechanism through which statins might prevent venous thrombosis is thought to involve their anti-inflammatory and antioxidant effects or perhaps a more specific action, by blocking the degradation of antithrombotic proteins. A mechanism involving the action of statins on interactions between risk factors for atherosclerosis and venous thromboembolism is supported by some studies, but not all. In the absence of firm evidence, statins cannot currently be recommended for primary or secondary prevention of venous thromboembolism.

  4. Association of Traditional Cardiovascular Risk Factors with Venous Thromboembolism

    DEFF Research Database (Denmark)

    Mahmoodi, Bakhtawar K; Cushman, Mary; Næss, Inger Anne

    2017-01-01

    BACKGROUND: -There is much controversy surrounding the association of traditional cardiovascular disease (CVD) risk factors with venous thromboembolism (VTE). METHODS: - We performed an individual level random-effect meta-analysis including 9 prospective studies with measured baseline CVD risk...

  5. The up-to-date management of venous thromboembolism.

    Science.gov (United States)

    Chakrabarti, Anob M

    2015-08-01

    There have been a number of developments in the management of venous thromboembolism over the past few years. Old questions, such as thrombolysis, have been revisited in recent trials. New initiatives, such as ambulatory care pathways, are being established across the country. This conference brought together doctors from the UK, USA, Spain and Australia to review the up-to-date management of venous thromboembolism.

  6. Prophylaxis against venous thromboembolism in orthopedic surgery

    Institute of Scientific and Technical Information of China (English)

    LIU Lin-tao; MA Bao-tong

    2006-01-01

    Venous thromboembolism ( VTE), which is manifested as deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a significant cause of death, disability,and discomfort. They are frequent complications of various surgical procedures. The aging population and the survival of more severely injured patients may suggest an increasing risk of thromboembolism in the trauma patients. Expanded understanding of the population at risk challenges physicians to carefully examine risk factors for VTE to identify high-risk patients who can benefit from prophylaxis. An accurate knowledge of evidence-based risk factors is important in predicting and preventing postoperative DVT, and can be incorporated into a decision support system for appropriate thromboprophylaxis use.Standard use of DVT prophylaxis in a high-risk trauma population leads to a low incidence of DVT. The incidence of VTE is common in Asia. The evaluation includes laboratory tests, Doppler test and phlebography. Screening Doppler sonography should be performed for surveillance on all critically injured patients to identify DVT. D-Dimer is a useful marker to monitor prophylaxis in trauma surgery patients. The optimal time to start prophylaxis is between 2 hours before and 10 hours after surgery, but the risk of PE continues for several weeks. Thromboprophylaxis includes graduated compression stockings and anticoagulants for prophylaxis. Anticoagulants include Warfarin, which belongs to Vitamin K antagonists, unfractionated heparin,low molecular weight heparins, factor Xa indirect inhibitor Fondaparinux, and the oral Ⅱa inhibitor Melagatran and ximelagatran. Recombinant human soluble thrombomodulin is a new and highly effective antithrombotic agent. Prophylactic placement of vena caval filters in selected trauma patients may decrease the incidence of PE. The indications for prophylactic inferior vena cava filter insertion include prolonged immobilization with multiple injuries, closed head injury, pelvic

  7. Prophylaxis against venous thromboembolism in orthopedic surgery.

    Science.gov (United States)

    Liu, Lin-tao; Ma, Bao-tong

    2006-08-01

    Venous thromboembolism (VTE), which is manifested as deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a significant cause of death, disability, and discomfort. They are frequent complications of various surgical procedures. The aging population and the survival of more severely injured patients may suggest an increasing risk of thromboembolism in the trauma patients. Expanded understanding of the population at risk challenges physicians to carefully examine risk factors for VTE to identify high-risk patients who can benefit from prophylaxis. An accurate knowledge of evidence-based risk factors is important in predicting and preventing postoperative DVT, and can be incorporated into a decision support system for appropriate thromboprophylaxis use. Standard use of DVT prophylaxis in a high-risk trauma population leads to a low incidence of DVT. The incidence of VTE is common in Asia. The evaluation includes laboratory tests, Doppler test and phlebography. Screening Doppler sonography should be performed for surveillance on all critically injured patients to identify DVT. D-Dimer is a useful marker to monitor prophylaxis in trauma surgery patients. The optimal time to start prophylaxis is between 2 hours before and 10 hours after surgery, but the risk of PE continues for several weeks. Thromboprophylaxis includes graduated compression stockings and anticoagulants for prophylaxis. Anticoagulants include Warfarin, which belongs to Vitamin K antagonists, unfractionated heparin, low molecular weight heparins, factor Xa indirect inhibitor Fondaparinux, and the oral IIa inhibitor Melagatran and ximelagatran. Recombinant human soluble thrombomodulin is a new and highly effective antithrombotic agent. Prophylactic placement of vena caval filters in selected trauma patients may decrease the incidence of PE. The indications for prophylactic inferior vena cava filter insertion include prolonged immobilization with multiple injuries, closed head injury, pelvic

  8. The HAS-BLED Score Identifies Patients with Acute Venous Thromboembolism at High Risk of Major Bleeding Complications during the First Six Months of Anticoagulant Treatment.

    Directory of Open Access Journals (Sweden)

    Judith Kooiman

    Full Text Available The HAS-BLED score enables a risk estimate of major bleeds in patients with atrial fibrillation on vitamin K-antagonists (VKA treatment, but has not been validated for patients with venous thromboembolism (VTE. We analyzed whether the HAS-BLED score accurately identifies patients at high risk of major bleeds during VKA treatment for acute VTE.Medical records of 537 patients with acute VTE (primary diagnosis pulmonary embolism in 223, deep vein thrombosis in 314 starting VKA treatment between 2006-2007 were searched for items on the HAS-BLED score and the occurrence of major bleeds during the first 180 days of follow-up. The hazard ratio (HR for the occurrence of major bleeds comparing non-high with high-risk patients as defined by a HAS-BLED score ≥ 3 points was calculated using Cox-regression analysis.Major bleeds occurred in 11/537 patients (2.0%, 5.2/100 person years, 95% CI 2.8-9.2. Cumulative incidences of major bleeds were 1.3% (95% CI 0.1-2.5 in the non-high (HAS-BLED < 3 and 9.6% (95%CI 2.2-17.0 in the high-risk group (HAS-BLED ≥ 3, (p <0.0001 by Log-Rank test, with a HR of 8.7 (95% CI 2.7-28.4. Of the items in the HAS-BLED score, abnormal renal function (HR 10.8, 95% CI 1.9-61.7 and a history of bleeding events (HR 10.4, 95% CI 2.5-42.5 were independent predictors of major bleeds during follow-up.Acute VTE patients with a HAS-BLED score ≥ 3 points are at increased risk of major bleeding. These results warrant for correction of the potentially reversible risk factors for major bleeding and careful International Normalized Ratio monitoring in acute VTE patients with a high HAS-BLED score.

  9. The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism.

    Science.gov (United States)

    Jaffray, Julie; Bauman, Mary; Massicotte, Patti

    2017-01-01

    The use of central venous catheters (CVCs) in children is escalating, which is likely linked to the increased incidence of pediatric venous thromboembolism (VTE). In order to better understand the specific risk factors associated with CVC-VTE in children, as well as available prevention methods, a literature review was performed. The overall incidence of CVC-VTE was found to range from 0 to 74%, depending on the patient population, CVC type, imaging modality, and study design. Throughout the available literature, there was not a consistent determination regarding whether a particular type of central line (tunneled vs. non-tunneled vs. peripherally inserted vs. implanted), catheter material, insertion technique, or insertion location lead to an increased VTE risk. The patient populations who were found to be most at risk for CVC-VTE were those with cancer, congenital heart disease, gastrointestinal failure, systemic infection, intensive care unit admission, or involved in a trauma. Both mechanical and pharmacological prophylactic techniques have been shown to be successful in preventing VTE in adult patients, but studies in children have yet to be performed or are underpowered. In order to better determine true CVC-VTE risk factors and best preventative techniques, an increase in large, prospective pediatric trials needs to be performed.

  10. The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism

    Science.gov (United States)

    Jaffray, Julie; Bauman, Mary; Massicotte, Patti

    2017-01-01

    The use of central venous catheters (CVCs) in children is escalating, which is likely linked to the increased incidence of pediatric venous thromboembolism (VTE). In order to better understand the specific risk factors associated with CVC-VTE in children, as well as available prevention methods, a literature review was performed. The overall incidence of CVC-VTE was found to range from 0 to 74%, depending on the patient population, CVC type, imaging modality, and study design. Throughout the available literature, there was not a consistent determination regarding whether a particular type of central line (tunneled vs. non-tunneled vs. peripherally inserted vs. implanted), catheter material, insertion technique, or insertion location lead to an increased VTE risk. The patient populations who were found to be most at risk for CVC-VTE were those with cancer, congenital heart disease, gastrointestinal failure, systemic infection, intensive care unit admission, or involved in a trauma. Both mechanical and pharmacological prophylactic techniques have been shown to be successful in preventing VTE in adult patients, but studies in children have yet to be performed or are underpowered. In order to better determine true CVC-VTE risk factors and best preventative techniques, an increase in large, prospective pediatric trials needs to be performed. PMID:28168186

  11. New anticoagulants for the prevention and treatment of venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Simon J McRae

    2005-04-01

    Full Text Available Simon J McRae, Jeffrey S GinsbergDepartment of Medicine, McMaster University, Hamilton, ON, CanadaAbstract: Anticoagulant therapy is effective at preventing the development of venous thromboembolism in high-risk patients, and reduces morbidity and mortality in individuals with established thromboembolic disease. Vitamin K antagonists and heparins are currently the most commonly used anticoagulant drugs, but they have practical limitations. Therefore, new antithrombotic agents with predictable dose-responses (thereby decreasing the need for monitoring without compromising efficacy or safety, ideally available in an oral formulation and with a rapidly reversible anticoagulant effect, are needed. New drugs fulfilling some of the above criteria have been developed and have proven to be effective agents for the treatment and prevention of venous thromboembolism.Keywords: venous thromboembolism, anticoagulants, antithrombotic

  12. Inadequate use of prophylaxis against venous thromboembolism in Danish medical departments

    DEFF Research Database (Denmark)

    Kolodzeike, Piotr; Wille-Jørgensen, Peer; Rasmussen, Morten Schnack;

    2011-01-01

    Venous thromboembolism (VTE) constitutes a major risk factor in hospitalized acutely ill medical patients. It has been demonstrated in numerous papers that by using different forms of prophylaxis, a significant reduction of the incidence of VTE can be achieved. In this article we assessed...

  13. Feasibility and safety of rehabilitation after venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Noack F

    2015-07-01

    one. Four patients (0.9% had to be transferred to a primary care hospital for non-PE-associated reasons (acute coronary syndrome, pharyngeal abscess, and acute abdominal problems. No influence of any of the physical activity interventions on the incidence of any AE was found. Conclusion: Since PE is a life-threatening disease, it seems reasonable to recommend rehabilitation at least in PE patients with an intermediate or high risk. It is shown for the first time in this study that a standard rehabilitation program after PE is safe. However, efficacy and safety in the long term need to be studied prospectively. Keywords: venous thromboembolism, pulmonary embolism, rehabilitation

  14. [Current and future diagnostic strategies in venous thromboembolic disease].

    Science.gov (United States)

    Gabriel Botella, F; Labiós Gómez, M; Brasó Aznar, J V; Llavador Ros, G; Bort Martí, J

    1999-08-01

    Thromboembolic disease (TD), which includes deep venous thrombosis (DVT) and pulmonary embolism (PE), is the most common acute cardiovascular condition after ischemic cardiopathy and stroke. It is often difficult to diagnose, as it is well-known that half of PE episodes appear are recognized while the patient is still alive and which appear in 30-40% of symptomatic patients. Nonetheless, there are two well-differentiated phases in the diagnosis of TD: the suspicion, and the diagnosis. The first is very important, and is within the competence of any physician. The second can be ratified when carrying out specific tests. We have developed successive steps in the two phases of diagnosis, we critically review the distinct parts currently implicated in the strategic diagnosis of TD. Finally, we analyze the new diagnostic techniques to substitute, possibly, angiography in many cases, and perhaps to include ventilation/perfusion (V/Q) pulmonary gammagraphy, once become generally available.

  15. [New strategies in the secondary prevention of relapsing venous thromboembolism].

    Science.gov (United States)

    Lecumberri, Ramón; Feliu, Jesús; Rocha, Eduardo

    2005-11-26

    Treatment of venous thromboembolism includes an acute phase treatment, followed by a secondary prophylaxis period. Oral anticoagulants have been the usual treatment for secondary prophylaxis of VTE. However, some issues regarding oral anticoagulant treatment (OAT), such as length or intensity are controversial. The appropriate duration of OAT depends on the individual risk of both, thrombotic recurrence and hemorrhagic complications. Recent studies suggest that full-dose OAT is more effective and as safe as low-dose OAT. On the other hand, low-molecular-weight heparins are an alternative for the secondary prophylaxis of VTE, being the treatment of choice in patients with cancer or during pregnancy. Probably, new antithrombotic drugs such as idraparinux or ximelagatran, will be considered as another therapeutic alternative in a near future.

  16. Oral contraceptives and venous thromboembolism: a five-year national case-control study

    DEFF Research Database (Denmark)

    Lidegaard, Øjvind; Edström, Birgitte; Kreiner, Svend

    2002-01-01

    Venous thromboembolism; Oral contraceptives; Pulmonary embolism; Third-generation; Second-generation; Pill Scare......Venous thromboembolism; Oral contraceptives; Pulmonary embolism; Third-generation; Second-generation; Pill Scare...

  17. Differentiation of parenteral anticoagulants in the prevention and treatment of venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Adiguzel Cafer

    2011-03-01

    Full Text Available Abstract Background The prevention of venous thromboembolism has been identified as a leading priority in hospital safety. Recommended parenteral anticoagulant agents with different indications for the prevention and treatment of venous thromboembolism include unfractionated heparin, low-molecular-weight heparins and fondaparinux. Prescribing decisions in venous thromboembolism management may seem complex due to the large range of clinical indications and patient types, and the range of anticoagulants available. Methods MEDLINE and EMBASE databases were searched to identify relevant original articles. Results Low-molecular-weight heparins have nearly replaced unfractionated heparin as the gold standard antithrombotic agent. Low-molecular-weight heparins currently available in the US are enoxaparin, dalteparin, and tinzaparin. Each low-molecular-weight heparin is a distinct pharmacological entity with different licensed indications and available clinical evidence. Enoxaparin is the only low-molecular-weight heparin that is licensed for both venous thromboembolism prophylaxis and treatment. Enoxaparin also has the largest body of clinical evidence supporting its use across the spectrum of venous thromboembolism management and has been used as the reference standard comparator anticoagulant in trials of new anticoagulants. As well as novel oral anticoagulant agents, biosimilar and/or generic low-molecular-weight heparins are now commercially available. Despite similar anticoagulant properties, studies report differences between the branded and biosimilar and/or generic agents and further clinical studies are required to support the use of biosimilar low-molecular-weight heparins. The newer parenteral anticoagulant, fondaparinux, is now also licensed for venous thromboembolism prophylaxis in surgical patients and the treatment of acute deep-vein thrombosis; clinical experience with this anticoagulant is expanding. Conclusions Parenteral

  18. Venous Thromboembolism After Knee Arthroscopy in Undiagnosed Familial Thrombophilia.

    Science.gov (United States)

    Jetty, Vybhav; Glueck, Charles J; Freiberg, Richard A; Wang, Ping

    2016-11-01

    Venous thromboembolism is uncommon after knee arthroscopy, and there are no guidelines for thromboprophylaxis in elective routine knee arthroscopy. Preoperative evaluation of common thrombophilias should provide guidance for postarthroscopy thromboprophylaxis in otherwise healthy patients who are at high risk for venous thromboembolism. This study assessed 10 patients with venous thromboembolism after total hip or knee arthroplasty. Patients were assessed if venous thromboembolism occurred within 6 months after knee arthroscopy (n=10) or total hip or knee arthroplasty (n=21). This study assessed gene mutations (factor V Leiden, prothrombin G20210A, plasminogen activator inhibitor, methylenetetrahydrofolate reductase) and serologic thrombophilias (high levels of factors VIII and XI, homocysteine, anticardiolipin immunoglobulin G and immunoglobulin M antibodies, and lupus anticoagulant; low antigenic protein C, S, and free S; and antithrombin III deficiency). The same coagulation data were obtained for normal subjects (n=110). The major thrombophilias in the arthroscopy group were factor V Leiden heterozygosity (40%), high factor VIII level (50%), and high homocysteine (30%). The respective values in control subjects were 2% (P=.0004), 7% (P=.0011), and 5% (P=.02). When the arthroscopy group was compared with the 21 patients who had venous thromboembolism after total hip or knee arthroplasty, the sole difference was factor V Leiden heterozygosity, which was 40% vs 0%, respectively (P=.007). Although venous thromboembolism after knee arthroscopy is uncommon, to identify high-risk patients and guide postoperative thromboprophylaxis, the authors suggest routine preoperative measurement of 3 common familial thrombophilias: factor V Leiden, factor VIII, and homocysteine. [Orthopedics. 2016; 39(6):e1052-e1057.].

  19. Prevention and treatment of venous thromboembolism in the elderly patient

    Directory of Open Access Journals (Sweden)

    Enrico Tincani

    2007-07-01

    Full Text Available Enrico Tincani1, Mark A Crowther2, Fabrizio Turrini1, Domenico Prisco31Unità Operativa di Medicina Interna Cardiovascolare, Nuovo Ospedale Civile di Modena S.Agostino-Estense, Modena, Italy; 2McMaster University, St. Joseph’s Hospital and McMaster University, Hamilton, Canada; 3Dipartimento di Area Critica Medico Chirurgica, Universita’ di Firenze, Florence, ItalyAbstract: Venous thromboembolism (VTE is a common complication among hospitalized patients. Pharmacological thromboprophylaxis has emerged as the cornerstone for VTE prevention. As trials on thromboprophylaxis in medical patients have proven the efficacy of both lowmolecular-weight heparins (LMWHs and unfractionated heparin (UFH, all acutely medical ill patients should be considered for pharmacological thromboprophylaxis. Unlike in the surgical setting where the risk of associated VTE attributable to surgery is well recognized, and where widespread use of pharmacological thromboprophylaxis and early mobilization has resulted in significant reductions in the risk of VTE, appropriate VTE prophylaxis is under-used in medical patients. Many reasons for this under-use have been identified, including low perceived risk of VTE in medical patients, absence of optimal tools for risk assessment, heterogeneity of patients and their diseases, and fear of bleeding complications. A consistent group among hospitalized medical patients is composed of elderly patients with impaired renal function, a condition potentially associated with bleeding. How these patients should be managed is discussed in this review. Particular attention is devoted to LMWHs and fondaparinux and to measures to improve the safety and the efficacy of their use.Keywords: venous thromboembolism, elderly patient, fondaparinux

  20. Review of the cost of venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Fernandez MM

    2015-08-01

    Full Text Available Maria M Fernandez,1 Susan Hogue,1 Ronald Preblick,2 Winghan Jacqueline Kwong2 1RTI-Health Solutions, Market Access and Outcomes Strategy, Research Triangle Park, NC, 2Daiichi Sankyo, Inc., Health Economics & Outcomes Research, Parsippany, NJ, USA Background: Venous thromboembolism (VTE is the second most common medical complication and a cause of excess length of hospital stay. Its incidence and economic burden are expected to increase as the population ages. We reviewed the recent literature to provide updated cost estimates on VTE management. Methods: Literature search strategies were performed in PubMed, Embase, Cochrane Collaboration, Health Economic Evaluations Database, EconLit, and International Pharmaceutical Abstracts from 2003–2014. Additional studies were identified through searching bibliographies of related publications. Results: Eighteen studies were identified and are summarized in this review; of these, 13 reported data from the USA, four from Europe, and one from Canada. Three main cost estimations were identified: cost per VTE hospitalization or per VTE readmission; cost for VTE management, usually reported annually or during a specific period; and annual all-cause costs in patients with VTE, which included the treatment of complications and comorbidities. Cost estimates per VTE hospitalization were generally similar across the US studies, with a trend toward an increase over time. Cost per pulmonary embolism hospitalization increased from $5,198–$6,928 in 2000 to $8,764 in 2010. Readmission for recurrent VTE was generally more costly than the initial index event admission. Annual health plan payments for services related to VTE also increased from $10,804–$16,644 during the 1998–2004 period to an estimated average of $15,123 for a VTE event from 2008 to 2011. Lower costs for VTE hospitalizations and annualized all-cause costs were estimated in European countries and Canada. Conclusion: Costs for VTE treatment are

  1. Risk factors for venous thromboembolism in 1.3 million pregnancies: a nationwide prospective cohort.

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    Rie Adser Virkus

    Full Text Available OBJECTIVE: To quantify risk factors for venous thromboembolism during pregnancy and the puerperal period. DESIGN: In a nationwide prospective cohort study we followed pregnant and puerperal women in Denmark from 1995 to 2009 for venous thromboembolism. Information on risk factors and confounders was retrieved from national registries. The diagnosis of venous thromboembolism was confirmed through medical charts. We calculated adjusted incidence rates per 10,000 women years and used Poisson regression to estimate effects during pregnancy and the puerperal period. RESULTS: We studied 1,297,037 pregnancies and related puerperal periods, during which there were 748 venous thromboembolisms. The incidence rate for venous thromboembolism during a pregnancy with and without hospitalization for hyperemesis was 15.2/10,000 yr and 6.3/10,000 yr, respectively, (adjusted rate ratio: 2.5 (95%-confidence interval; 1.4-4.5. The incidence rate among women with multiple pregnancies was 18.2/10,000 yr and 6.3/10,000 yr in singletons (adjusted rate ratio: 2.8 (1.9-4.2. Increased risk was found with hospitalization during pregnancy or the puerperal period with incidence rates of 42.1/10.000 and 54.7/10.000, respectively, (rate ratios: 12.2 (8.7-17 and 5.9 (4.0-8.8. Women hospitalized with infections during pregnancy had incidence rates of 25.9/10,000 yr and 29.3/10,000 yr during pregnancy and the puerperal period, respectively, and of 62.7/10,000 yr if hospitalized with infection in the puerperal period. Puerperal venous thromboembolism was associated with hospitalization for preeclampsia and intrauterine growth restriction/fetal death with incidence rates of 45.8/10,000 yr and 18.3/10,000 yr, respectively (rate ratio: 5.0 (3.1-7.8 and 1.9 (0.9-4.4. Additionally puerperal venous thromboembolism was associated with obesity, elective and acute caesarean sections and major postpartum bleeding with incidence rates of 25.5/10,000 yr, 23.2/10,000 yr, 34.0/10,000 yr and 20

  2. Statins, fibrates, and venous thromboembolism: A meta-analysis

    NARCIS (Netherlands)

    Squizzato, A.; Galli, M.; Romualdi, E.; Dentali, F.; Kamphuisen, P.W.; Guasti, L.; Venco, A.; Ageno, W.

    2010-01-01

    Background/Aims: Recent data suggest a possibile benefit of lipid-lowering drugs, in particular statins, in preventing venous thromboembolism (VTE). The aim of this systematic review of the literature is to assess the effect of lipid-lowering drugs on VTE occurrence. Materials and methods: MEDLINE a

  3. Incidental venous thromboembolism in cancer patients: prevalence and consequence

    NARCIS (Netherlands)

    Douma, Renée A.; Kok, Maayke G.M.; Verberne, Lisa M.; Kamphuisen, Pieter W.; Büller, Harry R.

    2010-01-01

    Introduction: Careful re-evaluation of CT-scans for cancer staging frequently reveals unsuspected venous thromboembolism (VTE) on CT-scans. However, it is unknown how often these findings lead to anticoagulant treatment in daily clinical practice. Methods: Reports from thoracic and/or abdominal CT-s

  4. How I treat pregnancy-related venous thromboembolism

    NARCIS (Netherlands)

    S. Middeldorp

    2011-01-01

    Venous thromboembolism (VTE) complicates ~ 1 to 2 of 1000 pregnancies, with pulmonary embolism being a leading cause of maternal mortality and deep vein thrombosis an important cause of maternal morbidity, also on the long term. However, a strong evidence base for the management of pregnancy-related

  5. Venous thromboembolism and occult cancer: impact on clinical practice.

    Science.gov (United States)

    Gheshmy, Afshan; Carrier, Marc

    2016-04-01

    Unprovoked venous thromboembolism (VTE) can be the first manifestation of cancer. Given this relationship between unprovoked VTE and cancer, it is appealing for clinicians to screen their patients with a first episode of acute unprovoked VTE for a potential occult malignancy. Five different studies have compared a limited (thorough history and physical exam, basic bloodwork) to a more extensive occult cancer screening strategy (e.g. computed tomography, fludeoxyglucose positron emission tomography, etc.). Most of these studies have failed to show that an extensive occult cancer screening strategy diagnoses more occult cancer (including early cancers), misses fewer cancers during follow-up or improves overall and/or cancer-related mortality suggesting that extensive occult cancer screening should not be performed routinely. Therefore, patients with a first unprovoked VTE should undergo a limited cancer screening only and clinicians should ensure that their patients are up to date regarding age- and gender- specific cancer screening (colon, breast, cervix and prostate) as per their national recommendations. Current evidence does not support a net clinical benefit to perform an extensive occult cancer screening on all patients, and a decision to do additional testing should be made on a case by case basis.

  6. Diagnosis of suspected venous thromboembolic disease in pregnancy

    Energy Technology Data Exchange (ETDEWEB)

    Scarsbrook, A.F. [Department of Radiology, Churchill Hospital, Oxford Radcliffe NHS Trust, Headington, Oxford (United Kingdom); Evans, A.L. [Department of Radiology, Churchill Hospital, Oxford Radcliffe NHS Trust, Headington, Oxford (United Kingdom); Owen, A.R. [Department of Radiology, Churchill Hospital, Oxford Radcliffe NHS Trust, Headington, Oxford (United Kingdom); Gleeson, F.V. [Department of Radiology, Churchill Hospital, Oxford Radcliffe NHS Trust, Headington, Oxford (United Kingdom)]. E-mail: fergus.gleeson@radiology.oxford.ac.uk

    2006-01-15

    Venous thromboembolic disease is a leading cause of maternal mortality during pregnancy. Early and accurate radiological diagnosis is essential as anticoagulation is not without risk and clinical diagnosis is unreliable. Although the disorder is potentially treatable, unnecessary treatment should be avoided. Most of the diagnostic imaging techniques involve ionizing radiation which exposes both the mother and fetus to finite radiation risks. There is a relative lack of evidence in the literature to guide clinicians and radiologists on the most appropriate method of assessing this group of patients. This article will review the role of imaging of suspected venous thromboembolic disease in pregnant patients, highlight contentious issues such as radiation risk, intravenous contrast use in pregnancy and discuss the published guidelines, as well as suggesting an appropriate imaging algorithm based on the available evidence.

  7. Venous Thromboembolism Prophylaxis in Plastic Surgery: A Literature Review.

    Science.gov (United States)

    Hernandez, Sergio; Valdes, Jorge; Salama, Moises

    2016-06-01

    Venous thromboembolism (VTE) is a major health concern because it increases morbidity and mortality after a surgical procedure. A number of well-defined, evidence-based guidelines are available delineating suitable use of prophylaxis to prevent deep vein thrombosis and pulmonary embolism. Despite the available literature, there are clear gaps between recommendations and clinical practice, affecting the incidence of VTE. Plastic surgeons underuse the substantiated literature and risk stratification tools that are available to decrease the incidence of VTE in the office-based surgical setting because of fear of bleeding or hematoma complications postoperatively. Venous thromboembolism creates an economic burden on both the patient and the healthcare system. The intent of this literature review is to determine existing VTE risk using assessment models available to aid in the implementation of protocols for VTE prevention, specifically for high-risk cosmetic surgical patients in office-based settings.

  8. Epidemiological study of venous thromboembolism in a big Danish cohort

    DEFF Research Database (Denmark)

    Severinsen, Marianne Tang; Kristensen, Søren Risom; Overvad, Kim

    Introduction: Epidemiological data on venous thromboembolism (VT), i.e. pulmonary emboli (PE) and deep venous thrombosis (DVT) are sparse. We have examined VT-diagnoses registered in a big Danish Cohort study.  Methods: All first-time VT diagnoses in The Danish National Patient Register were...... were probable cases (1.7%) whereas for 449 (41.6%) the diagnosis could be excluded. The incidence rate was 1 per 1000 personyears. Out of the 632 cases 60% were DVT and 40% PE. 315 VT were considered idiopathic (49.8%), 311 were secondary (49.2%) and 15 were unclassifiable. 122 patients had cancer, 87...

  9. Venous Thromboembolism in Children with Cancer and Blood Disorders

    Science.gov (United States)

    Ko, Richard H.; Thornburg, Courtney D.

    2017-01-01

    Venous thromboembolism (VTE) in children is multifactorial and most often related to a combination of inherited and acquired thrombophilias. Children with cancer and blood disorders are often at risk for VTE due to disease-related factors such as inflammation and abnormal blood flow and treatment-related factors such as central venous catheters and surgery. We will review risk factors for VTE in children with leukemia, lymphoma, and solid tumors. We will also review risk factors for VTE in children with blood disorders with specific focus on sickle cell anemia and hemophilia. We will present the available evidence and clinical guidelines for prevention and treatment of VTE in these populations. PMID:28220143

  10. Venous thromboembolism and subsequent permanent work-related disability.

    Science.gov (United States)

    Braekkan, S K; Grosse, S D; Okoroh, E M; Tsai, J; Cannegieter, S C; Naess, I A; Krokstad, S; Hansen, J-B; Skjeldestad, F E

    2016-10-01

    Essentials The burden of venous thromboembolism (VTE) related to permanent work-related disability is unknown. In a cohort of 66 005 individuals, the risk of work-related disability after a VTE was assessed. Unprovoked VTE was associated with 52% increased risk of work-related disability. This suggests that indirect costs due to loss of work time may add to the economic burden of VTE.

  11. VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

    Directory of Open Access Journals (Sweden)

    Bonno van BELLEN

    2013-09-01

    Full Text Available Context Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. Objective To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Methods Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrassonographic findings, type of surgery (open or laparoscopic, abdominal circumference, body mass index (BMI and post-operative ultrassonography search for venous insufficiency and deep venous thrombosis. Results Between March 2007 and December 2009, 95 patients candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%, the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%, but no one had clinically manifested pulmonary embolism. Conclusion No relation between BMI, CEAP classification and venous ultrassonographic findings were found. Although

  12. Venous thromboembolism and antithrombotic therapy in pregnancy.

    Science.gov (United States)

    Chan, Wee-Shian; Rey, Evelyne; Kent, Nancy E; Chan, Wee-Shian; Kent, Nancy E; Rey, Evelyne; Corbett, Thomas; David, Michèle; Douglas, M Joanne; Gibson, Paul S; Magee, Laura; Rodger, Marc; Smith, Reginald E

    2014-06-01

    Objectif : Présenter une approche, fondée sur les données actuelles, envers le diagnostic, la prise en charge et la thromboprophylaxie de la thromboembolie veineuse pendant la grossesse et la période postpartum. Résultats : La littérature publiée a été récupérée par l’intermédiaire de recherches menées dans PubMed, Medline, CINAHL et The Cochrane Library entre novembre 2011 et juillet 2013 au moyen d’un vocabulaire contrôlé (p. ex. « pregnancy », « venous thromboembolism », « deep vein thrombosis », « pulmonary embolism », « pulmonary thrombosis ») et de mots clés (p. ex. « maternal morbidity », « pregnancy complications », « thromboprophylaxis », « antithrombotic therapy ») appropriés. Les résultats ont été restreints aux analyses systématiques, aux essais comparatifs randomisés / essais cliniques comparatifs et aux études observationnelles publiés en anglais ou en français. Aucune restriction n’a été imposée en matière de dates. La littérature grise (non publiée) a été identifiée par l’intermédiaire de recherches menées dans les sites Web d’organismes s’intéressant à l’évaluation des technologies dans le domaine de la santé et d’organismes connexes, dans des collections de directives cliniques, dans des registres d’essais cliniques et auprès de sociétés de spécialité médicale nationales et internationales. Valeurs : La qualité des résultats est évaluée au moyen des critères décrits dans le rapport du Groupe d’étude canadien sur les soins de santé préventifs (Tableau). Recommandations 1. La tenue d’un examen objectif s’avère requise lorsque la présence d’une thrombose veineuse profonde ou d’une embolie pulmonaire est soupçonnée sur le plan clinique. (II-2A) 2. Pour diagnostiquer la présence d’une thrombose veineuse profonde, il est recommandé d’avoir recours à une échographie; lorsque l’examen initial donne des résultats n

  13. [The problem of the venous thromboembolic disease in Mexico].

    Science.gov (United States)

    Majluf-Cruz, Abraham

    2011-01-01

    It is necessary to spread the knowledge about the disease, however, venous thromboembolic guidelines published in this issue give little attention to prevention, minimize the evaluation of the risk factors, do not evaluate its impact on the non-surgical patient, and do not emphasize the benefits of non-pharmacological and extended thromboprophylaxis. Guidelines for clinical practice of the Instituto Mexicano del Seguro Social must suggest the way to attend patients at the lowest cost with quality. Because prevention is the best tool to fight VTD, these guidelines do not totally accomplish their institutional objectives.

  14. [Risk of venous thromboembolic disease in general surgery].

    Science.gov (United States)

    Lozano, Francisco S; Arcelus, Juan I; Ramos, José L; Alós, Rafael; Espín, Eloy; Rico, Pedro; Ros, Eduardo

    2009-06-01

    Despite preventive efforts, venous thromboembolic disease (VTED) is still a major problem for surgeons due to its frequency and the morbidity, mortality and enormous resource consumption caused by this entity. However, the most important feature of VTED is that it is one of the most easily preventable complications and causes of death. To take appropriate prophylactic decisions (indication, method, initiation, duration, etc.), familiarity with the epidemiology of VTED in general surgery and some of its most significant populations (oncologic, laparoscopic, bariatric, ambulatory and short-stay) is essential. These factors must also be known to determine the distinct risk factors in these settings with a view to stratifying preoperative risk.

  15. Risk factors for venous thromboembolism in 1.3 million pregnancies

    DEFF Research Database (Denmark)

    Virkus, Rie Adser; Løkkegaard, Ellen; Lidegaard, Ojvind;

    2014-01-01

    OBJECTIVE: To quantify risk factors for venous thromboembolism during pregnancy and the puerperal period. DESIGN: In a nationwide prospective cohort study we followed pregnant and puerperal women in Denmark from 1995 to 2009 for venous thromboembolism. Information on risk factors and confounders ...

  16. High risk of pregnancy-related venous thromboembolism in women with multiple thrombophilic defects

    NARCIS (Netherlands)

    Folkeringa, Nienke; Leendert, Jan; Brouwer, P.; Korteweg, Fleurisca J.; Veeger, Nic J. G. M.; Erwich, Jan Jaap H. M.; van der Meer, Jan

    2007-01-01

    Pregnancy is associated with an increased risk of venous thromboembolism, which probably varies according to the presence of single or multiple thrombophilic defects. This retrospective family cohort study assessed the risk of venous thromboembolism during pregnancy and puerperium, and the contribut

  17. Acute Thrombo-embolic Renal Infarction

    Directory of Open Access Journals (Sweden)

    Haijiang Zhou

    2016-07-01

    Full Text Available A 65-year-old woman was admitted for acute onset of right lower abdominal pain. She was taking anticoagulant medication regularly for rheumatic valvular disease and atrial fibrillation. Physical examination revealed no obvious abdominal or flank tenderness. Right thrombo-embolic renal infarction was diagnosed after performing computed tomography angiography (CTA.

  18. Acute Thrombo-embolic Renal Infarction.

    Science.gov (United States)

    Zhou, Haijiang; Yan, Yong; Li, Chunsheng; Guo, Shubin

    2016-07-01

    A 65-year-old woman was admitted for acute onset of right lower abdominal pain. She was taking anticoagulant medication regularly for rheumatic valvular disease and atrial fibrillation. Physical examination revealed no obvious abdominal or flank tenderness. Right thrombo-embolic renal infarction was diagnosed after performing computed tomography angiography (CTA).

  19. Prevention of venous thromboembolism in patients undergoing bariatric surgery

    Directory of Open Access Journals (Sweden)

    Bartlett MA

    2015-08-01

    Full Text Available Matthew A Bartlett, Karen F Mauck, Paul R Daniels Division of General Internal Medicine, Mayo Clinic Thrombophilia Center, Department of Medicine, Mayo Clinic, Rochester, MN, USA Abstract: Bariatric surgical procedures are now a common method of obesity treatment with established effectiveness. Venous thromboembolism (VTE events, which include deep vein thrombosis and pulmonary embolism, are an important source of postoperative morbidity and mortality among bariatric surgery patients. Due to an understanding of the frequency and seriousness of these complications, bariatric surgery patients typically receive some method of VTE prophylaxis with lower extremity compression, pharmacologic prophylaxis, or both. However, the optimal approach in these patients is unclear, with multiple open questions. In particular, strategies of adjusted-dose heparins, postdischarge anticoagulant prophylaxis, and the role of vena cava filters have been evaluated, but only to a limited extent. In contrast to other types of operations, the literature regarding VTE prophylaxis in bariatric surgery is notable for a dearth of prospective, randomized clinical trials, and current professional guidelines reflect the uncertainties in this literature. Herein, we summarize the available evidence after systematic review of the literature regarding approaches to VTE prevention in bariatric surgery. Identification of risk factors for VTE in the bariatric surgery population, analysis of the effectiveness of methods used for prophylaxis, and an overview of published guidelines are presented. Keywords: bariatric surgery, venous thromboembolism, prophylaxis, vena cava filter, heparin

  20. Venous Thromboembolism and Risk of Idiopathic Interstitial Pneumonia A Nationwide Study

    DEFF Research Database (Denmark)

    Sode, Birgitte Margareta; Dahl, Morten; Nielsen, Sune Fallgaard;

    2010-01-01

    Danish registries. Measurements and Main Results: Age-standardized incidence rates per 10,000 person-years for idiopathic interstitial pneumonia were higher among those ever diagnosed with venous thromboembolism (1.8; n = 158,676), pulmonary embolism (2.8; n = 70,586), and deep venous thrombosis only (1...... embolism, and 1.3 (95% CI, 1.2-1.4) in those ever diagnosed with deep venous thrombosis only, compared with control subjects. Corresponding hazard ratios in those ever diagnosed with venous thromboembolism stratified in those ever and never treated with anticoagulants were 1.4(95% CI, 1.2-1.6) and 2.8 (95......Rationale: Idiopathic interstitial pneumonia is characterized by pulmonary fibrosis and high mortality. Objectives: We examined the association between ever-diagnosed venous thromboembolism and risk of incident idiopathic interstitial pneumonia. Venous thromboembolism was taken as a proxy...

  1. Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophylaxis.

    Science.gov (United States)

    Minet, Clémence; Potton, Leila; Bonadona, Agnès; Hamidfar-Roy, Rébecca; Somohano, Claire Ara; Lugosi, Maxime; Cartier, Jean-Charles; Ferretti, Gilbert; Schwebel, Carole; Timsit, Jean-François

    2015-08-18

    Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep venous thrombosis (DVT), is a common and severe complication of critical illness. Although well documented in the general population, the prevalence of PE is less known in the ICU, where it is more difficult to diagnose and to treat. Critically ill patients are at high risk of VTE because they combine both general risk factors together with specific ICU risk factors of VTE, like sedation, immobilization, vasopressors or central venous catheter. Compression ultrasonography and computed tomography (CT) scan are the primary tools to diagnose DVT and PE, respectively, in the ICU. CT scan, as well as transesophageal echography, are good for evaluating the severity of PE. Thromboprophylaxis is needed in all ICU patients, mainly with low molecular weight heparin, such as fragmine, which can be used even in cases of non-severe renal failure. Mechanical thromboprophylaxis has to be used if anticoagulation is not possible. Nevertheless, VTE can occur despite well-conducted thromboprophylaxis.

  2. Venous thromboembolism at uncommon sites in neonates and children.

    Science.gov (United States)

    Pergantou, Helen; Avgeri, Maria; Komitopoulou, Anna; Xafaki, Panagiota; Kapsimali, Zoey; Mazarakis, Michail; Adamtziki, Eftychia; Platokouki, Helen

    2014-11-01

    We retrospectively analyzed the data of 24 children (whereof 11 neonates), with non-central venous line-related and nonmalignancy-related venous thromboembolism (VTE) at uncommon sites, referred to our Unit from January 1999 to January 2012. Thirty patients who also suffered deep vein thrombosis, but in upper/low extremities, were not included in the analysis. The location of rare site VTE was: portal (n=7), mesenteric (n=2) and left facial vein (n=1), spleen (n=3), lung (n=3), whereas 10 neonates developed renal venous thrombosis. The majority of patients (91.7%) had at least 1 risk factor for thrombosis. Identified thrombophilic factors were: antiphospholipid antibodies (n=2), FV Leiden heterozygosity (n=6), MTHFR C677T homozygosity (n=4), protein S deficiency (n=2), whereas all neonates had age-related low levels of protein C and protein S. All but 6 patients received low-molecular-weight heparin, followed by warfarin in 55% of cases, for 3 to 6 months. Prolonged anticoagulation was applied in selected cases. During a median follow-up period of 6 years, the clinical outcome was: full recovery in 15 patients, evolution to both chronic portal hypertension and esophageal varices in 2 children, and progression to renal failure in 7 of 10 neonates. Neonates are greatly vulnerable to complications after VTE at uncommon sites, particularly renal. Future multicentre long-term studies on neonatal and pediatric VTE at unusual sites are considered worthwhile.

  3. Inherited Thrombophilia in Pediatric Venous Thromboembolic Disease: Why and Who to Test

    Science.gov (United States)

    van Ommen, C. Heleen; Nowak-Göttl, Ulrike

    2017-01-01

    Venous thromboembolic disease in childhood is a multifactorial disease. Risk factors include acquired clinical risk factors such as a central venous catheter and underlying disease and inherited thrombophilia. Inherited thrombophilia is defined as a genetically determined tendency to develop venous thromboembolism. In contrast to adults, acquired clinical risk factors play a larger role than inherited thrombophilia in the development of thrombotic disease in children. The contributing role of inherited thrombophilia is not clear in many pediatric thrombotic events, especially catheter-related thrombosis. Furthermore, identification of inherited thrombophilia will not often influence acute management of the thrombotic event as well as the duration of anticoagulation. In some patients, however, detection of inherited thrombophilia may lead to identification of other family members who can be counseled for their thrombotic risk. This article discusses the potential arguments for testing of inherited thrombophilia, including factor V Leiden mutation, prothrombin mutation, and deficiencies of antithrombin, protein C, or protein S and suggests some patient groups in childhood, which may be tested. PMID:28352625

  4. Prevention of Hospital-Acquired Venous Thromboembolism in Children: A Review of Published Guidelines

    Science.gov (United States)

    Faustino, E. Vincent S.; Raffini, Leslie J.

    2017-01-01

    Venous thromboembolism, which includes deep venous thrombosis and pulmonary embolism, is a potentially preventable condition in children. In adults, pharmacologic prophylaxis has been shown to significantly reduce the incidence of venous thromboembolism in distinct patient cohorts. However, pediatric randomized controlled trials have failed to demonstrate the efficacy of pharmacologic prophylaxis against thrombosis associated with central venous catheters, the most important risk factor for venous thromboembolism in children. Despite the lack of supporting evidence, hospital-based initiatives are being undertaken to try to prevent venous thromboembolism in children. In this study, we sought to review the published guidelines on the prevention of venous thromboembolism in hospitalized children. We identified five guidelines, all of which were mainly targeted at adolescents and used various risk-stratification approaches. In low-risk children, ambulation was the recommended prevention strategy, while mechanical prophylaxis was recommended for children at moderate risk and pharmacologic and mechanical prophylaxis were recommended for the high-risk group. The effectiveness of these strategies has not been proven. In order to determine whether venous thromboembolism can be prevented in children, innovative clinical trial designs are needed. In the absence of these trials, guidelines can be a source of valuable information to inform our practice. PMID:28184368

  5. The risk of venous thromboembolism in patients with multiple sclerosis

    DEFF Research Database (Denmark)

    Peeters, P J H L; Bazelier, M T; Uitdehaag, B M J

    2014-01-01

    BACKGROUND: In patients with multiple sclerosis (MS), disability and autoinflammatory processes may result in an increased risk of venous thromboembolism (VTE) OBJECTIVE: To evaluate the risk of VTE associated with MS. METHODS: We conducted an observational-cohort study within the Clinical Practice...... followed from the index date until the occurrence of VTE, end of data collection, migration, or death, whichever came first. Cox proportional-hazards models were used to derive adjusted hazard ratios and 95% confidence intervals for VTE associated with MS and VTE risk factors within the MS cohort. Time...... evidence that this association is, at least in part, mediated through an increased prevalence of VTE risk factors in MS patients....

  6. Epidemiology, risk and outcomes of venous thromboembolism in cancer.

    Science.gov (United States)

    Falanga, A; Russo, L

    2012-01-01

    Cancer is associated with a fourfold increased risk of venous thromboembolism (VTE). The risk of VTE varies according to the type of malignancy (i. e. pancreatic cancer, brain cancer, lymphoma) and its disease stage and individual factors (i. e. sex, race, age, previous VTE history, immobilization, obesity). Preventing cancer-associated VTE is important because it represents a significant cause of morbidity and mortality. In order to identify cancer patient at particularly high risk, who need thromboprophylaxis, risk prediction models have become available and are under validation. These models include clinical risk factors, but also begin to incorporate biological markers. The major American and European scientific societies have issued their recommendations to guide the management of VTE in patients with cancer. In this review the principal aspects of epidemiology, risk factors and outcome of cancer-associated VTE are summarized.

  7. Venous thromboembolism after fibula fracture: a patient's perspective.

    Science.gov (United States)

    Harvey, Carol V; Runner, Megan

    2011-01-01

    Venous Thromboembolism (VTE) is a significant healthcare issue in the United States. This article presents information on the scope of the problem of VTE through a case study demonstrating the physical and psychosocial experiences of a 24-year-old woman with a fibula fracture treated in a short leg cast who developed a deep vein thrombosis that went on to become a pulmonary embolism. The patient experience is evaluated and supported by literature review in terms of risk factors as well as diagnostic, prophylaxis, medical treatment, and nursing implications. Analysis of a patient experience with VTE is valuable to add to the nursing body of knowledge for improvement of evidence-based practice.

  8. Adolescents' and Young Adults' Lived Experiences Following Venous Thromboembolism

    DEFF Research Database (Denmark)

    Højen, Anette Arbjerg; Dreyer, Pia S; Lane, Deirdre A;

    2016-01-01

    BACKGROUND: Long-term, mental well-being of adolescence and young adults diagnosed with venous thromboembolism (VTE) as experienced by the patients has received little attention. OBJECTIVE: The purpose of this study was to explore the essential meaning of adolescents' and young adults' lived...... experiences following VTE to gain an in-depth understanding of their long-term, mental well-being. METHODS: Semistructured interviews were conducted with 12 Danish patients who were diagnosed with VTE in adolescence or young adulthood. Interviews were analyzed according to a phenomenological hermeneutical...... approach inspired by the French philosopher Paul Ricœur's theory of interpretation. RESULTS: Four themes emerged. Participants described an experience of a creeping loss of youth immortality, a perception of being different, to live with a body in a state of alarm, and feel symptom management insecurity...

  9. Venous thromboembolism in cancer patients: an underestimated major health problem.

    Science.gov (United States)

    Khalil, Jihane; Bensaid, Badr; Elkacemi, Hanan; Afif, Mohamed; Bensaid, Younes; Kebdani, Tayeb; Benjaafar, Noureddine

    2015-06-20

    Venous thromboembolism (VTE) is a major health problem among patients with cancer, its incidence in this particular population is widely increasing. Although VTE is associated with high rates of mortality and morbidity in cancer patients, its severity is still underestimated by many oncologists. Thromboprophylaxis of VTE now considered as a standard of care is still not prescribed in many institutions; the appropriate treatment of an established VTE is not yet well known by many physicians and nurses in the cancer field. Patients are also not well informed about VTE and its consequences. Many studies and meta-analyses have addressed this question so have many guidelines that dedicated a whole chapter to clarify and expose different treatment strategies adapted to this particular population. There is a general belief that the prevention and treatment of VTE cannot be optimized without a complete awareness by oncologists and patients. The aim of this article is to make VTE a more clear and understood subject.

  10. [Clinical evaluation of thrombo-embolic venous disease].

    Science.gov (United States)

    Chagnon, Isabelle

    2003-01-01

    Clinical manifestations of venous thromboembolism are often subtle or misleading. Yet it is a potentially fatal condition. Although the symptoms and signs at presentation have a poor sensitivity and specificity when considered singly, the physician can accurately assess a clinical probability based on the history, the risk factors, the physical examination and some simple laboratory exams. This essential step allows us to identify a low risk group of patients which will benefit of a non invasive diagnostic strategy. More recently explicit prediction rules were proposed to offset the lack of standardization of this clinical assessment. These new didactic tools can simplify clinical evaluation. Nevertheless, their comparison to implicit evaluation reveals that they should be complemented by the physician's judgement.

  11. Venous thromboembolism as an adverse effect of antipsychotic treatment

    Directory of Open Access Journals (Sweden)

    Bałkowiec-Iskra, Ewa

    2014-10-01

    Full Text Available Many studies suggest an association between the use of antipsychotics (APs and occurrence of venous thromboembolism (VTE. Thromboembolism is often related to a significant risk of disability or death. Despite many years of investigating the interrelations between use of APs and VTE, they have not been specified yet. This paper aims to summarize reports on the VTE risk factors in patients using APs. Based on the analyzed clinical studies, meta-analyses and data published by European Medicines Agency, it has been determined, that the main risk factors for VTE are duration of treatment and patient-related factors, such as gender, age, body mass, and physical activity. Current data do not allow to identify the prothrombotic potential for individual APs or indicate a higher risk for developing VTE in patients treated with newer atypical APs. Due to the complex pathogenesis of VTE it would be necessary to perform large, comparative studies, allowing to identify precisely differences in prothrombotic potential of individual APs. It is necessary to specify products with the lowest VTE risk, what would be useful in the treatment of high-risk patients. All patients treated with APs should be assessed with the risk of VTE and, if needed, appropriate prevention methods (including most of all the elimination of modifiable risk factors should be implemented. Moreover, patients should be educated in scope of VTE prodromal symptoms. All patients with the higher VTE risk should be diagnosed as soon as possible and adequate treatment should be implemented.

  12. Association between thrombophilia and seated immobility venous thromboembolism.

    Science.gov (United States)

    Siniarski, Aleksander; Wypasek, Ewa; Fijorek, Kamil; Gajos, Grzegorz; Undas, Anetta

    2014-03-01

    Prolonged work and recreation-related seated immobility increases the risk of venous thromboembolism (VTE). Little is known about links of thrombophilia and prolonged immobility. We sought to determine factors associated with the occurrence of seated immobility venous thromboembolism (SIT). Four hundred and ninety-three consecutive outpatients with a history of first-ever VTE, aged up to 65 years were referred for evaluation of suspected thrombophilia. Exclusion criteria were provoked VTE unless family history of VTE was positive, arterial thrombosis, cancer, infection and chronic inflammatory diseases. The prolonged immobility group was defined as being seated at least 8 h daily and at least 3 h daily without getting up, or 10 h daily and 2 h daily without getting up, or 12 h daily and 1 h daily without getting up during 12 weeks prior to VTE onset. SIT was observed in 115 patients (24.5%). Inherited thrombophilia was more common among SIT patients than in the remainder [Odds ratio (OR) 3.98, 95% confidence interval (CI) 2.55-6.25], with a major impact of factor V Leiden mutation (FVL) (OR 4.86, 95% CI 2.95-8.05). In multivariate analysis, FVL (OR 5.43, 95% CI 3.23-9.15), trauma (OR 2.55, 95% CI 1.30-4.99), current smoking (OR 1.68, 95% CI 1.06-2.67) and varices (OR 2.08, 95% CI 1.27-3.40) were independent predictors of SIT. Moreover, FVL (OR 4.05, 95% CI 2.12-7.76), prothrombin G20210A variant (OR 3.84, 95% CI 1.47-10.05) and computer use (OR 2.84, 95% CI 1.43-5.63) were independent predictors of unprovoked VTE in the SIT group. Inherited thrombophilia, current smoking and varices characterize patients with SIT.

  13. Underutilization of Anticoagulant for Venous Thromboembolism Prophylaxis in Three Hospitals in Jakarta

    Directory of Open Access Journals (Sweden)

    T. Djumhana Atmakusuma

    2016-05-01

    Full Text Available Aim: to assess the current use of anticoagulants and implementation of International Guidelines in venous thromboembolism (VTE prophylaxis in hospitalized patients with acute medical illnesses in Jakarta, Indonesia. Methods: a multicenter, prospective, disease registry, recruiting patients diagnosed as acutely ill medical diseases and other medical conditions at risk of VTE, with in-hospital immobilization for at least 3 days. Results: of 401 patients, 46.9% received anticoagulants which included unfractionated heparin (64.4%, fondaparinux (11.7%, enoxaparin (9.6%, warfarin (3.7%, and combination of anticoagulants (10.6%. VTE prophylaxis using physical and mechanical method was used in 81.3% of patients, either as a single modality or in combination with anticoagulants. During hospitalization, VTE were found in 3.2% patients; 10 patients (2.5% had lower limb events and 3 patients (0.75% had a suspected pulmonary embolism. The main reference international guidelines used were AHA/ASA 2007 (47.4%, followed by ACCP 2008 (21.7%. Conclusion: the study showed underutilization of prophylaxis anticoagulants in which mechanical thromboprophylaxis either alone or combination with anticoagulants was the most commonly used. Unfractionated heparin was the preferable choice. The most commonly used guideline was AHA/ASA 2007. VTE thromboprophylaxis in medically ill patients needs to be encouraged. Key words: venous thromboembolism (VTE, prophylaxis, registry, non-surgery hospitalization.

  14. The Saudi Clinical Practice Guideline for the treatment of venous thromboembolism

    Science.gov (United States)

    Al-Hameed, Fahad M.; Al-Dorzi, Hasan M.; Al-Momen, Abdulkarim M.; Algahtani, Farjah H.; Al-Zahrani, Hazzaa A.; Al-Saleh, Khalid A.; Al-Sheef, Mohammed A.; Owaidah, Tarek M.; Alhazzani, Waleed; Neumann, Ignacio; Wiercioch, Wojtek; Brozek, Jan; Schünemann, Holger; Akl, Elie A.

    2015-01-01

    Venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) is commonly encountered in daily clinical practice. After diagnosis, its management frequently carries significant challenges to the clinical practitioner. Treatment of VTE with the inappropriate modality and/or in the inappropriate setting may lead to serious complications and have life-threatening consequences. As a result of an initiative of the Ministry of Health of the Kingdom of Saudi Arabia, an expert panel led by the Saudi Association for Venous Thrombo-Embolism (a subsidiary of the Saudi Thoracic Society) and the Saudi Scientific Hematology Society with the methodological support of the McMaster University Guideline working group, this clinical practice guideline was produced to assist health care providers in VTE management. Two questions were identified and were related to the inpatient versus outpatient treatment of acute DVT, and the early versus standard discharge from hospital for patients with acute PE. The corresponding recommendations were made following the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. PMID:26219456

  15. Different Finite Durations of Anticoagulation and Outcomes following Idiopathic Venous Thromboembolism: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Aaron B. Holley

    2010-01-01

    Full Text Available Introduction. Controversy remains over the optimal length of anticoagulation following idiopathic venous thromboembolism. We sought to determine if a longer, finite course of anticoagulation offered additional benefit over a short course in the initial treatment of the first episode of idiopathic venous thromboembolism. Data Extraction. Rates of deep venous thrombosis, pulmonary embolism, combined venous thromboembolism, major bleeding, and mortality were extracted from prospective trials enrolling patients with first time, idiopathic venous thromboembolism. Data was pooled using random effects meta-regression. Results. Ten trials, with a total of 3225 patients, met inclusion criteria. For each additional month of initial anticoagulation, once therapy was stopped, recurrent venous thromboembolism (0.03 (95% CI: −0.28 to 0.35; =.24, mortality (−0.10 (95% CI: −0.24 to 0.04; =.15, and major bleeding (−0.01 (95% CI: −0.05 to 0.02; =.44 rates measured in percent per patient years, did not significantly change. Conclusions: Patients with an initial idiopathic venous thromboembolism should be treated with 3 to 6 months of secondary prophylaxis with vitamin K antagonists. At that time, a decision between continuing with indefinite therapy can be made, but there is no benefit to a longer (but finite course of therapy.

  16. Venous Thromboembolism in Critical Illness and Trauma: Pediatric Perspectives

    Science.gov (United States)

    Chima, Ranjit S.; Hanson, Sheila J.

    2017-01-01

    Critically ill children and those sustaining severe traumatic injuries are at higher risk for developing venous thromboembolism (VTE) than other hospitalized children. Multiple factors including the need for central venous catheters, immobility, surgical procedures, malignancy, and dysregulated inflammatory state confer this increased risk. As well as being at higher risk of VTE, this population is frequently at an increased risk of bleeding, making the decision of prophylactic anticoagulation even more nuanced. The use of pharmacologic and mechanical prophylaxis remains variable in this high-risk cohort. VTE pharmacologic prophylaxis is an accepted practice in adult trauma and intensive care to prevent VTE development and associated morbidity, but it is not standardized in critically ill or injured children. Given the lack of pediatric specific guidelines, prevention strategies are variably extrapolated from the successful use of mechanical and pharmacologic prophylaxis in adults, despite the differences in developmental hemostasis and thrombosis risk between children and adults. Whether the burden of VTE can be reduced in the pediatric critically ill or injured population is not known given the lack of robust data. There are no trials in children showing efficacy of mechanical compression devices or prophylactic anticoagulation in reducing the rate of VTE. Risk stratification using clinical factors has been shown to identify those at highest risk for VTE and allows targeted prophylaxis. It remains unproven if such a strategy will mitigate the risk of VTE and its potential sequelae. PMID:28349046

  17. Allergy and Venous Thromboembolism: A Casual or Causative Association.

    Science.gov (United States)

    Lippi, Giuseppe; Favaloro, Emmanuel J

    2016-02-01

    Allergic diseases are very frequent conditions worldwide. The pathogenesis of allergic reactions and venous thromboembolism (VTE) shares several risk factors and predisposing conditions. In particular, the concentration of immunoglobulin E (IgE) is considerably increased in patients with allergic diseases, and this immunoglobulin exert many prothrombotic and antifibrinolytic activities, especially through interaction with mast cells. Therefore, this narrative review is aimed to provide an overview of the current scientific evidence supporting a potential relationship between allergy and the risk of VTE. Although no prospective studies have been published so far, the evidence provided by six large cross-sectional studies and several case reports support the existence of an unquestionable epidemiological association between different allergic diseases (especially atopy, asthma, and celiac disease) and venous thrombosis. Two additional investigations reported that the concentration of IgE might predict the onset of severe complications of pulmonary embolism such as pulmonary infarction and pleural fluid accumulation. Therefore, the existence of a convincing epidemiologic link between allergy and VTE paves the way to future investigations aimed to establish whether the prevention or treatment of allergic diseases might be regarded as an effective measure to lower the risk of VTE.

  18. Psoriasis carries an increased risk of venous thromboembolism: a danish nationwide cohort study

    DEFF Research Database (Denmark)

    Ahlehoff, Ole; Gislason, Gunnar Hilmar; Lindhardsen, Jesper;

    2011-01-01

    Background Psoriasis is an immunoinflammatory disease associated with cardiovascular risk factors, atherothrombotic events, and hypercoagulability. Venous thromboembolism (VTE) is potentially lethal and shares risk factors with psoriasis, but the risk of VTE associated with psoriasis is unknown. ...

  19. C-reactive protein and risk of venous thromboembolism in the general population

    DEFF Research Database (Denmark)

    Zacho, Jeppe; Tybjærg-Hansen, Anne; Nordestgaard, Børge G

    2010-01-01

    To examine the robustness of the association between C-reactive protein (CRP) levels and increased risk of venous thromboembolism (VTE) and to examine whether genetically elevated CRP levels cause VTE....

  20. Symptomatic venous thromboembolism in orthognathic surgery and distraction osteogenesis: a retrospective cohort study of 4127 patients

    NARCIS (Netherlands)

    C.R.A. Verlinden; D.B. Tuinzing; T. Forouzanfar

    2014-01-01

    Venous thromboembolism is a common postoperative complication, and orthopaedic procedures are particularly at risk. We designed a retrospective, single centre, observational, cohort study of 4127 patients (mean (SD) age 27 (11) years) who had elective orthognathic operations or distraction osteogene

  1. Incidence of venous thromboembolism in oral and maxillofacial surgery: a retrospective analysis

    NARCIS (Netherlands)

    T. Forouzanfar; M.W. Heymans; A. van Schuilenburg; S. Zweegman; E.A.J.M. Schulten

    2010-01-01

    This study retrospectively investigates the incidence and risk factors for venous thromboembolism (VTE) in patients undergoing maxillofacial surgery. Data were obtained from patients treated between January 2005 and June 2006. Patients’ records were reviewed for complaints and information relating t

  2. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer

    NARCIS (Netherlands)

    Farge, D.; Debourdeau, P.; Beckers, M.; Baglin, C.; Bauersachs, R. M.; Brenner, B.; Brilhante, D.; Falanga, A.; Gerotzafias, G. T.; Haim, N.; Kakkar, A. K.; Khorana, A. A.; Lecumberri, R.; Mandala, M.; Marty, M.; Monreal, M.; Mousa, S. A.; Noble, S.; Pabinger, I.; Prandoni, P.; Prins, M. H.; Qari, M. H.; Streiff, M. B.; Syrigos, K.; Bounameaux, H.; Buller, H. R.

    2013-01-01

    . Background: Guidelines addressing the management of venous thromboembolism (VTE) in cancer patients are heterogeneous and their implementation has been suboptimal worldwide. Objectives: To establish a common international consensus addressing practical, clinically relevant questions in this settin

  3. High absolute risks and predictors of venous and arterial thromboembolic events in patients with nephrotic syndrome

    NARCIS (Netherlands)

    Mahmoodi, Bakhtawar K.; ten Kate, Min Ki; Waanders, Femke; Veeger, Nic J. G. M.; Brouwer, Jan-Leendert P.; Vogt, Liffert; Navis, Gerjan; van der Meer, Jan

    2008-01-01

    Background-No data are available on the absolute risk of either venous thromboembolism (VTE) or arterial thromboembolism (ATE) in patients with nephrotic syndrome. Reported risks are based on multiple case reports and small studies with mostly short-term follow-up. We assessed the absolute risk of V

  4. Thrombophilia in Korean patients with arterial or venous thromboembolisms

    Science.gov (United States)

    Kim, Sungbae; Song, Incheol; Huh, Seung

    2016-01-01

    Purpose To determine the prevalence of thrombophilia in Korean patients with an arterial thromboembolism (ATE) or a venous thromboembolism (VTE), and to evaluate the characteristic of VTE in patients with thrombophilia. Methods Hospital records of 294 patients (228 with VTE, 66 with ATE) including two foreign ones (mean age, 51.4 years) who underwent thrombophilia testing between August 2006 and March 2015 were reviewed retrospectively. In general, such screening was performed according to the guidelines of the international consensus statement for VTE. Thrombophilia testing included evaluations of the factor V Leiden and prothrombin G20210A mutations, levels of proteins C and S and antithrombin, and antiphospholipid antibody syndrome (APLS). Results A factor V Leiden mutation was not found in the 292 Korean patients. A prothrombin G21210A mutation was investigated in 33 patients but none was found. Among 226 Korean patients with VTE, 130 demonstrated no thrombophilia and 55 patients did after exclusion of 41 patients without confirmatory test. The most common form was protein S deficiency (31 of 55, 56%) followed by protein C deficiency, antithrombin deficiency, and APLS. When comparing patients with a VTE or deep vein thrombosis (DVT) according to the presence of thrombophilia, thrombophilia was associated with younger age (P = 0.001 for VTE; P < 0.001 for DVT) and a family history (P < 0.001 for VTE and DVT). Conclusion We did not find any factor V Leiden mutation in Korean subjects at high risk for thrombophilia. Therefore, this testing is not warranted. Thrombophilia was associated with VTE in younger age and a family history. PMID:27274510

  5. The real value of thrombophilia markers in identifying patients at high risk of venous thromboembolism.

    Science.gov (United States)

    Mannucci, Pier Mannuccio; Franchini, Massimo

    2014-12-01

    Thrombophilia is defined as a condition predisposing to the development of venous thromboembolic complications. Over the past decades, there have been great advances in the understanding of the pathogenesis of venous thromboembolism (VTE) through the identification of several inherited and acquired risk factors. However, in spite of such progress, a number of questions remain unanswered. In particular, it is well known that some subjects carrying several risk factors for VTE will never experience a thrombotic episode while other individuals developed recurrent thromboembolic events with no known risk factor. In this review, we summarize the current knowledge on the various thrombophilia markers, and also discuss their role in the development of thrombotic complications.

  6. Clinical study of venous thromboembolism during pregnancy and puerperium.

    Science.gov (United States)

    Adachi, T; Hashiguchi, K; Arai, Y; Ohta, H

    2001-01-01

    We encountered 16 cases of venous thromboembolism (VTE) in women during pregnancy and/or puerperium over the past 15 years at our perinatal center, representing 0.14% of all patients who delivered babies. The present study was undertaken to analyze the risk factors, clinical course and outcomes in these 16 cases. The ages of the patients varied from 29 to 39 years. Four women had pulmonary embolism (PE), 3 of which after caesarean section (C/S) at 35 to 40 weeks, and one case after ovarian cystectomy at 13 weeks of gestation. Twelve cases had deep venous thrombosis (DVT), 4 of which during pregnancy, and the remaining 8 cases after C/S. Four patients who had DVT during a normal course of pregnancy had severe thrombophilia: antiphospholipid antibody syndrome, a history of thrombosis and antithrombin (AT) deficiency. They were treated with heparin with or without AT and had healthy babies via successful vaginal deliveries. The common risk factors in 3 cases of PE with C/S was prolonged bed rest due to threatened premature delivery with total placenta previa, uterine myoma and Ehlers-Danlos syndrome. Other risk factors were massive bleeding, and positive lupus anticoagulant. However, the case of the ovarian cystectomy had only one risk factor, which was obesity. This patient died but the remaining patients recovered with treatment. Because of the low incidence of thrombosis in the Japanese population, prophylactic anticoagulant therapy has not routinely been given to patients undergoing obstetrical operations. However, proper management including prophylactic anticoagulant therapy might be considered for risk patients, depending on the risk factors.

  7. Predictors of Venous Thromboembolic Events Associated with Central Venous Port Insertion in Cancer Patients

    Directory of Open Access Journals (Sweden)

    Christine Hohl Moinat

    2014-01-01

    Full Text Available Insertion of central venous port (CVP catheter in the cancer population is associated with increased incidence of venous thromboembolic events (VTE. However, trials have shown limited benefit of antithrombotic treatment to prevent catheter-related venous thrombosis. This prospective observational cohort study was designed to assess the incidence of VTE closely related to CVP implantation in patients with cancer and undergoing chemotherapy, and to identify a high risk subgroup of patients. Between February 2006 and December 2011, 1097 consecutive cancer patients with first CVP implantation were included. Catheter-related VTE were defined as deep venous thrombosis in the arm, with or without pulmonary embolism (PE, or isolated PE. The incidence of CVP-associated VTE was 5.9% (IC95 4.4–7.3% at 3 months, and 11.3% (IC95 9.4–13.2% at 12 months. The incidence of any VTE was 7.6% (IC95 6.0–9.3% at 3 months, and 15.3% (IC95 13.1–17.6% at 12 months. High Khorana risk score and lung cancer were significant predictors of 3 month VTE. In conclusion, this large cohort study of patients with first CVP catheter implantation confirms the high incidence of VTE associated with the CVP implantation and allow identifying high risk patients who may benefit from thromboprophylaxis.

  8. Venous Thromboembolism Following Dantrolene Treatment for Neuroleptic Malignant Syndrome

    Science.gov (United States)

    Chen, Po-Hao; Lane, Hsien-Yuan; Lin, Chieh-Hsin

    2016-01-01

    Neuroleptic malignant syndrome (NMS) is one of the most severe iatrogenic emergencies in clinical service. The symptoms including sudden consciousness change, critical temperature elevation and electrolytes imbalance followed by mutli-organ system failure were common in NMS. In addition to aggressive interventions with intravenous fluid resuscitation and antipyretics, several antidotes have been suggested to prevent further progression of the muscle damage. Dantrolene has been reported to be one of the most effective treatments for NMS. However, the adverse effects of dantrolene treatment for NMS have not yet been evaluated thoroughly. Here we report a young male patient with bipolar I disorder who developed NMS after rapid tranquilization with haloperidol. Dantrolene was given intravenously for the treatment of NMS. However, fever accompanied with local tenderness, hardness with clear border and swelling with heat over the patient’s left forearm occurred on the sixth day of dantrolene treatment. Venous thromboembolism (VTE) over intravenous indwelling site at the patient’s forearm was noted and confirmed by Doppler ultrasound. The patient’s VTE recovered after heparin and warfarin thrombolytic therapy. To our knowledge, this is the first case report demonstrating the possible relationship between dantrolene use and VTE in a patient with antipsychotic treatment. Although the causal relationship and the underlying pathogenesis require further studies, dantrolene should be used with caution for patients with NMS. PMID:27776396

  9. Risk assessment models for cancer-associated venous thromboembolism.

    Science.gov (United States)

    Dutia, Mrinal; White, Richard H; Wun, Ted

    2012-07-15

    Venous thromboembolism (VTE) is common in cancer patients, and is associated with significant morbidity and mortality. Several factors, including procoagulant agents secreted by tumor cells, immobilization, surgery, indwelling catheters, and systemic treatment (including chemotherapy), contribute to an increased risk of VTE in cancer patients. There is growing interest in instituting primary prophylaxis in high-risk patients to prevent incident (first-time) VTE events. The identification of patients at sufficiently high risk of VTE to warrant primary thromboprophylaxis is essential, as anticoagulation may be associated with a higher risk of bleeding. Current guidelines recommend the use of pharmacological thromboprophylaxis in postoperative and hospitalized cancer patients, as well as ambulatory cancer patients receiving thalidomide or lenalidomide in combination with high-dose dexamethasone or chemotherapy, in the absence of contraindications to anticoagulation. However, the majority of cancer patients are ambulatory, and currently primary thromboprophylaxis is not recommended for these patients, even those considered at very high risk. In this concise review, the authors discuss risk stratification models that have been specifically developed to identify cancer patients at high risk for VTE, and thus might be useful in future studies designed to determine the potential benefit of primary thromboprophylaxis.

  10. Oral contraceptives and venous thromboembolism: pill scares and public health.

    Science.gov (United States)

    Reid, Robert L

    2011-11-01

    Post-marketing surveillance of combined oral contraceptives (COCs) for rare complications such as venous thromboembolism (VTE) presents unique challenges. Prospective studies, which are costly and time consuming, have to date been undertaken by only a few contraceptive manufacturers willing to commit to full evaluation of product safety. Often such studies are conducted with the approval of regulatory authorities as a precondition for marketing. Alternatively, independent investigators with access to large databases have conducted retrospective studies to compare the incidence of VTE between new and older products. Such studies, however, run the risk of erroneous conclusions if they cannot ensure comparable risk profiles for users of these different products. Often database studies are unable to access information on important confounders, and medical records may not be available to validate the actual diagnosis of VTE. "Pill scares" generated following publication and media dissemination of worrisome findings, when the conclusions are in doubt and not corroborated by stronger prospective study designs, are frequently damaging to public health. From a review of recent publications on the VTE risk with drospirenone-containing COCs, it can be concluded that the best quality evidence does not support a difference in risk between users of COCs containing drospirenone and those of COCs containing levonorgestrel.

  11. Silent venous thromboembolism in multiple myeloma patients treated with lenalidomide.

    Science.gov (United States)

    Isoda, Atsushi; Sato, Naru; Miyazawa, Yuri; Matsumoto, Yoshinobu; Koumoto, Mina; Ookawa, Masahito; Sawamura, Morio; Matsumoto, Morio

    2015-09-01

    Lenalidomide treatment in combination with dexamethasone and/or chemotherapy is associated with a significant risk of venous thromboembolism (VTE) in patients with multiple myeloma (MM). However, the incidence of asymptomatic VTE in lenalidomide-treated MM patients remains unclear. A total of 80 relapsed and refractory MM patients treated with lenalidomide-containing regimens in a single institution between July 2010 and July 2014 were retrospectively analyzed. Of these, eight patients had asymptomatic VTE before starting lenalidomide. The remaining 72 patients received thromboprophylaxis with low-dose aspirin (100 mg daily) and monitoring of plasma D-dimer levels on each visit. During the median follow-up time of 7.3 months (range 1.0-43.5 months), 29 patients (40.3 %) showed an elevation of D-dimer (≥2.5 μg/mL), and 13 (18.1 %) showed asymptomatic VTE in a lower extremity. Median time to asymptomatic VTE events from initiation of lenalidomide treatment was 3.0 months (range 1.0-13.1 months). All patients having an asymptomatic VTE continued lenalidomide treatment on warfarinization (target international normalized ratio 1.5-2.5), and none of them developed symptomatic VTE. In conclusion, an asymptomatic VTE event occurred in 18 % of Japanese MM patients receiving lenalidomide-containing therapy despite aspirin prophylaxis. Serial monitoring of plasma D-dimer levels and early intervention may help to prevent symptomatic or lethal VTE events.

  12. Aspirin increases the risk of venous thromboembolism in surgical patients.

    Science.gov (United States)

    Barmparas, Galinos; Jain, Monica; Mehrzadi, Devorah; Melo, Nicolas; Chung, Rex; Bloom, Matthew; Ley, Eric J; Margulies, Daniel R

    2014-10-01

    The risk of venous thromboembolism (VTE) for patients taking an antiplatelet agent is largely unknown. This study aimed to investigate the association between antiplatelet agent use before admission with the risk of in-hospital VTE in surgical intensive care unit (ICU) patients. A retrospective review of all patients admitted to the surgical ICU at a Level I trauma center over 30 months was performed. Patients who underwent diagnostic imaging for VTE were selected. Patients were divided based on whether or not antiplatelet agents were used before admission (APTA vs NAPTA). The primary outcome was VTE occurrence. A forward logistic regression model was used to identify factors independently associated with the primary outcome. During the study period, 461 (24%) patients met inclusion criteria: 70 (15%) APTA and 391 (85%) NAPTA. After adjusting for confounding factors, APTA patients were at a significantly higher risk for developing VTE (59 vs 40%; adjusted odds ratio, 1.8; 95% confidence interval, 1.0 to 3.0; adjusted P = 0.04). Whether or not antiplatelet agents were resumed during the hospital stay and the day on which they were resumed did not affect VTE risk. In conclusion, surgical ICU patients receiving antiplatelet agents before admission are at a significantly higher risk for development of VTE.

  13. Prevention of venous thromboembolism in patients undergoing bariatric surgery.

    Science.gov (United States)

    Bartlett, Matthew A; Mauck, Karen F; Daniels, Paul R

    2015-01-01

    Bariatric surgical procedures are now a common method of obesity treatment with established effectiveness. Venous thromboembolism (VTE) events, which include deep vein thrombosis and pulmonary embolism, are an important source of postoperative morbidity and mortality among bariatric surgery patients. Due to an understanding of the frequency and seriousness of these complications, bariatric surgery patients typically receive some method of VTE prophylaxis with lower extremity compression, pharmacologic prophylaxis, or both. However, the optimal approach in these patients is unclear, with multiple open questions. In particular, strategies of adjusted-dose heparins, postdischarge anticoagulant prophylaxis, and the role of vena cava filters have been evaluated, but only to a limited extent. In contrast to other types of operations, the literature regarding VTE prophylaxis in bariatric surgery is notable for a dearth of prospective, randomized clinical trials, and current professional guidelines reflect the uncertainties in this literature. Herein, we summarize the available evidence after systematic review of the literature regarding approaches to VTE prevention in bariatric surgery. Identification of risk factors for VTE in the bariatric surgery population, analysis of the effectiveness of methods used for prophylaxis, and an overview of published guidelines are presented.

  14. PERIOPERATIVE PROPHYLAXIS OF VENOUS THROMBOEMBOLISM IN ROUTINE ONCOSURGERY

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    V. E. Khoronenko

    2016-01-01

    Full Text Available The article is devoted the problem of prevention of perioperative venous thromboembolic complications (VTEC in cancer patients. The study identifies the causes of thrombosis in this category of patients and describes in details the major and minor risk factors for the development of VTEC. The results of studies on the influence of the morphological characteristics of the tumor, the stage and location of tumor on the risk of development of  VTEC are performed. It is noted that along with the likelihood of thrombosis, cancer patients at the stages of surgical treatment there is an alternative risk factor – bleeding. The frequency of hemorrhagic complications and their risk increases in the presence of disintegration of the tumor, its proximity to the main vessels, extent of surgical aggression, as well as due to the introduction of anticoagulants. The approaches to the selection of the optimal method is specific or nonspecific prevention of VTEC depending on the nature and volume of the intervention, estimated blood loss and patients’ rehabilitation time are described. We show the advantages of  low  molecular weight heparins compared with unfractionated heparin for the prevention of VTEC in Oncology. The article presents long-term experience of employees of one of the leading cancer institutions in Russia – P. Hertsen MORI, whose team took an active part in the development of Russian clinical guidelines for the prevention and treatment of VTEC in Oncology. 

  15. Population genetics of venous thromboembolism. A narrative review.

    Science.gov (United States)

    Margaglione, Maurizio; Grandone, Elvira

    2011-02-01

    Results from epidemiological studies are consistent with the hypothesis that disparities in venous thromboembolism (VTE) burden are attributable to differences in genetic structure among populations from different genetic backgrounds. To that end, recent genetic studies have demonstrated not only potential associations between certain alleles and VTE but also clear differences in the distribution of these alleles in patients stratified by ancestry. There are a number of notable clinical and pathophysiological questions that arise from these findings. First at all is defining the precise variant(s) that alter disease susceptibility. The comparatively lower rates of VTE recorded among Asians would imply that risk profile is devoid of many risk factors on comparison to Caucasian or African counterparts or that a putative protective factor is advocated in the former population. Identification of these variants provided specific insight into VTE disease in selected populations and also shed lights on the biology of the disease. The association observed between ancestry and VTE is likely to be multifactorial, possibly reflecting, in addition to genetic variation, also socioeconomic differences. Acknowledgment of this may provide useful information in biomedical contexts and help to identify individual risk factors for VTE.

  16. Multimodal prophylaxis for venous thromboembolic disease after total hip and knee arthroplasty: current perspectives

    Institute of Scientific and Technical Information of China (English)

    LU Ning; Eduardo A. Salvati

    2010-01-01

    Life-threatening in the short term and leading to a high level of morbidity in the long term, venous thromboembolism (VTE) is the most fearful complication following lower limb arthroplasty. With advances in surgical procedure, anesthetic management and postoperative convalescence have altered the risks of venous thromboembolism after total joint arthroplasty in the lower extremity.The pathogenesis of VTE is multifactorial and includes the well-known Virchow's triad of hypercoagulability, venous stasis and endothelial damage. Therefore, it is appropriate to use a multimodal approach to thromboprophylaxis. Despite extensive research, the ideal multimodal prophylaxis against venous thrombolism has not been identified. So this article reviews the recent developments in multimodal prophylaxis for thromboembolism after total joint arthroplasty.

  17. Effective management of venous thromboembolism in the community: non-vitamin K antagonist oral anticoagulants

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    Patel R

    2016-05-01

    Full Text Available Raj Patel Department of Haematological Medicine, King's Thrombosis Centre, King's College Hospital, London, UK Abstract: Anticoagulation therapy is essential for the effective treatment and secondary prevention of venous thromboembolism (VTE. For many years, anticoagulation for acute VTE was limited to the use of initial parenteral heparin, overlapping with and followed by a vitamin K antagonist. Although highly effective, this regimen has several limitations and is particularly challenging when given in an ambulatory setting. Current treatment pathways for most patients with deep-vein thrombosis typically involve initial hospital or community-based ambulatory care with subsequent follow-up in a secondary care setting. With the introduction of non-vitamin K antagonist oral anticoagulants (NOACs into routine clinical practice, it is now possible for the initial acute management of patients with deep-vein thrombosis to be undertaken by primary care. As hospital admissions associated with VTE become shorter, primary care will play an increasingly important role in the long-term management of these patients. Although the NOACs can potentially simplify patient management and improve clinical outcomes, primary care physicians may be less familiar with these new treatments compared with traditional therapy. To assist primary care physicians in further understanding the role of the NOACs, this article outlines the main differences between NOACs and traditional anticoagulation therapy and discusses the benefit–risk profile of the different NOACs in the treatment and secondary prevention of recurrent VTE. Key considerations for the use of NOACs in the primary care setting are highlighted, including dose transition, risk assessment and follow-up, duration of anticoagulant therapy, how to minimize bleeding risks, and the importance of patient education and counseling. Keywords: venous thromboembolism, oral anticoagulant, prevention, treatment, primary

  18. Value of CT pulmonary arteriography and venography in the evaluation of venous thromboembolism in a multiracial Asian population

    Institute of Scientific and Technical Information of China (English)

    Yeong Ji Lee; Rozman Zakaria; Zaleha Abdul Manaf; Zahiah Mohamed; Yeong Yeh Lee

    2013-01-01

    Background There is increasing evidence that CT pulmonary arteriography and venography allow a better diagnostic yield for deep vein thrombosis (DVT) in suspected acute pulmonary embolism (PE).The aim was to investigate the value for using such an approach in a multiracial Asian population.Methods A total of 135 consecutive subjects with clinically suspected PE in various clinical settings (postoperative in 23 subjects) were referred and evaluated for venous thromboembolism using CT pulmonary arteriography and venography in a tertiary hospital,Malaysia.The distribution of DVT was assessed based on the frequency rate of thrombosis in a particular anatomical region (inferior vena cava,pelvic,femoral and popliteal).Results In 130 subjects,excluding 5 subjects having poor images,both DVT and PE were detected in 11.5% (15/130) subjects and DVT alone was detected in 6.9% (9/130) subjects giving a combined rate of venous thromboembolism of 18.4%.A history of malignancy was significantly associated with positive scans,P=0.02.It was found that left pelvic veins (18.2%) and left femoral veins (19.5%) were more commonly thrombosed in this population.Conclusion CT pulmonary arteriography and venography is a useful technique in the evaluation of venous thromboembolism in a multi-racial Asian population.

  19. Results of a venous thromboembolism prophylaxis program for hospitalized patients

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    Cardoso LF

    2016-12-01

    Full Text Available Luiz Francisco Cardoso, Daniella Vianna C Krokoscz, Edison Ferreira de Paiva, Ilka Spinola Furtado, Jorge Mattar Jr, Marcia Martiniano de Souza e Sá, Antonio Carlos Onofre de Lira Sírio Libanês Hospital, São Paulo, Brazil Introduction: Venous thromboembolism (VTE is the leading cause of preventable death in hospitalized patients. However, existing prophylaxis guidelines are rarely followed. Objective: The aim of the study was to present and discuss implementation strategies and the results of a VTE prophylaxis program for medical and surgical patients admitted to a large general hospital. Patients and methods: This prospective observational study was conducted to describe the strategy used to implement a VTE prophylaxis program in hospitalized medical and surgical patients and to analyze the results in terms of the risk assessment rate within the first 24 hours after admission, adequacy of the prophylaxis prescription, and prevalence of  VTE in the discharge records before and after program implementation. We used the Mantel–Haenszel chi-square test for the linear trend of the data analysis and set the significance level to P<0.05. Results: With the support of an institutional VTE prophylaxis committee, a multiple-strategy approach was used in the implementation of the protocol, which included continuing education, complete data recording using computerized systems, and continuous auditing of and feedback to the medical staff and multidisciplinary teams. Approximately 90% of patients were evaluated within the first 24 hours after admission, and no significant difference in this percentage was observed among the years analyzed. A progressive increase in adherence to protocol recommendations, from 63.8% in 2010 to 75.0% in 2014 (P<0.001, was noted. The prevalence of symptomatic VTE in the discharge records of patients decreased from 2.03% in 2009 to 1.69% in 2014 (P=0.033. Conclusion: The implementation of a VTE prophylaxis program

  20. Diet as prophylaxis and treatment for venous thromboembolism?

    Directory of Open Access Journals (Sweden)

    Cundiff David K

    2010-08-01

    Full Text Available Abstract Background Both prophylaxis and treatment of venous thromboembolism (VTE: deep venous thrombosis (DVT and pulmonary emboli (PE with anticoagulants are associated with significant risks of major and fatal hemorrhage. Anticoagulation treatment of VTE has been the standard of care in the USA since before 1962 when the U.S. Food and Drug Administration began requiring randomized controlled clinical trials (RCTs showing efficacy, so efficacy trials were never required for FDA approval. In clinical trials of 'high VTE risk' surgical patients before the 1980s, anticoagulant prophylaxis was clearly beneficial (fatal pulmonary emboli (FPE without anticoagulants = 0.99%, FPE with anticoagulants = 0.31%. However, observational studies and RCTs of 'high VTE risk' surgical patients from the 1980s until 2010 show that FPE deaths without anticoagulants are about one-fourth the rate that occurs during prophylaxis with anticoagulants (FPE without anticoagulants = 0.023%, FPE while receiving anticoagulant prophylaxis = 0.10%. Additionally, an FPE rate of about 0.012% (35/28,400 in patients receiving prophylactic anticoagulants can be attributed to 'rebound hypercoagulation' in the two months after stopping anticoagulants. Alternatives to anticoagulant prophylaxis should be explored. Methods and Findings The literature concerning dietary influences on VTE incidence was reviewed. Hypotheses concerning the etiology of VTE were critiqued in relationship to the rationale for dietary versus anticoagulant approaches to prophylaxis and treatment. Epidemiological evidence suggests that a diet with ample fruits and vegetables and little meat may substantially reduce the risk of VTE; vegetarian, vegan, or Mediterranean diets favorably affect serum markers of hemostasis and inflammation. The valve cusp hypoxia hypothesis of DVT/VTE etiology is consistent with the development of VTE being affected directly or indirectly by diet. However, it is less consistent with

  1. Venous thromboembolism in 13 Indonesian patients undergoing major orthopedic surgery

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    Karmel L. Tambunan

    2009-12-01

    Full Text Available Aim: To estimate the incidence of VTE in Indonesian patients undergoing major orthopedic surgery and not receiving thromboprophylaxis.Methods: This was an open clinical study of consecutive Indonesian patients undergoing major orthopedic surgery, conducted in 3 centers in Jakarta. Bilateral venography was performed between days 5 and 8 after surgery to detect the asymptomatic and to confi rm the symptomatic VTE. These patients were followed up to one month after surgery.Results: A total of 17 eligible patients were studied, which a median age of 69 years and 76.5% were females. Sixteen out of the 17 patients (94.1% underwent hip fracture surgery (HFS. The median time from injury to surgery was 23 days (range 2 to 197 days, the median duration of surgery was 90 minutes (range 60 to 255 minutes, and the median duration of immobilization was 3 days (range 1 to 44 days. Thirteen out of the 17 patients were willing to undergo contrast venography. A symptomatic VTE was found in 9 patients (69.2% at hospital discharge. Symptomatic VTE was found in 3 patients (23.1%, all corresponding to clinical signs of DVT and none with clinical sign of PE. These patients were treated initially with a low molecular weight heparin, followed by warfarin. Sudden death did not occur up to hospital discharge. From hospital discharge until 1-month follow-up, there were no additional cases of symptomatic VTE. No sudden death, bleeding complication, nor re-hospitalization was found in the present study.Conclusion: The incidence of asymptomatic (69.2% and symptomatic (23.1% VTE after major orthopedic surgery without thromboprophylaxis in Indonesian patients (SMART and AIDA, and still higher than the results of the Western studies. A larger study is required to establish the true incidence, and more importantly, that the use of thromboprophylaxis in these patients is warranted. (Med J Indones 2009; 18: 249-56Keywords: venous thromboembolism (VTE, orthopedic surgery, Indonesia

  2. Venous thromboembolism: identifying patients at risk and establishing prophylaxis.

    Science.gov (United States)

    Shirvanian, Shant; Tapson, Victor F

    2015-12-01

    Venous thromboembolism (VTE) is a major cause of morbidity and mortality and is associated with substantial healthcare costs. Identification of patients at risk of developing VTE enables appropriate thromboprophylaxis to be implemented. Although no predisposing risk factors can be identified in many patients in whom VTE develops, most have at least one underlying risk factor which can be categorized according to whether it confers low, moderate, or high risk. Clinical trials have demonstrated the effectiveness of thromboprophylaxis, both non-pharmacological and pharmacological, in a host of medical settings and there is sufficient evidence to support routine prophylaxis in many groups of patients. The implementation of decision making tools based on risk factor assessment improves the prescription of appropriate VTE prophylaxis. Nonetheless, thromboprophylaxis is often inadequate, with haphazard risk assessment and application of guidelines, leading to easily preventable instances of VTE. The most commonly used agents for pharmacological thromboprophylaxis of VTE are low dose unfractionated heparin; a low molecular weight heparin such as dalteparin, enoxaparin or tinzaparin; fondaparinux; warfarin; or aspirin. However, these have a number of drawbacks, principally the need for parenteral administration (with heparins) and frequent coagulation monitoring (with warfarin). The optimal anticoagulant would be orally administered, with a wide therapeutic window, rapid onset of action, predictable pharmacodynamics and pharmacokinetics, minimal interactions with food and other drugs, an ability to inhibit free and clot-bound coagulation factors, low, non-specific binding, and no requirement for routine coagulation monitoring or dose adjustment. A number of novel, single-target oral anticoagulants have been developed that appear to fulfill many of these requirements. This narrative review discusses the use of guidelines and risk assessment tools to identify patients at risk

  3. Predicting perioperative venous thromboembolism in Japanese gynecological patients.

    Directory of Open Access Journals (Sweden)

    Masae Ikeda

    Full Text Available OBJECTIVE: To develop a convenient screening method that can predict perioperative venous thromboembolism (VTE and identify patients at risk of fatal perioperative pulmonary embolism (PE. METHODS: Patients hospitalized for gynecological abdominal surgery (n = 183 underwent hematology tests and multidetector computed tomography (MDCT to detect VTE. All statistical analyses were carried out using the SPSS software program (PASWV19.0J. RESULTS: The following risk factors for VTE were identified by univariate analysis: plasmin-alpha2-plasmin inhibitor complex (PIC, thrombin-antithrombin III complex (TAT, and prolonged immobility (all p<0.001; age, neoadjuvant chemotherapy (NAC, malignancy, hypertension, past history of VTE, and hormone therapy (all p<0.01; and hemoglobin, transverse tumor diameter, ovarian disease, and menopause (all p<0.05. Multivariate analysis using these factors revealed that PIC, age, and transverse tumor diameter were significant independent determinants of the risk of VTE. We then calculated the incidence rate of perioperative VTE using PIC and transverse tumor diameter in patient groups stratified by age. In patients aged ≤40 years, PIC ≥1.3 µg/mL and a transverse tumor diameter ≥10 cm identified the high-risk group for VTE with an accuracy of 93.6%. For patients in their 50 s, PIC ≥1.3 µg/mL identified a high risk of VTE with an accuracy of 78.2%. In patients aged ≥60 years, a transverse tumor diameter ≥15 cm (irrespective of PIC or PIC ≥1.3 µg/mL identified the high-risk group with an accuracy of 82.4%. CONCLUSIONS: We propose new screening criteria for VTE risk that are based on PIC, transverse tumor diameter, and age. Our findings suggest the usefulness of these criteria for predicting the risk of perioperative VTE and for identifying patients with a high risk of fatal perioperative PE.

  4. Recurrent Venous Thromboembolism: What Is the Risk and How to Prevent It

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    Gualtiero Palareti

    2012-01-01

    Full Text Available Venous thromboembolism (VTE that includes deep vein thrombosis and/or pulmonary embolism is a frequent, severe, and potentially lethal disease. After a first episode, VTE has a strong tendency to recur. While VTE is an acute disease, it may have variable outcomes in early and late phases after initial presentation. Furthermore, the incidence of late, clinically important consequences (postthrombotic syndrome and/or chronic thromboembolic pulmonary hypertension increases in case of recurrent events. The aims of the present review are (i to analyze the incidence and risk factors for recurrence of VTE (either those related to the type of first thrombotic event or to the patients, the risks associated with occurrence of recurrent events, and the problems linked to the diagnosis, not always easy, of recurrent events; (ii to discuss whether or not it is possible to predict the individual risk of recurrence after a first event, by stratifying patients at high or low risk of recurrence, and how this can influence their treatment; (iii to comment what the current guidelines and guidance suggest/recommend about anticoagulant treatment after a first VTE event and, finally, to propose practical indications on how to manage individual patients affected by VTE.

  5. Combined hormonal contraception and risk of venous thromboembolism within the first year following pregnancy

    DEFF Research Database (Denmark)

    Petersen, Jesper Friis; Bergholt, T; Nielsen, Anne Kathrine

    2014-01-01

    Estimating the risk of venous thromboembolism (VTE) associated with combined hormonal contraceptives following early terminated pregnancies or birth, a Danish nationwide retrospective cohort observing a one-year follow-up was defined using three unique registries. All Danish women with confirmed...... pregnancies aged 15-49 during the period of 1995-2009 were included. The main outcomes were relative and absolute risks of first time venous thromboembolism in users as well as non-users of combined hormonal contraceptives. In 985,569 person-years, 598 venous thromboembolisms were recorded. After early...... terminated pregnancies and births, respectively, 113 and 485 events occurred in 212,552 and 773,017 person-years. After early terminated pregnancies, the crude VTE incidence ratios were similar, and the numbers needed to harm were equal between groups that did or did not use combined hormonal contraceptives...

  6. Bleeding events with dabigatran or warfarin in patients with venous thromboembolism.

    Science.gov (United States)

    Majeed, Ammar; Goldhaber, Samuel Z; Kakkar, Ajay; Kearon, Clive; Eriksson, Henry; Kreuzer, Jörg; Feuring, Martin; Hantel, Stephan; Friedman, Jeffrey; Schellong, Sebastian; Schulman, Sam

    2016-01-01

    Dabigatran was as effective as warfarin for the acute treatment of venous thromboembolism in the RE-COVER and RE-COVER II trials. We compared the incidence of bleeding with dabigatran versus warfarin in pooled data from these studies. The localisation, bleeding severity, and the impact of key factors on the incidence of bleeding, were compared between the dabigatran and warfarin treatment group. Altogether, 2553 patients received dabigatran and 2554 warfarin, each for a mean of 164 days. The incidence of any bleeding event was significantly lower with dabigatran (hazard ratio [HR] 0.70; 95% confidence interval [CI], 0.61-0.79), as was the incidence of the composite of MBEs and clinically relevant non-major bleeding events (HR 0.62; 95% CI, 0.50-0.76). The incidence of major bleeding events (MBEs) was also significantly lower with dabigatran in the double-dummy phase (HR, 0.60; 95%CI, 0.36-0.99) but not statistically different between the two treatment arms when the entire treatment period is considered (HR 0.73 95% CI, 0.48-1.11). Increasing age, reduced renal function, Asian ethnicity, and concomitant antiplatelet therapy were associated with higher bleeding rates in both treatment groups. The reduction in bleeding with dabigatran compared to warfarin was consistent among the subgroups and with a similar pattern for intracranial, and urogenital major bleeding. In conclusion, treatment of venous thromboembolism with dabigatran is associated with a lower risk of bleeding compared to warfarin. This reduction did not differ with respect to the location of bleeding or among predefined subgroups.

  7. [Venous thromboembolism's risk assessment: rationale, objectives, and methodology--the ARTE study].

    Science.gov (United States)

    França, Ana; De Sousa, Joaquim Abreu; Felicíssimo, Paulo; Ferreira, Daniel

    2011-12-01

    Venous thromboembolism is a frequent clinical condition with high impact on both morbidity and mortality. Venous thromboembolism risk is particularly high in hospitalized patients as well as in oncologic patients, being a factor of poor prognosis for the oncologic disease. Several clinical studies have shown the need to develop effective hospital strategies using a systematic and individualized assessment of venous thromboembolism risk, and additionally to optimize the institution of prophylaxis treatment and its proper use in the context of in-hospital and outpatient management. The ARTE national study is a non-interventional, multicentre, prospective study which is divided in two phases. In the first phase patients are followed in the hospital; in the second phase patients are followed in ambulatory context for a period of 6 months after discharge. Four thousand patients will be included, equally distributed over medical, surgical, oncologic and orthopaedic patients. Data will be collected from the patient's clinical files and through direct clinical evaluation of risk factors for venous thromboembolism, in the departments of medicine, oncology, surgery, and orthopaedics of the participating centres. The main objectives of the study are to assess the risk profile of venous thromboembolism of the study population using a risk assessment model adapted from the Caprini and Khorana et al models, and the validation of the score for the Portuguese population. Simultaneously, the secondary objectives are as follows: to determine the proportion of patients with venous thromboembolism risk, according to the risk assessment model, that are doing prophylaxis; to determine the duration of prophylaxis during the hospitalization; to determine the proportion of patients doing long-term prophylaxis, at the moment of the discharge; to determine the incidence of thromboembolic events (deep venous thrombosis; stroke; pulmonary thromboembolism; transient ischemic attack

  8. The incidence of venous thromboembolism and practice of deep venous thrombosis prophylaxis in hospitalized cirrhotic patients

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    Alqahtani Saad

    2011-01-01

    Full Text Available Abstract Background Cirrhotic patients are characterized by a decreased synthesis of coagulation and anticoagulation factors. The coagulopathy of cirrhotic patients is considered to be auto-anticoagulation. Our aim was to determine the incidence and predictors of venous thromboembolism (VTE and examine the practice of deep venous thrombosis (DVT prophylaxis among hospitalized cirrhotic patients. Methods A retrospective cohort study was performed in a tertiary teaching hospital. We included all adult patients admitted to the hospital with a diagnosis of liver cirrhosis from January 1, 2009 to December 31, 2009. We grouped our cohort patients in two groups, cirrhotic patients without VTE and cirrhotic with VTE. Results Over one year, we included 226 cirrhotic patients, and the characteristics of both groups were similar regarding their clinical and laboratory parameters and their outcomes. Six patients (2.7% developed VTE, and all of the VTEs were DVT. Hepatitis C was the most common (51% underlying cause of liver cirrhosis, followed by hepatitis B (22%; 76% of the cirrhotic patients received neither pharmacological nor mechanical DVT prophylaxis. Conclusion Cirrhotic patients are at risk for developing VTE. The utilization of DVT prophylaxis was suboptimal.

  9. Challenges facing venous thromboembolism in China: more public awareness and research needed

    Institute of Scientific and Technical Information of China (English)

    WANG Chen; ZHAI Zhen-guo; Ying H Shen

    2010-01-01

    @@ Venous thromboembolism (VTE), composed of deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE), has been recognized as worldwide health problem not only in the western countries but also in Asian-Pacific regions. Tremendous progress has been made in recent years in identifying the potential risk factors, understanding the pathogenesis and developing therapeutic approaches for VTE. However, most of the currently available data are from American and European populations. Limited data from Chinese population are validated. Efforts should be made to increase public awareness, and promote clinical and translational research of VTE in modern China.

  10. Increased risk of venous thromboembolism and arterial cardiovascular events in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Kristensen, Søren Lund; Ahlehoff, Ole; Lindhardsen, Jesper;

    2012-01-01

    This focused review describes the current knowledge of the association between inflammatory bowel disease (IBD) and cardiovascular disease. Atherosclerosis is a chronic inflammatory disease, and as well as venous thromboembolism this disease shares inflammatory mechanisms with IBD. Patients...... with IBD have a high risk of venous thromboembolism especially during IBD flare-ups. Their risk of arterial cardiovascular disease may also be increased. The risk of cardiovascular disease in patients with IBD warrants clinical attention, and it is possible that the risk can be modified by applying anti...

  11. Prevention and treatment of venous thromboembolism with low-molecular-weight heparins: Clinical implications of the recent European guidelines

    Directory of Open Access Journals (Sweden)

    Prandoni Paolo

    2008-09-01

    Full Text Available Abstract Venous thromboembolism (VTE is an important cause of avoidable morbidity and mortality. However, routine prophylaxis for at-risk patients is underused. Recent guidelines issued by an international consensus group, including the International Union of Angiology (IUA, recommend use of low-molecular-weight heparins (LMWHs for the treatment of acute VTE and prevention of recurrence, and for prophylaxis in surgical and medical patients. This review highlights current inadequacies in the provision of thromboprophylaxis, and considers the clinical implications of the European guidelines on the prevention and treatment of VTE.

  12. Venous Thromboembolism – Risk Assessment Tool and Thromboprophylaxis Policy: A National Survey

    LENUS (Irish Health Repository)

    Khan, MI

    2017-01-01

    Venous Thromboembolic (VTE) events in hospitalised patients are associated with significant mortality and morbidity and a major economic burden on the health service. It is well established in the literature that active implementation of a mandatory risk assessment tool and thromboprophylaxis policy reduces the incidence of hospital associated thrombosis (HAT). This study examines the utilization of a VTE risk assessment tool and thromboprophylaxis (TP) policy in Irish hospitals that manage acute admissions. A national survey was distributed to forty acute hospitals throughout Ireland. The response rate was 78% (31\\/40). The results showed that only 26% (n=8\\/31) of acute hospitals in Ireland have a local implemented TP policy. Six (75%) of these eight had a risk assessment tool in conjunction with the TP policy. All respondents who did not report to have a TP policy and risk assessment tool agreed that they should implement VTE prevention policy at their hospital. Based on the data from this survey and evidence from the effectiveness of the VTE prevention programme introduced in the United Kingdom, there is a need for a national risk assessment and thromboprophylaxis policy in Ireland. This change in practice would have the potential to prevent or reduce the morbidity and mortality associated with hospital acquired thrombosis

  13. Recurrent venous thromboembolism in anticoagulated patients with cancer : management and short-term prognosis

    NARCIS (Netherlands)

    Schulman, S.; Zondag, M.; Linkins, L.; Pasca, S.; Cheung, Y. W.; De Sancho, M.; Gallus, A.; Lecumberri, R.; Molnar, S.; Ageno, W.; Le Gal, G.; Falanga, A.; Hulegardh, E.; Ranta, S.; Kamphuisen, P.; Debourdeau, P.; Rigamonti, V.; Ortel, T. L.; Lee, A.

    2015-01-01

    BackgroundRecommendations for management of cancer-related venous thromboembolism (VTE) in patients already receiving anticoagulant therapy are based on low-quality evidence. This international registry sought to provide more information on outcomes after a breakthrough VTE in relation to anticoagul

  14. Use of bisphosphonates and raloxifene and risk of deep venous thromboembolism and pulmonary embolism

    DEFF Research Database (Denmark)

    Vestergaard, P; Schwartz, K; Pinholt, E M;

    2010-01-01

    Prior studies have associated raloxifene and strontium ranelate with deep venous thromboembolism and pulmonary embolism. In a cohort study, we observed an increased risk also with the bisphosphonates. However, the increase was present already before the start of bisphosphonates pointing at an eff...

  15. Factor XIII Va134Leu and the risk of venous thromboembolism in factor V Leiden carriers

    NARCIS (Netherlands)

    Franco, RF; Middeldorp, S; Meinardi, [No Value; van Pampus, ECM; Reitsma, PH

    2000-01-01

    A mutation in factor XIII (Val34Leu) was reported to protect against Venous thromboembolism. We evaluated the effect of Val34Leu on thrombotic risk in 352 factor V Leiden carriers who were first-degree relatives of 132 thrombotic propositi carrying factor V Leiden. The total observation period was 2

  16. Von Willebrand factor, ADAMTS13 levels and prediction of venous thromboembolism in patients with cancer

    NARCIS (Netherlands)

    Pepin, M.; Kleinjan, A.; Hajage, D.; Büller, H.R.; DiNisio, M.; Kamphuisen, P.W.; Mahe, I.; Stepanian, A.

    2013-01-01

    Background: Cancer patients are at high risk for venous thromboembolism (VTE). However, thromboprophylaxis in these patients is associated with an increased hemorrhagic risk. The Khorana score is a risk scoring model for prediction of VTE that includes clinical and laboratory parameters. It has been

  17. An audit of pressure sores caused by intermittent compression devices used to prevent venous thromboembolism.

    Science.gov (United States)

    Skillman, Joanna; Thomas, Sunil

    2011-12-01

    When intermittent compression devices (ICDs) are used to prevent venous thromboembolism (VTE) they can cause pressure sores in a selected group of women, undergoing long operations. A prospective audit pre and post intervention showed a reduced risk with an alternative device, without increasing the risk of VTE.

  18. Venous thromboembolism in ANCA-associated vasculitis - incidence and risk factors

    NARCIS (Netherlands)

    Stassen, P. M.; Derks, R. P. H.; Kallenberg, C. G. M.; Stegeman, C. A.

    2008-01-01

    Objectives. In patients with ANCA-associated vasculitis (AAV), an increased incidence of venous thromboembolism (VTE), mainly during active disease, has been described. In a large cohort of AAV patients, live assessed the incidence of VTE and its relation with disease activity and classic risk facto

  19. Statin use in patients with nephrotic syndrome is associated with a lower risk of venous thromboembolism

    NARCIS (Netherlands)

    Resh, Mohammad; Mahmoodi, Bakhtawar K.; Navis, Gerjan J.; Veeger, Nic J. G. M.; Lijfering, Willem M.

    2011-01-01

    Background: Nephrotic syndrome (NS) is a well-known risk factor for venous thromboembolism (VTE), however preventive measures are not routinely taken. In non-renal populations, statins are associated with lower risk of VTE. Hence, we set up this single-center retrospective cohort study to assess whe

  20. Insulin resistance and risk of venous thromboembolism : results of a population-based cohort study

    NARCIS (Netherlands)

    Van Schouwenburg, I. M.; Mahmoodi, B. K.; Veeger, N. J. G. M.; Bakker, S. J. L.; Kluin-Nelemans, H. C.; Meijer, K.; Gansevoort, R. T.

    2012-01-01

    Background: Obesity is an established risk factor for venous thromboembolism (VTE), but it is uncertain how this is mediated. Insulin resistance has a central role in the pathophysiology of the metabolic effects of obesity. Objective: We aimed to investigate whether insulin resistance is a risk fact

  1. Oral rivaroxaban for the prevention of symptomatic venous thromboembolism after elective hip and knee replacement

    DEFF Research Database (Denmark)

    Eriksson, B I; Kakkar, A K; Turpie, A G G;

    2009-01-01

    A once-daily dose of rivaroxaban 10 mg, an oral, direct Factor Xa inhibitor, was compared with enoxaparin 40 mg subcutaneously once daily for prevention of venous thromboembolism in three studies of patients undergoing elective hip and knee replacement (RECORD programme). A pooled analysis of dat...

  2. Jobs encompassing prolonged sitting in cramped positions and risk of venous thromboembolism

    DEFF Research Database (Denmark)

    Suadicani, Poul; Hannerz, Harald; Bach, Elsa;

    2012-01-01

    There is mounting evidence that prolonged cramped sitting in connection with long-lasting air travel increases the risk of deep vein thrombosis of the legs and pulmonary embolism, i.e. venous thromboembolism (VTE). Prolonged cramped sitting may occur even in various jobs unrelated to air travel...

  3. Venous thromboembolism in ovarian cancer: incidence, risk factors and impact on survival.

    LENUS (Irish Health Repository)

    Abu Saadeh, Feras

    2013-09-01

    Ovarian cancer has a higher incidence of venous thromboembolism (VTE) than other cancers. Clear cell cancers carry the highest risk at 11-27%. The aim of this study was to identify the predisposing factors for VTE in a population of ovarian cancer patients and to determine the influence of VTE on overall survival.

  4. Repair of Chronic Achilles Ruptures Has a High Incidence of Venous Thromboembolism.

    Science.gov (United States)

    Bullock, Mark J; DeCarbo, William T; Hofbauer, Mark H; Thun, Joshua D

    2016-11-23

    Background Despite the low incidence of deep vein thrombosis (DVT) in foot and ankle surgery, some authors report a high incidence of symptomatic DVT following Achilles tendon rupture. The purpose of this study was to identify DVT risk factors inherent to Achilles tendon repair to determine which patients may benefit from prophylaxis. Methods One hundred and thirteen patient charts were reviewed following elective and nonelective Achilles tendon repair. For elective repair of insertional or noninsertional Achilles tendinopathy, parameters examined included lateral versus prone positioning and the presence versus absence of a flexor hallucis longus transfer. For nonelective repair, acute Achilles tendon ruptures were compared to chronic Achilles tendon ruptures. Results Of 113 Achilles tendon repairs, 3 venous thromboembolism (VTE) events (2.65%) occurred including 2 pulmonary emboli (1.77%). Seventeen of these repairs were chronic Achilles tendon ruptures, and all 3 VTE events (17.6%) occurred within this subgroup. Elevated body mass index was associated with VTE in patients with chronic Achilles ruptures although this did not reach significance (P = .064). No VTE events were reported after repair of 28 acute tendon ruptures or after 68 elective repairs of tendinopathy. Two patients with misdiagnosed partial Achilles tendon tears were excluded because they experienced a VTE event 3 weeks and 5 weeks after injury, prior to surgery. Conclusion In our retrospective review, chronic Achilles ruptures had a statistically significant higher incidence of VTE compared with acute Achilles ruptures (P = .048) or elective repair (P = .0069). Pharmaceutical anticoagulation may be considered for repair of chronic ruptures. Repair of acute ruptures and elective repair may not warrant routine prophylaxis due to a lower incidence of VTE.

  5. Primary prevention and treatment of venous thromboembolic events in patients with gastrointestinal cancers- Review

    Institute of Scientific and Technical Information of China (English)

    Hanno Riess; Piet Habbel; Anja Jühling; Marianne Sinn; Uwe Pelzer

    2016-01-01

    Venous thromboembolism event(VTE) is a common and morbid complication in cancer patients. Patients with gastrointestinal cancers often suffer from symptomatic or incidental splanchnic vein thrombosis, impaired liver function and/or thrombocytopenia. These characteristics require a thorough risk/benefit evaluation for individual patients. Considering the risk factors for the development of VTE and bleeding events in addition to recent study results may be helpful for correct initiation of primary pharmacological prevention and treatment of cancer-associated thrombosis(CAT), preferably with low molecular weight heparins(LMWH). Whereas thromboprophylaxis is most often recommended in hospitalized surgical and non-surgical patients with malignancy, there is less agreement as to its duration. With regard to ambulatory cancer patients, the lack of robust data results in low grade recommendations against routine use of anticoagulant drugs. Anticoagulation with LMWH for the first months is the evidence-based treatment for acute CAT, but duration of secondary prevention and the drug of choice are unclear. Based on published guidelines and literature, this review will focus on prevention and treatment strategies of VTE in patients with gastrointestinal cancers.

  6. Improving venous thromboembolic disease prophylaxis in medical inpatients: a role for education and audit.

    LENUS (Irish Health Repository)

    Kent, B D

    2012-02-01

    BACKGROUND: Venous thromboembolic disease (VTED) prophylaxis is a key strategy in reducing preventable deaths in medical inpatients. We assessed compliance with internationally published guidelines for VTED prophylaxis in at-risk medical patients before and 1 month after an educational intervention to enhance compliance with such guidelines. RESULTS: One hundred and fifty patients were assessed on each occasion. Pre-intervention, VTED prophylaxis was prescribed in only 48% of at-risk cases. Compliance was best among patients under stroke services and worst for those under acute medical teams. Patients within specialist units were more likely to be prescribed prophylaxis than those in general wards (75 vs. 53%; p = 0.0019). Post-intervention, overall compliance improved to 63% (p = 0.041 for comparison). There was a significant improvement among general medical teams (48 vs. 75%; p = 0.001), and in general wards (52 vs. 74%; p = 0.003). CONCLUSIONS: Thromboprophylaxis is under-prescribed in medical inpatients, but compliance with international guidelines can be significantly enhanced with targeted educational intervention.

  7. Prophylaxis for venous thrombo-embolism in neurocritical care: a critical appraisal.

    Science.gov (United States)

    Raslan, Ahmed M; Fields, Jeremy D; Bhardwaj, Anish

    2010-04-01

    Venous thrombo-embolism (VTE) is frequently encountered in critically ill neurological and neurosurgical patients admitted to intensive care units. This patient population includes those with brain neoplasm, intracranial hemorrhage, ischemic stroke, subarachnoid hemorrhage, pre- and post-operative patients undergoing neurosurgical procedures and those with traumatic brain injury, and acute spinal cord injury (SCI). There is a wide variability in clinical practice for thromboprophylaxis in these patients, in part due to paucity of data based on randomized clinical trials. Here, we review the current literature on the incidence of VTE in the critically ill neurological and neurosurgical patients as well as appraise available data to support particular practice paradigms for specific subsets of these patients. Data synthesis was conducted via search of Medline, Cochrane databases, and manual review of article bibliographies. Critically ill neurological and neurosurgical patients have higher susceptibility to VTE. Intermittent compression devices with or without anti-thrombotics is generally the method of choice for thromboprophylaxis. Low molecular weight heparin is the method of choice in certain patient subgroups such as those with SCI and ischemic stroke. Inferior vena cava filters may play a role in thromboprophylaxis in selected cases. Without clear guidelines that can be universally applied to this diverse group of patients, prophylaxis for VTE should be tailored to the individual patient with cautious assessment of benefits versus risks. There is a need for higher level evidence to guide VTE prophylaxis in certain subgroups of this patient population.

  8. Venous Thromboembolism during Combat Operations: A 10-y Review

    Science.gov (United States)

    2014-01-01

    7.0%) were having PE, and 29 (2.9%) were found to have both a DVT and a PE. Risk factors found to be independently associated with VTE in amputees ...were multiple ampu tations (OR, 2; 95% CI, 1.35 3.42) and above the knee amputation (OR, 2.11; 95% CI, 1.3 3.32). Conclusions: Combat wounded are at a...high risk for thromboembolic complications with the highest risk associated with multiple or above the knee amputations. Published by Elsevier Inc. 1

  9. The strong but nonspecific relationship between 18F-FDG uptake in the lower-extremity veins and venous thromboembolism

    DEFF Research Database (Denmark)

    Zhu, Hongyun June; Hess, Søren; Rubello, Domenico;

    2016-01-01

    Venous thromboembolism (VTE) can present as deep vein thrombosis (DVT) and/or acute pulmonary embolism (PE). In fluorine-18 fluorodeoxyglucose (F-FDG) PET/CT, F-FDG activity along the deep veins of the lower extremities (LE) is often observed and, unless it is associated with focal intense activity......±101 and 49±82 days, respectively, and the closest and the most remote F-FDG-PET after the VTE event averaged 58±50 and 122±124 days. The extent of uptake in the LE veins averaged 7±2 for the patients with an acute DVT on LE duplex and 5±3 for those with negative or chronic DVT on LE duplex (P...

  10. Arterial complications, venous thromboembolism and deep venous thrombosis prophylaxis after anterior cruciate ligament reconstruction: A systematic review

    Science.gov (United States)

    Janssen, Rob Paulus Augustinus; Reijman, Max; Janssen, Daan Martijn; van Mourik, Jan Bernardus Antonius

    2016-01-01

    AIM To summarize the current knowledge on vascular complications and deep venous thrombosis (DVT) prophylaxis after anterior cruciate ligament (ACL) reconstruction. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. MEDLINE, EMBASE, Cochrane, Web of Science, CINAHL, PubMed publisher, and Google scholar medical literature databases were searched up to November 10, 2015. Any arthroscopic surgical method of primary or revision intra-articular ACL reconstruction of all graft types in humans was included. A risk of bias assessment was determined. RESULTS Fourty-seven studies were included in the review. Pseudaneurysms were the most frequently reported arterial complication after ACL reconstruction, irrespective of graft type or method of graft fixation with an incidence of 0.3%. The time to diagnosis of arterial complications after ACL reconstruction varied from days to mostly weeks but even years. After ACL reconstruction without thromboprophylaxis, the incidence of DVT was 9.7%, of which 2.1% was symptomatic. The incidence of pulmonary embolism was 0.1%. Tourniquet time > 2 h was related to venous thromboembolism. Thromboprophylaxis is indicated in patients with risk factors for venous thromboembolism. CONCLUSION After ACL reconstruction, the incidence of arterial complications, symptomatic DVT and pulmonary embolism was 0.3%, 2.1% and 0.1% respectively. Arterial complications may occur with all types of arthroscopic ACL reconstruction, methods of graft fixation as well as any type of graft. Patients considered to be at moderate or high risk of venous thromboembolism should routinely receive thromboprophylaxis after ACL reconstruction. PMID:27672574

  11. PO-06 - Cancer and the risk of venous thromboembolism in stroke patients

    DEFF Research Database (Denmark)

    Corraini, P; Ording, A G; Henderson, V W

    2016-01-01

    INTRODUCTION: The impact of comorbidity and in particular cancer on the risk of venous thromboembolism (VTE) after stroke is poorly understood. AIM: We aimed to determine the impact of comorbidity, in particular cancer, on the risk of venous thromboembolism in stroke patients as the excess VTE...... was matched to the stroke patients by date of diagnosis, year of birth, sex, and specific comorbidities using the Charlson Comorbidity Index and other VTE risk factors. We computed VTE cumulative risks, rates and rate ratios, as well as the interaction with comorbidity (as the excess VTE rates not explained...... by stroke and comorbidity alone) during five years of follow-up. RESULTS: Five-year VTE risks were 2.16% and 1.85% in the stroke and general population comparison cohorts, respectively. Three-month VTE rate ratios peaked at a 6-fold increase (95% confidence interval: 4.9;6.2) in stroke patients and remained...

  12. [Protein C deficiency in black African with venous thromboembolism in Cotonou, Benin].

    Science.gov (United States)

    Houénassi, D M; Bigot, A; Tchabi, Y; Vehounkpé-Sacca, J; Akindes-Dossou Yovo, R; Gbaguidi, L; d'Almeida-Massougbodji, M; Agboton, H

    2013-02-01

    The aim of this study is to evaluate the frequency of protein C deficiency in venous thromboembolism in black African patients of Benin. It is a descriptive study. Inclusion criteria were: acceptance- having a venous thromboembolism. No exlusion criteria was retained. Protein C deficiency was diagnosed by quantitative technic with a Minividas materiel in the blood. Protein C dosage has been done before antivitamin k therapy and a second dosage has been done if the first one demonstrated a low level of protein C. Acuired aetiology have been research. For the 54 patients of this study mean age was 52.7±14.1 and sex-ratio 1.08. The frequency of protein C deficiency was 9.3% in all patients and 12.5% in those with clinical thrombophily (p=1). No acquired deficit has been found.

  13. Venous thromboembolism in Latin America: a review and guide to diagnosis and treatment for primary care.

    Science.gov (United States)

    Ceresetto, Jose Manuel

    2016-01-01

    There are various region-specific challenges to the diagnosis and effective treatment of venous thromboembolism in Latin America. Clear guidance for physicians and patient education could improve adherence to existing guidelines. This review examines available information on the burden of pulmonary embolism and deep vein thrombosis in Latin America and the regional issues surrounding the diagnosis and treatment of pulmonary embolism and deep vein thrombosis. Potential barriers to appropriate care, as well as treatment options and limitations on their use, are discussed. Finally, an algorithmic approach to the diagnosis and treatment of venous thromboembolism in ambulatory patients is proposed and care pathways for patients with pulmonary embolism and deep vein thrombosis are outlined for primary care providers in Latin America.

  14. Hormonal contraception and risk of venous thromboembolism: national follow-up study

    DEFF Research Database (Denmark)

    Lidegaard, Øjvind; Løkkegaard, Ellen; Svendsen, Anne Louise

    2009-01-01

    .22), with gestodene 1.86 (1.59 to 2.18), with drospirenone 1.64 (1.27 to 2.10), and with cyproterone 1.88 (1.47 to 2.42). Compared with non-users of oral contraceptives, the rate ratio for venous thromboembolism in users of progestogen only oral contraceptives with levonorgestrel or norethisterone was 0.59 (0.33 to 1...... and the same length of use, oral contraceptives with desogestrel, gestodene, or drospirenone were associated with a significantly higher risk of venous thrombosis than oral contraceptives with levonorgestrel. Progestogen only pills and hormone releasing intrauterine devices were not associated with any...

  15. Venous thromboembolism following L-asparaginase treatment for lymphoid malignancies in Korea.

    Science.gov (United States)

    Lee, J H; Lee, J; Yhim, H-Y; Oh, D; Bang, S-M

    2017-02-02

    Essentials Data on venous thromboembolism (VTE) after L-asparaginase (L-asp) in Asian lymphoma are scarce. This is a population-based study in Asian patients with lymphoid disease and L-asp-related VTE. The overall incidence of L-asp-associated VTE was similar to reports on Caucasians. This first and largest study in Asians shows that mainly adult patients are at risk of thrombosis.

  16. Psoriasis complicated with venous thromboembolism: report of two cases and a literature review

    Institute of Scientific and Technical Information of China (English)

    ZHAO Yun-xia; CHEN Gang; ZHAO Rui-zhen; ZHANG Xiao-guang

    2011-01-01

    Cases of psoriasis complicated with venous thromboembolism are rarely reported. Here, we report two cases and review the current literature on the subject. Two patients with long-standing severe psoriasis presented with chest pain,shortness of breath and breathing difficulties. The patients were diagnosed using lung ventilation-perfusion scans or computed tomographic pulmonary angiography. Anticoagulation or thrombolytic therapy was initiated, and long-term continuous anticoagulation with warfarin prevented any recurrences.

  17. Venous thromboembolic disease in systemic autoimmune diseases: an association to keep in mind.

    Science.gov (United States)

    Silvariño, Ricardo; Danza, Álvaro; Mérola, Valentina; Bérez, Adriana; Méndez, Enrique; Espinosa, Gerard; Cervera, Ricard

    2012-12-01

    Systemic autoimmune diseases are conditions of unknown etiology, characterized by the simultaneous or successive involvement of most organs and systems, as well as the presence of autoantibodies as biological markers. Venous thromboembolic disease has a higher incidence in this population when compared to healthy individuals. This responds to the increase in congenital and acquired risk factors in this group. One of the main risk factors is linked to the presence of antiphospholipid antibodies, whose prevalence is increased among patients with such conditions.

  18. Management of Venous Thromboembolism%肺栓塞治疗的研究进展

    Institute of Scientific and Technical Information of China (English)

    徐萍芳; 周伟英(综述); 姜衡(审校)

    2015-01-01

    静脉血栓栓塞是心肌梗死和脑卒中后最常发生的急性心血管并发症之一,其中肺栓塞又是致残和致死率最高的临床表现形式。因此,一旦确诊肺栓塞,即应进行积极干预,目前常用的治疗手段包括抗凝、溶栓、介入和外科手术。近年来,肺栓塞危险分层策略的演变,新型口服抗凝药的出现,溶栓适应证的改变等为肺栓塞的治疗带来了革命性的发展。现就肺栓塞治疗的最新研究进展进行简要综述。%Venous thromboembolism is one of the most frequent acute cardiovascular complication.Its most serious clinical presenta-tion, acute pulmonary embolism, is a major cause of mortality and morbidity.Therefore, upon the diagnosis of pulmonary embolism, active treatments such as anticoagulation, thrombolysis, interventional or surgical operation, should be considered.Recently, the evolution of risk stratification strategies, the emergence of new oral anticoagulants, and changes in thrombolysis indications, have created a new therapy for pulmonary embolisms.Here, we briefly review the recent advances in the management of pulmonary embolisms.

  19. Differential benefit risk assessment of DOACs in the treatment of venous thromboembolism: focus on dabigatran

    Directory of Open Access Journals (Sweden)

    Leung TS

    2015-07-01

    Full Text Available Timothy S Leung,1 Ernest H Law2 1Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada; 2Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA Abstract: Venous thromboembolism includes deep vein thrombosis and pulmonary embolism and is a serious medical condition that requires anticoagulation as part of treatment. Currently, standard therapy consists of parenteral anticoagulation followed by a vitamin K antagonist (VKA. The pharmacokinetic and pharmacodynamic profiles of the direct oral anticoagulants (DOACs differ from VKAs, which overcome some of the limitations of VKAs and have practical implications on their use in clinical situations. Dabigatran is a prodrug that undergoes primarily renal elimination and does not affect cytochrome P450 enzymes. Assays to quantify the degree of anticoagulation and the therapeutic level of DOAC are either unavailable for routine clinical use or require specific calibration. Routine monitoring of DOACs is not recommended at this time. Dabigatran, rivaroxaban, and apixaban are DOACs that have been studied for treatment of venous thromboembolism. Clinical trials comparing DOACs with standard therapy have shown them to be non-inferior for acute and extended therapy. Each DOAC has a unique benefit and harm profile that should be considered prior to use. The distinguishing characteristics of dabigatran include a requirement of parenteral anticoagulation prior to acute treatment, clinical trial results comparing it with a VKA for extended treatment, association with upper gastrointestinal adverse events, and increased risk of gastrointestinal bleed. Rivaroxaban is the only DOAC that has once-daily dosing while apixaban is the only DOAC that has lower risk of overall, major, and gastrointestinal bleeding compared with VKA. A common drawback of DOACs is the lack of an available reversal agent. Clinical trials of

  20. Regional lymph node metastases are a strong risk factor for venous thromboembolism: results from the Vienna Cancer and Thrombosis Study

    Science.gov (United States)

    Dickmann, Boris; Ahlbrecht, Jonas; Ay, Cihan; Dunkler, Daniela; Thaler, Johannes; Scheithauer, Werner; Quehenberger, Peter; Zielinski, Christoph; Pabinger, Ingrid

    2013-01-01

    Advanced cancer is a risk factor for venous thromboembolism. However, lymph node metastases are usually not considered an established risk factor. In the framework of the prospective, observational Vienna Cancer and Thrombosis Study we investigated the association between local (N0), regional (N1–3), and distant (M1) cancer stages and the occurrence of venous thromboembolism. Furthermore, we were specifically interested in the relationship between stage and biomarkers that have been reported to be associated with venous thromboembolism. We followed 832 patients with solid tumors for a median of 527 days. The study end-point was symptomatic venous thromboembolism. At study inclusion, 241 patients had local, 138 regional, and 453 distant stage cancer. The cumulative probability of venous thromboembolism after 6 months in patients with local, regional and distant stage cancer was 2.1%, 6.5% and 6.0%, respectively (P=0.002). Compared to patients with local stage disease, patients with regional and distant stage disease had a significantly higher risk of venous thromboembolism in multivariable Cox-regression analysis including age, newly diagnosed cancer (versus progression of disease), surgery, radiotherapy, and chemotherapy (regional: HR=3.7, 95% CI: 1.5–9.6; distant: HR=5.4, 95% CI: 2.3–12.9). Furthermore, patients with regional or distant stage disease had significantly higher levels of D-dimer, factor VIII, and platelets, and lower hemoglobin levels than those with local stage disease. These results demonstrate an increased risk of venous thromboembolism in patients with regional disease. Elevated levels of predictive biomarkers in patients with regional disease underpin the results and are in line with the activation of the hemostatic system in the early phase of metastatic dissemination. PMID:23585523

  1. The damage to a person caused by venous thromboembolism in the civil responsibility.

    Science.gov (United States)

    Di Blasi, A; Di Blasi, L; Manferoce, O; Napoli, P

    2000-01-01

    The venous thromboembolism can clinically show itself as deep venous thrombosis or as pulmonary embolism. Both serious and potentially fatal, for this high incidence, they assume importance in social economic sphere. The authors take into account the medicolegal diagnostics methodology of the deep venous thrombosis and of the pulmonary embolism, the traumatic and post traumatic etiology, to determine the connection of causality and the estimating parameters of the damage to a person in the sphere of civil responsibility. To attain to a certain diagnosis of thromboembolism, since its difficult cause of paucisymtomaticity or asymtomaticity of the pathology after an attentive evaluation of symptoms, clinic manifestations and factors of risk, it can't be disregarded to utilize scientific diagnostic criteria, and instrumental ascertainments, serial too, helped by conventional means of standardization, such as the new American system of classification CEAP. The following phases of medicolegal ascertainment consist in identifying the causal connection between disease and event and in estimating of the damage to a person, with rigorous and objective methodology and using tabular orientation guides, that have to indicate the percentage incidence of the undergone disablement on the person's validity for indemnity. It is showed the particular delicacy of the medical examiner's evaluation in thromboembolic disease, in the sphere of civil responsibility, both for the difficulties of the diagnostic identification of the deep venous thrombosis, and of the pulmonary embolism, and for the determination of the connection of causality with traumatic events and with following operation of orthopedics-traumatology and neurosurgery (sector on which the most difficult problems of professional responsibility can connect) and finally for the real evaluation of the consequent damage to a persons, in order to its indemnity.

  2. Increased risk of arterial thromboembolism after a prior episode of venous thromboembolism : results from the Prevention of REnal and Vascular ENd stage Disease (PREVEND) Study

    NARCIS (Netherlands)

    van Schouwenburg, Inge M.; Gansevoort, Ron T.; Mahmoodi, Bakhtawar K.; Visser, Margaretha M.; Kluin-Nelemans, Hanneke C.; Lijfering, Willem M.; Veeger, Nic J. G. M.

    2012-01-01

    Large population-based studies are needed to establish the magnitude and duration of the recently suggested association between arterial and venous thromboembolism. In 199798, all inhabitants of Groningen, the Netherlands, aged 2875 years (n = 85 421), were invited to participate in a study that fol

  3. Symptomatic venous thromboembolism following fractures distal to the knee

    DEFF Research Database (Denmark)

    Wahlsten, L. R.; Eckardt, H.; Lyngbæk, S.

    2015-01-01

    BACKGROUND: Our aims were to determine the incidence of symptomatic deep venous thrombosis (DVT) and pulmonary embolism (PE) that required inpatient or outpatient treatment, and to identify specific risk factors associated with DVT/PE in patients who had undergone surgery for a fracture distal...... to the knee. METHODS: Using individual linkage of nationwide registries, we included all Danish patients who had undergone surgery for a fracture distal to the knee between 1999 and 2011. Patients were followed for 180 days from discharge. Event rates of DVT/PE were calculated, and significant risk factors.......56) were the factors associated with the highest risk of postoperative DVT/PE. Also, increasing age, increasing body mass index, cancer, and treatment with nonsteroidal anti-inflammatory drugs were associated with a significantly increased risk of DVT/PE. CONCLUSIONS: The incidence of DVT/PE was low...

  4. Venous thromboembolism prophylaxis in hospitalized elderly patients:Time to consider a 'MUST' strategy

    Institute of Scientific and Technical Information of China (English)

    Kwok M Ho; Edward Litton

    2011-01-01

    Venous thromboembolism (VTE) is the commonest cause of preventable death in hospitalized patients.Elderly patients have higher risk of VTE because of the high prevalence of predisposing comorbidities and acute illnesses.Clinical diagnosis of VTE in the elderly patient is particularly difficult and,as such,adequate VTE prophylaxis is of pivotal importance in reducing the mortality and morbidities of VTE.Omission of VTE prophylaxis is,however,very common despite continuous education.A simple way to overcome this problem is to implement universal VTE prophylaxis for all hospitalized elderly patients instead of selective prophylaxis for some patients only according to individual's risk of VTE.Although pharmacological VTE prophylaxis is effective for most patients,a high prevalence of renal impairment and drug interactions in the hospitalized elderly patients suggests that a multimodality approach may be more appropriate.Mechanical VTE prophylaxis,including calf and thigh compression devices and/or an inferior vena cava filter,are often underutilized in hospitalized elderly patients who are at high-risk of bleeding and VTE.Because pneumatic compression devices and thigh length stockings are virtually risk free,mechanical VTE prophylaxis may allow early or immediate implementation of VTE prophylaxis for all hospitalized elderly patients,regardless of their bleeding and VTE risk.Although the cost-effectiveness of this Multimodality Universal STat ('MUST') VTE prophylaxis approach for hospitalized elderly patients remains uncertain,this strategy appears to offer some advantages over the traditional `selective and single-modal' VTE prophylaxis approach,which often becomes `hit or miss' or not implemented promptly in many hospitalized elderly patients.A large clustered randomized controlled trial is,however,needed to assess whether early,multimodality,universal VTE prophylaxis can improve important clinical outcomes of hospitalized elderly patients.

  5. Decisions to withhold diagnostic investigations in nursing home patients with a clinical suspicion of venous thromboembolism.

    Directory of Open Access Journals (Sweden)

    Henrike J Schouten

    Full Text Available This study aimed to gather insights in physicians' considerations for decisions to either refer for- or to withhold additional diagnostic investigations in nursing home patients with a suspicion of venous thromboembolism.Our study was nested in an observational study on diagnostic strategies for suspected venous thromboembolism in nursing home patients. Patient characteristics, bleeding-complications and mortality were related to the decision to withhold investigations. For a better understanding of the physicians' decisions, 21 individual face-to-face in-depth interviews were performed and analysed using the grounded theory approach.Referal for additional diagnostic investigations was forgone in 126/322 (39.1% patients with an indication for diagnostic work-up. 'Blind' anticoagulant treatment was initiated in 95 (75.4% of these patients. The 3 month mortality rates were higher for patients in whom investigations were withheld than in the referred patients, irrespective of anticoagulant treatment (odds ratio 2.45; 95% confidence interval 1.40 to 4.29 but when adjusted for the probability of being referred (i.e. the propensity score, there was no relation of non-diagnosis decisions to mortality (odds ratio 1.75; 0.98 to 3.11. In their decisions to forgo diagnostic investigations, physicians incorporated the estimated relative impact of the potential disease; the potential net-benefits of diagnostic investigations and whether performing investigations agreed with established management goals in advance care planning.Referral for additional diagnostic investigations is withheld in almost 40% of Dutch nursing home patients with suspected venous thromboembolism and an indication for diagnostic work-up. We propose that, given the complexity of these decisions and the uncertainty regarding their indirect effects on patient outcome, more attention should be focused on the decision to either use or withhold additional diagnostic tests.

  6. Increased risk of venous thromboembolism within the first year after Staphylococcus aureus bacteraemia

    DEFF Research Database (Denmark)

    Mejer, Niels; Westh, Henrik T.; Schønheyder, Henrik Carl

    2014-01-01

    OBJECTIVES: Recent evidence suggests that there is an association between infection and venous thromboembolism (VTE). Here, we examined the risk of VTE after Staphylococcus aureus bacteraemia (SAB) compared to the risk in control subjects. DESIGN AND SETTING: Register-based nationwide observational...... patients persisted after excluding cases with identified VTE risk factors. CONCLUSIONS: There was a particularly high risk of VTE during the first month following an episode of SAB. The risk declined over time, but remained at a threefold increased level compared to control subjects, suggesting...... that there are shared risk factors for SAB and VTE. Patients with SAB and well-documented risk factors for VTE may benefit from thromboprophylaxis....

  7. [Testing for thrombophilia in patients with venous thromboembolism - why and whom to test?

    Science.gov (United States)

    Linnemann, Birgit

    2016-09-01

    Hereditary and acquired thrombophilias are known risk factors for a first venous thromboembolism (VTE). In contrast, the relative risk of VTE recurrence in presence of hereditary thrombophilia seems to be at most moderately elevated. However, thrombophilia still contributes to a greater extent to the absolute risk of VTE recurrence. This is explained by the 20-50-fold increased risk of VTE in a subject after a first VTE when compared to the state without previous VTE. Testing for thrombophilia may therefore be helpful in patients at intermediate risk of recurrence in whom the finding of a "strong" thrombophilia can bring about a decision for long-term anticoagulation.

  8. OPTIMAL PREVENTION OF HOSPITAL VENOUS THROMBOEMBOLISM WITH THE HELP OF MEDICAL INFORMATION SYSTEM

    Directory of Open Access Journals (Sweden)

    G. I. Nazarenko

    2014-01-01

    Full Text Available Deep vein thrombosis and pulmonary embolism are an important medical and social problem, contributing to the structure of morbidity and mortality in the developed countries. Despite the availability of clinical guidelines for the prevention of venous thromboembolic complications there is a gap between scientific knowledge and clinical practice. Clinical decision support systems (CDSS are confirmed to be effective tool for the implementation of clinical guidelines in daily practice. CDSS should be based on national and international clinical guidelines; their effectiveness depends upon successful integration with other health information systems and care flow processes.

  9. Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001-9

    DEFF Research Database (Denmark)

    Lidegaard, Øjvind; Nielsen, Lars Hougaard; Skovlund, Charlotte Wessel;

    2011-01-01

    To assess the risk of venous thromboembolism from use of combined oral contraceptives according to progestogen type and oestrogen dose.......To assess the risk of venous thromboembolism from use of combined oral contraceptives according to progestogen type and oestrogen dose....

  10. Pulmonary tuberculosis - An emerging risk factor for venous thromboembolism: A case series and review of literature

    Directory of Open Access Journals (Sweden)

    Amitesh Gupta

    2017-01-01

    Full Text Available One-third of patients with symptomatic venous thromboembolism (VTE manifest pulmonary embolism, whereas two-thirds manifest deep vein thrombosis (DVT. Overall, 25%–50% of patients with first-time VTE have an idiopathic condition, without a readily identifiable risk factor, and its association with tuberculosis (TB is a rare occurrence. Deep venous thrombosis has been associated with 1.5%–3.4% cases of TB. Early initiation of anti-TB treatment along with anticoagulant therapy decreases the overall morbidity and mortality associated with the disease. We report three cases of DVT associated with pulmonary TB who were diagnosed due to high index of suspicion as the risk factors for the development of DVT were present in these cases.

  11. Endogenous sex hormones and risk of venous thromboembolism in women and men

    DEFF Research Database (Denmark)

    Holmegard, Haya N; Nordestgaard, B G; Schnohr, P

    2014-01-01

    Heart Study, who had estradiol and testosterone concentrations measured. Of these, 636 developed VTE (deep venous thrombosis [DVT] and/or pulmonary embolism [PE]) during a follow-up of 21 years (range, 0.02-32 years). Associations between endogenous estradiol and testosterone concentrations and risk......BACKGROUND: Use of oral contraceptives with estrogen and hormone replacement therapy with estrogen or testosterone are associated with increased risk of venous thromboembolism (VTE). However, whether endogenous estradiol and testosterone concentrations are also associated with risk of VTE...... is unknown. OBJECTIVE: We tested the hypothesis that elevated endogenous total estradiol and total testosterone concentrations are associated with increased risk of VTE in the general population. METHODS: We studied 4658 women, not receiving exogenous estrogen, and 4673 men from the 1981-1983 Copenhagen City...

  12. The Saudi clinical practice guideline for the prophylaxis of venous thromboembolism in long-distance travelers

    Science.gov (United States)

    Al-Hameed, Fahad M.; Al-Dorzi, Hasan M.; Abdelaal, Mohamed A.; Alaklabi, Ali; Bakhsh, Ebtisam; Alomi, Yousef A.; Baik, Mohammad Al; Aldahan, Salah; Schünemann, Holger; Brozek, Jan; Wiercioch, Wojtek; Darzi, Andrea J.; Waziry, Reem; Akl, Elie A.

    2017-01-01

    Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a preventable disease. Long distant travelers are prone to variable degree to develop VTE. However, the low risk of developing VTE among long-distance travelers and which travelers should receive VTE prophylaxis, and what prophylactic measures should be used led us to develop these guidelines. These clinical practice guidelines are the result of an initiative of the Ministry of Health of the Kingdom of Saudi Arabia involving an expert panel led by the Saudi Association for Venous Thrombo Embolism (a subsidiary of the Saudi Thoracic Society). The McMaster University Guideline working group provided the methodological support. The expert panel identified 5 common questions related to the thromboprophylaxis in long-distance travelers. The corresponding recommendations were made following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. PMID:28042639

  13. Pulmonary tuberculosis - An emerging risk factor for venous thromboembolism: A case series and review of literature

    Science.gov (United States)

    Gupta, Amitesh; Mrigpuri, Parul; Faye, Abhishek; Bandyopadhyay, Debdutta; Singla, Rupak

    2017-01-01

    One-third of patients with symptomatic venous thromboembolism (VTE) manifest pulmonary embolism, whereas two-thirds manifest deep vein thrombosis (DVT). Overall, 25%–50% of patients with first-time VTE have an idiopathic condition, without a readily identifiable risk factor, and its association with tuberculosis (TB) is a rare occurrence. Deep venous thrombosis has been associated with 1.5%–3.4% cases of TB. Early initiation of anti-TB treatment along with anticoagulant therapy decreases the overall morbidity and mortality associated with the disease. We report three cases of DVT associated with pulmonary TB who were diagnosed due to high index of suspicion as the risk factors for the development of DVT were present in these cases. PMID:28144063

  14. Current Status of New Anticoagulants in the Management of Venous Thromboembolism

    Directory of Open Access Journals (Sweden)

    Roberto C. Montoya

    2012-01-01

    Full Text Available Venous Thromboembolism, manifested as deep venous thrombosis and pulmonary embolism, is a common problem associated with significant morbidity, mortality, and resource expenditure. Unfractionated heparin, low-molecular-weight heparin, and vitamin K antagonists are the most common treatment and prophylaxis, and have demonstrated their efficacy in a vast number of previous studies. Despite their broad use, these agents have important limitations that have led to the development of new drugs in a bid to overcome the disadvantages of the old ones without decreasing their therapeutic effect. These novel medications, some approved and others in different stages of development, include direct thrombin inhibitors like dabigatran etexilate, and direct activated factor X inhibitors like rivaroxaban. The current paper will review the characteristics, clinical trial results, and current and potential therapeutic uses of these new agents with a focus on the categories of direct thrombin inhibitors and activated factor X inhibitors.

  15. [Computerized medical register of venous thromboembolic disease at the Grenoble University Hospital Center: description and evaluation].

    Science.gov (United States)

    Michoud, E; Bosson, J L; Pichot, O; Vidal, F; Rossignol, S; Schwartzmann, J; Carpentier, P H

    1994-01-01

    The number of vascular exams for venous thromboembolic disease increases dramatically in the vascular medicine unit at the Grenoble University Hospital (France). In order to improve the efficiency and the homogeneity of all the medical staff involved, a computerized register has been created. It automatically provides a letter for the prescriber of the consultation. This database, working on a computer network, has three main functions: office automation (medical folder, report), education, and clinical research. The office automation evaluation is performed after a 6 month experience, comparing 100 medical reports about venous thrombosis assisted by the computer to 100 medical reports written before the installation of the system. The introduction of digitized register is real, still this evaluation has induced some modification in the system in order to be more efficient.

  16. Efficacy and safety of venous thromboembolism prophylaxis with apixaban in major orthopedic surgery

    Directory of Open Access Journals (Sweden)

    Werth S

    2012-03-01

    Full Text Available Sebastian Werth, Kai Halbritter, Jan Beyer-WestendorfCenter for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital “Carl Gustav Carus” Dresden, Dresden, GermanyAbstract: Over the last 15 years, low-molecular-weight heparins (LMWHs have been accepted as the “gold standard” for pharmaceutical thromboprophylaxis in patients at high risk of venous thromboembolism (VTE in most countries around the world. Patients undergoing major orthopedic surgery (MOS represent a population with high risk of VTE, which may remain asymptomatic or become symptomatic as deep vein thrombosis or pulmonary embolism. Numerous trials have investigated LMWH thromboprophylaxis in this population and demonstrated high efficacy and safety of these substances. However, LMWHs have a number of disadvantages, which limit the acceptance of patients and physicians, especially in prolonged prophylaxis up to 35 days after MOS. Consequently, new oral anticoagulants (NOACs were developed that are of synthetic origin and act as direct and very specific inhibitors of different factors in the coagulation cascade. The most developed NOACs are dabigatran, rivaroxaban, and apixaban, all of which are approved for thromboprophylaxis in MOS in a number of countries around the world. This review is focused on the pharmacological characteristics of apixaban in comparison with other NOACs, on the impact of NOAC on VTE prophylaxis in daily care, and on the management of specific situations such as bleeding complications during NOAC therapy.Keywords: major orthopedic surgery, apixaban, dabigatran, edoxaban, rivaroxaban, deep vein thrombosis, venous thromboembolism, VTE prophylaxis

  17. [The PROMET study: Prophylaxis for venous thromboembolic disease in at-risk patients hospitalized in Algeria].

    Science.gov (United States)

    Guermaz, R; Belhamidi, S; Amarni, A

    2015-07-01

    PROMET is an observational study aimed to assess the management of patients at venous thromboembolism risk in the Algerian hospitals and to evaluate the proportion of at-risk patients treated with an adequate prophylaxis. Following the ENDORSE study achieved five years before with a similar protocol, PROMET included 435hospitalized patients (229 in medical units and 206 in surgical units). Compared to the ENDORSE results, the PROMET data reflect progress in the management of venous thromboembolism: 73.3% of at-risk patients received prophylaxis (57.6% of medical patients and 90.8% of surgical patients). In 93.1% of cases, this prophylaxis was provided by a low molecular weight heparin, mainly at the dose of one injection per day. In medical population, the prescription was triggered by long-term immobilization (P=0.01; OR=5.8 95%CI [1.5-23.0]), associated risk factors (P=0.025; OR=4.13 [1.2-14.2]) and the cause of hospitalization (P=0.056). In surgical departments, the therapeutic decision depended on the nature of the surgical intervention and was influenced by the presence of a contraindication for prophylaxis (Pthromboprophylaxis. The process of preventive treatment (particularly the optimal duration) needs to be clarified.

  18. Clinical utility of apixaban in the prevention and treatment of venous thromboembolism: current evidence

    Directory of Open Access Journals (Sweden)

    Zalpour A

    2014-11-01

    Full Text Available Ali Zalpour,1 Thein Hlaing Oo21Division of Pharmacy – Clinical Programs, 2Section of Thrombosis and Benign Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX, USAAbstract: Anticoagulation with heparin and vitamin K antagonist has been the mainstay of prevention and treatment of venous thromboembolism (VTE for many years. In recent years, novel oral anticoagulants such as dabigatran etexilate (a direct thrombin inhibitor and rivaroxaban, apixaban, and edoxaban (a direct factor Xa inhibitor have emerged for the prevention and treatment of VTE. Novel oral anticoagulants have been shown to be noninferior to vitamin K antagonist or heparin in the prevention and treatment of VTE. This review specifically examines the role of apixaban in the prevention and treatment of VTE based on the available literature. The management of apixaban in the perioperative setting is also explored because some patients on apixaban may require surgical intervention. Finally, we discuss the management of apixaban-induced major bleeding complications, the relevance of drug–drug interactions, and patient education.Keywords: new oral anticoagulants, apixaban, venous thromboembolism, thromboprophylaxis

  19. Incidence of venous thromboembolism among patients who underwent major surgery in a public hospital in Singapore

    Directory of Open Access Journals (Sweden)

    Anindya P. Susanto

    2014-03-01

    Full Text Available Background: Venous thromboembolism (VTE is a fatal yet potentially preventable complication of surgery. Routine thromboprophylaxis is still unequivocal prescription is problematic due to perception of low VTE incidence among Asian population. This study aims to investigate the incidence of VTE and thromboprophylaxis prescription among patients undergoing major surgery in a Singapore hospital.Methods: This was a cross-sectional study. Data were obtained from medical record of 1,103 patients who had underwent major orthopaedic or abdominal surgery in 2011-2012 at Khoo Teck Puat Hospital, Singapore. Incidence of VTE events either in the same admission or re-admission in less than one month time were noted as study parameters.Results: Incidence of VTE was 2.1% (95% CI: 1.67 - 2.53 of which 1.3% and 0.8% were DVT and PE cases respectively. Age, gender, history of VTE, ischemic heart disease, and mechanical prophylaxis were associated with VTE incidence based on bivariate analysis. The prescription of pharmacological thromboprophylaxis was associated with prior anticoagulant medication, type of surgery, and incidence of new bleeding. Conclusion: Subsequent to major surgeries, VTE is as common in Asian patients as published data in other populations. Pharmacologic thromboprophylaxis should be considered as recommended in non-Asian guidelines.Keywords: thromboprophylaxis, venous thromboembolism

  20. Optimal management of venous thromboembolism in adolescent and young adult oncology patients

    Directory of Open Access Journals (Sweden)

    McKillop S

    2016-09-01

    Full Text Available Sarah McKillop,1 Cynthia Wu,2 Aisha Bruce,1 Joseph Brandwein2 1Division of Immunology, Hematology, Oncology, Palliative Care and Environmental Medicine, Department of Pediatrics, 2Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada Abstract: Venous thromboembolism (VTE is a serious complication experienced by adolescents and young adults (AYAs diagnosed with cancer. Data exist in the adult literature to guide the management of cancer-associated thrombosis. Unfortunately, little is known regarding the epidemiology of cancer-associated thrombosis in AYAs. As a result, evidence on the treatment and prevention of thrombosis in this vulnerable population is lacking, posing a great challenge to physicians caring for AYAs with cancer. It is clear that the basic principles of VTE likely apply to AYAs and that low-molecular-weight heparin is the drug of choice for the treatment of VTE regardless of age. We review the available data on the epidemiology, diagnostic methods, and management of AYAs with cancer and VTE. Recognizing the lack of accepted guidelines for the prevention or management of VTE in this population, we offer expert opinion recommendations to serve as guidance to improve management of thrombosis in AYA cancer patients. Keywords: adolescents, young adults, thrombosis, cancer, venous thromboembolism, anticoagulation

  1. Comparative risk impact of edoxaban in the management of stroke and venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Tellor KB

    2016-04-01

    Full Text Available Katie B Tellor, Joseph S Van Tuyl, Anastasia L Armbruster Department of Pharmacy Practice, St Louis College of Pharmacy, St Louis, MO, USA Abstract: Edoxaban, a factor Xa inhibitor, was approved by the United States Food and Drug Administration in 2015 for stroke prevention in nonvalvular atrial fibrillation and treatment of venous thromboembolism. It is the fourth target-specific oral anticoagulant to be approved. Edoxaban is noninferior for efficacy compared to warfarin for both approved indications. Edoxaban is superior to warfarin for the first major or clinically relevant nonmajor bleeding event in venous thromboembolism and major bleeding in nonvalvular atrial fibrillation. Edoxaban is dosed once daily for both indications and requires dose adjustment for renal function. In patients with nonvalvular atrial fibrillation, use is not recommended in patients with a creatinine clearance greater than 95 mL/min due to reduced efficacy. Edoxaban offers a new therapeutic alternative to the currently available options in the market. Keywords: anticoagulation, stroke, deep vein thrombosis, pulmonary embolism, atrial fibrillation, Savaysa™

  2. Prevention of venous thromboembolism in hospitalized patients with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Marcora Mandreoli

    2013-04-01

    Full Text Available Despite the high morbidity and mortality associated with venous thromboembolism in hospitalized medical patients with a number of risk factors, and large evidence that prophylaxis is effective, prophylaxis rates remain elusive in medically ill patients. Furthermore, in patients with renal failure, prophylaxis often is omitted or sub-optimal, due to fear of provoking hemorrhage. Patients with end-stage renal disease often have platelet deficits. Low molecular weight heparin (LMWH therapy may also be difficult to manage in these cases because LMWH clearance is largely dependent on the kidneys. Administration of LMWH to patients with some degree of renal failure may lead to bioaccumulation of anti-Xa activity with an increased risk of bleeding. In recent years, LMWH has largely replaced unfractionated heparin (UFH for the treatment and prophylaxis of thromboembolic disease. LMWHs have been shown to be superior to UFH in the prevention of venous thromboembolism. They are also easier to administer and do not require laboratory monitoring. However, several case reports and a metaanalysis indicate that the use of LMWHs at therapeutic doses in patients with advanced renal failure can be associated with major bleeding with serious adverse effects. In this paper, we review recent evidence supporting the safety of LMWHs at prophylactic doses in patients with mild or moderate renal disease. Current evidence suggests that bioaccumulation of enoxaparin (the most widely used LMWH can occur when the drug is used at standard therapeutic doses in patients with severely impaired renal function. This risk can be reduced by empiric dose reduction or monitoring of anti-Xa heparin levels.

  3. Risk of venous thromboembolism and myocardial infarction associated with factor V Leiden and prothrombin mutations and blood type

    DEFF Research Database (Denmark)

    Sode, Birgitte F; Allin, Kristine H; Dahl, Morten

    2013-01-01

    ABO blood type locus has been reported to be an important genetic determinant of venous and arterial thrombosis in genome-wide association studies. We tested the hypothesis that ABO blood type alone and in combination with mutations in factor V Leiden R506Q and prothrombin G20210A is associated...... with the risk of venous thromboembolism and myocardial infarction in the general population....

  4. Cost-effectiveness of new oral anticoagulants in the treatment and secondary prevention of venous thromboembolism

    Directory of Open Access Journals (Sweden)

    A. V. Rudakova

    2015-01-01

    Full Text Available Aim. To assess the cost-effectiveness of apixaban in the treatment and secondary prevention of venous thromboembolism (VTE compared with low molecular weight heparin (LMWH/warfarin and other new oral anticoagulants (NOACs. Material and methods. Cost-effectiveness analysis was performed using a Markov model, developed on the basis of the results of AMPLIFY AMPLIFY-Ext trials, and network meta-analyzes on the use of antithrombotic drugs in acute VTE and long-term administration after VTE. Markov cycle duration was 3 months. The duration of therapy in the simulation was 6 and 12 months. The time horizon of the study was 5 years. Life expectancy and costs were discounted by 3.5% per year. The costs on drugs were estimated based on the registered marginal cost price. Besides, the analysis was performed to the weighted average auctions prices for NOACs. The costs of monitoring and treatment of complications were calculated on the basis of the collective agreement of compulsory health insurance system (St. Petersburg, 2015. Results. Apixaban provided significant cost savings compared with other modes of anticoagulant therapy for hospital treatment. Apixaban provided cost savings compared with other NOACs with a minimal increase in life expectancy with regard to quality in long-term analysis. Apixaban provided an increase in life expectancy compared with the appointment of LMWH/warfarin, but required some increase in costs. At therapy duration of 6 months, the costs per one additional year of life with regard to quality and to one additional calendar year of life were 309.8-403.7 and 481.6-627.4 thousand rubles, respectively; at therapy duration of 12 months – 1254.4-1476.9 and 649.0-764.1 thousand rubles, respectively. Conclusion. Apixaban provided a reduction in the incidence of bleeding compared with other NOACs and LMWH/warfarin with comparable efficacy in treatment and secondary prevention of VTE. Apixaban therapy costs were lower than these

  5. ROLE OF PRO-INFLAMMATORY CYTOKINE GENE POLYMORPHISMS IN PATIENTS WITH EARLY-ONSET VENOUS THROMBOEMBOLISM

    Directory of Open Access Journals (Sweden)

    A. P. Polyakova

    2014-01-01

    Full Text Available Taking into account interrelations between inflammation and hemostasis, as well as immediate effects of IL-1β, IL-6 and TNFα upon blood coagulation system, one may suggest that their functional variantscould determine thrombosis risks both in arterial and venous circulation. The aim of this study was to assess possible role of allelic IL-1β, IL-6 and TNFα variants in pathogenesis of venous thromboembolism (VTEin young patients. A retrospective analysis was performed for a group of 180 patients with early-onset VTE, and 150 healthy. In a sub-group with deep-vein thrombosis of lower extremities (DWTLE complicated bypulmonary artery thromboembolia (PAT, we have revealed increased frequencies of IL-6 –174C homozygotes (30.8% vs 13.0%, p = 0.02 and IL-1β –31Т (61.5% vs 40.9%, p = 0.03, when compared with a subgroup of DWTLE. Among patients with “isolated” PAT a tendency for increased IL-1β –31ТТ ratio was found, as compared with DWTLE (53.8% vs 40.9%, р = 0,3, like as with control group (53.8% vs 40.7%, р = 0,3, These differences, however, were statistically insignificant. These data may suggest certain effects of IL-1β and IL-6 gene polymorphisms upon clinical characteristics of venous thromboembolism, rather than upon general VTE risk among young persons.

  6. 25-hydroxyvitamin D concentrations and risk of venous thromboembolism in the general population with 18,791 participants

    DEFF Research Database (Denmark)

    Brøndum-Jacobsen, Peter; Benn, Marianne; Tybjaerg-Hansen, A;

    2013-01-01

    thromboembolism. Corresponding risk increases in an age, sex, body mass index, smoking, and cancer adjusted model was 26%(5%-51%), and in a multivariable adjusted model further including physical activity, hormone replacement therapy, menopausal status, oral contraception use, and lipid lowering therapy 28......BACKGROUND: Vitamin D has potential antithrombotic effects suggesting that vitamin D analogs could be used as adjunctive antithrombotic agents. However, epidemiological evidence of an association between reduced 25-hydroxyvitamin D concentrations and risk of venous thromboembolism is lacking....... OBJECTIVES: We tested the hypothesis that reduced plasma 25-hydroxyvitamin D concentrations associate with increased risk of venous thromboembolism in the general population. METHODS: We prospectively studied 18,791 participants from the Copenhagen City Heart Study and the Copenhagen General Population Study...

  7. Combined arterial and venous whole-body MR angiography with cardiac MR imaging in patients with thromboembolic disease - initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Vogt, Florian M.; Hunold, Peter; Barkhausen, Joerg [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Herborn, Christoph U. [University Hospital Hamburg-Eppendorf, Medical Prevention Center Hamburg (MPCH) at University Hospital Hamburg-Eppendorf, Hamburg (Germany); Ruehm, Stefan G. [David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, CA (United States); Kroger, Knut [University Hospital Essen, Department of Angiology, Essen (Germany)

    2008-05-15

    The objective was to assess the feasibility of a combined arterial and venous whole-body three-dimensional magnetic resonance (MR) angiography, together with a cardiac MR examination, in patients with arterial thromboembolism. Ten patients with arterial thromboembolism underwent a contrast-enhanced whole-body MR examination of the arterial and venous vessels, followed by a cardiac MR examination on a separate occasion within 24 h. All examinations were performed on a 1.5-T MR scanner. For both arterial and venous MR angiography only one injection of contrast agent was necessary. The cardiac imaging protocol included dark-blood-prepared half-Fourier acquisition single-shot turbo-spin-echo sequences, fast steady-state free precession cine sequences, T2-weighted turbo-spin-echo sequences and inversion recovery gradient-echo fast low-angle-shot sequences after injection of contrast agent. MR imaging revealed additional clinically unknown arterial thromboembolisms in four patients. The thoracic aorta was depicted as embolic source in four patients, while deep vein thrombosis (DVT) was found in one patient as the underlying disease. Unsuspected infarction of parenchymal organs was detected by MRI in two patients. An unknown additional DVT was found in one patient. Four patients were considered to have arterial emboli of cardiac origin. In conclusion, acquisition of arterial and venous MR angiograms of the entire vascular system combined with cardiac MR imaging is a most comprehensive and valuable strategy in patients with arterial thromboembolism. (orig.)

  8. Rivaroxaban for the prevention of venous thromboembolism after hip or knee arthroplasty. Pooled analysis of four studies

    DEFF Research Database (Denmark)

    Turpie, A G G; Lassen, M R; Eriksson, Birgit;

    2011-01-01

    Four phase III studies compared oral rivaroxaban with subcutaneous enoxaparin for the prevention of venous thromboembolism (VTE) after total hip or knee arthroplasty (THA or TKA). A pooled analysis of these studies compared the effect of rivaroxaban with enoxaparin on symptomatic VTE plus all-cau...

  9. Survey of Perceptions and Practices among Canadian Gastroenterologists regarding the Prevention of Venous Thromboembolism for Hospitalized Inflammatory Bowel Disease Patients

    Directory of Open Access Journals (Sweden)

    Roshan Razik

    2012-01-01

    Full Text Available BACKGROUND: Patients with inflammatory bowel disease (IBD who are hospitalized with disease flares are known to be at an increased risk of venous thromboembolism (VTE. This is a preventable complication; however, there is currently no standardized approach to the prevention and management of VTE.

  10. Elevated albuminuria associated with increased risk of recurrent venous thromboembolism : results of a population-based cohort study

    NARCIS (Netherlands)

    van Schouwenburg, Inge M.; Mahmoodi, Bakhtawar K.; Veeger, Nic J. G. M.; Kluin-Nelemans, Hanneke C.; Gansevoort, Ron T.; Meijer, Karina

    2012-01-01

    This study examined the risk of recurrent venous thromboembolism (VTE) in patients with elevated albuminuria. In 1997-1998, inhabitants of Groningen, the Netherlands, aged 28-75 years (n = 85 421), were invited to participate in the PREVEND(Prevention of REnal and Vascular ENd stage Disease) Study,

  11. Association of Mild to Moderate Chronic Kidney Disease With Venous Thromboembolism Pooled Analysis of Five Prospective General Population Cohorts

    NARCIS (Netherlands)

    Mahmoodi, Bakhtawar K.; Gansevoort, Ron T.; Naess, Inger Anne; Lutsey, Pamela L.; Braekkan, Sigrid K.; Veeger, Nic J. G. M.; Brodin, Ellen E.; Meijer, Karina; Sang, Yingying; Matsushita, Kunihiro; Hallan, Stein I.; Hammerstrom, Jens; Cannegieter, Suzanne C.; Astor, Brad C.; Coresh, Josef; Folsom, Aaron R.; Hansen, John-Bjarne; Cushman, Mary

    2012-01-01

    Background-Recent findings suggest that chronic kidney disease (CKD) may be associated with an increased risk of venous thromboembolism (VTE). Given the high prevalence of mild-to-moderate CKD in the general population, in depth analysis of this association is warranted. Methods and Results-We poole

  12. Impact of inherited thrombophilia on the risk of recurrent venous thromboembolism onset in Georgian population.

    Science.gov (United States)

    Pirtskhelani, N; Kochiashvili, N; Makhaldiani, L; Pargalava, N; Gaprindashvili, E; Kartvelishvili, K

    2014-02-01

    Inherited thrombophilia means a predisposition of an individual to thrombosis caused by genetic disorders of homeostasis system. Purpose of the conducted study was to establish the role of point mutations of prothrombin (PGM) - 20210G/A; Factor V Leiden (FVL) - 1691G/A and methylenetetrahydrofolate reductase (MTHFR) - 677C/T genes, i.e. inherited thrombophilia in the pathogenesis of primary and recurrent venous thromboembolism in patients of the Georgian population. The above mentioned mutations were detected by PCR and single nucleotide primer extension reaction, followed by Enzyme Linked Immuno-Sorbent Assay (ELISA) in 93 patients with venous thromboembolism, out of which: 56 patients were diagnosed with unprovoked, primary thromboembolism confirmed by objective studies and 37 patients were diagnosed with recurrent thromboembolism. According to statistical analysis of the results, incidence of FVL mutation in the group of patients with recurrent thrombosis was significantly higher compared to patients with primary thrombosis - respectively 0.21 and 0.44 (p=0.0164<0.05). It should also be mentioned that homozygous carriage of FVL mutation was confirmed only with patients having recurrent thrombosis. Similar tendency was observed during study of prothrombin gene; however the difference was not statistically significant. Similar tendencies were not observed in case of homozygous carriage of MTHFR gene C677T mutation. Double and triple heterozygous/homozygous carriage of studied mutations (total of 20 cases) was observed in patients of both groups. Distribution of these genotypes in the recurrent thrombosis group was higher compared to patients with primary thrombosis - respectively 27% and 17.9%. Herewith, it should be mentioned that the patients with primary thrombosis were much younger than those with recurrent thrombosis and their age did not exceed 50 years. According to the results obtained by us, it is possible to consider Leiden mutation, especially its

  13. Dynamics of case-fatalilty rates of recurrent thromboembolism and major bleeding in patients treated for venous thromboembolism.

    Science.gov (United States)

    Lecumberri, Ramón; Alfonso, Ana; Jiménez, David; Fernández Capitán, Carmen; Prandoni, Paolo; Wells, Philip S; Vidal, Gemma; Barillari, Giovanni; Monreal, Manuel

    2013-10-01

    In patients with venous thromboembolism (VTE), assessment of the risk of fatal recurrent VTE and fatal bleeding during anticoagulation may help to guide intensity and duration of therapy. We aimed to provide estimates of the case-fatality rate (CFR) of recurrent VTE and major bleeding during anticoagulation in a 'real life' population, and to assess these outcomes according to the initial presentation of VTE and its etiology. The study included 41,826 patients with confirmed VTE from the RIETE registry who received different durations of anticoagulation (mean 7.8 ± 0.6 months). During 27,110 patient-years, the CFR was 12.1% (95% CI, 10.2-14.2) for recurrent VTE, and 19.7% (95% CI, 17.4-22.1) for major bleeding. During the first three months of anticoagulant therapy, the CFR of recurrent VTE was 16.1% (95% CI, 13.6-18.9), compared to 2.0% (95% CI, 0-4.2) beyond this period. The CFR of bleeding was 20.2% (95% CI, 17.5-23.1) during the first three months, compared to 18.2% (95% CI, 14.0-23.2) beyond this period. The CFR of recurrent VTE was higher in patients initially presenting with PE (18.5%; 95% CI, 15.3-22.1) than in those with DVT (6.3%; 95% CI, 4.5-8.6), and in patients with provoked VTE (16.3%; 95% CI, 13.6-19.4) than in those with unprovoked VTE (5.5%; 95% CI, 3.5-8.0). In conclusion, the CFR of recurrent VTE decreased over time during anticoagulation, while the CFR of major bleeding remained stable. The CFR of recurrent VTE was higher in patients initially presenting with PE and in those with provoked VTE.

  14. Venous thromboembolism in systemic autoimmune diseases: A narrative review with emphasis on primary systemic vasculitides.

    Science.gov (United States)

    Tamaki, Hiromichi; Khasnis, Atul

    2015-08-01

    Venous thromboembolism (VTE) is a prevalent multifactorial health condition associated with significant morbidity and mortality. Population-based epidemiological studies have revealed an association between systemic autoimmune diseases and deep venous thrombosis (DVT)/VTE. The etiopathogenesis of increased risk of VTE in systemic autoimmune diseases is not entirely clear but multiple contributors have been explored, especially in the context of systemic inflammation and disordered thrombogenesis. Epidemiologic data on increased risk of VTE in patients with primary systemic vasculitides (PSV) have accumulated in recent years and some of these studies suggest the increased risk while patients have active diseases. This could lead us to hypothesize that venous vascular inflammation has a role to play in this phenomenon, but this is unproven. The role of immunosuppressive agents in modulating the risk of VTE in patients with PSV is not yet clear except for Behçet's disease, where most of the studies are retrospective. Sensitizing physicians to this complication has implications for prevention and optimal management of patients with these complex diseases. This review will focus on the epidemiology and available evidence regarding pathogenesis, and will attempt to summarize the best available data regarding evaluation and treatment of these patients.

  15. Red meat, processed meat and the risk of venous thromboembolism: friend or foe?

    Science.gov (United States)

    Lippi, Giuseppe; Cervellin, Gianfranco; Mattiuzzi, Camilla

    2015-08-01

    Venous thromboembolism (VTE) is a highly prevalent condition worldwide, which can be triggered by a combination of inherited and acquired risk factors, including diet. Several lines of evidence suggest that consumption of red and processed meat is associated with a significant risk of colorectal cancer, cardiovascular disease and diabetes. Therefore, an electronic search was conducted to identify clinical studies investigating the potential association between the risk of venous thrombosis and consumption of red or processed meat. Seven articles were finally included in this review, 6 prospective studies and 1 case-control investigation. Taken together, the evidence of the current scientific literature suggests that whether or not a pathophysiological link may exist between red or processed meat consumption and venous thrombosis, the association is definitely weak, since it was found to be non-statistically significant in four prospective cohort studies, marginally significant in one prospective cohort study and highly significant in the remaining prospective cohort study. In the single case-control study, the risk was also found to be non-statistically significant. Although further studies will be needed to definitely establish the existence of a thrombotic risk associated with different subtypes of red or processed meat, it seems premature to conclude that a reduced consumption of red and processed meat lowers the risk of VTE.

  16. Elevated white blood cell count and outcome in cancer patients with venous thromboembolism. Findings from the RIETE Registry.

    Science.gov (United States)

    Trujillo-Santos, Javier; Di Micco, Pierpaolo; Iannuzzo, Mariateresa; Lecumberri, Ramón; Guijarro, Ricardo; Madridano, Olga; Monreal, Manuel

    2008-11-01

    A significant association between elevated white blood cell (WBC) count and mortality in patients with cancer has been reported, but the predictive value of elevated WBC on mortality in cancer patients with acute venous thromboembolism (VTE) has not been explored. RIETE is an ongoing registry of consecutive patients with acute VTE. We compared the three-month outcome of cancer patients with acute VTE according to their WBC count at baseline. As of May 2007, 3805 patients with active cancer and acute VTE had been enrolled in RIETE. Of them, 215 (5.7%) had low- (11,000 cells/microl) WBC count. During the study period 190 patients (5.0%) had recurrent VTE, 156 (4.1%) major bleeding, 889 (23%) died (399 of disseminated cancer, 113 of PE, 46 of bleeding. Patients with elevated WBC count at baseline had an increased incidence of recurrent VTE (odds ratio [OR]: 1.6; 95% confidence interval [CI]: 1.2-2.2), major bleeding (OR: 1.5; 95% CI: 1.1-2.1) or death (OR: 2.7; 95% CI: 2.3-3.2). Most of the reported causes of death were significantly more frequent in patients with elevated WBC count. Multivariate analysis confirmed that elevated WBC count was independently associated with an increased incidence of all three complications. In conclusion, cancer patients with acute VTE and elevated WBC count had an increased incidence of VTE recurrences, major bleeding or death. This worse outcome was consistent among all subgroups and persisted after multivariate adjustment.

  17. Lower extremity deep venous thrombosis with fatal pulmonary thromboembolism caused by benign pelvic space-occupying lesions--an overview.

    Science.gov (United States)

    Rosenfeld, Hannah; Byard, Roger W

    2012-05-01

    Venous stasis predisposes to thrombosis. One hundred and sixty cases of fatal pulmonary thromboembolism were reviewed to determine how many cases had deep venous thromboses associated with venous blood flow reduction caused by external pressure from benign pelvic masses. Three cases were identified, representing 2% of cases overall (3/160): a 44-year-old woman with a large uterine leiomyoma (1048 g); a 74-year-old man with prostatomegaly and bladder distension (containing 1 L of urine); and a 70-year-old man with prostatomegaly and bladder distension (containing 3 L of urine). Although a rare cause of fatal deep venous thrombosis and pulmonary thromboembolism, space-occupying pelvic lesions can lead to extrinsic pressure on adjacent veins reducing blood flow and causing stasis and thrombosis. Individuals with large pelvic masses may, therefore, be at increased risk of pulmonary thromboembolism from deep venous thrombosis, particularly in the presence of concurrent risk factors such as immobility, thrombophilias, malignancy, and significant cardiopulmonary disease.

  18. Incidence and sequelae of symptomatic venous thromboembolic disease among patients with traumatic brain injury.

    Science.gov (United States)

    Lai, J M; Yablon, S A; Ivanhoe, C B

    1997-05-01

    Venous thromboembolism (VTE) is a potentially life-threatening complication among patients with traumatic brain injury (TBI). However, few reports describe the incidence of this important disease. We reviewed the incidence of symptomatic VTE among 124 consecutive admissions with TBI to a free-standing rehabilitation hospital over an 18-month period. Four patients manifested evidence of VTE within 2 months of injury: two with leg swelling, one with an oedematous arm, and one with respiratory distress. None of the patients with suspected VTE received prophylactic anticoagulant therapy. Diagnosis of VTE was confirmed with venograph in two of the four patients. Although VTE is frequently asymptomatic, the incidence of symptomatic VTE (1.6%) among this series of rehabilitation inpatients with TBI still appears surprisingly low. These results have implications regarding the utility of non-invasive diagnostic screening of asymptomatic VTE and routine anticoagulant prophylaxis of high-risk patients with TBI.

  19. Adipsic diabetes insipidus and venous thromboembolism (VTE): recommendations for addressing its hypercoagulability.

    Science.gov (United States)

    Miljic, Dragana; Miljic, Predrag; Doknic, Mirjana; Pekic, Sandra; Stojanovic, Marko; Petakov, Milan; Popovic, Vera

    2014-01-01

    Adipsic diabetes insipidus (ADI) is a rare disorder. It can occur after transcranial surgery for craniopharyngeoma, suprasellar pituitary adenoma and anterior communicating artery aneurysm but also with head injury, toluene exposure and developmental disorders. It is often associated with significant hypothalamic dysfunction and complications like obesity, sleep apnea, thermoregulatory disorders, seizures and venous thromboembolism (VTE). Morbidity and mortality data have been reported as single case reports with only one large series suggesting increased risk for VTE in patients with ADI. Here we report a mini-series of four patients with ADI and VTE. Post-surgery immobilization, obesity, infection, with prolonged hospitalization, hemoconcentration and changes in coagulation which might be induced by inadequate hormone treatment in the postoperative period (high doses of glucocorticoids, sex steroids and DDAVP replacement) may all contribute to the pathogenesis of VTE. Thromboprophylactic treatment after pituitary surgery and during episodes of hypernatremia is therefore warranted.

  20. Venous thromboembolism in patients with cancer: an overview for pharmacists using a case-based approach.

    Science.gov (United States)

    Pangilinan, Joanna Maudlin

    2010-08-01

    Clinicians must always maintain a heightened suspicion for the development of venous thromboembolism (VTE) in the cancer patient population. VTE is common in this population and often results in morbidity and mortality. The pathophysiology is complex and likely multifactorial. Risk factors for VTE include patient-associated, cancer-associated, and treatment-associated factors as well as biomarkers. Low-molecular-weight heparin (LMWH) is a cornerstone for VTE prophylaxis and treatment. Studies have shown that LMWH may decrease VTE recurrence and impart a survival benefit. Organizational guidelines are available to assist the clinician in choosing appropriate anticoagulant agents, dosing, and duration of prophylaxis and treatment. Pharmacists serve an important role for the safe and effective management of anticoagulation in this complex patient population. In addition, pharmacists can be important providers of patient education about VTE and anticoagulation.

  1. Benchmark for time in therapeutic range in venous thromboembolism: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Petra M G Erkens

    Full Text Available INTRODUCTION: The percentage of time within the target INR range 2.0 to 3.0 (TTR in patients treated with vitamin K antagonists varies considerably among efficacy-studies of novel anticoagulants. In order to properly asses the quality of anticoagulant control in upcoming cost-effectiveness studies and real life registries this systematic review reports a benchmark of TTR for different treatment durations in patients with venous thromboembolism and discusses ways to calculate TTR. METHODS: Medline and Embase were searched for studies published between January 1990 and May 2012. Randomized controlled trials and cohort studies reporting the TTR in patients with objectively confirmed venous thromboembolism treated with vitamin K antagonists (VKA were eligible. Duplicate reports, studies only reporting INR during initial treatment or with VKA treatment less than 3 months were excluded. Three authors assessed trials for inclusion and extracted data independently. Discrepancies were resolved by discussion between the reviewers. A meta-analysis was performed by calculating a weighted mean, based on the number of participants in each included study, for each time-period in which the TTR was measured since the confirmation of the diagnosis of VTE. RESULTS: Forty studies were included (26064 patients. The weighted means of TTR were 54.0% in the first month since the start of treatment, 55.6% in months 1 to 3, 60.0% in months 2 to 3, 60.0% in the months 1 to 6+ and 75.2% in months 4 to 12+. Five studies reported TTR in classes. The INR in these studies was ≥ 67% of time in therapeutic range in 72.0% of the patients. CONCLUSION: Reported quality of VKA treatment is highly dependent on the time-period since the start of treatment, with TTR ranging from approximately 56% in studies including the 1(st month to 75% in studies excluding the first 3 months.

  2. Should plasma homocysteine be used as a biomarker of venous thromboembolism? A case-control study.

    Science.gov (United States)

    Ducros, Véronique; Barro, Claire; Yver, Jacqueline; Pernod, Gilles; Polack, Benoît; Carpentier, Patrick; Desruet, Marie-Dominique; Bosson, Jean-Luc

    2009-10-01

    Mild or moderate hyperhomocysteinemia as a risk factor for venous thrombosis is still a matter of debate. The strength of this study is to bring a body of elements to evaluate whether hyperhomocysteinemia should be used as a biomarker for venous thromboembolism (VTE). These elements consist of a biological evaluation of several hematological risk factors, and an original control group made of patients with a negative Doppler ultrasonography. A total of 151 cases and 155 controls were included. Total plasma homocysteine level, MTHFR C677T polymorphism, inherited abnormalities of the natural anticoagulant system as well as plasma folate and cobalamin levels were determined. A total of 41 (27.2 %) of cases and only 9 (5.8%) of controls had at least one of the coagulation defects studied. No significant difference was observed for total homocysteine levels between the 2 groups: median (interquartile range) = 8.3 (7.2-10.8) micromol/L for cases and 8.4 (7-10.9) micromol/L for controls. We found significantly more plasma folates and/or cobalamin deficiencies in controls (18.3%) than in cases (8.6%). After adjustment for several variables significantly related to risk factors of VTE, hyperhomocysteinemia (>13.2 micromol/L) was not found statistically associated with VTE: odds ratio 1.36 (95% confidence interval, 0.52-3.54). The prevalence of the homozygous 677TT polymorphism in the MTHFR gene was not increased in cases compared with controls. Mild or moderate hyperhomocysteinemia does not seem to be a strong determinant in VTE not only when the control group does not exclusively include healthy persons but also in investigated disease-free (thromboembolic disease) controls.

  3. Profile of betrixaban and its potential in the prevention and treatment of venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Chan NC

    2015-06-01

    Full Text Available Noel C Chan,1,2 Vinai Bhagirath,1,3 John W Eikelboom1,3,41Population Health Research Institute, Hamilton, ON, Canada; 2Department of Haematology, Monash Medical Center, Clayton, VIC, Australia; 3Thrombosis and Atherosclerosis Research Institute, 4Department of Medicine, McMaster University, Hamilton, ON, CanadaAbstract: Venous thromboembolism (VTE, which includes deep vein thrombosis and pulmonary embolism, is a common and potentially preventable cause of morbidity and mortality. Unfractionated heparin, low-molecular-weight heparin, and warfarin have been the cornerstone of VTE prevention and treatment but are being replaced by recently approved non-vitamin K antagonist oral anticoagulants (NOACs: dabigatran, rivaroxaban, apixaban, and edoxaban. The NOACs are at least as effective and as safe as heparins and warfarin for VTE prevention and treatment and are more convenient because they have a low propensity for food and drug interactions and are given in fixed doses without routine coagulation monitoring. The remaining limitations of currently available NOACs include their dependence on renal and hepatic function for clearance, and the lack of an approved antidote. Betrixaban is a new NOAC with distinct pharmacological characteristics: minimal renal clearance, minimal hepatic metabolism, and long half-life. It has undergone successful Phase II studies in orthopedic thromboprophylaxis, and in stroke prevention in atrial fibrillation. Currently, it is being evaluated in a Phase III trial of extended thromboprophylaxis in medical patients (APEX study. In this article, we describe the development of betrixaban, review its pharmacological profile, discuss the results of clinical trials, and examine its potential for VTE prevention and treatment.Keywords: betrixaban, factor Xa inhibitors, anticoagulant, pharmacology, venous thromboembolism

  4. [Venous thromboembolism associated with long-term use of central venous catheters in cancer patients].

    Science.gov (United States)

    Debourdeau, P; Chahmi, D Kassab; Zammit, C; Farge-Bancel, D

    2008-06-01

    Increased incidence of cancers and the development of totally implanted venous access devices that contain their own port to deliver chemotherapy will lead to a greater than before numbers of central venous catheter-related thrombosis (CVCT). Medical consequences include catheter dysfunction and pulmonary embolism. Vessel injury caused by the procedure of CVC insertion is the most important risk factor for development of CVCT. This event could cause the formation of a fresh thrombus, which is reversible in the large majority of patients. In some cases, thrombus formation is not related to catheter insertion. The incidence of CVC-related DVT assessed by venography has been reported to vary from 30 to 60% but catheter-related DVT in adult patients is symptomatic in only 5% of cases. The majority of patients with CVC-related DVT is asymptomatic or has nonspecific symptoms: arm or neck swelling or pain, distal paresthesias, headache, congestion of subcutaneous collateral veins. In the case of clinical suspicion of CVC-related deep venous thrombosis (DVT), compressive ultrasonography (US), especially with doppler and color imaging, currently is first used to confirm the diagnosis. Consequently, contrast venography is reserved for clinical trials and difficult diagnostic situations. There is no consensus on the optimal management of patients with CVC-related DVT. Treatment of CVC-related VTE requires a five- to seven-day course of adjusted-dose unfractionated heparin or low molecular weight heparin (LMWH) followed by oral anticoagulants. Long-term LMWH that has been shown to be more effective than oral anticoagulant in cancer patients with lower limb DVT, could be used in these patients. The efficacy and safety of pharmacologic prophylaxis for CVC related thrombosis is not established and the last recommendations suggest that clinicians not routinely use prophylaxis to try to prevent thrombosis related to long-term indwelling CVCs in cancer patients. Additional studies

  5. Pulmonary Thromboembolism Complicating Acute Pancreatitis With Pancreatic Ascites: A Series of 4 cases

    OpenAIRE

    Ruchir Patel; Nirav Pipaliya; Prateik Poddar; Vikas Pandey; Meghraj Ingle; Prabha Sawant

    2016-01-01

    Acute pancreatitis is an inflammatory disease often associated with local and systemic complications. Portosplenic and splanchnic vascular complications of acute pancreatitis are common, but extrasplanchnic vessel thrombosis is less commonly seen. Among them, pulmonary thromboembolism is a very rare complication to be encountered with. We report four cases of acute pulmonary thromboembolism in patients with acute pancreatitis superimposed on chronic pancreatitis. All the patients had abdomina...

  6. Incidence of and Risk Factors for Symptomatic Venous Thromboembolism After Shoulder Arthroplasty.

    Science.gov (United States)

    Tashjian, Robert Z; Lilly, Daniel T; Isaacson, Aaron M; Georgopoulos, Cory E; Bettwieser, Stephen P; Burks, Robert T; Greis, Patrick E; Presson, Angela P; Granger, Erin K; Zhang, Yue

    Reported rates of venous thromboembolism (VTE) after shoulder arthroplasty (SA) range from 0.2% to 13%. Few studies have evaluated the incidence of VTE in a large patient population from a single institution. We conducted a study to determine the incidence of VTE (deep venous thrombosis [DVT] and pulmonary embolism [PE]) in a large series of SAs. Cases of SAs performed at our institution between January 1999 and May 2012 were retrospectively reviewed for development of symptomatic VTE within the first 90 days after surgery. During the study period, 533 SAs (245 anatomical total SAs [TSAs], 112 reverse TSAs, 92 hemiarthroplasties, 84 revision SAs) were performed. Logistic regression analyses were used to evaluate the association of various risk factors with VTE. For the 533 SAs, the symptomatic VTE rate was 2.6% (14 patients), the DVT rate was 0.9% (5), and the PE rate was 2.3% (12). Risk factors significantly correlated with a thrombotic event included raised Charlson Comorbidity Index, preoperative thrombotic event, lower preoperative hemoglobin and hematocrit levels, diabetes, lower postoperative hemoglobin level, use of general endotracheal anesthesia without interscalene nerve block, higher body mass index, and revision SA (P < .05). Our rates of symptomatic VTE events (DVT, PE) after SA are relatively low, though they are higher than the rates in studies that have used large state or national databases. Risk factors associated with thrombosis can be useful in identifying patients at risk for clotting after SA.

  7. Review of fondaparinux sodium injection for the prevention of venous thromboembolism in patients undergoing surgery

    Directory of Open Access Journals (Sweden)

    David Bergqvist

    2006-12-01

    Full Text Available David BergqvistDepartment of Surgery, University Hospital, Uppsala, SwedenAbstract: The antithrombin binding sequence of heparin, a pentasaccharide, has been synthesized as fondaparinux, an indirect, selective, and reversible factor Xa inhibitor. It can be administered subcutaneously, is well absorbed, and has a half-life of c. 17 hours permitting once-daily injection. It has been evaluated in an extensive study program in major orthopedic surgery, including hip fracture, and in major abdominal surgery with a large proportion of surgery for cancer. The effect is at least as effective as for low-molecular-weight heparins and it has also been shown effective for extended prophylaxis in hip fracture patients. Several thousands of patients have been studied and the substance is safe, although a slightly higher frequency of bleedings is found than in patients on low-molecular-weight heparins. There is no specific antidote but if necessary, recombinant activated factor VII can be used. Other side-effects are rare. Fondaparinux is cost saving and sometimes cost neutral when compared with enoxaparin. Keywords: fondaparinux, venous thrombosis, venous thromboembolism, surgery, orthopedic surgery, major abdominal surgery, bleeding complications

  8. Efficacy and Safety of Low Molecular Weight Heparin Prophylaxis for Venous Thromboembolism Following Lumbar Decompression Surgery

    Institute of Scientific and Technical Information of China (English)

    Zhi-jian Sun; Xiang Li; Yu Zhao; Giu-xing Qiu; Yi-peng Wang; Xi-sheng Weng; Hong Zhao; Jian-xiong Shen; Yu Jiang; Ye Li

    2011-01-01

    Objective To evaluate the efficacy and safety of low molecular weight heparin (LMWH) prophylaris for venous thromboembolism (VTE) after lumbar decompression surgery.Methods Patients at high or the highest risk of VTE who underwent lumbar spine surgery in Peking Union Medical College Hospital from January 2004 to April 2011 were included in the present study.All the patients received a half dose of LMWH 6 hours after surgery followed by a full dose LMWH once per day until discharge.We recorded incidences of deep venous thrombosis (DVT),pulmonary embolism (PE),bleeding complications,and medication side effects.Results Seventy-eight consecutive patients were eligible and enrolled in this study.The mean hospital stat was 8.5+4.5 days.No symptomatic DVT,PE,or major bleeding events were observed.One patient developed wound ecchymosis,another developed wound bleeding,four had mild hepatic aminotransferase level elevation,and one developed a suspicious allergic reaction.Conclusion LMWH may be applied as an effective and safe prophylaxis for VTE in high-risk patients undergoing lumbar decompression surgery.

  9. What's New in Venous Thromboembolic Prophylaxis Following Total Knee and Total Hip Arthroplasty? An Update.

    Science.gov (United States)

    Pierce, Todd P; Elmallah, Randa K; Jauregui, Julio J; Cherian, Jeffrey J; Mont, Michael A

    2015-05-01

    Venous thromboembolic disease (VTED) (deep venous thrombosis and pulmonary embolism) is a considerable source of morbidity and mortality following lower extremity total joint arthroplasty. The purpose of this review was to: (1) evaluate the most recent updated guidelines on thromboprophylaxis; and to (2) provide an overview and update of current modalities of VTED prophylaxis, such as pharmacological agents and mechanical compression. Although the AAOS and ACCP guidelines have not changed since the last review, the SCIP guidelines have focused on implementing the concepts proposed by each of these organizations. Specifically, the use of aspirin has been highlighted as an acceptable chemoprophylactic agent. Warfarin and low molecular weight heparin remain widely used, but maintaining therapeutic levels of warfarin remains a challenge, and LWMH has not shown itself to be superior to any of the other chemoprophylactic agents. The newer oral anticoagulants, such as factor Xa inhibitors and direct thrombin inhibitors, may have superior efficacy, but their safety profile must be studied further. Additionally, the use of mechanical prophylaxis continues to rise in popularity because of their ability to minimize bleeding complications. Future research should emphasize the development of prophylactic modalities that maximize efficacy while minimizing the risk of adverse events.

  10. Pulmonary Thromboembolism in a Child with Sickle Cell Hemoglobin D Disease in the Setting of Acute Chest Syndrome

    OpenAIRE

    Hazel Villanueva; Sandeepkumar Kuril; Jennifer Krajewski; Aziza Sedrak

    2013-01-01

    Introduction. Sickle cell hemoglobin D disease (HbSD) is a rare variant of sickle cell disease (SCD). Incidence of pulmonary thromboembolism (PE) and deep venous thrombosis (DVT) in children with HbSD is unknown. PE and DVT are known complications of SCD in adults but have not been reported in the literature in children with HbSD. Case Report. We are reporting a case of a 12-year-old boy with HbSD with acute chest syndrome (ACS) complicated by complete thrombosis of the branch of the right pu...

  11. Potential role of new anticoagulants for prevention and treatment of venous thromboembolism in cancer patients

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    Gómez-Outes A

    2013-05-01

    Full Text Available Antonio Gómez-Outes,1 M Luisa Suárez-Gea,1 Ramón Lecumberri,2 Ana Isabel Terleira-Fernández,3,4 Emilio Vargas-Castrillón,3,4 Eduardo Rocha51Division of Pharmacology and Clinical Evaluation, Medicines for Human Use, Spanish Agency for Medicines and Medical Devices, Madrid, 2Department of Hematology, University Clinic of Navarra, Pamplona, 3Department of Clinical Pharmacology, Hospital Clínico, Madrid, 4Department of Pharmacology, Universidad Complutense, Madrid, 5Department of Hematology, School of Medicine, University of Navarra, Pamplona, SpainAbstract: Venous thromboembolism (VTE, encompassing deep vein thrombosis and pulmonary embolism, represents a major cause of morbidity and mortality in patients with cancer. Low molecular weight heparins are the preferred option for anticoagulation in cancer patients according to current clinical practice guidelines. Fondaparinux may also have a place in prevention of VTE in hospitalized cancer patients with additional risk factors and for initial treatment of VTE. Although low molecular weight heparins and fondaparinux are effective and safe, they require daily subcutaneous administration, which may be problematic for many patients, particularly if long-term treatment is needed. Studying anticoagulant therapy in oncology patients is challenging because this patient group has an increased risk of VTE and bleeding during anticoagulant therapy compared with the population without cancer. Risk factors for increased VTE and bleeding risk in these patients include concomitant treatments (surgery, chemotherapy, placement of central venous catheters, radiotherapy, hormonal therapy, angiogenesis inhibitors, antiplatelet drugs, supportive therapies (ie, steroids, blood transfusion, white blood cell growth factors, and erythropoiesis-stimulating agents, and tumor-related factors (local vessel damage and invasion, abnormalities in platelet function, and number. New anticoagulants in development for prophylaxis

  12. The recent clinical trials on use of the novel direct oral anticoagulants in patients with venous thromboembolism: a review

    Directory of Open Access Journals (Sweden)

    Gualtiero Palareti

    2014-10-01

    Full Text Available Venous thromboembolism (VTE, encompassing deep vein thrombosis and pulmonary embolism, requires an immediate anticoagulation, that has been carried out so far by administering a parenteral anticoagulant drug (heparin or derivatives overlapped with an oral vitamin K antagonist (VKA, more often warfarin. Several new direct oral anticoagulants (DOACs, with a mechanism of action completely different than VKA, have been developed in recent years. Recent clinical trials have investigated their use in VTE patients showing results at least equal for efficacy and safety, and sometime even better, as the standard anticoagulant treatment. There are differences in the design of the trials. In two cases the involved DOAC was administered immediately after VTE diagnosis as a single drug treatment (rivaroxaban and apixaban, whereas in the other trials (involving dabigatran and edoxaban the DOAC was administered after an initial course of approximately 7 days with heparin or derivatives. Some clinical trials have also investigated the use of DOACs for extended anticoagulant treatment after the acute phase. Aim of this article is to review the results of the currently available clinical trials that have compared the use of DOACs versus the standard of care in patients with VTE.

  13. Tromboprofilaxis en pacientes no quirúrgicos internados en un hospital general Venous thromboembolism prevention in non-surgical adult patients admitted in a general hospital

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    Marcelo J. Melero

    2012-10-01

    Full Text Available Los pacientes adultos internados por una enfermedad no quirúrgica tienen un riesgo alto de padecer una tromboembolia venosa y pueden desarrollar alguna forma de esta enfermedad cuando no reciben un tratamiento preventivo adecuado. Los objetivos de este estudio prospectivo, analítico, observacional y transversal, fueron: 1 determinar cuál es el porcentaje de pacientes adultos internados por una enfermedad aguda no quirúrgica en el Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, que tienen indicación de tromboprofilaxis, 2 establecer cuántos de ellos reciben un tratamiento preventivo para la tromboembolia venosa, y 3 comprobar cuántos estaban medicados con alguna forma de tromboprofilaxis sin tener causas que justificaran este tratamiento. Se estudiaron 93 pacientes durante un lapso de 72 horas consecutivas. Se encontró que el 90.3% de ellos necesitaba un tratamiento preventivo para la tromboembolia venosa y el 76.2% de estos enfermos recibían tromboprofilaxis farmacológica. Un 33.3% de los pacientes internados tenía indicado un tratamiento farmacológico preventivo sin tener una causa que justificara esta prescripción. El porcentaje encontrado de pacientes tratados con tromboprofilaxis es más alto que el comunicado en otros estudios observacionales.Adult patients hospitalized for a non-surgical condition, usually have a high risk of venous thromboembolism and may develop some form of this disease when they do not receive appropriate preventive treatment. The objectives of this prospective, analytical, observational and cross-sectional study were: 1 to determine what percentage of adult patients hospitalized for a non-surgical acute condition at the Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, had indication for preventive thromboprophylaxis, 2 to establish how many of them had been prescribed a preventive treatment of venous thromboembolism, 3 to establish how many of them had been

  14. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy.

    Science.gov (United States)

    Gherman; Goodwin; Leung; Byrne; Montoro

    1998-07-01

    Objective: To determine the incidence, timing, and associated clinical characteristics of objectively diagnosed pregnancy-associated venous thromboembolism (VTE).Methods: A retrospective review of VTE cases occurring between 1978 and 1996 was performed. Cases of deep venous thrombosis (DVT) and pulmonary embolism (PE) were identified by ICD-9 discharge diagnosis code and review of antepartum and coagulation laboratory databases. Study inclusion criteria required the objective diagnosis of VTE with either Doppler ultrasound, impedance plethysmography, pulmonary angiography, ventilation-perfusion scanning, or CT/MRI.Results: Among 268,525 deliveries there were 165 (0.06%) episodes of VTE (1/1627 births). There were 127 cases of DVT and 38 cases of PE. Only 14% (23/165) had a prior history of DVT or PE. Most DVTs occurred in the left leg (104/127, 81.9%). Nearly three quarters of the DVTs (95/127, 74.8%) occurred in the antepartum period. Among the antepartum DVT cases, half were detected prior to 15 weeks of gestation (47/95, 49.5%), with only 28 cases occurring after 20 weeks (P cesarean section. Only 1 patient developed PE while on heparin therapy for DVT while 11 others had complications attributable to heparin use.Conclusion: Most pregnancy-related VTE occurs in the antepartum period. The risk of deep venous thrombosis appears to begin early in pregnancy, even before the second trimester. The highest risk period for pulmonary embolism is after cesarean delivery. Maternal complications of heparin anticoagulation during pregnancy are rare.

  15. Thromboembolism in the Sub-Acute Phase of Spinal Cord Injury: A Systematic Review of the Literature

    Science.gov (United States)

    Belci, Maurizio; Van Middendorp, Joost J; Al Halabi, Ahmed; Meagher, Tom M

    2016-01-01

    To review the evidence of thromboembolism incidence and prophylaxis in the sub-acute phase of spinal cord injury (SCI) 3–6 months post injury. All observational and experimental studies with any length of follow-up and no limitations on language or publication status published up to March 2015 were included. Two review authors independently selected trials for inclusion and extracted data. Outcomes studied were incidence of pulmonary embolism (PE) and deep vein thrombosis (DVT) in the sub-acute phase of SCI. The secondary outcome was type of thromboprophylaxis. Our search identified 4305 references and seven articles that met the inclusion criteria. Five papers reported PE events and three papers reported DVT events in the sub-acute phase of SCI. Studies were heterogeneous in populations, design and outcome reporting, therefore a meta-analysis was not performed. The included studies report a PE incidence of 0.5%–6.0% and DVT incidence of 2.0%–8.0% in the sub-acute phase of SCI. Thromboprophylaxis was poorly reported. Spinal patients continue to have a significant risk of PE and DVT after the acute period of their injury. Clinicians are advised to have a low threshold for suspecting venous thromboembolism in the sub-acute phase of SCI and to continue prophylactic anticoagulation therapy for a longer period of time.

  16. 静脉血栓栓塞的诊断程序%Integrated Strategies for the Diagnosis of Venous Thromboembolism

    Institute of Scientific and Technical Information of China (English)

    刘泽霖

    2009-01-01

    @@ 1 诊断静脉血栓栓塞的重要性 静脉血拴栓塞(venous thromboembolism,VTE)性疾病涉及面甚广,具中最重要的是下肢近端深静脉血栓形成(deep venous thrombosis,DVT)与肺栓塞(pulmonary embolism,PE).因其具有1、髙发病率;2、髙死亡率;3、髙后遗症三大特征:故在临床上有着极其重要的地位.

  17. Quality of venous thromboembolism diagnoses among prostate cancer patients in the Danish National Registry of Patients

    Directory of Open Access Journals (Sweden)

    Drljevic A

    2014-10-01

    Full Text Available Aska Drljevic,1 Michael Borre,2 Morten Høyer,3 Vera Ehrenstein,4 Mary Nguyen-Nielsen4 1Department of Pharmacology, 2Department of Urology, 3Department of Oncology, 4Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark Background and aim: It is well established that cancer patients have an increased risk of venous thromboembolism (VTE. However, no previous study has examined the quality of VTE diagnoses related to cancer patients in the Danish National Registry of Patients (DNRP. To support future studies on cancer and risk of VTE, this study aimed to estimate the positive predictive value (PPV of VTE diagnoses among prostate cancer (PC patients registered in the DNRP. Materials and methods: We conducted a validation study using data from hospitals within the Central Denmark Region, which covers a population of 1.3 million people. Using the DNRP, we identified a total of 120 PC patients registered with VTE within the period 1995–2012. We also identified a random sample of 120 PC patients with no VTE registration within the same period. Therefore, a total of 240 patients were selected for medical chart review. We compared data from the DNRP to data collected from medical record review (ie, reference standard. We then computed PPV, sensitivity, and specificity with corresponding 95% confidence intervals (CIs using the Jeffreys method. Results: The final study sample included 232 PC patients, of which 115 were registered with VTE and 117 had no registration of VTE in the DNRP. We found the overall PPV of VTE diagnoses in the DNRP to be 86.1% (95% CI 78.9%–91.5%. Sensitivity was 98.0% (95% CI 93.8%–99.6%, and specificity was 87.8% (95% CI 81.4%–92.6%. We also found the PPV of incident PC diagnoses in the DNRP to be 98.3% (95% CI 96.1%–99.4%. Conclusion: For PC patients, the registration of VTE diagnoses in the DNRP is associated with a high PPV. We provide evidence that data from the DNRP are valid for studies

  18. 内科住院患者静脉血栓栓塞症的临床防治%Clinical prevention of venous thromboembolism in hospitalized medical patients

    Institute of Scientific and Technical Information of China (English)

    户海宁

    2015-01-01

    静脉血栓栓塞症(venous thromboembolism,VTE)是一种多种危险因子共同参与其发病机制的全身性疾病,VTE最终产生两种主要的临床类型,包括深静脉血栓形成(deep venous thrombosis,DVT)和肺血栓栓塞症(pulmonary thromboembolism,PTE),前者最为常见,而后者则较为严重。作为一种疾病的两种表现,DVT与PTE的防治方法相似,主要为抗凝治疗。文章就近年来内科住院患者静脉血栓栓塞症临床防治的相关研究进展进行阐述。%Venous thromboembolism (venous thromboembolism, VTE) is a systemic disease which multiple risk factors involved in the pathogenesis, VTE finally produced two major clinical types, including deep venous thrombosis (deep venous thrombosis, DVT) and pulmonary thromboembolism (pulmonary thromboembolism, PTE), The former is most common, While the latter is more serious. As two kinds of manifestations of one disease, the preventive treatments of DVT and PTE are similar, mainly for anticoagulation therapy. This article reviews the related research progress about clinical prevention of venous thromboembolism in hospitalized medical patients.

  19. Potential role of new anticoagulants for prevention and treatment of venous thromboembolism in cancer patients.

    Science.gov (United States)

    Gómez-Outes, Antonio; Suárez-Gea, M Luisa; Lecumberri, Ramón; Terleira-Fernández, Ana Isabel; Vargas-Castrillón, Emilio; Rocha, Eduardo

    2013-01-01

    Venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, represents a major cause of morbidity and mortality in patients with cancer. Low molecular weight heparins are the preferred option for anticoagulation in cancer patients according to current clinical practice guidelines. Fondaparinux may also have a place in prevention of VTE in hospitalized cancer patients with additional risk factors and for initial treatment of VTE. Although low molecular weight heparins and fondaparinux are effective and safe, they require daily subcutaneous administration, which may be problematic for many patients, particularly if long-term treatment is needed. Studying anticoagulant therapy in oncology patients is challenging because this patient group has an increased risk of VTE and bleeding during anticoagulant therapy compared with the population without cancer. Risk factors for increased VTE and bleeding risk in these patients include concomitant treatments (surgery, chemotherapy, placement of central venous catheters, radiotherapy, hormonal therapy, angiogenesis inhibitors, antiplatelet drugs), supportive therapies (ie, steroids, blood transfusion, white blood cell growth factors, and erythropoiesis-stimulating agents), and tumor-related factors (local vessel damage and invasion, abnormalities in platelet function, and number). New anticoagulants in development for prophylaxis and treatment of VTE include parenteral compounds for once-daily administration (ie, semuloparin) or once-weekly dosing (ie, idraparinux and idrabiotaparinux), as well as orally active compounds (ie, dabigatran, rivaroxaban, apixaban, edoxaban, betrixaban). In the present review, we discuss the pharmacology of the new anticoagulants, the results of clinical trials testing these new compounds in VTE, with special emphasis on studies that included cancer patients, and their potential advantages and drawbacks compared with existing therapies.

  20. Venous thromboembolism in pregnant and puerperal women in Denmark 1995-2005

    DEFF Research Database (Denmark)

    Virkus, R.A.; Løkkegaard, Ellen Christine Leth; Bergholt, Thomas

    2011-01-01

    Venous thromboembolism (VTE) is the leading cause of maternal death in the Western world, and the risk increases during pregnancy and puerperal period. It was the objective of the present study to estimate the absolute and the relative risk of VTE at different weeks of gestation....... Danish women 15 to 49 years old during the period January 1995 through December 2005 were included in the study. In total 819,751 pregnant women were identified of whom 727 had a diagnosis of VTE. The absolute risk of VTE per 10,000 pregnancy-years increased from 4.1 (95% CI, 3.2 to 5.2) during week 1.......9) in week 1–11, to 21.0 (95%CI16.7 to 27.4) in week 40 and 21.5 (95% CI:16.8 to 27.6) in the first week after delivery, declining to 3.8 (95% CI:2.5 to 5.8) 5–6 weeks after delivery. In conclusion, the risk of VTE increases almost exponentially through pregnancy and reaches maximum just after delivery...

  1. Do pregnant women have a higher risk for venous thromboembolism following air travel?

    Directory of Open Access Journals (Sweden)

    Morteza Izadi

    2015-01-01

    Full Text Available International travel has become increasingly common and accessible, and it is part of everyday life in pregnant women. Venous thromboembolism (VTE is a serious public health disorder that occurs following long-haul travel, especially after air travel. The normal pregnancy is accompanied by a state of hypercoagulability and hypofibrinolysis. Thus, it seems that pregnant women are at a higher risk of VTE following air travel, and, if they have preexisting risk factors, this risk would increase. There is limited data about travel-related VTE in pregnant women; therefore, in the present study, we tried to evaluate the pathogenesis of thrombosis, association of thrombosis and air travel, risk factors and prevention of VTE in pregnant women based on available evidences. Pregnancy is associated with a five- to 10-fold increased risk of VTE compared with nonpregnant women; however, during the postpartum period, this risk would increase to 20-80-fold. Furthermore, the risk of thrombosis is higher in individuals with preexisting risk factors, and the most common risk factor for VTE during pregnancy is a previous history of VTE. Pregnant women are at a higher risk for thrombosis compared with other women. Thus, the prevention of VTE and additional risk factors should be considered for all pregnant women who travel by plane.

  2. [Risk of venous thromboembolism in cancer patients: Reality, actuality and perspectives].

    Science.gov (United States)

    Gerotziafas, Grigoris T; Elalamy, Ismail

    2016-09-01

    Cancer is a leading cause of venous thromboembolism (VTE) and vice versa. Pulmonary embolism is the second cause of death in cancer patients. Tumor progression is associated with coagulation activation. The pathogenesis of thrombosis during cancer is particularly complex stemming from multiple connections of this disease with both systems of inflammation and hemostasis. The risk of VTE depends on cancer type and the stage of the disease, the anticancer treatments and the time since cancer diagnosis as well as on the presence of patient-related risk factors (i.e. age, obesity, previous history of VTE, underlying diseases…). The presence of other precipitating factors and the duration of the exposure to them are also key elements in the assessment of such a thrombotic risk. It is therefore important to identify all the VTE risk factors to identify patients at high vascular risk and to determine the period during which this risk is significantly increased. The integration of biomarkers of hypercoagulability in proposed risk assessment models for VTE will improve their capacity to identify patients eligible for pharmacological thromboprophylaxis. In this review, we report the current status of knowledge on the connection between cancer and hypercoagulability, the numerous risk factors for VTE must be identified in cancer patients and the best methodology to build a more accurate assessment of this vascular risk in such a complex medical context.

  3. Relation between preclinical atherosclerosis and venous thromboembolism in patients with thrombophilias - longitudinal study.

    Science.gov (United States)

    Auzký, O; Dembovská, R; Mrázková, J; Nováková, Š; Pagáčová, L; Piťha, J

    2014-01-01

    Preclinical atherosclerosis may represent a risk factor for venous thromboembolism (VTE). In longitudinal study we followed longitudinally 96 patients (32 men) with thrombophilias with (n=51) and without (n=45) history of VTE. In both groups we studied the changes of preclinical atherosclerosis at peripherally located arteries detected by ultrasound. In addition, we assessed changes in selected risk factors of atherosclerosis. During the mean follow-up of 56.0+/-7.62 months we did not find significant change in preclinical atherosclerosis defined as Belcaro score in either group (-3 % in the VTE group vs 0 % in non VTE group). Significant increase in body mass index (1.03+/-1.98 kg*m(-2), resp. 1.21+/-1.67 kg*m(-2), p<0.01) and non-significant increase in systolic blood pressure were detected in both groups. Waist circumference increased significantly only in patients without VTE (4.11+/-7.84 cm, p<0.05). No differences in changes of risk factors under study between both groups were detected. In summary, patients with thrombophilia and history of VTE showed no evidence of greater progression of atherosclerosis or increase in traditional risk factors of atherosclerosis than patients with thrombophilia without history of VTE. Unfavorable changes of body mass index, waist circumference and systolic blood pressure were detected in both groups during study period.

  4. The humanistic and economic burden of venous thromboembolism in cancer patients: a systematic review.

    Science.gov (United States)

    Kourlaba, Georgia; Relakis, John; Mylonas, Charalambos; Kapaki, Vasiliki; Kontodimas, Stathis; Holm, Majbrit V; Maniadakis, Nikos

    2015-01-01

    The objective of this study was to present evidence on the epidemiology, health outcomes and economic burden of cancer-related venous thromboembolism (VTE). Medline, Cochrane Central Register of Controlled Trials, Econlit, Science Direct, JSTOR, Oxford Journals and Cambridge Journals were searched. The systematic literature search was limited to manuscripts published from January 2000 to December 2012. On the basis of the literature, cancer patients experience between two-fold and 20-fold higher risk of developing VTE than noncancer patients. They are more likely to experience a VTE event during the first 3-6 months after cancer diagnosis. In addition, an increased risk of VTE in patients with distant metastases and certain types of cancer (i.e. pancreatic or lung) was revealed. VTE was found to be a leading cause of mortality in cancer patients. The annual average total cost for cancer patients with VTE was found to be almost 50% higher than that of cancer patients without VTE. Inpatient care costs accounted for more than 60% of total cost. The existing evidence assessed in the present review demonstrated the significant health and economic consequences of cancer-related VTE, which make a strong case for the importance of its proper and efficient prevention and management.

  5. Ankylosing spondylitis and risk of venous thromboembolism: A systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Patompong Ungprasert

    2016-01-01

    Full Text Available Background: Several immune-mediated inflammatory disorders, such as rheumatoid arthritis, psoriatic arthritis, and systemic lupus erythematosus have been linked to an increased risk of venous thromboembolism (VTE. However, the data on ankylosing spondylitis (AS are limited. Methods: We conducted a systematic review and meta-analysis of observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio comparing the risk of VTE and possible pulmonary embolism (PE in patients with AS versus non-AS participants. Pooled risk ratio and 95% confidence intervals were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird. Results: Of 423 potentially relevant articles, three studies met our inclusion criteria and thus, were included in the data analysis. The pooled risk ratio of VTE in patients with AS was 1.60 (95% confidence interval: 1.05–2.44. The statistical heterogeneity of this study was high with an I2 of 93%. Conclusion: Our study demonstrated a statistically significant increased VTE risk among patients with AS.

  6. Elevated risk of venous thromboembolic events in patients with inflammatory myopathies

    Directory of Open Access Journals (Sweden)

    Nowak M

    2016-06-01

    Full Text Available Michał Nowak, Katarzyna Królak-Nowak, Aleksandra Sobolewska-Włodarczyk, Jakub Fichna, Marcin Włodarczyk Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, Lodz, Poland Abstract: Venous thromboembolism (VTE is a multifactorial disease manifesting as either deep vein thrombosis or pulmonary embolism. Its prevalence makes VTE a significant issue for both the individual – as a negative factor influencing the quality of life and prognosis – and the society due to economic burden. VTE is the third most common vascular disorder in Western countries, after myocardial infarction and stroke, making it a major cause of in-hospital mortality, responsible for 5%–10% of hospital deaths. Despite many studies conducted, only 50%–60% provoking factors have been identified, while the remaining 40%–50% have been classified as idiopathic or unprovoked. Chronic inflammatory disorders, with their underlying prothrombotic state, reveal an increased risk of VTE (six to eight times compared with the general population. Among the inflammatory disorders, we can identify inflammatory myopathies – a group of rare, chronic diseases featuring weakness and inflammation of muscles with periods of exacerbation and remission; their main classes are polymyositis and dermatomyositis. The objective of this review is to emphasize the need of VTE prophylaxis in individuals with inflammatory myopathies in order to reduce morbidity and mortality rates among those patients and improve their quality of life and prognosis. Keywords: deep vein thrombosis, pulmonary embolism, inflammation, polymyositis, dermatomyositis, prothrombotic state

  7. Guidance for the practical management of the heparin anticoagulants in the treatment of venous thromboembolism.

    Science.gov (United States)

    Smythe, Maureen A; Priziola, Jennifer; Dobesh, Paul P; Wirth, Diane; Cuker, Adam; Wittkowsky, Ann K

    2016-01-01

    Venous thromboembolism (VTE) is a serious and often fatal medical condition with an increasing incidence. Despite the changing landscape of VTE treatment with the introduction of the new direct oral anticoagulants many uncertainties remain regarding the optimal use of traditional parenteral agents. This manuscript, initiated by the Anticoagulation Forum, provides clinical guidance based on existing guidelines and consensus expert opinion where guidelines are lacking. This specific chapter addresses the practical management of heparins including low molecular weight heparins and fondaparinux. For each anticoagulant a list of the most common practice related questions were created. Each question was addressed using a brief focused literature review followed by a multidisciplinary consensus guidance recommendation. Issues addressed included initial anticoagulant dosing recommendations, recommended baseline laboratory monitoring, managing dose adjustments, evidence to support a relationship between laboratory tests and meaningful clinical outcomes, special patient populations including extremes of weight and renal impairment, duration of necessary parenteral therapy during the transition to oral therapy, candidates for outpatient treatment where appropriate and management of over-anticoagulation and adverse effects including bleeding and heparin induced thrombocytopenia. This article concludes with a concise table of clinical management questions and guidance recommendations to provide a quick reference for the practical management of heparin, low molecular weight heparin and fondaparinux.

  8. [Prophylaxis of venous thromboembolic disease in high-risk orthopedic surgery].

    Science.gov (United States)

    Meza Reyes, Gilberto Eduardo; Esquivel Gómez, Ricardo; Martínez del Campo Sánchez, Antonio; Espinosa-Larrañaga, Francisco; Martínez Guzmán, Miguel Ángel Enrique; Torres González, Rubén; de la Fuente Zuno, Juan Carlos; Méndez Huerta, Juan Vicente; Villalobos Garduño, Enrique; Cymet Ramírez, José; Ibarra Hirales, Efrén; Díaz Borjón, Efraín; Aguilera Zepeda, José Manuel; Valles Figueroa, Juan Francisco; Majluf-Cruz, Abraham

    2012-01-01

    Venous thromboembolism (VTE) is a worldwide public health problem, with an annual incidence of 1-2 cases/1,000 individuals in the general population and a 1-5% associated mortality. Orthopedic surgery is a major surgical risk factor for VTE, but the problem is more important for patients with hip and knee joint replacement, multiple traumatisms, severe damage to the spine, or large fractures. Thromboprophylaxis is defined as the strategy and actions necessary to diminish the risk of VTE in high-risk orthopedic surgery. Antithrombotics may prevent VTE. At the end of this paper, we describe a proposal of thromboprophylaxis actions for patients requiring high-risk orthopedic surgery, based on the opinion of specialists in Orthopedics and Traumatology who work with high-risk orthopedic surgery patients. A search for evidence about this kind of surgery was performed and a 100-item inquiring instrument was done in order to know the opinions of the participants. Then, recommendations and considerations were built. In conclusion, this document reviews the problem of VTE in high-risk orthopedic surgery patients and describes the position of the Colegio Mexicano de Ortopedia y Traumatología related to VTE prevention in this setting.

  9. A venous thromboembolism risk assessment model for patients with Cushing's syndrome.

    Science.gov (United States)

    Zilio, Marialuisa; Mazzai, Linda; Sartori, Maria Teresa; Barbot, Mattia; Ceccato, Filippo; Daidone, Viviana; Casonato, Alessandra; Saggiorato, Graziella; Noventa, Franco; Trementino, Laura; Prandoni, Paolo; Boscaro, Marco; Arnaldi, Giorgio; Scaroni, Carla

    2016-05-01

    Cushing's syndrome (CS) is associated with an incidence of venous thromboembolism (VTE) about ten times higher than in the normal population. The aim of our study was to develop a model for identifying CS patients at higher risk of VTE. We considered clinical, hormonal, and coagulation data from 176 active CS patients and used a forward stepwise logistic multivariate regression analysis to select the major independent risk factors for thrombosis. The risk of VTE was calculated as a 'CS-VTE score' from the sum of points of present risk factors. VTE developed in 20 patients (4 pulmonary embolism). The group of CS patients with VTE were older (p 3.15 times the normality and shortened APTT were given one point each. A CS-VTE score <2 anticipated no risk of VTE; a CS-VTE score of two mild risk (10 %); a CS-VTE score of three moderate risk (46 %); a CS-VTE score ≥4 high risk (85 %). Considering a score ≥3 as predictive of VTE, 94 % of the patients were correctly classified. A simple score helps stratify the VTE risk in CS patients and identify those who could benefit from thromboprophylaxis.

  10. Venous thromboembolism in pregnant and puerperal women in Denmark 1995-2005. A national cohort study

    DEFF Research Database (Denmark)

    Virkus, Rie Adser; Løkkegaard, Ellen Christine Leth; Bergholt, Thomas

    2011-01-01

    -11 up to 59.0 (95% CI: 46.1 to 76.4) in week 40 and decreased in the puerperal period from 60.0 (95% CI:47.2-76.4) during the first week after birth to 2.1 (95% CI:1.1 to 4.2) during week 9-12 after birth. Compared with non-pregnant women, the incidence rate ratio rose from 1.5 (95% CI:1.1 to 1......Venous thromboembolism (VTE) is the leading cause of maternal death in the Western world, and the risk increases during pregnancy and puerperal period. It was the objective of the present study to estimate the absolute and the relative risk of VTE at different weeks of gestation....... Danish women 15 to 49 years old during the period January 1995 through December 2005 were included in the study. In total 819,751 pregnant women were identified of whom 727 had a diagnosis of VTE. The absolute risk of VTE per 10,000 pregnancy-years increased from 4.1 (95% CI, 3.2 to 5.2) during week 1...

  11. Effectiveness of self-managed oral anticoagulant therapy in patients with recurrent venous thromboembolism

    DEFF Research Database (Denmark)

    Larsen, Torben Bjerregaard; Skjøth, Flemming; Grove, Erik Lerkevang;

    2016-01-01

    Patient-self-management (PSM) of oral anticoagulant therapy (OAT) with vitamin K antagonists for venous thromboembolism (VTE) has demonstrated efficacy in randomised, controlled trials. The aim of this study was to evaluate the effectiveness of PSM of OAT in everyday clinical practice...... on recurrent VTE and bleeding up to a weighted rate difference of 0.86 (95 % CI 0.00-1.72) in favour of PSM. In conclusion, PSM of anticoagulant treatment was associated with a statistically significant lower rate of recurrent VTE and all-cause death compared to patients on conventionally managed anticoagulant...... to the control group with a hazard ratio (HR) of 0.63; 95 % confidence interval (CI) 0.42-0.95, whereas no difference was seen with bleeding (HR: 0.95; 95 % CI 0.44-2.02). The risk of all-cause death was lower for PSM patients (HR: 0.41; 95 % CI 0.21-0.81). A net clinical benefit analysis sums the effect...

  12. The incidence of venous thromboembolism in cervical cancer: a nationwide population-based study

    Directory of Open Access Journals (Sweden)

    Tsai Shiang-Jiun

    2012-06-01

    Full Text Available Abstract Background Venous thromboembolism (VTE is a life-threatening condition that occurs as a complication of cervical cancer. The aim of this study was to evaluate the incidence of VTE in cervical cancer patients during a 5-year follow-up. Methods The study analyzed data deposited between 2003 and 2008 in the National Health Insurance Research Database (NHIRD, provided by the National Health Research Institutes in Taiwan. Totally, 1013 cervical cancer patients after treatment and 2026 appendectomy patients were eligible. The Kaplan-Meier method and the Cox proportional hazards model were used to assess the VTE risk. Results The 5-year cumulative risk for VTE was significantly higher in the cervical cancer group than in the control group (3.3% vs 0.3%, p vs 30.3%, p  Conclusions The cumulative risk of VTE was significantly higher in cervical cancer patients, and these patients also had lower survival rates. Strategies to reduce these risks need to be examined.

  13. [Negative D-dimers and exclusion of venous thromboembolism--own experience].

    Science.gov (United States)

    Dworakowska, Dorota; Kazimierska, Ewa; Weyer-Hepka, Jolanta; Skibowska-Bielińska, Anna; Swiatkowska-Stodulska, Renata; Lubińska, Monika; Czestochowska, Eugenia

    2005-12-01

    The assessment of D-dimer concentration has become essential step during diagnostic algorithm of venous thromboembolism (VTE). This test characterizes high sensitivity but limited specificity. Negative D-dimer with high probability excludes VTE. The aim of this study was to assess the percentage of patients treated in Department of Internal Medicine, Endocrinology and Haemostatic Disorders, Medical University of Gdańisk, who in spite of clinical signs of VTE showed normal D-dimer level. Between 2000 and 2004 in our department 57 cases with recent deep vein thrombosis (DVT) were diagnosed, in 2 cases with co-existence of pulmonary embolism (PE). The D-dimer concentration was assessed in patients' plasma with the use of immunoturbidometry. Between 57 cases with VTE, 7 patients (12%) showed normal D-dimer level (<500 microg/ml). This group consisted of 4 men and 3 women, aged from 40 to 82 years (the mean age of 58 years). In all 7 cases DVT was diagnosed, in 2 patients with concomitent PE. The final diagnosis was confirmed by compression ultrasonography and pulmonary scintigraphy. Our analysis underlines the observation that occurrence of VTE and negative d-dimer concentration is possible and may probably be related to methodological limitations. However, the lack of increase of D-dimer could also be caused by fibrinolysis alteration.

  14. Venous thromboembolism and subsequent risk of cancer in patients with liver disease

    DEFF Research Database (Denmark)

    Montomoli, Jonathan; Erichsen, Rune; Søgaard, Kirstine Kobberøe;

    2015-01-01

    OBJECTIVE: Venous thromboembolism (VTE) may be a marker of occult cancer in the general population. While liver disease is known to increase the risk of VTE and cancer, it is unclear whether VTE in patients with liver disease is also a marker of occult cancer. DESIGN: A population-based cohort...... and patients with liver cirrhosis were followed as two separate cohorts from the date of their VTE. MEASURES: For each cohort, we computed the absolute and relative risk (standardised incidence ratio; SIR) of cancer after VTE. RESULTS: During the study period, 1867 patients with non-cirrhotic liver disease...... and 888 with liver cirrhosis were diagnosed with incident VTE. In the first year following VTE, the absolute risk of cancer was 2.7% among patients with non-cirrhotic liver disease and 4.3% among those with liver cirrhosis. The SIR for the first 90 days of follow-up was 9.96 (95% CI 6.85 to 13.99) among...

  15. Recurrent venous thromboembolism and abnormal uterine bleeding with anticoagulant and hormone therapy use.

    Science.gov (United States)

    Martinelli, Ida; Lensing, Anthonie W A; Middeldorp, Saskia; Levi, Marcel; Beyer-Westendorf, Jan; van Bellen, Bonno; Bounameaux, Henri; Brighton, Timothy A; Cohen, Alexander T; Trajanovic, Mila; Gebel, Martin; Lam, Phuong; Wells, Philip S; Prins, Martin H

    2016-03-17

    Women receiving vitamin K antagonists (VKAs) require adequate contraception because of the potential for fetal complications. It is unknown whether the use of hormonal therapy, especially those containing estrogens, is associated with recurrent venous thromboembolism (VTE) during anticoagulation. Despite the absence of data, World Health Organization guidelines state that use of estrogen-containing contraceptives confers an "unacceptable health risk" during established anticoagulation for VTE. We compared the incidences of recurrent VTE and abnormal uterine bleeding with and without concomitant hormonal therapy in women aged abnormal uterine bleeding. In total, 1888 women were included. VTE incidence densities on and off hormonal therapy were 3.7%/year and 4.7%/year (adjusted HR, 0.56; 95% confidence interval [CI], 0.23-1.39), respectively, and were 3.7%/year and 3.8%/year, respectively, for estrogen-containing and progestin-only therapy. The adjusted HR for all abnormal uterine bleeding (on vs off hormonal therapy) was 1.02 (95% CI, 0.66-1.57). Abnormal uterine bleeding occurred more frequently with rivaroxaban than with enoxaparin/VKA (HR, 2.13; 95% CI, 1.57-2.89). Hormonal therapy was not associated with an increased risk of recurrent VTE in women receiving therapeutic anticoagulation. The observed increased risk of abnormal uterine bleeding with rivaroxaban needs further exploration.

  16. Mechanical prophylaxis of venous thromboembolism in ill hospitalized medical patients: evidence and guidelines

    Directory of Open Access Journals (Sweden)

    Luca Masotti

    2012-07-01

    Full Text Available Venous thromboembolism (VTE represents one of the leading causes of mortality and morbidity in ill medical patients. Avoiding VTE is therefore of utmost importance in clinical practice. VTE prophylaxis can be assured by pharmacological strategies, such as heparinoids, unfractioned heparin, low molecular weight heparins, fondaparinux or oral anticoagulants and, when these are contraindicated, by mechanical measures, such as graduated compression stockings (GCS and/ or intermittent pneumatic compression (ICP. However, due to the lack of solid literature evidence, VTE mechanical prophylaxis is not standardized in hospitalized ill medical patients. Much recently, findings from randomized clinical trials on VTE prophylaxis in ill medical patients, such as CLOTS I in patients with stroke and LIFENOX in patients with other kind of medical diseases, seem to increase doubts and reduce certainness in this context and recommendations from guidelines don’t help in reducing confusion. Therefore the aim of this review is to focus on mechanical prophylaxis of VTE in hospitalized ill medical patients.http://dx.doi.org/10.7175/rhc.v3i3.202

  17. Clinical and economic analysis of the use of apixaban for the treatment of venous thromboembolic events

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    O. V. Shatalova

    2015-01-01

    Full Text Available Aim. Pharmacoeconomic analysis of apixaban use compared to conventional therapy in patients with venous thromboembolism (VTE.Material and methods. Economic evaluation was performed from a position of the health care system. The cost analysis, "cost-effectiveness" analysis, "impact on the budget” analysis, and sensitivity analysis were fulfilled.Results. In real clinical practice in hospitals direct medical costs of apixaban treatment of deep vein thrombosis and pulmonary embolism make up 2331.67 and 3142.98 rubles, respectively, while the costs of the standard therapy - 6192.15 and 6225.75 rubles. Potential resource savings will reduce 2.65 times the cost of the health system. The share of the costs of treatment of adverse effects (bleeding in the conventional therapy group was 4.8 times higher than the costs in apixaban group. The results of analysis of the effect on the budget show a decrease in the load on the budget when apixaban was included in the treatment regimen of VTE. Potential resource savings of the health system in the treatment of 1,000 patients with apixaban will account 3,911,860 rubles in comparison with conventional therapy.Conclusion. The inclusion of apixaban in the therapy of VTE can significantly reduce the burden on the budget of the health care system.

  18. Accuracy of D-Dimers to Rule Out Venous Thromboembolism Events across Age Categories

    Directory of Open Access Journals (Sweden)

    G. Der Sahakian

    2010-01-01

    Full Text Available Background. Strategies combining pretest clinical assessment and D-dimers measurement efficiently and safely rule out venous thromboembolism events (VTE in low- and intermediate-risk patients. Objectives. As process of ageing is associated with altered concentrations of coagulation markers including an increase in D-dimers levels, we investigated whether D-dimers could reliably rule out VTE across age categories. Method. We prospectively assessed the test performance in 1,004 patients visiting the emergency department during the 6-month period with low or intermediate risk of VTE who also received additional diagnostic procedures. Results. 67 patients had VTE with D-dimers levels above the threshold, and 3 patients displayed D-dimers levels below the threshold. We observed that specificity of D-dimers test decreased in an age-dependent manner. However, sensitivity and negative predictive value remained at very high level in each age category including older patients. Conclusion. We conclude that, even though D-dimers level could provide numerous false positive results in elderly patients, its high sensitivity could reliably help physicians to exclude the diagnosis of VTE in every low- and intermediate-risk patient.

  19. Risk factors for venous thromboembolic events in patients with rheumatoid arthritis

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    M. A. Satybaldyeva

    2016-01-01

    Full Text Available Objective: to determine the incidence and risk factors of venous thromboembolic events (VTEE in patients with rheumatoid arthritis (RA.Subjects and methods. The investigation enrolled 362 patients (302 women and 60 men with RA fulfilling the 2010 American College of Rheumatology/European League Against Rheumatism criteria. The patients' mean age was 53.7±13.3 years; the disease duration was 12.4±10.9 years. All the patients were treated at the V.A. Nasonova Research Institute of Rheumatology in the period 2014 to 2015. Each patient underwent standard clinical examination of peripheral joints. RA activity was assessed with DAS28. There was a questionnaire survey that included traditional risk factors for VTEE and risk factors that might be due to RA and its therapy.Results and discussion. 34 (9.9% patients were found to have VTEE during their hospitalization or in their history. In 32 of them thromboses were located in the veins of the lower extremities, namely 18 and 14 patients had thromboses in the distal and proximal segments, respectively. One patient was recorded to have upper extremity vein thrombosis and another had central retinal vein thrombosis. Lower extremity deep vein thrombosis was complicated by pulmonary thromboembolism in one case. Multivariate analysis has shown that the risk factors of VTEE in RA patients are bed care, heart failure, varicose vein disease, and oral administration of glucocorticoids (GC and intraarticular GC administration (>5 injections; the weighted coefficients of the risk factors are 1.0, 0.92, 3.13, 0.02, and 0.52, respectively. According to the model obtained (p < 0.0001, the risk of VTEE can be predicted using the following formula: Z = 1.0 × bed care (yes, 1 / no, 0 + 0.92 × heart failure (yes, 1 / no, 0 + 3.13 × varicose vein disease (yes, 1 / no, 0 + 0.02 × oral GC use (yes, 1 / no, 0 + 0.52 × intraarticular GC administration (>5 injections; yes, 1 / none, 0.Conclusion. The risk of VTEE should

  20. Determinants of venous thromboembolism among hospitalizations of US adults: a multilevel analysis.

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    James Tsai

    Full Text Available Venous thromboembolism (VTE is a significant clinical and public health concern. We evaluated a variety of multilevel factors--demographics, clinical and insurance status, preexisting comorbid conditions, and hospital characteristics--for VTE diagnosis among hospitalizations of US adults.We generated adjusted odds ratios with 95% confidence intervals (CIs and determined sources of outcome variation by conducting multilevel logistic regression analysis of data from the 2011 Nationwide Inpatient Sample that included 6,710,066 hospitalizations of US adults nested within 1,039 hospitals.Among hospitalizations of adults, age, sex, race or ethnicity, total days of hospital stay, status of health insurance, and operating room procedure were important determinants of VTE diagnosis; each of the following preexisting comorbid conditions--acquired immune deficiency syndrome, anemia, arthritis, congestive heart failure, coagulopathy, hypertension, lymphoma, metastatic cancer, other neurological disorders, obesity, paralysis, pulmonary circulation disorders, renal failure, solid tumor without metastasis, and weight loss--was associated independently with 1.04 (95% CI: 1.02-1.06 to 2.91 (95% CI: 2.81-3.00 times increased likelihood of VTE diagnosis than among hospitalizations of adults without any of these corresponding conditions. The presence of 2 or more of such conditions was associated a 180%-450% increased likelihood of a VTE diagnosis. Hospitalizations of adults who were treated in urban hospitals were associated with a 14%-15% increased likelihood of having a VTE diagnosis than those treated in rural hospitals. Approximately 7.4% of the total variation in VTE diagnosis occurred between hospitals.The presence of certain comorbidities and hospital contextual factors is associated with significantly elevated likelihood of VTE diagnosis among hospitalizations of adults. The findings of this study underscore the importance of clinical risk assessment and

  1. High incidence of symptomatic venous thromboembolism in Thai hospitalized medical patients without thromboprophylaxis.

    Science.gov (United States)

    Aniwan, Satimai; Rojnuckarin, Ponlapat

    2010-06-01

    Venous thromboembolism (VTE) is a common preventable cause of mortality during hospitalization. However, prophylaxis is frequently under-utilized due to the belief that it is rare in Asia. The objective of the study was to estimate the incidence of symptomatic VTE in hospitalized nonsurgical Thai patients. We performed a prospective study in medical wards in Chulalongkorn Hospital, a tertiary care university-based center, from June 2007 to December 2008. We included adult patients admitted beyond 3 days. Patients with VTE before admissions or undergoing major surgery during hospitalization were excluded. According to the usual practice, heparin prophylaxis was not given. However, the program of primary physician education and fast-track diagnostic imaging were implemented. Forty-two VTEs from 7126 susceptible patients [0.59%, 95% confidence interval (CI) 0.41-0.77%] were found; 20 (48%) definite pulmonary embolism, four of which also had symptomatic deep vein thrombosis (DVT), 19 (45%) definite DVT and three sudden deaths from possible pulmonary embolism. Immobilization (74%), active cancer (52%) and rheumatologic diseases (12%), including arthritis of lower extremities and systemic lupus erythematosus with antiphospholipid, were common VTE risk factors, which were present in our patients. The incidences in total cases of arthritis, cancer, mechanical ventilation and congestive heart failure were 7.7, 1.8, 1.5 and 0.5%, respectively. Notably, nine of 23 (39%) pulmonary embolism cases were fatal and two more patients (9.5%) expired from bleeding after treatment (one pulmonary embolism and one DVT). In conclusion, VTE contributes significant hazard to hospitalized nonsurgical Thai patients. Appropriate measures to assure proper thromboprophylaxis in high-risk patients are strongly needed.

  2. Venous thromboembolism in Croatia – Croatian Cooperative Group for Hematologic Diseases (CROHEM) study

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    Pulanić, Dražen; Gverić-Krečak, Velka; Nemet-Lojan, Zlatka; Holik, Hrvoje; Coha, Božena; Babok-Flegarić, Renata; Komljenović, Mili; Knežević, Dijana; Petrovečki, Mladen; Zupančić Šalek, Silva; Labar, Boris; Nemet, Damir

    2015-01-01

    Aim To analyze the incidence and characteristics of venous thromboembolism (VTE) in Croatia. Methods The Croatian Cooperative Group for Hematologic Diseases conducted an observational non-interventional study in 2011. Medical records of patients with newly diagnosed VTE hospitalized in general hospitals in 4 Croatian counties (Šibenik-Knin, Koprivnica-Križevci, Brod-Posavina, and Varaždin County) were reviewed. According to 2011 Census, the population of these counties comprises 13.1% of the Croatian population. Results There were 663 patients with VTE; 408 (61.54%) had deep vein thrombosis, 219 (33.03%) had pulmonary embolism, and 36 (5.43%) had both conditions. Median age was 71 years, 290 (43.7%) were men and 373 (56.3%) women. Secondary VTE was found in 57.3% of participants, idiopathic VTE in 42.7%, and recurrent VTE in 11.9%. There were no differences between patients with secondary VTE and patients with idiopathic VTE in disease recurrence and sex. The most frequent causes of secondary VTE were cancer (40.8%), and trauma, surgery, and immobilization (38.2%), while 42.9% patients with secondary VTE had ≥2 causes. There were 8.9% patients ≤45 years; 3.3% with idiopathic or recurrent VTE. Seventy patients (10.6%) died, more of whom had secondary (81.4%) than idiopathic (18.6%) VTE (P thromboprophylaxis during the presence of risk factors for secondary VTE might substantially lower the VTE burden. PMID:26718761

  3. Risk of venous thromboembolism among hospitalizations of adults with selected autoimmune diseases.

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    Yusuf, Hussain R; Hooper, W Craig; Beckman, Michele G; Zhang, Qing C; Tsai, James; Ortel, Thomas L

    2014-10-01

    Previous research has suggested autoimmune diseases are risk factors for developing venous thromboembolism (VTE). We assessed whether having diagnoses of selected autoimmune diseases associated with antiphospholipid antibodies--autoimmune hemolytic anemia (AIHA), immune thrombocytopenic purpura (ITP), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE)--were associated with having a VTE diagnosis among US adult hospitalizations. A cross-sectional study was conducted using the 2010 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. VTE and autoimmune diseases were identified using International Classification of Diseases, Ninth Revision, Clinical Modification coded diagnoses information. The percentages of hospitalizations with a VTE diagnosis among all non-maternal adult hospitalizations without any of the four autoimmune diseases of interest and among those with AIHA, ITP, RA, and SLE diagnoses were 2.28, 4.46, 3.35, 2.65 and 2.77%, respectively. The adjusted odds ratios (OR) for having a diagnosis of VTE among non-maternal adult hospitalizations with diagnoses of AIHA, ITP, RA, and SLE were 1.25 [95% confidence interval (CI) 1.05-1.49], 1.20 (95% CI 1.07-1.34), 1.17 (95% CI 1.13-1.21), and 1.23 (95% CI 1.15-1.32), respectively, when compared to those without the corresponding conditions. The adjusted OR for a diagnosis of VTE associated with a diagnosis of any of the four autoimmune diseases was 1.20 (95% CI 1.16-1.24). The presence of a diagnosis of AIHA, ITP, RA, and SLE was associated with an increased likelihood of having a VTE diagnosis among the group of all non-maternal adult hospitalizations.

  4. Menstrual Cycle Control in Female Astronauts and the Associated Risk of Venous Thromboembolism

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    Jain, Varsha; Wotring, Virginia

    2015-01-01

    Venous thromboembolism (VTE) is a common and serious condition affecting approximately 1-2 per 1000 people in the USA every year. There have been no documented case reports of VTE in female astronauts during spaceflight in the published literature. Some female astronauts use hormonal contraception to control their menstrual cycles and it is currently unknown how this affects their risk of VTE. Current terrestrial risk prediction models do not account for the spaceflight environment and the physiological changes associated with it. We therefore aim to estimate a specific risk score for female astronauts who are taking hormonal contraception for menstrual cycle control, to deduce whether they are at an elevated risk of VTE. A systematic review of the literature was conducted in order to identify and quantify known terrestrial risk factors for VTE. Studies involving analogues for the female astronaut population were also reviewed, for example, military personnel who use the oral contraceptive pill for menstrual suppression. Well known terrestrial risk factors, for example, obesity or smoking would not be applicable to our study population as these candidates would have been excluded during astronaut selection processes. Other risk factors for VTE include hormonal therapy, lower limb paralysis, physical inactivity, hyperhomocysteinemia, low methylfolate levels and minor injuries, all of which potentially apply to crew members LSAH data will be assessed to identify which of these risk factors are applicable to our astronaut population. Using known terrestrial risk data, an overall estimated risk of VTE for female astronauts using menstrual cycle control methods will therefore be calculated. We predict this will be higher than the general population but not significantly higher requiring thromboprophylaxis. This study attempts to delineate what is assumed to be true of our astronaut population, for example, they are known to be a healthy fit cohort of individuals, and

  5. Prediction of recurrent venous thromboembolism by clot lysis time: a prospective cohort study.

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    Ludwig Traby

    Full Text Available Venous thromboembolism (VTE is a chronic disease, which tends to recur. Whether an abnormal fibrinolytic system is associated with an increased risk of VTE is unclear. We assessed the relationship between fibrinolytic capacity (reflected by clot lysis time [CLT] and risk of recurrent VTE. We followed 704 patients (378 women; mean age 48 yrs with a first unprovoked VTE for an average of 46 months after anticoagulation withdrawal. Patients with natural coagulation inhibitor deficiency, lupus anticoagulant, cancer, homozygosity for factor V Leiden or prothrombin mutation, or requirement for indefinite anticoagulation were excluded. Study endpoint was symptomatic recurrent VTE. For measurement of CLT, a tissue factor-induced clot was lysed by adding tissue-type plasminogen activator. Time between clot formation and lysis was determined by measuring the turbidity. 135 (19% patients had recurrent VTE. For each increase in CLT of 10 minutes, the crude relative risk (RR of recurrence was 1.13 (95% CI 1.02-1.25; p = 0.02 and was 1.08 (95% CI 0.98-1.20; p = 0.13 after adjustment for age and sex. For women only, the adjusted RR was 1.14 (95% CI, 0.91-1.42, p = 0.22 for each increase in CLT of 10 minutes. CLT values in the 4(th quartile of the female patient population, as compared to values in the 1(st quartile, conferred a risk of recurrence of 3.28 (95% CI, 1.07-10.05; p = 0.04. No association between CLT and recurrence risk was found in men. Hypofibrinolysis as assessed by CLT confers a moderate increase in the risk of recurrent VTE. A weak association between CLT and risk of recurrence was found in women only.

  6. Intermittent Pneumatic Compression for the Prevention of Venous Thromboembolism after Total Hip Arthroplasty

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    Kwak, Hong Suk; Cho, Jai Ho; Kim, Jung Taek; Yoo, Jeong Joon

    2017-01-01

    Background Venous thromboembolism (VTE) is a relatively common and potentially life threatening complication after major hip surgery. There are two main types of prophylaxis: chemical and mechanical. Chemical prophylaxis is very effective but causes bleeding complications in surgical wounds and remote organs. On the other hand, mechanical methods are free of hemorrhagic complications but are less effective. We hypothesized that mechanical prophylaxis is effective enough for Asians in whom VTE occurs less frequently. This study evaluated the effect of intermittent pneumatic compression (IPC) in the prevention of VTE after major hip surgery. Methods Incidences of symptomatic VTE after primary total hip arthroplasty with and without application of IPC were compared. A total of 379 patients were included in the final analysis. The IPC group included 233 patients (106 men and 127 women) with a mean age of 54 years. The control group included 146 patients (80 men and 66 women) with a mean age of 53 years. All patients took low-dose aspirin for 6 weeks after surgery. IPC was applied to both legs just after surgery and maintained all day until discharge. When a symptom or a sign suspicious of VTE, such as swelling or redness of the foot and ankle, Homans' sign, and dyspnea was detected, computed tomography (CT) angiogram or duplex ultrasonogram was performed. Results Until 3 months after surgery, symptomatic VTE occurred in three patients in the IPC group and in 6 patients in the control group. The incidence of VTE was much lower in the IPC group (1.3%) than in the control group (4.1%), but the difference was not statistically significant. Complications associated with the application of IPC were not detected in any patient. Patients affected by VTE were older and hospitalized longer than the unaffected patients. Conclusions The results of this study suggest that IPC might be an effective and safe method for the prevention of postoperative VTE. PMID:28261425

  7. Assessing the Caprini Score for Risk Assessment of Venous Thromboembolism in Hospitalized Medical Patients

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    Chopra, Vineet; Bernstein, Steven J.; Hofer, Timothy P.; Flanders, Scott A.

    2017-01-01

    Background The optimal approach to assess risk of venous thromboembolism (VTE) in hospitalized medical patients is unknown. We examined how well the Caprini risk assessment model (RAM) predicts VTE in hospitalized medical patients. Methods Between January 2011 and March 2014, VTE events and risk factors were collected from non-intensive care unit (ICU) medical patients hospitalized in facilities across Michigan. Following calculation of the Caprini score for each patient, mixed logistic spline regression was used to determine the predicted probabilities of 90-day VTE by receipt of pharmacologic prophylaxis across the Caprini risk continuum. Results A total of 670 (1.05%) of 63,548 eligible patients experienced a VTE event within 90 days of hospital admission. The mean Caprini risk score was 4.94 (range 0 - 28). Predictive modeling revealed a consistent linear increase in VTE for Caprini scores between 1-10; estimates beyond a score of 10 were unstable. Receipt of pharmacologic prophylaxis resulted in a modest decrease in VTE risk (odds ratio=0.85; 95% confidence interval 0.72 - 0.99, p = 0.04). However, the low overall incidence of VTE led to large estimates of numbers needed to treat in order to prevent a single VTE event. A Caprini cut-point demonstrating clear benefit of prophylaxis was not detected. Conclusions Although a linear association between the Caprini RAM and risk of VTE was noted, an extremely low incidence of VTE events in non-ICU medical patients was observed. The Caprini RAM was unable to identify a subset of medical patients who benefit from pharmacologic prophylaxis. PMID:26551977

  8. Prevention and treatment of venous thromboembolism in pregnancy in patients with hereditary antithrombin deficiency

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    James AH

    2013-05-01

    Full Text Available Andra H James,1 Barbara A Konkle,2,3 Kenneth A Bauer4 1Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, Virginia, 2Puget Sound Blood Center, Seattle, Washington, 3Department of Medicine, University of Washington, Seattle, Washington, 4Department of Medicine, Beth Israel Deaconess Medical Center and VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA Objective: The aims of the study reported here were to provide data from six pregnant subjects who were enrolled in a clinical trial of antithrombin (AT concentrate, discuss other published case series and case reports, and provide general guidance for the use of AT concentrate for inherited AT deficiency in pregnancy. Methods: In the late 1980s, 31 AT-deficient subjects were enrolled in a prospective treatment trial of the plasma-derived AT concentrate Thrombate III®. Herein, newly available treatment data about the six pregnant subjects in the trial is tabulated and summarized. Results: All six experienced venous thromboembolism (VTE during pregnancy, were dosed according to a weight-based protocol, and were treated concomitantly with anticoagulation. Loading doses of AT concentrate of 54–62 units/kg were followed by maintenance doses of 50%–100% of the loading dose for 3–10 days. At the time of labor, loading doses of 46–50 units/kg were followed by maintenance doses of 50%–75% of the loading dose for 5–7 days. None of the six experienced recurrent thrombosis while receiving treatment with AT concentrate. Conclusion: Currently we suggest that women with AT deficiency who are pregnant or postpartum and have a personal history of VTE or current VTE receive AT concentrates. Keywords: thrombophilia, thrombosis, plasma-derived concentrate, labor, delivery, heparin.

  9. Venous thromboembolic risk and protein S deficiency: ethnic difference and remaining issues

    Institute of Scientific and Technical Information of China (English)

    Tong Yin; Toshiyuki Miyata

    2009-01-01

    Protein S deficiency is an autosomal dominant disorder that results from mutations in the protein S gene (PROS1). Inherited deficiency of protein S constitutes a risk factor for venous thromboembolism. Protein S functions as a nonenzymatic cofactor for activated protein C in the proteolytic degradation of coagulation factors V a and Villa. The frequency of protein S deficiency seems to differ between populations. More than 200 rare mutations in PROS1 have been identified in patients with protein S deficiency. Among the prevalent mutations within PROS1, the S460P substitution (known as Heerlen polymorphism) detected in Caucasians and the K196E substitution (known as protein S Tokushima) found in Japanese have been intensively studied for their structures and potential functions in the disorder of protein S deficiency. Until now, causative mutations in PROS1 have been found in only approximately 50% of cases with protein S deficiency. Co-segregation analysis of microsatellite haplotypes with protein S deficiency in families with protein S deficiency suggests that the causative defects in the PROS1 mutation-negative patients are located in or close to the PROS 1 gene. Large PROS 1 gene deletions have been identified in 3 out of 9 PROS 1 mutation-negative Swedish VTE families with protein S deficiency and 1 out of 6 PROS1 mutation-negative Japanese patients with protein S deficiency. Intensive sequencing of the entire PROS 1 gene, including introns, may be needed to identify the cryptic mutations in those patients, and these efforts might uncover the pathogenesis of protein S deficiency.

  10. The Johns Hopkins Venous Thromboembolism Collaborative: Multidisciplinary team approach to achieve perfect prophylaxis.

    Science.gov (United States)

    Streiff, Michael B; Lau, Brandyn D; Hobson, Deborah B; Kraus, Peggy S; Shermock, Kenneth M; Shaffer, Dauryne L; Popoola, Victor O; Aboagye, Jonathan K; Farrow, Norma A; Horn, Paula J; Shihab, Hasan M; Pronovost, Peter J; Haut, Elliott R

    2016-12-01

    Venous thromboembolism (VTE) is an important cause of preventable harm in hospitalized patients. The critical steps in delivery of optimal VTE prevention care include (1) assessment of VTE and bleeding risk for each patient, (2) prescription of risk-appropriate VTE prophylaxis, (3) administration of risk-appropriate VTE prophylaxis in a patient-centered manner, and (4) continuously monitoring outcomes to identify new opportunities for learning and performance improvement. To ensure that every hospitalized patient receives VTE prophylaxis consistent with their individual risk level and personal care preferences, we organized a multidisciplinary task force, the Johns Hopkins VTE Collaborative. To achieve the goal of perfect prophylaxis for every patient, we developed evidence-based, specialty-specific computerized clinical decision support VTE prophylaxis order sets that assist providers in ordering risk-appropriate VTE prevention. We developed novel strategies to improve provider VTE prevention ordering practices including face-to-face performance reviews, pay for performance, and provider VTE scorecards. When we discovered that prescription of risk-appropriate VTE prophylaxis does not ensure its administration, our multidisciplinary research team conducted in-depth surveys of patients, nurses, and physicians to design a multidisciplinary patient-centered educational intervention to eliminate missed doses of pharmacologic VTE prophylaxis that has been funded by the Patient Centered Outcomes Research Institute. We expect that the studies currently underway will bring us closer to the goal of perfect VTE prevention care for every patient. Our learning journey to eliminate harm from VTE can be applied to other types of harm. Journal of Hospital Medicine 2016;11:S8-S14. © 2016 Society of Hospital Medicine.

  11. Risk of venous thromboembolism in patients with splenic injury and splenectomy. A nationwide cohort study.

    Science.gov (United States)

    Lin, Jiun-Nong; Chen, Hsuan-Ju; Lin, Ming-Chia; Lai, Chung-Hsu; Lin, Hsi-Hsun; Yang, Chih-Hui; Kao, Chia-Hung

    2016-01-01

    The spleen is a crucial organ in humans. However, little is known about the association of venous thromboembolism (VTE) with splenic injury and splenectomy in trauma patients. The aim of this study was to determine the subsequent risk of VTE following splenic injury and splenectomy. A nationwide retrospective cohort study was conducted by analysing data from the National Health Insurance Research Database in Taiwan. We included 6,162 splenic injury patients (3,033 splenectomised and 3,129 nonsplenectomised patients) and 24,648 comparison patients who were selected by frequency match based on sex, age, and the index year during 2000-2006. All patients were followed until the occurrence of VTE, 31 December, 2011, death, or withdrawal from the insurance program. The age of patients with splenic injury was 41.93 ± 16.44 years. The incidence rates of VTE were 11.81, 8.46, and 5.21 per 10,000 person-years in the splenic injury patients with splenectomy, splenic injury patients without splenectomy, and comparison patients, respectively. Compared with the comparison cohort, splenic injury patients with splenectomy exhibited a 2.21-fold risk of VTE (95% confidence interval [CI], 1.43-3.43), whereas those without splenectomy exhibited a 1.71-fold risk of VTE (95% CI, 1.05-2.80). The overall incidence rate of VTE was 1.97-fold higher in the splenic injury cohort than the comparison cohort (95% CI, 1.38-2.81). Although splenectomy increased the risk of VTE 1.35-fold compared with no splenectomy, the difference was not statistically significant (95% CI, 0.74-2.45). These results may alert physicians and patients to the complications of splenic injury and splenectomy.

  12. Venous thromboembolism and desogestrel- or gestodene-containing combination oral contraceptives: what are the facts?

    Science.gov (United States)

    1996-04-01

    The UK's prescription drug regulatory agency warned the public and health care providers about the possible increased risk of venous thromboembolism (VTE) among users of the combined oral contraceptives (OCs) containing desogestrel or gestodene. Data from three large not-yet-published studies served as the basis for the warning. The studies found about a 2-fold increased risk of VTE for these OC users when compared to users of OCs with other progestins. Yet the observational studies are subject to inherent biases (e.g., hospitalized cases and selection bias), which may explain the increased risk. Assuming the increased risk to be true, the risk of VTE is still lower than that linked to pregnancy (30 vs. 60 VTE cases per 100,000). The risk of VTE for users of OCs containing older progestins is about 15 VTE cases and that among healthy, nonpregnant, nonusers is about 4 VTE cases. The mortality risk associated with VTE among users of OCs containing desogestrel or gestodene is 1-1.5 deaths/1 million woman-years. The US Food and Drug Administration has examined the data and has concluded that the risk is not high enough to justify switching to other OCs or stopping use of OCs containing desogestrel or gestodene. It recommends that users of the OCs in question discuss the OCs with their providers and make an informed choice based on the benefits and risks and individual preferences. It might consider changes in labeling, but not pulling the OCs off the market. In Germany, women aged less than 30 were temporarily advised not to begin use of desogestrel- or gestodene-containing OCs. Women using them were advised to continue their use, however. The European Union announced that bias or chance could account for the findings and thus did not recommend changes in prescribing desogestrel- or gestodene-containing OCs.

  13. PHARMACOECONOMIC ASPECTS OF THE PREVENTION OF VENOUS THROMBOEMBOLIC EVENTS AFTER LARGE JOINTS REPLACEMENT

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    A. V. Rudakova

    2015-09-01

    Full Text Available Venous thromboembolic (VTE events are a major concern in large joints replacement leading to patients’ death. The prevention of VTE events suggests the prescription of low molecular weight heparin or oral anticoagulants that differ significantly in their efficacy, safety and cost of the therapy.Aim. To assess the cost-effectiveness of different options for the prevention of VTE events in hip and knee joints replacement.Material and methods. The model, which allows evaluation of the VTE complications incidence in patients aged 60-65years, was developed based on the results of such clinical trials as ADVANCE-2, ADVANCE-3, RE-MODEL, RE-NOVATE. Analysis was performed on survival period of patients. Weighted average prices of public bidding for the purchase of drugs (enoxaparin, dabigatran and apixaban during the first quarter of 2015 were the source of the data on the expenses on VTE events prevention. The cost of treatment of VTE events matched for the rate of compulsory health insurance in St. Petersburg for 2015. The costs and life expectancy of patients were discounted at 3.5% per year.Results. The best results for the prevention of VTE events are observed at the treatment regimen with apixsaban. Treatment regimens with dabigatran and enoxaparin were less effective and comparable with each other. At that, the prevalence of major bleedings was similar for all treatment regiments. Apixaban reduced the cost of treatment and prevention of VTE events 1.8-2.0 times as compared with enoxaparin and 1.2-1.4 times in comparison with dabigatran.Conclusion. The new oral anticoagulants are effective and safe alternative to low molecular weight heparins used for the prevention of VTE events in large joints replacement and provide budgetary savings as compared with enoxaparin. Apixaban has a maximum capacity for the reduction of VTE events, lowering the cost of treatment and prevention of VTE events.

  14. PHARMACOECONOMIC ASPECTS OF THE PREVENTION OF VENOUS THROMBOEMBOLIC EVENTS AFTER LARGE JOINTS REPLACEMENT

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    A. V. Rudakova

    2015-01-01

    Full Text Available Venous thromboembolic (VTE events are a major concern in large joints replacement leading to patients’ death. The prevention of VTE events suggests the prescription of low molecular weight heparin or oral anticoagulants that differ significantly in their efficacy, safety and cost of the therapy.Aim. To assess the cost-effectiveness of different options for the prevention of VTE events in hip and knee joints replacement.Material and methods. The model, which allows evaluation of the VTE complications incidence in patients aged 60-65years, was developed based on the results of such clinical trials as ADVANCE-2, ADVANCE-3, RE-MODEL, RE-NOVATE. Analysis was performed on survival period of patients. Weighted average prices of public bidding for the purchase of drugs (enoxaparin, dabigatran and apixaban during the first quarter of 2015 were the source of the data on the expenses on VTE events prevention. The cost of treatment of VTE events matched for the rate of compulsory health insurance in St. Petersburg for 2015. The costs and life expectancy of patients were discounted at 3.5% per year.Results. The best results for the prevention of VTE events are observed at the treatment regimen with apixsaban. Treatment regimens with dabigatran and enoxaparin were less effective and comparable with each other. At that, the prevalence of major bleedings was similar for all treatment regiments. Apixaban reduced the cost of treatment and prevention of VTE events 1.8-2.0 times as compared with enoxaparin and 1.2-1.4 times in comparison with dabigatran.Conclusion. The new oral anticoagulants are effective and safe alternative to low molecular weight heparins used for the prevention of VTE events in large joints replacement and provide budgetary savings as compared with enoxaparin. Apixaban has a maximum capacity for the reduction of VTE events, lowering the cost of treatment and prevention of VTE events.

  15. Contribution of novel anticoagulants fondaparinux and dabigatran to venous thromboembolism prevention

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    Antonijević Nebojša

    2015-01-01

    Full Text Available The data that episodes and sequels of venous thromboembolism (VTE are recorded in a significant percentage of patients receiving standard anticoagulants as VTE prophylaxis (unfractionated, low-molecular-weight heparin and vitamin K inhibitors as well as the fact that these drugs have significant limitations and that they may cause serious side-effects in some patients indicate the need for the introduction of new anticoagulant drugs. Fondaparinux, a selective inhibitor of Factor Xa, administered following major orthopedic surgeries having a high risk for the development of VTE, is more efficient than enoxaparin sodium used in European and North-American approved doses. The increased incidence of major bleeding (excluding fatal due to fondaparinux could be perhaps lowered by dosage reduction in patients with a mildly decreased creatinine clearance. Dabigatran, a peroral direct thrombin inhibitor, administered for VTE prophylaxis in elective hip and knee surgery, showed in to date studies the efficacy comparable (if dabigatran is given in both dosage regimes of 150 mg and 220 mg daily or superior (if dabigatran is given at a dose of 220 mg daily to enoxaparin administered in European-approved doses, while North American-approved doses of enoxaparin were superior than dabigatran in VTE reduction. No significant differences in bleeding rates were determined in any of the study groups. We consider that the introduction of new anticoagulants, including fondaparinux and dabigatran, will contribute to the establishment of a better safety profile and efficacy, and will also enable adequate therapy individualization for each patient depending on his/hers clinical characteristics. The introduction of novel peroral anticoagulants will, inter alia, significantly contribute to improvement in the quality of life, release the patient from numerous limitations in nutrition, interreaction, frequent laboratory monitoring, and also significantly improve therapeutic

  16. Risk-assessment algorithm and recommendations for venous thromboembolism prophylaxis in medical patients

    Directory of Open Access Journals (Sweden)

    Ana T Rocha

    2007-09-01

    Full Text Available Ana T Rocha1, Edison F Paiva2, Arnaldo Lichtenstein2, Rodolfo Milani Jr2, Cyrillo Cavalheiro-Filho3, Francisco H Maffei41Hospital Universitario Professor Edgard Santos da Universidade Federal da Bahia, Salvador, Bahia, Brazil; 2Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil; 3Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil; 4Faculdade de Medicina de Botucatu, Botucatu, Sao Paulo, BrazilAbstract: The risk for venous thromboembolism (VTE in medical patients is high, but risk assessment is rarely performed because there is not yet a good method to identify candidates for prophylaxis.Purpose: To perform a systematic review about VTE risk factors (RFs in hospitalized medical patients and generate recommendations (RECs for prophylaxis that can be implemented into practice.Data sources: A multidisciplinary group of experts from 12 Brazilian Medical Societies searched MEDLINE, Cochrane, and LILACS.Study selection: Two experts independently classified the evidence for each RF by its scientific quality in a standardized manner. A risk-assessment algorithm was created based on the results of the review.Data synthesis: Several VTE RFs have enough evidence to support RECs for prophylaxis in hospitalized medical patients (eg, increasing age, heart failure, and stroke. Other factors are considered adjuncts of risk (eg, varices, obesity, and infections. According to the algorithm, hospitalized medical patients ≥40 years-old with decreased mobility, and ≥1 RFs should receive chemoprophylaxis with heparin, provided they don’t have contraindications. High prophylactic doses of unfractionated heparin or low-molecular-weight-heparin must be administered and maintained for 6–14 days.Conclusions: A multidisciplinary group generated evidence-based RECs and an easy-to-use algorithm to facilitate VTE prophylaxis in medical patients

  17. Feasibility of intermittent pneumatic compression for venous thromboembolism prophylaxis during magnetic resonance imaging-guided interventions

    Energy Technology Data Exchange (ETDEWEB)

    Maybody, Majid, E-mail: maybodym@mskcc.org [Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (United States); Taslakian, Bedros, E-mail: bt05@aub.edu.lb [Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh, 1107 2020 Beirut (Lebanon); Durack, Jeremy C., E-mail: durackj@mskcc.org [Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (United States); Kaye, Elena A., E-mail: kayee@mskcc.org [Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (United States); Erinjeri, Joseph P., E-mail: erinjerj@mskcc.org [Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (United States); Srimathveeravalli, Govindarajan, E-mail: srimaths@mskcc.org [Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (United States); Solomon, Stephen B., E-mail: solomons@mskcc.org [Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (United States)

    2015-04-15

    Highlights: •The controller of a standard SCD is labeled as an “MR-unsafe”. •No commercially available “MR-safe” SCDs. •Standard SCDs can be used in iMRI by placing the device outside the MRI scanner room. •Using serial extension tubing did not cause device failure. -- Abstract: Purpose: Venous thromboembolism (VTE) is a common cause of morbidity and mortality in hospitalized and surgical patients. To reduce risk, perioperative VTE prophylaxis is recommended for cancer patients undergoing surgical or interventional procedures. Magnetic resonance imaging (MRI) is increasingly used in interventional oncology when alternative imaging modalities do not adequately delineate malignancies. Extended periods of immobilization during MRI-guided interventions necessitate an MR compatible sequential compression device (SCD) for intra-procedural mechanical VTE prophylaxis. Such devices are not commercially available. Materials and methods: A standard SCD routinely used at our institution for VTE prophylaxis during interventional procedures was used. To satisfy MR safety requirements, the SCD controller was placed in the MR control room and connected to the compression sleeves in the magnet room through the wave guide using tubing extensions. The controller pressure sensor was used to monitor adequate pressure delivery and detect ineffective low or abnormal high pressure delivery. VTE prophylaxis was provided using the above mentioned device for 38 patients undergoing MR-guided ablations. Results: There was no evidence of device failure due to loss of pressure in the extension tubing assembly. No interference with the anesthesia or interventional procedures was documented. Conclusion: Although the controller of a standard SCD is labeled as “MR-unsafe”, the SCD can be used in interventional MR settings by placing the device outside the MR scanner room. Using serial tubing extensions did not cause device failure. The described method can be used to provide

  18. Practice patterns in venous thromboembolism (VTE) prophylaxis in thoracic surgery: a comprehensive Canadian Delphi survey

    Science.gov (United States)

    Agzarian, John; Linkins, Lori-Ann; Schneider, Laura; Hanna, Waël C.; Finley, Christian J.; Schieman, Colin; De Perrot, Marc; Crowther, Mark; Douketis, James

    2017-01-01

    Background The incidence of venous thromboembolic events (VTE) after resection of thoracic malignancies can reach 15%, but prophylaxis guidelines are yet to be established. We aimed to survey Canadian practitioners regarding perioperative risk factors for VTE, impact of those factors on extended prophylaxis selection, type of preferred prophylaxis, and timing of initiation and duration of thromboprophylaxis. Methods A modified Delphi survey was undertaken over three rounds with thoracic surgeons, thoracic anesthesiologists and thrombosis experts across Canada. Participants were asked to rate each parameter on a ten-point scale. Agreement was determined a priori as an item reaching a coefficient of variation of ≤30% (0.3), with the item then discontinued from later rounds. Results In total, 72, 57 and 50 respondents participated in three consecutive rounds, respectively. Consensus was reached on previous VTE, age, cancer diagnosis, thrombophilia, poor mobilization, extended resections, and pre-operative chemotherapy as risk factors. Consensus on risk factors impacting extended prophylaxis decisions was achieved on cancer diagnosis, obesity, previous VTE and poor mobilization. With respect to perioperative prophylaxis, once daily low-molecular-weight heparin (LMWH) was the only parameter that demonstrated agreement as a common practice pattern. No agreement was achieved regarding the role of mechanical prophylaxis, unfractionated heparin (UFH) or timing of initiation of peri-operative treatment. VTE prophylaxis until discharge reached agreement but there was substantial variability regarding the role of extended prophylaxis. Conclusions There is agreement between Canadian clinicians treating patients with thoracic malignancies regarding most risk factors for VTE, but there is no agreement on timing of initiation of prophylaxis, the agents used or factors mandating usage of extended prophylaxis. PMID:28203409

  19. High incidence of venous thromboembolism despite electronic alerts for thromboprophylaxis in hospitalised cancer patients.

    Science.gov (United States)

    Lecumberri, Ramón; Marqués, Margarita; Panizo, Elena; Alfonso, Ana; García-Mouriz, Alberto; Gil-Bazo, Ignacio; Hermida, José; Schulman, Sam; Páramo, José A

    2013-07-01

    Many cancer patients are at high risk of venous thromboembolism (VTE) during hospitalisation; nevertheless, thromboprophylaxis is frequently underused. Electronic alerts (e-alerts) have been associated with improvement in thromboprophylaxis use and a reduction of the incidence of VTE, both during hospitalisation and after discharge, particularly in the medical setting. However, there are no data regarding the benefit of this tool in cancer patients. Our aim was to evaluate the impact of a computer-alert system for VTE prevention in patients with cancer, particularly in those admitted to the Oncology/Haematology ward, comparing the results with the rest of inpatients at a university teaching hospital. The study included 32,167 adult patients hospitalised during the first semesters of years 2006 to 2010, 9,265 (28.8%) with an active malignancy. Appropriate prophylaxis in medical patients, significantly increased over time (from 40% in 2006 to 57% in 2010) and was maintained over 80% in surgical patients. However, while e-alerts were associated with a reduction of the incidence of VTE during hospitalisation in patients without cancer (odds ratio [OR] 0.31; 95% confidence interval [CI], 0.15-0.64), the impact was modest in cancer patients (OR 0.89; 95% CI, 0.42-1.86) and no benefit was observed in patients admitted to the Oncology/Haematology Departments (OR 1.11; 95% CI, 0.45-2.73). Interestingly, 60% of VTE episodes in cancer patients during recent years developed despite appropriate prophylaxis. Contrary to the impact on hospitalised patients without cancer, implementation of e-alerts for VTE risk did not prevent VTE effectively among those with malignancies.

  20. Maintained effectiveness of an electronic alert system to prevent venous thromboembolism among hospitalized patients.

    Science.gov (United States)

    Lecumberri, Ramón; Marqués, Margarita; Díaz-Navarlaz, María Teresa; Panizo, Elena; Toledo, Jon; García-Mouriz, Alberto; Páramo, José A

    2008-10-01

    Despite current guidelines, venous thromboembolism (VTE) prophylaxis is underused. Computerized programs to encourage physicians to apply thromboprophylaxis have been shown to be effective in selected populations. Our aim was to analyze the impact of the implementation of a computer-alert system for VTE risk in all hospitalized patients of a teaching hospital. A computer program linked to the clinical record database was developed to assess all hospitalized patients' VTE risk daily. The physician responsible for patients at high risk was alerted, but remained free to order or withhold prophylaxis. Over 19,000 hospitalized, medical and surgical, adult patients between January to June 2005 (pre-intervention phase), January to June 2006 and January to June 2007 (post-intervention phase), were included. During the first semesters of 2006 and 2007, an electronic alert was sent to 32.8% and 32.2% of all hospitalized patients, respectively. Appropriate prophylaxis among alerted patients was ordered in 89.7% (2006) and 88.5% (2007) of surgical patients, and in 49.2% (2006) and 64.4% (2007) of medical patients. A sustained reduction of VTE during hospitalization was achieved, Odds ratio (OR): 0.53, 95% confidence interval (CI) (0.25-1.10) and OR: 0.51, 95%CI (0.24-1.05) during the first semesters of 2006 and 2007 respectively, the impact being significant (p < 0.05) among medical patients in 2007, OR: 0.36, 95%CI (0.12-0.98). The implementation of a computer-alert program helps physicians to assess each patient's thrombotic risk, leading to a better use of thromboprophylaxis, and a reduction in the incidence of VTE among hospitalized patients. For the first time, an intervention aimed to improve VTE prophylaxis shows maintained effectiveness over time.

  1. Clinical course of postthrombotic syndrome in children with history of venous thromboembolism.

    Science.gov (United States)

    Creary, Susan; Heiny, Mark; Croop, James; Fallon, Robert; Vik, Terry; Hulbert, Monica; Knoderer, Holly; Kumar, Manjusha; Sharathkumar, Anjali

    2012-01-01

    Postthrombotic syndrome (PTS) is a chronic morbidity of venous thromboembolism (VTE) in children. Information about the evolution of PTS is lacking in children. Present study was aimed to evaluate the time-course of extremity PTS in children who were serially followed in a hematology clinic. This retrospective cohort study included 69 consecutive children with documented VTEs that presented with symptoms of extremity VTE: 67 extremity VTEs with or without extension to vena cava, 2 inferior vena cava VTEs. Severity of PTS was assessed using modified Villalta scale. Median age of the cohort was 12.6 years (interquartile range 1.6-15 years) while median follow-up was 28.7 months (interquartile range 13.3-33.4 months. PTS prevalence was 46.8% [95% confidence interval (CI) 37.9-57.7%]. Lower extremity VTE was associated with development of PTS compared to upper extremity VTE regardless of catheter use (P = 0.002). The time-course of PTS fluctuated in 11 of 33 children (33%; 95% CI 20-47%) at a median interval of 12 months from diagnosis of VTE (range 4-14 months): three progressed from mild/moderate to severe, one improved from moderate to mild, seven fluctuated between mild and moderate. Recurrence and incomplete resolution of VTE were associated with variability in PTS severity (P course of PTS was not static in one third of children. Future research should focus on identifying the predictors contributing to the worsening of PTS and developing risk-stratified treatment interventions so as to improve the outcome of children with VTE.

  2. Breast cancer-associated venous thromboembolism: A case-control study.

    Science.gov (United States)

    Rebouças, Danilo; Costa, Maria; Thuler, Luiz; Garces, Alvaro; Aquino, Luciana; Bines, José

    2016-08-01

    Breast cancer is frequently associated with venous thromboembolism (VTE). VTE may result in significant morbidity, a substantial economic burden and even leads to patients' death. Risk factor identification and management of VTE in breast cancer patients remains poorly studied. We evaluated breast cancer patients' baseline and treatment characteristics in predicting VTE occurrence as well as its prognosis. We conducted a case-control study of all breast cancer patients with a VTE diagnosed between January 2007 and December 2011 at the Instituto Nacional de Câncer (INCA) in Brazil. Two hundred and twenty five patients developed VTE and were compared with 225 controls, in the 5-year study period. The bulk of the thrombotic events were unilateral (94.2%) VTEs of the lower extremity (78.7%), largely proximally located (78%). VTE occurred more often within the first 3 years after the diagnosis of cancer (66.2%), being more common in the first 6 months (21.8%). Significant predictors of developing VTE were age 50 years and over (OR 1.85, 95% CI: 1.16-2.95), PS equal to or above 3 (OR 2.01, 95% CI: 1.24-3.26), and the presence of a CVC (OR 2.56, 95% CI: 1.42-4.62). This large retrospective analysis of VTE in breast cancer patients confirms that most events occur early in the treatment course. The incidence of VTE was associated with patients' age, PS, and the presence of CVC. Prospective studies are needed to evaluate outpatient thromboprophylaxis for selected groups of patients.

  3. Competing events in patients with malignant disease who are at risk for recurrent venous thromboembolism.

    Science.gov (United States)

    Parpia, S; Julian, J A; Thabane, L; Lee, A Y Y; Rickles, F R; Levine, M N

    2011-11-01

    Patients with malignant disease enrolled in trials of thrombotic disorders may experience competing events such as death. The occurrence of a competing event may prevent the thrombotic event from being observed. Standard survival analysis techniques ignore competing risks, resulting in possible bias and distorted inferences. To assess the impact of competing events on the results of a previously reported trial comparing low molecular weight heparin (LMWH) with oral anticoagulant (OAC) therapy for the prevention of recurrent venous thromboembolism (VTE) in patients with advanced cancer, we compare the results from standard survival analysis with those from competing risk techniques which are based on the cumulative incidence function (CIF) and Gray's test. The Kaplan-Meier method overestimates the risk of recurrent VTE (17.2% in the OAC group and 8.7% in the LMWH group). Risk of recurrence using the CIF is 12.0% and 6.0% in the OAC and LMWH groups, respectively. Both the log-rank test (p=0.002) and Gray's test (p=0.006) suggest evidence in favor of LMWH. The overestimation of risk is 30% in each treatment group, resulting in a similar relative treatment effect; using the Cox model the hazard ratio (HR) is 0.48 (95% confidence interval [CI], 0.30 to 0.78) and HR=0.47 (95% CI, 0.29 to 0.74) using the CIF model. Failing to account for competing risks may lead to incorrect interpretations of the probability of recurrent VTE. However, when the distribution of competing risks is similar within each treatment group, standard and competing risk methods yield comparable relative treatment effects.

  4. Venous thromboembolism after oral and maxillofacial oncologic surgery: Report and analysis of 14 cases in Chinese population

    Science.gov (United States)

    Wang, Yang; Liu, Jiannan; Yin, Xuelai; Hu, Jingzhou; Kalfarentzos, Evagelos; Zhang, Chenping

    2017-01-01

    Background Venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) is a leading cause of death in cancer patients. The aim of this study was to explore the potential risk factor of VTE in oral and maxillofacial oncological surgery. Material and Methods The data of patients who received operation in our institution were gathered in this retrospective study. A diagnosis of VTE was screened and confirmed by computer tomography angiography (CTA) of pulmonary artery or ultrasonography examination of lower extremity. Medical history and all perioperative details were analyzed. Results 14 patients were diagnosed as VTE, including 6 cases of PE, 7 cases of DVT, 1case of DVT and PE. The mean age of these patients was 62.07 years. Reconstruction was performed in 12 patients of these cases, most of which were diagnosed as malignance. Mean length of surgery was 8.74 hours, and lower extremity deep venous cannula (DVC) was performed in all these patients. Conclusions We analyzed several characters of oral and maxillofacial surgery and suggested pay attention to lower extremity DVC which had a high correlation with DVT according to our data. Key words:Venous thromboembolism, pulmonary embolism, deep vein thrombosis, oral and maxillofacial surgery. PMID:27918738

  5. Tenecteplase in the treatment of acute pulmonary thrombo-embolism.

    Science.gov (United States)

    Bhuvaneswaran, J S; Premchand, Rajendra Kumar; Iyengar, S S; Rajeev Khare; Chabra, C B; Padmanabhan, T N C; Sharma, S K; Jain, Alkesh; Pandian, S A; Rajdev, S; Modi, N; Kumar, V

    2011-05-01

    This is a retrospective study documenting the use of tenecteplase in 41 cases of suspected or confirmed pulmonary embolism receiving in-hospital tenecteplase as per weight-adjusted dosing in addition to standard heparin and oral anticoagulant therapy. The presenting symptoms of dyspnoea, chest pain, hemoptysis and syncope were found in 40 (97.56%), 19 (46.34%), 6 (14.63%) and 9 (21.95%) patients, respectively. There was one case of mortality who was a 26 yrs old female of postpartum pulmonary thrombo-embolism with severe hypotension, cyanosis, bilateral crepitations in lungs and pulmonary hypertension. In the 40 survived patients, there was alleviation of dyspnoea and hemoptysis in all patients. Significant reduction in tachycardia (P tenecteplase therapy. Resolution of pulmonary embolism on CT pulmonary angiography was documented in only two patients. No bleeding events or any other adverse events were reported during this study. The present study suggests favourable efficacy of tenecteplase in patients with suspected or confirmed acute pulmonary embolism. Although no major adverse events were noted, a large prospective study on the use of tenecteplase in pulmonary embolism is suggested.

  6. Differences in urinary prothrombin fragment 1 + 2 levels after total hip replacement in relation to venous thromboembolism and bleeding events

    DEFF Research Database (Denmark)

    Borris, L C; Breindahl, M; Lassen, M R;

    2008-01-01

    events. PATIENTS/METHODS: This study was conducted in parallel with a prospective, dose-finding study evaluating the efficacy and safety of different doses of rivaroxaban (Xarelto, Bayer HealthCare AG, Wuppertal, Germany) for thromboprophylaxis, relative to enoxaparin. Deep vein thrombosis was diagnosed......BACKGROUND: Prothrombin fragment 1 + 2 is excreted in urine (uF1 + 2) as a result of thrombin generation and, therefore, may be a useful marker of coagulation status. OBJECTIVES: To assess uF1 + 2 levels after total hip replacement (THR) in patients with venous thromboembolism (VTE) and bleeding...

  7. 骨折常见并发症--静脉血栓栓塞症%Fracture complications-venous thromboembolism

    Institute of Scientific and Technical Information of China (English)

    吴新宝; 杨明辉

    2015-01-01

    Prevention and treatment of complications are very important in fracture management. Venous thromboembolism ( VTE ), including deep vein thrombosis ( DVT ) and pulmonary embolism ( PE ), is a common complication in orthopaedic patients. It attracted wide attention and was investigated thoroughly in recent years. Despite of these efforts, there are still controversies regarding the prevention, screening and treatment of VTE in orthopaedic patients. We reviewed the guidelines and recommendations on VTE in orthopaedic trauma patients, including guidelines from Chinese Orthopaedic Association in 2009, 9th guidelines from the American College of Chest Physicians in 2012 and Expert Consensus from the Orthopaedic Trauma Group. These guidelines act signiifcantly in the clinical work.

  8. New oral antithrombotics: focus on dabigatran, an oral, reversible direct thrombin inhibitor for the prevention and treatment of venous and arterial thromboembolic disorders

    Directory of Open Access Journals (Sweden)

    Dahl OE

    2012-01-01

    Full Text Available Ola E Dahl1,21Department of Orthopaedics, Innlandet Hospital Trust, Elverum Central Hospital, Elverum, Norway; 2Thrombosis Research Institute, London, UKAbstract: Venous thromboembolism, presenting as deep vein thrombosis or pulmonary embolism, is a major challenge for health care systems. It is the third most common vascular disease after coronary heart disease and stroke, and many hospitalized patients have at least one risk factor. In particular, patients undergoing hip or knee replacement are at risk, with an incidence of asymptomatic deep vein thrombosis of 40%–60% without thromboprophylaxis. Venous thromboembolism is associated with significant mortality and morbidity, with patients being at risk of recurrence, post-thrombotic syndrome, and chronic thromboembolic pulmonary hypertension. Arterial thromboembolism is even more frequent, and atrial fibrillation, the most common embolic source (cardiac arrhythmia, is associated with a five-fold increase in the risk of stroke. Strokes due to atrial fibrillation tend to be more severe and disabling and are more often fatal than strokes due to other causes. Currently, recommended management of both venous and arterial thromboembolism involves the use of anticoagulants such as coumarin and heparin derivatives. These agents are effective, although have characteristics that prevent them from providing optimal anticoagulation and convenience. Hence, new improved oral anticoagulants are being investigated. Dabigatran is a reversible, direct thrombin inhibitor, which is administered as dabigatran etexilate, the oral prodrug. Because it is the first new oral anticoagulant that has been licensed in many countries worldwide for thromboprophylaxis following orthopedic surgery and for stroke prevention in patients with atrial fibrillation, this compound will be the main focus of this review. Dabigatran has been investigated for the treatment of established venous thromboembolism and prevention of

  9. Advanced management of acute iliofemoral deep venous thrombosis: emergency department and beyond.

    Science.gov (United States)

    Pollack, Charles V

    2011-06-01

    Recent attention to the increasing incidence of venous thromboembolism has included a call to action from the surgeon general and new guidelines from various specialty organizations. The standard of care for treatment of deep venous thrombosis in the emergency department (ED), supported by the 2008 American College of Chest Physicians (ACCP) guidelines, involves initiation of anticoagulation with low-molecular-weight heparin, pentasaccharide, or unfractionated heparin. For selected appropriate patients with extensive acute proximal deep venous thrombosis, the ACCP guidelines now recommend thrombolysis in addition to anticoagulation to reduce not only the risk of pulmonary embolism but also the risk of subsequent postthrombotic syndrome and recurrent deep venous thrombosis. Postthrombotic syndrome is a potentially debilitating chronic cluster of lower-extremity symptoms occurring in 20% to 50% of deep venous thrombosis patients subsequent to the acute insult, sometimes not until years later. A strategy of early thrombus burden reduction or frank removal might reduce the incidence of postthrombotic syndrome, as per natural history studies, venous thrombectomy data, observations after systemic and catheter-directed thrombolysis, and the still-limited number of randomized trials of catheter-directed thrombolysis (with anticoagulation) versus anticoagulation alone. Contemporary invasive (endovascular) treatments mitigate the drawbacks historically associated with thrombolytic approaches by means of intrathrombus delivery of drugs with greater fibrin specificity and lower allergenicity, followed by mechanical dispersion to accelerate lysis and then aspiration of remaining drug and clot debris. With a 2016 target completion date, the National Heart, Lung, and Blood Institute--sponsored Acute Venous Thrombosis: Thrombus Removal With Adjunctive Catheter-Directed Thrombolysis trial is comparing the safety and efficacy, in terms of both deep venous thrombosis and

  10. Calcified pulmonary thromboembolism in a child with sickle cell disease: value of multidetector CT in patients with acute chest syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Staser, Jonathan A. [Indiana University Medical Center, Department of Radiology, Indianapolis, IN (United States); Alam, Tariq [Medical College of Ohio, Department of Radiology, Toledo, OH (United States); Applegate, Kimberly [Indiana University Medical Center, Sections of Pediatric Radiology and Health Services Research, Indianapolis, IN (United States); Indiana University Medical Center, Department of Radiology, Riley Hospital for Children, Indianapolis, IN (United States)

    2006-06-15

    The incidence of pulmonary embolism in children is not clearly known, but is believed to be low. Risk factors for pulmonary thromboembolism include central venous catheter, malignancy, surgery, infection, trauma, and congenital hypercoagulable disorders. Children with sickle cell disease are prothrombotic and are at an increased risk of thromboembolism. The incidence of this event is unknown because these children are often not thoroughly imaged. We report here a case of a calcified pulmonary thromboembolism in a child with sickle cell disease and emphasize the use of multidetector CT in detection of pulmonary thromboembolism in children with sickle cell disease. (orig.)

  11. Incidence, determinants and the transient impact of cancer treatments on venous thromboembolism risk among lymphoma patients in Denmark

    DEFF Research Database (Denmark)

    Lund, Jennifer L; Østgård, Lene Sofie; Prandoni, Paolo

    2015-01-01

    BACKGROUND: Valid estimation of the incidence and risk factors for venous thromboembolism (VTE) among lymphoma patients has been limited by small studies focused on selected lymphoma subtypes and failure to account for death as a competing risk. Using a nationwide cohort of Danish lymphoma patients......- and 2-year incidence accounting for competing risks. Using Cox proportional hazards models, we identified factors associated with VTE risk. In a nested self-controlled design, we evaluated the transient effect of chemotherapy, radiation, central venous catheter use and rituximab on VTE risk using...... diagnosed from 2000 to 2010, we examined the incidence and risk factors for VTE and evaluated the transient impact of cancer treatments on VTE risk. METHODS: Medical databases contained cancer, comorbidity, treatment, and VTE information. We computed VTE incidence rates (IRs) per 1000person-years and 1...

  12. Prothrombin and risk of venous thromboembolism, ischemic heart disease and ischemic cerebrovascular disease in the general population

    DEFF Research Database (Denmark)

    Weischer, Maren; Juul, Klaus; Zacho, Jeppe

    2010-01-01

    OBJECTIVE: We tested the hypotheses that Prothrombin G20210A heterozygosity associate with increased risk of venous thromboembolism (VTE), ischemic heart disease (IHD), and ischemic cerebrovascular disease (ICVD) in the general population and re-tested risk of IHD and ICVD in two case......-control studies. METHODS: 9231 individuals from the Danish general population were followed for VTE (VTE=DVT+PE), deep venous thrombosis (DVT), pulmonary embolism (PE), IHD, myocardial infarction (MI), ICVD, and ischemic stroke (IS) for a median of 24 years. Case-control studies included 2461 IHD cases and 867.......0(1.0-3.8) for MI, 1.4(0.7-3.1) for ICVD, and 2.1(0.8-5.4) for IS. CONCLUSION: Prothrombin G20210A heterozygosity alone and in combination with Factor V Leiden R506Q heterozygosity predicts 1.5 and 6.0 fold risk of IHD compared to non-carriers....

  13. Profilaxia para tromboembolia venosa em um hospital geral Venous thromboembolism prophylaxis in a general hospital

    Directory of Open Access Journals (Sweden)

    Fernanda Fuzinatto

    2011-04-01

    Full Text Available OBJETIVO: Avaliar a prática de profilaxia para tromboembolia venosa (TEV em pacientes em um hospital geral. MÉTODOS: Estudo de coorte transversal conduzido no Hospital Nossa Senhora da Conceição, localizado na cidade de Porto Alegre (RS, com uma amostra constituída de pacientes internados selecionados randomicamente entre outubro de 2008 e fevereiro de 2009. Foram incluídos pacientes maiores de 18 anos e internados por mais de 48 h. Os critérios de exclusão foram pacientes em uso de anticoagulantes, história de doença tromboembólica, gestação e puerpério. A adequação da profilaxia foi avaliada seguindo as recomendações de um protocolo criado pela instituição e tendo como base principal a diretriz da American College of Chest Physician, oitava edição. RESULTADOS: Foram incluídos 262 pacientes com média de idade de 59,1 ± 16,6 anos. Os fatores de risco mais comuns foram imobilização (70,6%, infecção (44,3%, câncer (27,5%, obesidade (23,3% e cirurgia maior (14,1%. Na avaliação do nível de risco para TEV, 143 (54,6% e 117 pacientes (44,7%, respectivamente, foram classificados como de risco alto e moderado. No geral, 46,2% dos pacientes tiveram profilaxia adequada, assim como 25% dos pacientes com três ou mais fatores de risco e 18% dos pacientes com câncer, e houve diferenças estatisticamente significativas entre esses grupos quando comparados àqueles com menos de três fatores de risco e sem câncer (p OBJECTIVE: To evaluate the use of venous thromboembolism (VTE prophylaxis in a general hospital. METHODS: A cross-sectional cohort study at the Hospital Nossa Senhora da Conceição, located in the city of Porto Alegre, Brazil, involving a random sample of patients admitted between October of 2008 and February of 2009. We included patients over 18 years of age and hospitalized for more than 48 h. The exclusion criteria were anticoagulant use, pregnancy, puerperium, and a history of thromboembolic disease. The

  14. Evaluation of the risk of venous thromboembolism after quadrivalent human papillomavirus vaccination among US females.

    Science.gov (United States)

    Yih, W Katherine; Greene, Sharon K; Zichittella, Lauren; Kulldorff, Martin; Baker, Meghan A; de Jong, Jill L O; Gil-Prieto, Ruth; Griffin, Marie R; Jin, Robert; Lin, Nancy D; McMahill-Walraven, Cheryl N; Reidy, Megan; Selvam, Nandini; Selvan, Mano S; Nguyen, Michael D

    2016-01-02

    After the Food and Drug Administration (FDA) licensed quadrivalent human papillomavirus vaccine (HPV4) in 2006, reports suggesting a possible association with venous thromboembolism (VTE) emerged from the Vaccine Adverse Event Reporting System and the Vaccine Safety Datalink. Our objective was to determine whether HPV4 increased VTE risk. The subjects were 9-26-year-old female members of five data partners in the FDA's Mini-Sentinel pilot project receiving HPV4 during 2006-2013. The outcome was radiologically confirmed first-ever VTE among potential cases identified by diagnosis codes in administrative data during Days 1-77 after HPV4 vaccination. With a self-controlled risk interval design, we compared counts of first-ever VTE in risk intervals (Days 1-28 and Days 1-7 post-vaccination) and control intervals (Days 36-56 for Dose 1 and Days 36-63 for Doses 2 and 3). Combined hormonal contraceptive use was treated as a potential confounder. The main analyses were: (1) unadjusted for time-varying VTE risk from contraceptive use, (2) unadjusted but restricted to cases without such time-varying risk, and (3) adjusted by incorporating the modeled risk of VTE by week of contraceptive use in the analysis. Of 279 potential VTE cases identified following 1,423,399 HPV4 doses administered, 225 had obtainable charts, and 53 were confirmed first-ever VTE. All 30 with onsets in risk or control intervals had known risk factors for VTE. VTE risk was not elevated in the first 7 or 28 days following any dose of HPV in any analysis (e.g. relative risk estimate (95% CI) from both unrestricted analyses, for all-doses, 28-day risk interval: 0.7 (0.3-1.4)). Temporal scan statistics found no clustering of VTE onsets after any dose. Thus, we found no evidence of an increased risk of VTE associated with HPV4 among 9-26-year-old females. A particular strength of this evaluation was its control for both time-invariant and contraceptive-related time-varying potential confounding.

  15. European Union-28: An annualised cost-of-illness model for venous thromboembolism.

    Science.gov (United States)

    Barco, Stefano; Woersching, Alex L; Spyropoulos, Alex C; Piovella, Franco; Mahan, Charles E

    2016-04-01

    Annual costs for venous thromboembolism (VTE) have been defined within the United States (US) demonstrating a large opportunity for cost savings. Costs for the European Union-28 (EU-28) have never been defined. A literature search was conducted to evaluate EU-28 cost sources. Median costs were defined for each cost input and costs were inflated to 2014 Euros (€) in the study country and adjusted for Purchasing Power Parity between EU countries. Adjusted costs were used to populate previously published cost-models based on adult incidence-based events. In the base model, annual expenditures for total, hospital-associated, preventable, and indirect costs were €1.5-2.2 billion, €1.0-1.5 billion, €0.5-1.1 billion and €0.2-0.3 billion, respectively (indirect costs: 12 % of expenditures). In the long-term attack rate model, total, hospital-associated, preventable, and indirect costs were €1.8-3.3 billion, €1.2-2.4 billion, €0.6-1.8 billion and €0.2-0.7 billion (indirect costs: 13 % of expenditures). In the multiway sensitivity analysis, annual expenditures for total, hospital-associated, preventable, and indirect costs were €3.0-8.5 billion, €2.2-6.2 billion, €1.1-4.6 billion and €0.5-1.4 billion (indirect costs: 22 % of expenditures). When the value of a premature life-lost increased slightly, aggregate costs rose considerably since these costs are higher than the direct medical costs. When evaluating the models aggregately for costs, the results suggests total, hospital-associated, preventable, and indirect costs ranging from €1.5-13.2 billion, €1.0-9.7 billion, €0.5-7.3 billion and €0.2-6.1 billion, respectively. Our study demonstrates that VTE costs have a large financial impact upon the EU-28's healthcare systems and that significant savings could be realised if better preventive measures are applied.

  16. Screening for occult malignancy with FDG-PET/CT in patients with unprovoked venous thromboembolism.

    Science.gov (United States)

    Alfonso, Ana; Redondo, Margarita; Rubio, Tomás; Del Olmo, Beatriz; Rodríguez-Wilhelmi, Pablo; García-Velloso, María J; Richter, José A; Páramo, José A; Lecumberri, Ramón

    2013-11-01

    Extensive screening strategies to detect occult cancer in patients with unprovoked venous thromboembolism (VTE) are complex and no benefit in terms of survival has been reported. FDG-PET/CT (2-[F-18] fluoro-2-deoxy-D-glucose positron emission tomography combined with computed tomography), a noninvasive technique for the diagnosis and staging of malignancies, could be useful in this setting. Consecutive patients ≥ 50 years with a first unprovoked VTE episode were prospectively included. Screening with FDG-PET/CT was performed 3-4 weeks after the index event. If positive, appropriate diagnostic work-up was programmed. Clinical follow-up continued for 2 years. Blood samples were collected to assess coagulation biomarkers. FDG-PET/CT was negative in 68/99 patients (68.7%), while suspicious FDG uptake was detected in 31/99 patients (31.3%). Additional diagnostic work-up confirmed a malignancy in 7/31 patients (22.6%), with six of them at early stage. During follow-up, two patients with negative FDG-PET/CT were diagnosed with cancer. Sensitivity (S), positive (PPV) and negative predictive values (NPV) of FDG-PET/CT as single tool for the detection of occult malignancy were 77.8% (95% CI: 0.51-1), 22.6% (95% CI: 0.08-0.37) and 97.1% (95% CI: 0.93-1), respectively. Median tissue factor (TF) activity in patients with occult cancer was 5.38 pM vs. 2.40 pM in those without cancer (p = 0.03). Limitation of FDG-PET/CT screening to patients with TF activity > 2.8 pM would improve the PPV to 37.5% and reduce the costs of a single cancer diagnosis from 20,711€ to 11,670€. FDG-PET/CT is feasible for the screening of occult cancer in patients with unprovoked VTE, showing high S and NPV. The addition of TF activity determination may be useful for patient selection.

  17. Introduction of a Venous Thromboembolism Prophylaxis Protocol for Older Adult Psychiatric Patients.

    Science.gov (United States)

    Croxford, Anna; Clare, Adam; McCurdy, Kathleen

    2015-01-01

    Hospital-Acquired venous thromboembolism (VTE) is a common cause of morbidity and mortality in older adults. In psychiatric patients these risks are increased due to multiple factors including poor mobility, restraint, catatonia, sedation, and conventional antipsychotic use. Diagnosis and treatment of psychiatric patients presenting with signs and symptoms of a VTE can be delayed due to a patient's communication difficulties, non-compliance, or attribution of symptoms to a psychosomatic cause. However, despite the increased risk, approved VTE prophylaxis protocols are infrequently used on Psychiatric wards. On one Older Adult Psychiatric Ward, two patients presented with VTE (a fatal pulmonary embolism and a symptomatic deep vein thrombosis) over a 6 month period demonstrating the necessity for prophylactic assessment. A baseline audit over 3 months showed that 63-83% of patients on the ward had received no assessment of VTE risk, on any given week, although this improved slightly following the critical incidents. A VTE prophylaxis protocol, based on NICE guidance for VTE risk assessment in Medical and Surgical patients, was developed with consideration given to additional Psychiatric risk factors. This took the form of a pro-forma with a tick-box design that included mobility assessment, VTE risk factors, bleeding risk factors, and guidance on prescribing decisions. This was implemented on an Older Adult Psychiatric ward and prophylaxis was provided to those meeting the threshold. Weekly audit of all pro-formas (including assessments completed within 48 hours of admission and prophylaxis prescription) was conducted after the pro-forma introduction from 1st February 2013 to 24th May 2013. Frequency of assessments increased after protocol implementation with between 36% and 85% of all patients being assessed for VTE risk post intervention. Fluctuations in numbers assessed may have related to ward pressures, staff changes, and practicalities of pro-forma use. After

  18. Incident venous thromboembolic events in the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER

    Directory of Open Access Journals (Sweden)

    Ford Ian

    2011-02-01

    Full Text Available Abstract Background Venous thromboembolic events (VTE, including deep venous thrombosis and pulmonary embolism, are common in older age. It has been suggested that statins might reduce the risk of VTE however positive results from studies of middle aged subjects may not be generalisable to elderly people. We aimed to determine the effect of pravastatin on incident VTE in older people; we also studied the impact of clinical and plasma risk variables. Methods This study was an analysis of incident VTE using data from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER, a randomized, double-blind, placebo-controlled trial of pravastatin in men and women aged 70-82. Mean follow-up was 3.2 years. Risk for VTE was examined in non-warfarin treated pravastatin (n = 2834 and placebo (n = 2865 patients using a Cox's proportional hazard model, and the impact of other risk factors assessed in a multivariate forward stepwise regression analysis. Baseline clinical characteristics, blood biochemistry and hematology variables, plasma levels of lipids and lipoproteins, and plasma markers of inflammation and adiposity were compared. Plasma markers of thrombosis and hemostasis were assessed in a nested case (n = 48 control (n = 93 study where the cohort was those participants, not on warfarin, for whom data were available. Results There were 28 definite cases (1.0% of incident VTE in the pravastatin group recipients and 20 cases (0.70% in placebo recipients. Pravastatin did not reduce VTE in PROSPER compared to placebo [unadjusted hazard ratio (95% confidence interval 1.42 (0.80, 2.52 p = 0.23]. Higher body mass index (BMI [1.09 (1.02, 1.15 p = 0.0075], country [Scotland vs Netherlands 4.26 (1.00, 18.21 p = 0.050 and Ireland vs Netherlands 6.16 (1.46, 26.00 p = 0.013], lower systolic blood pressure [1.35 (1.03, 1.75 p = 0.027] and lower baseline Mini Mental State Examination (MMSE score [1.19 (1.01, 1.41 p = 0.034] were associated with an

  19. Nontraumatic vascular emergencies: imaging and intervention in acute venous occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Haage, Patrick; Schmitz-Rode, Thomas [Department of Diagnostic Radiology, University of Technology Aachen, Pauwelsstrasse 30, 52057 Aachen (Germany); Krings, Timo [Department of Neuroradiology, University of Technology Aachen, Pauwelsstrasse 30, 52057 Aachen (Germany)

    2002-11-01

    Risk factors for acute venous occlusion range from prolonged immobilization to hypercoagulability syndromes, trauma, and malignancy. The aim of this review article is to illustrate the different imaging options for the diagnosis of acute venous occlusion and to assess the value of interventional strategies for venous thrombosis treatment in an emergency setting. First, diagnosis and treatment of the most common form of venous occlusion, at the level of the lower extremities, is presented, followed by pelvic vein and inferior vena cava occlusion, mesenteric venous thrombosis, upper extremity occlusion, acute cerebral vein thrombosis, and finally acute venous occlusion of hemodialysis access. In acute venous occlusion of the lower extremity phlebography is still the reference gold standard. Presently, duplex ultrasound with manual compression is the most sensitive and specific noninvasive test. Limitations of ultrasonography include isolated distal calf vein occlusion, obesity, and patients with lower extremity edema. If sonography is nondiagnostic, venography should be considered. Magnetic resonance venography can differentiate an acute occlusion from chronic thrombus, but because of its high cost and limited availability, it is not yet used for the routine diagnosis of lower extremity venous occlusion only. Regarding interventional treatment, catheter-directed thrombolysis can be applied to dissolve thrombus in charily selected patients with symptomatic occlusion and no contraindications to therapy. Acute occlusion of the pelvic veins and the inferior vena cava, often due to extension from the femoropopliteal system, represents a major risk for pulmonary embolism. Color flow Doppler imaging is often limited owing to obesity and bowel gas. Venography has long been considered the gold standard for identifying proximal venous occlusion. Both CT scanning and MR imaging, however, can even more accurately diagnose acute pelvis vein or inferior vena cava occlusion. MRI is

  20. 静脉血栓栓塞症的诊治现状%Current status of diagnosis and therapy in venous thromboembolism

    Institute of Scientific and Technical Information of China (English)

    方宏; 王乐民

    2010-01-01

    @@ 静脉内形成的血栓脱落后,随血循环堵塞肺动脉或静脉的临床和病理生理综合征被称为静脉血栓栓塞症(venous thromboembolism,VTE),可分为深静脉血栓(deep venous thrombosis,DVT)和肺栓塞(pulmonary embolism,PE)两大类.

  1. A genome-wide association study for venous thromboembolism: the extended cohorts for heart and aging research in genomic epidemiology (CHARGE) consortium

    NARCIS (Netherlands)

    Tang, W.; Teichert, M.; Chasman, D.I.; Heit, J.A.; Morange, P.E.; Li, G.; Pankratz, N.; Leebeek, F.W.; Pare, G.; Andrade, M. de; Tzourio, C.; Psaty, B.M.; Basu, S.; Ruiter, R. de; Rose, L.; Armasu, S.M.; Lumley, T.; Heckbert, S.R.; Uitterlinden, A.G.; Lathrop, M.; Rice, K.M.; Cushman, M.; Hofman, A.; Lambert, J.C.; Glazer, N.L.; Pankow, J.S.; Witteman, J.C.; Amouyel, P.; Bis, J.C.; Bovill, E.G.; Kong, X.; Tracy, R.P.; Boerwinkle, E.; Rotter, J.I.; Tregouet, D.A.; Loth, D.W.; Stricker, B.H.; Ridker, P.M.; Folsom, A.R.; Smith, N.L.

    2013-01-01

    Venous thromboembolism (VTE) is a common, heritable disease resulting in high rates of hospitalization and mortality. Yet few associations between VTE and genetic variants, all in the coagulation pathway, have been established. To identify additional genetic determinants of VTE, we conducted a two-s

  2. Direct treatment comparison of DAbigatran and RIvaroxaban versus NAdroparin in the prevention of venous thromboembolism after total knee arthroplasty surgery : design of a randomised pilot study (DARINA)

    NARCIS (Netherlands)

    van der Veen, L.; van Raay, J.J.A.M.; Gerritsma-Bleeker, C.L.E.; Veeger, N.J.G.M.; van Hulst, M.

    2013-01-01

    Introduction: Two novel agents, dabigatran and rivaroxaban, recently gained market authorisation for prevention of venous thromboembolism (VTE) after hip and knee arthroplasty. However, safety data of the new oral anticoagulants with a long-term use of 42 days are not available for total knee arthro

  3. Risk of venous thromboembolism associated with single and combined effects of Factor V Leiden, Prothrombin 20210A and Methylenetethraydrofolate reductase C677T

    DEFF Research Database (Denmark)

    Simone, Benedetto; De Stefano, Valerio; Leoncini, Emanuele

    2013-01-01

    Genetic and environmental factors interact in determining the risk of venous thromboembolism (VTE). The risk associated with the polymorphic variants G1691A of factor V (Factor V Leiden, FVL), G20210A of prothrombin (PT20210A) and C677T of methylentetrahydrofolate reductase (C677T MTHFR) genes ha...

  4. Use of combined oral contraceptives and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases

    Science.gov (United States)

    Coupland, Carol; Hippisley-Cox, Julia

    2015-01-01

    Objective To investigate the association between use of combined oral contraceptives and risk of venous thromboembolism, taking the type of progestogen into account. Design Two nested case-control studies. Setting General practices in the United Kingdom contributing to the Clinical Practice Research Datalink (CPRD; 618 practices) and QResearch primary care database (722 practices). Participants Women aged 15-49 years with a first diagnosis of venous thromboembolism in 2001-13, each matched with up to five controls by age, practice, and calendar year. Main outcome measures Odds ratios for incident venous thromboembolism and use of combined oral contraceptives in the previous year, adjusted for smoking status, alcohol consumption, ethnic group, body mass index, comorbidities, and other contraceptive drugs. Results were combined across the two datasets. Results 5062 cases of venous thromboembolism from CPRD and 5500 from QResearch were analysed. Current exposure to any combined oral contraceptive was associated with an increased risk of venous thromboembolism (adjusted odds ratio 2.97, 95% confidence interval 2.78 to 3.17) compared with no exposure in the previous year. Corresponding risks associated with current exposure to desogestrel (4.28, 3.66 to 5.01), gestodene (3.64, 3.00 to 4.43), drospirenone (4.12, 3.43 to 4.96), and cyproterone (4.27, 3.57 to 5.11) were significantly higher than those for second generation contraceptives levonorgestrel (2.38, 2.18 to 2.59) and norethisterone (2.56, 2.15 to 3.06), and for norgestimate (2.53, 2.17 to 2.96). The number of extra cases of venous thromboembolism per year per 10 000 treated women was lowest for levonorgestrel (6, 95% confidence interval 5 to 7) and norgestimate (6, 5 to 8), and highest for desogestrel (14, 11 to 17) and cyproterone (14, 11 to 17). Conclusions In these population based, case-control studies using two large primary care databases, risks of venous thromboembolism associated with combined oral

  5. Venous thromboembolism in pregnancy: prophylaxis and treatment with low molecular weight heparin

    DEFF Research Database (Denmark)

    Andersen, Anita Sylvest; Berthelsen, Jørgen G; Bergholt, Thomas

    2010-01-01

    OBJECTIVE: To evaluate the safety of individually dosed low molecular weight heparin (LMWH) for prophylaxis and treatment of thromboembolic complications in pregnancy. DESIGN: Cohort study with a chronologic register-based control group. SETTING: Department of Obstetrics and Gynecology, Hillerød...... Hospital, Denmark. POPULATION: All 166 women treated with LMWH in pregnancy between 1 January 2001 and 31 December 2005. METHODS: Women treated with LMWH in pregnancy were identified and individual case records reviewed retrospectively. General data on the LMWH-treated women were compared to the 18......,020 untreated pregnancies within the same period and with 306 matched controls as regards to postpartum hemorrhage (PPH). MAIN OUTCOME MEASURES: Side effects of treatment, thromboembolic manifestations, postpartum bleeding and obstetric outcome. RESULTS: There were no thromboembolic events during therapy, few...

  6. The cardiovascular risk marker asymmetrical dimethylarginine is not affected by venous thromboembolism.

    Science.gov (United States)

    Haider, Dominik G; Bucek, Robert A; Reiter, Markus; Minar, Erich; Hron, Gregor; Kyrle, Paul A; Mittermayer, Friedrich; Wolzt, Michael

    2006-07-01

    Asymmetrical dimethylarginine (ADMA) is an endogenous inhibitor of endothelial nitric oxide synthase, causes vasoconstriction, impairs cardiac function, and may predict cardiovascular risk. The prognostic value of plasma ADMA concentrations in acute vascular situations may be confounded by concomitant factors such as clot formation. In an effort to address the effect of hemostatic system activation, the authors have measured plasma concentrations of ADMA, its stereoisomer symmetrical dimethylarginine (SDMA), and L-arginine in 74 patients with suspected deep vein thrombosis (DVT). DVT was confirmed by sonography or venography in 39 subjects. There was no difference of L-arginine, ADMA, or SDMA (all P > 0.05) between subjects with or without DVT. ADMA correlated with SDMA, L-arginine, and plasma creatinine (all P < 0.05) but not with age, body mass index, D-dimer, thrombus extension, or history of symptoms. Venous thrombembolism does not influence circulating ADMA concentrations. The lack of association between ADMA and DVT argues against a contribution of endogenous NO synthase inhibition in hemostatic systemic activation.

  7. Association of interleukin-6 and C-reactive protein genetic polymorphisms levels with venous thromboembolism

    Institute of Scientific and Technical Information of China (English)

    Ailiman Mahemuti; Kailibinuer Abudureheman; Xiaimuxikamaier Aihemaiti; HU Xue-mei; XIA Yu-ning; TANG Bao-peng; Halmurat Upur

    2012-01-01

    Background Increased levels of interleukin-6(IL-6)and C-reactive protein(CRP)have been reported in patients with venous thromboembolisms(VTE).However,prospective studies did not confirm an association between IL-6,CRP and their polymorphism with the risk of V-TE.Methods One hundred and forty patients(including 66 males and 74 females,mean age(55.55±17.11)years)and one hundred and sixty controls(including 74 males and 86 females,mean age(56.58±12.24)years)were involved.An enzyme linked immunosorbent assay(ELISA)method was used for detecting the serum levels of inflammatory factors IL-6 and CRP in both groups.Polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP)was used for analyzing the distribution of polymorphisms at the-572C/G and-597G/A sites of the promoter of the IL-6 gene and at 1059G/C of the CRP gene.Results Serum levels of IL-6 and CRP were significantly higher in the VTE group than in the control group(P<0.05).The frequencies of-572C/G promoter polymorphisms CC,CG,and GG in the IL-6 gene were found to be 34%,48%,and 18%,respectively,and the derived allele frequencies for the C and G alleles were 58% and 42%.There was a significant difference in the-572C/G promoter polymorphisms between the VTE group and control group(P<0.05).For the-597G/A polymorphism,individuals all carried the GG and GA type;AA genotypes were not detected.The frequency of the GG,GC,and CC genotypes at the CRP1059G/C promoter was 87.57%,7.86% and 3.57% in VTE group,while 86.25%,10%,and 3.75% in control group,respectively.The frequency of G and C alleles at CRP 1059G/C was 91.43%and 8.57% in VTE group and 91.56% and 8.44% in the control group.The results showed that there was no statistically significant difference of 1059G/C genotype and mutation frequency of the allele between the VTE group and control group(P>0.05).Multiple Logistic regression analysis showed CC homozygotes of the IL-6-572G/C,body mass index(BMI),and CRP

  8. Diagnostic Indication for Venous Echo-Doppler of the Lower Limbs in the Diagnosis of Thromboembolic; Indicacion de eco-Doppler venosa de extremidades inferiores en el diagnostico de la enfermedad tromboembolica ante una sospecha de tromboembolismo pulmonar

    Energy Technology Data Exchange (ETDEWEB)

    Bolado, A. G.; Barcena, M. V.; Cura, J. L. del; Gorrno, O.; Grande, D. [Hospital de Basurto. Bilbao (Spain)

    2003-07-01

    To study the effectiveness of Doppler echography in the deep venous system of the lower limbs for deep venous thrombosis detection in patients suspected of having pulmonary thromboembolism. There were received 341 consecutive suspected pulmonary thromboembolism patients, all of whom were emergency room attended. All were submitted to CT pulmonary angiography in order to evaluate thrombus presence in the pulmonary tree. Without knowing the results of the previous exploration, we studied 301 of the patients using Doppler echography in deep venous system of the lower limbs in order to evaluate thrombus presence. In the group of CT-detected pulmonary thromboembolism patients, the percentage of Doppler echography-detected deep venous thrombosis was 46.3%, while in the group of non-detected patients this percentage decreased to 4.7%. Additional deep venous system exploration in clinically suspected pulmonary thiolcarbamate patients is useful, since it can increase the detection rate of venous thromboembolic disease, thereby leading to early treatment and prevention of the disease's manifestation in the lungs. Realization of Doppler echography is especially beneficial in those patients who exhibit no factors which predispose them to thromboembolic disease, as well as in patients who have previously had venous thrombosis. This exploration account for 4.7% of non-detected pulmonary embolism patients being added to the ranks of those with thromboembolic disease, an important percentage when taking into consideration the high pulmonary thromboembolism morbimortality rate. (Author) 30 refs.

  9. Pulmonary thromboembolism in a child with sickle cell hemoglobin d disease in the setting of acute chest syndrome.

    Science.gov (United States)

    Villanueva, Hazel; Kuril, Sandeepkumar; Krajewski, Jennifer; Sedrak, Aziza

    2013-01-01

    Introduction. Sickle cell hemoglobin D disease (HbSD) is a rare variant of sickle cell disease (SCD). Incidence of pulmonary thromboembolism (PE) and deep venous thrombosis (DVT) in children with HbSD is unknown. PE and DVT are known complications of SCD in adults but have not been reported in the literature in children with HbSD. Case Report. We are reporting a case of a 12-year-old boy with HbSD with acute chest syndrome (ACS) complicated by complete thrombosis of the branch of the right pulmonary artery and multiple small pulmonary artery emboli seen on computed tomography (CT) pulmonary angiogram and thrombosis of the right brachial vein seen on Doppler ultrasound. Our patient responded to treatment with anticoagulant therapy. Conclusion. There are no cases reported in children with HbSD disease presenting as ACS with pulmonary thromboembolism. We suggest that PE should be suspected in patients presenting with ACS who do not show improvement with standard management. CT pulmonary angiogram should be utilized for early diagnosis and appropriate management as there is no current protocol for management of PE/DVT in pediatric patients with SCD.

  10. Role of Physical Therapists in the Management of Individuals at Risk for or Diagnosed With Venous Thromboembolism: Evidence-Based Clinical Practice Guideline.

    Science.gov (United States)

    Hillegass, Ellen; Puthoff, Michael; Frese, Ethel M; Thigpen, Mary; Sobush, Dennis C; Auten, Beth

    2016-02-01

    The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular & Pulmonary and Acute Care sections of APTA, have developed this clinical practice guideline to assist physical therapists in their decision-making process when treating patients at risk for venous thromboembolism (VTE) or diagnosed with a lower extremity deep vein thrombosis (LE DVT). No matter the practice setting, physical therapists work with patients who are at risk for or have a history of VTE. This document will guide physical therapist practice in the prevention of, screening for, and treatment of patients at risk for or diagnosed with LE DVT. Through a systematic review of published studies and a structured appraisal process, key action statements were written to guide the physical therapist. The evidence supporting each action was rated, and the strength of statement was determined. Clinical practice algorithms, based on the key action statements, were developed that can assist with clinical decision making. Physical therapists, along with other members of the health care team, should work to implement these key action statements to decrease the incidence of VTE, improve the diagnosis and acute management of LE DVT, and reduce the long-term complications of LE DVT.

  11. CERTIFY: prophylaxis of venous thromboembolism in patients with severe renal insufficiency.

    Science.gov (United States)

    Bauersachs, R; Schellong, S M; Haas, S; Tebbe, U; Gerlach, H-E; Abletshauser, C; Sieder, C; Melzer, N; Bramlage, P; Riess, H

    2011-06-01

    Patients with severe renal insufficiency (sRI) have been suggested to be at an increased risk of bleeding with low-molecular-weight heparins (LMWH). We aimed at assessing the benefits and risks of certoparin in comparison to unfractionated heparin (UFH) in these patients. In this subgroup analysis of the CERTIFY trial, acutely ill, non-surgical patients ≥70 years received certoparin 3,000U aXa o.d. or UFH 5,000 IU t.i.d. One hundred eighty-nine patients had a glomerular filtration rate (GFR) ≤30 ml/min/1.73 m2, 3,050 patients served as controls. Patients with sRI had a mean age of 85.9 ± 6.6 years (controls 78.4 ± 6.0) and were treated for a mean of 9.3 ± 3.7 days (9.9 ± 4.3). Thromboembolic event rates were comparable (4.55 vs. 4.21%; OR1.08; 95%CI 0.5-2.37) but bleeding was increased in sRI (9.52 vs. 3.54%; OR2.87; 95%CI 1.70-4.83). The incidence of the combined end-point of proximal DVT, symptomatic non-fatal PE and VTE related death was 6.49% with certoparin and 2.60% with UFH (OR2.60; 95%CI 0.49-13.85). There was a decrease in total bleeding with certoparin (OR0.33; 95%CI 0.11-0.97), which was non-significant in patients with GFR >30 ml/min/1.73 m2. In two multivariable regression models certoparin and immobilisation 30 ml/min/1.73 m2). In conclusion, certoparin 3,000U anti Xa o.d. was as efficacious as 5,000 IU UFH t.i.d. in patients with sRI but had a reduced risk of bleeding.

  12. Polymorphisms in thrombophilic genes are associated with deep venous thromboembolism in an Iranian population

    Directory of Open Access Journals (Sweden)

    Malak Farajzadeh

    2014-12-01

    We concluded that the prevalence of FV (G1691A and A4070G and PAI-1 4G/5G polymorphisms increased the risk of DVT occurrence in subjects. These findings provide additional evidence to support the hypothesis that thrombophilic gene polymorphisms are involved in vascular thromboembolism.

  13. Low-molecular-weight heparin in the treatment of patients with venous thromboembolism

    NARCIS (Netherlands)

    tenCate, JW; Buller, HR; Gent, M; Hirsh, J; Prins, MH; Baildon, R; Lensing, AWA; Anderson, DR; vanBeek, EJR; Fiesinger, JN; Tijssen, JGP; vanBarneveld, A; Eimers, LT; Graafsma, YP; Hettiarachchi, R; Hutten, B; Redekop, K; Haley, S; LIberale, L; Finch, T; Whittaker, S; Wilkinson, L; Prandoni, P; Villalta, S; Girolami, B; Bagatella, P; Rossi, L; Girolami, A; Piovella, F; Barone, M; Beltrametti, C; Serafini, S; Siragusa, S; Ascari, E; Kovacs, MJ; Morrow, B; Kovacs, J; Kuijer, PMM; Koopman, MMW; Jagt, H; Weitz, J; Kearon, C; Biagioni, L; Haas, S; Lossner, F; Spengel, FA; Berger, M; Demers, C; Poulin, J; vanderMeer, J; Que, GTH; Smid, WM; Robinson, KS; Boyle, E; Leclerc, [No Value; StJacques, B; Finkenbine, S; Gallus, AS; Cohlan, D; Rich, C; Brandjes, DPM; Hoefnagel, CA; deRijk, M; Turkstra, F; Desjardins, L; CoteDesjardins, J; Couture, L; Ruel, M; Villenueve, J; Geerts, WH; Jay, RM; Code, EKI; Turpie, AGG; Johnson, J; Nguyen, P; Cusson, [No Value; Roy, S; Wells, PS; Bormanis, J; Goudie, D; Cruickshank, M; vonLewinski, M; Monreal, M; Sahuquillo, JC; Lafoz, E; Simonneau, G; Parent, F; Jagot, J; Douketis, JD; Kinnon, K; Ginsberg, JS; BrillEdwards, P; Donovan, D; Ockelford, PA; Kassis, J; Bornais, S; Planchon, B; ElKouri, D; Pistorius, MA; Escribano, M; Garrido, G; Chesterman, CN; Chong, BH; Pritchard, S; Cade, JF; Bynon, T; Stanford, J; Brien, WM; Palmer, B; Faivre, R; Petiteau, B; Manucci, PM; Moia, M; Bucciarelli, P

    1997-01-01

    Background Low-molecular-weight heparin is known to be safe and effective for the initial Treatment of patients with proximal deep-vein thrombosis. However, its application to patients with pulmonary embolism or previous episodes of thromboembolism has not been studied. Methods We randomly assigned

  14. The Anti-Clot Treatment Scale (ACTS in clinical trials: cross-cultural validation in venous thromboembolism patients

    Directory of Open Access Journals (Sweden)

    Cano Stefan J

    2012-09-01

    Full Text Available Abstract Background The Anti-Clot Treatment Scale (ACTS is a 15-item patient-reported instrument of satisfaction with anticoagulant treatment. It includes a 12-item ACTS Burdens scale and a 3-item ACTS Benefits scale. Its role in clinical trials and other settings should be supported by evidence that it is both clinically meaningful and scientifically sound. The aim of the study was to evaluate the measurement performance of the ACTS (Dutch, Italian, French, German and English language versions in patients with venous thromboembolism based on traditional psychometric methods. Methods ACTS Burdens and Benefits scale data from a large clinical trial (EINSTEIN DVT involving 1336 people with venous thromboembolism were analysed at both the scale and item level. Five key psychometric properties were examined using traditional psychometric methods: acceptability, scaling assumptions, reliability (including internal consistency reliability, test-retest reproducibility; validity (including known groups and discriminant validity; and responsiveness. These methods of examination underpin the US Food and Drug Administration recommendations for patient-reported outcome instrument evaluation. Results Overall, the 12-item ACTS Burdens scale and 3-item ACTS Benefits scale met the psychometric criteria evaluated at both item and scale levels, with the exception of some relatively minor issues in the Dutch language version, which were just below reliability criteria (i.e. alpha = 0.72, test-retest intraclass correlation = 0.79. A consistent finding from item-level evaluations of aggregate endorsement frequencies and skewness suggested that response scales may be improved by reducing the number of response options from five to four. Conclusions Both the ACTS Burdens and ACTS Benefits scales consistently satisfied traditional reliability and validity criteria across multiple language datasets, supporting it as a clinically useful patient

  15. Pulmonary thromboembolism following laparoscopic cholecystectomy in a patient with preexisting risk factors for deep venous thrombosis

    Directory of Open Access Journals (Sweden)

    Jyotsna A Goswami

    2007-01-01

    Full Text Available We report a case of a forty-five year old male who was admitted fifteen days prior with biliary pancreatitis. He developed pulmonary thromboembolism (PTE after uneventful laparoscopic cholecystec-tomy. He was initially treated with intravenous (IV heparin and inferior vena cava (IVC filter. Later on he underwent emergency pulmonary embolectomy due to haemodynamic deterioration. There is less incidence of PTE after laparoscopic cholecystectomy, but it becomes high-risk for postoperative thromboembolic complications when it is associated with other risk factors. The purpose of this report is to highlight that preoperative detection of risk factors and thromboprophylaxis in indicated cases can prevent this complication. We also review the incidence of PTE, risk factors and thromboprophylaxis.

  16. Venous thromboembolism in pregnancy: prophylaxis and treatment with low molecular weight heparin

    DEFF Research Database (Denmark)

    Andersen, Anita Sylvest; Berthelsen, Jørgen G.; Bergholt, Thomas

    2010-01-01

    were in good health at discharge. CONCLUSIONS: Individually dosed LMWH is well tolerated and safe for prophylaxis and treatment of thromboembolic complications during pregnancy, delivery and the postpartum periodOBJECTIVE: To evaluate the safety of individually dosed low molecular weight heparin (LMWH...... December 2005. METHODS: Women treated with LMWH in pregnancy were identified and individual case records reviewed retrospectively. General data on the LMWH-treated women were compared to the 18,020 untreated pregnancies within the same period and with 306 matched controls as regards to postpartum......OBJECTIVE: To evaluate the safety of individually dosed low molecular weight heparin (LMWH) for prophylaxis and treatment of thromboembolic complications in pregnancy. DESIGN: Cohort study with a chronologic register-based control group. SETTING: Department of Obstetrics and Gynecology, Hiller...

  17. Hormonal contraception and risk of venous thromboembolism: national follow-up study

    DEFF Research Database (Denmark)

    2009-01-01

    and the same length of use, oral contraceptives with desogestrel, gestodene, or drospirenone were associated with a significantly higher risk of venous thrombosis than oral contraceptives with levonorgestrel. Progestogen only pills and hormone releasing intrauterine devices were not associated with any......OBJECTIVE: To assess the risk of venous thrombosis in current users of different types of hormonal contraception, focusing on regimen, oestrogen dose, type of progestogen, and route of administration. DESIGN: National cohort study. SETTING: Denmark, 1995-2005. PARTICIPANTS: Danish women aged 15.......4 million woman years were recorded, 3.3 million woman years in receipt of oral contraceptives. In total, 4213 venous thrombotic events were observed, 2045 in current users of oral contraceptives. The overall absolute risk of venous thrombosis per 10 000 woman years in non-users of oral contraceptives was 3...

  18. Prophylaxis of venous and pulmonary thrombo-embolism. Profilaxis del tromboembolismo venoso y pulmonar. Conceptos actuales.

    OpenAIRE

    Hugo Jiménez Vázquez; José Julio Requeiro Molina; Yusimí Isaguirre Martínez

    2004-01-01

    This bibliographical revision stands out the importance of the vein thromboembolism prevention in patients under different surgical and injuries procedures, wicked illnesses and medical conditions. The epidemiology, etiopatogenia and factors of risk of the deep vein thrombosis and the lung embolism are exposed in different categories of patient. Up to dates prophylactic methods are taken into account and compared their effectiveness and cautions according to the last studies on the topic.<...

  19. Risk factors for venous thromboembolism in cancer: novel findings from the Vienna Cancer and Thrombosis Study (CATS).

    Science.gov (United States)

    Königsbrügge, Oliver; Pabinger, Ingrid; Ay, Cihan

    2014-05-01

    Venous thromboembolism (VTE) occurs frequently in patients with cancer and contributes to elevated morbidity and mortality. Risk factors for the occurrence of VTE events in patients with cancer have been investigated in numerous clinical studies. For now more than 10 years, the Vienna Cancer and Thrombosis Study (CATS) has focused on the identification of parameters predictive of future VTE occurrence. CATS has contributed to new findings, which may help identify patients at high risk of developing VTE, by means of biomarkers (such as D-dimer, prothrombin fragment 1+2, soluble P-selectin, platelet count, coagulation factor VIII activity, thrombin generation potential, etc.). The association of tissue factor bearing microparticles and the mean platelet volume with the risk of VTE was also elaborately investigated in the framework of CATS. More recently CATS has researched clinical and clinicopathologic parameters which contribute to identification of patients at risk of VTE. The type of cancer is one of the most important risk factor for VTE occurrence. Also the stage of cancer and the histological grade of a tumor have been found to be associated with the occurrence of cancer-related VTE. In further investigations, venous diseases including a history of previous VTE, a history of superficial thrombophlebitis and the presence of varicose veins, have been associated with the risk of VTE in CATS.

  20. Acute Pulmonary Thromboembolism Presenting As Complete Heart Block - A Rare Presentation

    Directory of Open Access Journals (Sweden)

    Vikash Goyal

    2015-08-01

    Full Text Available Acute pulmonary thromboembolism (PTE is a life threatening condition which requires early diagnosis and management. Electrocardiogram (ECG is helpful for suspecting the disease. The various ECG changes are sinus tachycardia, P pulmonale, Right bundle branch block (RBBB -incomplete or complete, axis shift, S1Q3T3, T wave inversion, and ST-segment depression in leads V1-4, aVF, and Lead III, supra ventricular tachycardia, low voltage QRS complex in limb leads. In addition, sinus bradycardia and complete heart block (CHB can be seen. CHB has been reported as an exceptionally rare manifestation of acute PTE. Here, we are reporting a case of 66 year old male presented with CHB with acute pulmonary thromboembolism, who reverted to sinus rhythm after thrombolysis.

  1. Significant reduction of the risk of venous thromboembolism in all long-term immobile patients a few months after the onset of immobility.

    Science.gov (United States)

    Gaber, Tarek A-Z K

    2005-01-01

    Prophylactic anticoagulation is a standard practice in patients with sudden lower limbs paralysis. Thromboprophylaxis is usually continued until the patient regains independent mobility. The duration of anticoagulation in long-term immobile patients is unknown. Spinal cord injury patients are the only population that was comprehensively studied and prophylactic anticoagulation is discontinued after 4 months as the risk of venous thromboembolism drops dramatically after 3-4 months. Development of muscle spasticity has been traditionally considered to be the reason for this low risk as lower limbs spasticity/spasms might be able to improve the calf muscle pump action. We are presenting the evidence from physiological studies of the lower limbs vascular system that cast doubt over this explanation and present an alternative hypothesis backed by several clinical circumstantial evidence suggesting that the vascular changes following long term lower limbs inactivity which are universal to all immobile patients is probably the main protecting factor. We suggest that prophylactic anticoagulation is necessary only on the first 4 months following the acute onset of immobility in all neurologically impaired immobile patients regardless of their muscle tone state.

  2. Two doses of rivaroxaban versus aspirin for prevention of recurrent venous thromboembolism. Rationale for and design of the EINSTEIN CHOICE study.

    Science.gov (United States)

    Weitz, Jeffrey I; Bauersachs, Rupert; Beyer-Westendorf, Jan; Bounameaux, Henri; Brighton, Timothy A; Cohen, Alexander T; Davidson, Bruce L; Holberg, Gerlind; Kakkar, Ajay; Lensing, Anthonie W A; Prins, Martin; Haskell, Lloyd; van Bellen, Bonno; Verhamme, Peter; Wells, Philip S; Prandoni, Paolo

    2015-08-31

    Patients with unprovoked venous thromboembolism (VTE) are at high risk for recurrence. Although rivaroxaban is effective for extended VTE treatment at a dose of 20 mg once daily, use of the 10 mg dose may further improve its benefit-to-risk ratio. Low-dose aspirin also reduces rates of recurrent VTE, but has not been compared with anticoagulant therapy. The EINSTEIN CHOICE study is a multicentre, randomised, double-blind, active-controlled, event-driven study comparing the efficacy and safety of two once daily doses of rivaroxaban (20 and 10 mg) with aspirin (100 mg daily) for the prevention of recurrent VTE in patients who completed 6-12 months of anticoagulant therapy for their index acute VTE event. All treatments will be given for 12 months. The primary efficacy objective is to determine whether both doses of rivaroxaban are superior to aspirin for the prevention of symptomatic recurrent VTE, while the principal safety outcome is the incidence of major bleeding. The trial is anticipated to enrol 2,850 patients from 230 sites in 31 countries over a period of 27 months. In conclusion, the EINSTEIN CHOICE study will provide new insights into the optimal antithrombotic strategy for extended VTE treatment by comparing two doses of rivaroxaban with aspirin (clinicaltrials.gov NCT02064439).

  3. The Effect of High-Dose Vitamin D3 on Soluble P-Selectin and hs-CRP Level in Patients With Venous Thromboembolism: A Randomized Clinical Trial.

    Science.gov (United States)

    Gholami, Kheirollah; Talasaz, Azita Hajhossein; Entezari-Maleki, Taher; Salarifar, Mojtaba; Hadjibabaie, Molouk; Javadi, Mohammad Reza; Dousti, Samaneh; Hamishehkar, Hadi; Maleki, Saleh

    2016-07-01

    High plasma level of P-selectin is associated with the development of venous thromboembolism (VTE). Furthermore, supplementation of vitamin D could decrease thrombotic events. Hence, this study was designed to examine whether the administration of vitamin D can influence the plasma level of P-selectin in patients with VTE. In the randomized controlled trial, 60 patients with confirmed acute deep vein thrombosis and/or pulmonary embolism (PE) were randomized into the intervention (n = 20) and control (n = 40) groups. The intervention arm was given an intramuscular single dose of 300 000 IU vitamin D3 Plasma level of 25-hydroxy vitamin D, P-selectin, and high-sensitive C-reactive protein (hs-CRP) was measured at baseline and 4 weeks after. The plasma level of P-selectin (95% confidence interval = -5.99 to -1.63, P = .022) and hs-CRP (P = .024) significantly declined in vitamin D-treated group, while only hs-CRP was significantly decreased in the control group (P = .011). However, the magnitude of these reductions was not statistically significant. This study could not support the potential benefit of the high-dose vitamin D on plasma level of P-selectin and hs-CRP in patients with VTE.

  4. Venous Return and Clinical Hemodynamics: How the Body Works during Acute Hemorrhage

    Science.gov (United States)

    Shen, Tao; Baker, Keith

    2015-01-01

    Venous return is a major determinant of cardiac output. Adjustments within the venous system are critical for maintaining venous pressure during loss in circulating volume. This article reviews two factors that are thought to enable the venous system to compensate during acute hemorrhage: 1) changes in venous elastance and 2) mobilization of…

  5. Effectiveness of self-managed oral anticoagulant therapy in patients with recurrent venous thromboembolism. A propensity-matched cohort study.

    Science.gov (United States)

    Larsen, Torben Bjerregaard; Skjøth, Flemming; Grove, Erik Lerkevang; Nielsen, Peter Brønnum; Christensen, Thomas Decker

    2016-08-30

    Patient-self-management (PSM) of oral anticoagulant therapy (OAT) with vitamin K antagonists for venous thromboembolism (VTE) has demonstrated efficacy in randomised, controlled trials. The aim of this study was to evaluate the effectiveness of PSM of OAT in everyday clinical practice. Prospectively registered patient data were obtained from databases at two hospitals, and cross-linkage with national patient registries provided detailed information on comorbidities and events. Patients with VTE performing PSM affiliated to major PSM centres were included as cases (N=444). A control group of patients on conventional treatment was propensity score selected in a ratio of 1:5 (N=2220) within matched groups. The effectiveness and safety was estimated using recurrent VTE, major bleeding events and all-cause death as outcomes. We found a lower rate of recurrent VTE among PSM patients compared to the control group with a hazard ratio (HR) of 0.63; 95 % confidence interval (CI) 0.42-0.95, whereas no difference was seen with bleeding (HR: 0.95; 95 % CI 0.44-2.02). The risk of all-cause death was lower for PSM patients (HR: 0.41; 95 % CI 0.21-0.81). A net clinical benefit analysis sums the effect on recurrent VTE and bleeding up to a weighted rate difference of 0.86 (95 % CI 0.00-1.72) in favour of PSM. In conclusion, PSM of anticoagulant treatment was associated with a statistically significant lower rate of recurrent VTE and all-cause death compared to patients on conventionally managed anticoagulant treatment. All major thromboembolic outcomes were less frequent among self-managed patients, whereas bleedings were observed with similar frequency.

  6. Heparin based prophylaxis to prevent venous thromboembolic events and death in patients with cancer - a subgroup analysis of CERTIFY

    Directory of Open Access Journals (Sweden)

    Abletshauser Claudia

    2011-07-01

    Full Text Available Abstract Background Patients with cancer have an increased risk of VTE. We compared VTE rates and bleeding complications in 1 cancer patients receiving LMWH or UFH and 2 patients with or without cancer. Methods Acutely-ill, non-surgical patients ≥70 years with (n = 274 or without cancer (n = 2,965 received certoparin 3,000 UaXa o.d. or UFH 5,000 IU t.i.d. for 8-20 days. Results 1 Thromboembolic events in cancer patients (proximal DVT, symptomatic non-fatal PE and VTE-related death occurred at 4.50% with certoparin and 6.03% with UFH (OR 0.73; 95% CI 0.23-2.39. Major bleeding was comparable and minor bleedings (0.75 vs. 5.67% were nominally less frequent. 7.5% of certoparin and 12.8% of UFH treated patients experienced serious adverse events. 2 Thromboembolic event rates were comparable in patients with or without cancer (5.29 vs. 4.13% as were bleeding complications. All cause death was increased in cancer (OR 2.68; 95%CI 1.22-5.86. 10.2% of patients with and 5.81% of those without cancer experienced serious adverse events (OR 1.85; 95% CI 1.21-2.81. Conclusions Certoparin 3,000 UaXa o.d. and 5,000 IU UFH t.i.d. were equally effective and safe with respect to bleeding complications in patients with cancer. There were no statistically significant differences in the risk of thromboembolic events in patients with or without cancer receiving adequate anticoagulation. Trial Registration clinicaltrials.gov, NCT00451412

  7. Prevention of venous thromboembolism in hospitalized medical patients%内科住院患者静脉血栓栓塞症的预防

    Institute of Scientific and Technical Information of China (English)

    石建平; 赵梦华

    2013-01-01

    Venous thromboembolism (VTE) ,which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE) ,is a leading cause of mortality following hospitalization. 70% to 80% of inpatient deaths due to pulmonary embolism ocurr in medical patients. Identifying medical patients at risk for VTE and providing effective prophylaxis is now an important health care priority to reduce the burden of this morbid and sometimes fatal disease. Pharmacologic prophylaxis is the mainstay of VTE prevention. Multiple scientific guidelines support VTE prophylaxis in medical patients.

  8. Enfermedad tromboembólica venosa y cirrosis hepática Venous thromboembolism and liver cirrhosis

    Directory of Open Access Journals (Sweden)

    M. J. García-Fuster

    2008-05-01

    Full Text Available Objetivos: la enfermedad tromboembólica venosa (ETV es poco frecuente en la cirrosis hepática, no estando su tratamiento contemplado en las guías del American College of Chest Physicians. El objetivo del presente trabajo es aportar la experiencia de pacientes cirróticos con ETV hospitalizados en nuestro centro en los últimos 15 años. Material y método: de enero de 1992 a diciembre de 2007 fueron hospitalizados en nuestro centro 2.074 pacientes con cirrosis hepática. Presentaron una ETV no esplácnica 17, siendo ellos la población a estudio. Se recogen datos epidemiológicos y analíticos: hemograma, VSG, química hemática, coagulación, trombofilia congénita, anticuerpos antifosfolípidos (AAFL y homocisteinemia. Se valoran factores de riesgo adquiridos, características de la trombosis, el tratamiento y las complicaciones. Resultados y conclusiones: la ETV no esplácnica se observa en el 0,8% de pacientes cirróticos. En ellos es frecuente observar hipoalbuminemia, disminución de factores anticoagulantes (ATIII, PC, y PS, presencia de AAFL e hiperhomocisteinemia, así como la presencia de factores de riesgo adquiridos: intervenciones quirúrgicas, insuficiencia venosa, inmovilización e infecciones. Tras la anticoagulación, se observan complicaciones hemorrágicas mayores en el 35% de los pacientes.Objective: despite the endogenous coagulopathy of cirrhosis, some patients do experience thrombophilic states. The American College of Chest Physicians failed to address the prevention and treatment of venous thromboembolism (VTE occurring among these patients. This study aims to describe the characteristics of cirrhotics patients hospitalized in the last 15 years, and to use the experience gained. Material and method: we retrospectively reviewed all admissions for cirrhosis in our hospital from 1992 to 2007. A total of 17 patients had non-portal venous thromboembolic disease. We recorded risk factors, epidemiological and laboratory data

  9. Rationale and design of three observational, prospective cohort studies including biobanking to evaluate and improve diagnostics, management strategies and risk stratification in venous thromboembolism: the VTEval Project

    Science.gov (United States)

    Frank, Bernd; Ariza, Liana; Lamparter, Heidrun; Grossmann, Vera; Prochaska, Jürgen H; Ullmann, Alexander; Kindler, Florentina; Weisser, Gerhard; Walter, Ulrich; Lackner, Karl J; Espinola-Klein, Christine; Münzel, Thomas; Konstantinides, Stavros V; Wild, Philipp S

    2015-01-01

    Introduction Venous thromboembolism (VTE) with its two manifestations deep vein thrombosis (DVT) and pulmonary embolism (PE) is a major public health problem. The VTEval Project aims to investigate numerous research questions on diagnosis, clinical management, treatment and prognosis of VTE, which have remained uncertain to date. Methods and analysis The VTEval Project consists of three observational, prospective cohort studies on VTE comprising cohorts of individuals with a clinical suspicion of acute PE (with or without DVT), with a clinical suspicion of acute DVT (without symptomatic PE) and with an incidental diagnosis of VTE (PE or DVT). The VTEval Project expects to enrol a total of approximately 2000 individuals with subsequent active and passive follow-up investigations over a time period of 5 years per participant. Time points for active follow-up investigations are at months 3, 6, 12, 24 and 36 after diagnosis (depending on the disease cohort); passive follow-up investigations via registry offices and the cancer registry are performed 48 and 60 months after diagnosis for all participants. Primary short-term outcome is defined by overall mortality (PE-related death and all other causes of death), primary long-term outcome by symptomatic VTE (PE-related death, recurrence of non-fatal PE or DVT). The VTEval Project includes three ‘all-comer’ studies and involves the standardised acquisition of high-quality data, covering the systematic assessment of VTE including symptoms, risk profile, psychosocial, environmental and lifestyle factors as well as clinical and subclinical disease, and it builds up a large state-of-the-art biorepository containing various materials from serial blood samplings. Ethics and dissemination The VTEval Project has been approved by the local data safety commissioner and the responsible ethics committee (reference no. 837.320.12 (8421-F)). Trial results will be published in peer-reviewed journals and presented at national and

  10. Genetics University of Toronto Thrombophilia Study in Women (GUTTSI: genetic and other risk factors for venous thromboembolism in women

    Directory of Open Access Journals (Sweden)

    Evrovski Jovan

    2001-05-01

    Full Text Available Abstract Background Women may be at increased risk for venous thromboembolism (VTE as compared with men. We studied the effects of genetic and biochemical markers of thrombophilia in women, in conjunction with other established risk factors for VTE. Method The present retrospective case-control study was conducted in a thrombosis treatment programme at a large Toronto hospital. The cases were 129 women aged 16-79 years with objectively confirmed VTE. Age-matched control individuals were women who were free of venous thrombosis. Neither cases nor control individuals had known cardiovascular disease. Participants were interviewed regarding personal risk factors for VTE, including smoking, history of malignancy, pregnancy, and oestrogen or oral contraceptive use. Blood specimens were analyzed for common single nucleotide polymorphisms of prothrombin, factor V and methylenetetrahydrofolate reductase (MTHFR; C677T, A1298C and T1317C, and the A66G polymorphism for methionine synthase reductase (MTRR.Fasting plasma homocysteine was also analyzed. Results Women with VTE were significantly more likely than female control individuals to carry the prothrombin polymorphism and the factor V polymorphism, or to have fasting hyperhomocysteinaemia. Homozygosity for the C677T MTHFR gene was not a significant risk factor for VTE, or were the A1298C or T1317C MTHFR homozygous variants. Also, the A66G MTRR homozygous state did not confer an increased risk for VTE. Conclusion Prothrombin and factor V polymorphisms increased the risk for VTE in women, independent from other established risk factors. Although hyperhomocysteinaemia also heightens this risk, common polymorphisms in two genes that are responsible for homocysteine remethylation do not. These findings are consistent with previous studies that included both men and women.

  11. [Diagnostic validity of radionuclide phlebography in the detection of clinically occult deep venous thrombosis in patients with thromboembolism].

    Science.gov (United States)

    Markovic, S; Baskot, B; Ajdinovic, B; Pervulov, S; Gligic, B; Perovanovic, M

    2001-01-01

    Diagnostic reliability of radionuclide phlebography (RNP) compared to contrast phlebography in the detection of deep veins' thrombosis (DVT) in patients with confirmed thromboembolism of the lungs (TEL) was evaluated. RNP. These findings were compared to contrast phlebography (CP), performed in the group of 25 patients in whom TEL was confirmed clinically, radiologically, scintigraphically and biochemically, but without clinical signs and symptoms of DVT. In 15 patients where RNP revealed unilateral DVT, CP finding was confirmed in all: in 6 (40%) on the left, and in 9 (60%) on the right side. In 10 patients with bilateral signs of DVT observed by scintigraphy, DVT finding was confirmed in 7 (70%), while in 3 (30%) patients, scintigraphic signs of DVT were falsely positive. In the segments of deep venous system, specificity of RNP in the detection of DVT in the lower leg was 60%, sensitivity was 100%, accuracy was 64% with 62% falsely positive findings. In the upper legs specificity was 79%, sensitivity was 100%, and accuracy was 86% with 24% falsely positive findings, while in the pelvis specificity was 87%, sensitivity was 100%, accuracy was 83% with 14% falsely positive findings.

  12. Risk factors for venous thromboembolism in women under combined oral contraceptive. The PILl Genetic RIsk Monitoring (PILGRIM) Study.

    Science.gov (United States)

    Suchon, Pierre; Al Frouh, Fadi; Henneuse, Agathe; Ibrahim, Manal; Brunet, Dominique; Barthet, Marie-Christine; Aillaud, Marie-Françoise; Venton, Geoffroy; Alessi, Marie-Christine; Trégouët, David-Alexandre; Morange, Pierre-Emmanuel

    2016-01-01

    Identifying women at risk of venous thromboembolism (VTE) is a major public health issue. The objective of this study was to identify environmental and genetic determinants of VTE risk in a large sample of women under combined oral contraceptives (COC). A total of 968 women who had had one event of VTE during COC use were compared to 874 women under COC but with no personal history of VTE. Clinical data were collected and a systematic thrombophilia screening was performed together with ABO blood group assessment. After adjusting for age, family history, and type and duration of COC use, main environmental determinants of VTE were smoking (odds ratio [OR] =1.65, 95% confidence interval [1.30-2.10]) and a body mass index higher than 35 kg.m⁻² (OR=3.46 [1.81-7.03]). In addition, severe inherited thrombophilia (OR=2.13 [1.32-3.51]) and non-O blood groups (OR=1.98 [1.57-2.49]) were strong genetic risk factors for VTE. Family history poorly predicted thrombophilia as its prevalence was similar in patients with or without first degree family history of VTE (29.3% vs 23.9%, p=0.09). In conclusion, this study confirms the influence of smoking and obesity and shows for the first time the impact of ABO blood group on the risk of VTE in women under COC. It also confirms the inaccuracy of the family history of VTE to detect inherited thrombophilia.

  13. Prophylaxis of Stroke and a Therapeutic Approach to Venous Thromboembolism Using Novel Oral Anticoagulants (NOAC’s

    Directory of Open Access Journals (Sweden)

    T.K. Mohammed Rayees

    2016-09-01

    Full Text Available In the prophylaxis of stroke in Non valvular Atrial Fibrillation (NVAF as well as Deep Vein Thrombosis (DVT and Pulmonary Embolism (PE treatment, the Novel Oral Anticoagulants are becoming popular management option. These NOACs have efficacy similar to that of Warfarin along with non inferior safety profiles. Though Warfarin has been widely used because of its anticoagulant effect and also has a probable reversibility in terms of bleeding, it may also be disadvantageous sometimes in few cases such as food interactions, drug and drug interaction, having a poor and unpredictable therapeutic response. The use of Novel Oral Anticoagulants (NOACs, approved by U.S Food and Drug Administration (FDA rendered a new hope in patients who needed anticoagulant therapy. There are about four Novel Oral Anticoagulants approved by FDA, which includes Dabigatran (direct thrombin inhibitor, Rivaroxaban, Apixaban and Edoxaban (selective factor Xa Inhibitors. The predictable pharmacokinetics and minimal drug interactions of apixaban should allow for safe anticoagulation in the majority of patients, including temporary interruption for elective procedures. The main aim is to provide better treatment and prophylaxis of stroke, venous thromboembolism and Pulmonary Embolism using Novel Oral Anticoagulants (NOACs as they exhibit minimal adverse effects when compared to Warfarin.

  14. Venous thromboembolism in patients with Cushing's syndrome: need of a careful investigation of the prothrombotic risk profile.

    Science.gov (United States)

    Koutroumpi, S; Daidone, V; Sartori, M T; Cattini, M G; Albiger, N M; Occhi, G; Ferasin, S; Frigo, A; Mantero, F; Casonato, A; Scaroni, C

    2013-06-01

    A high incidence of venous thromboembolic (VTE) complications has been reported in Cushing's syndrome (CS), mostly post-operatively and attributable to hypercoagulability. The prevalence of symptomatic VTE was investigated retrospectively in 58 consecutive CS patients in relation to acquired and genetic thrombotic risk factors. Eight CS patients (14 %) developed VTE (group A), 3 of them related and 5 unrelated to surgery. These patients had higher urinary free cortisol (p = 0.01) and VWF levels (p = 0.02) than the 50 patients without VTE (group B), as well an increase in the hemostatically more efficient, high-molecular-weight VWF multimers (p = 0.002). Factor V Leiden and the prothrombin gene 20210A variants (the most common inherited thrombophilic defects) were more represented in group A than in group B, as was the genotype GCAG/GCAG of the VWF gene promoter, known to hyperinduce VWF upregulation under cortisol excess. All but one of the patients with VTE unrelated to surgery had at least four acquired and at least one inherited risk factor. Severe hypercortisolism and VWF levels with increased haemostatic activity are strongly associated with VTE in CS. VTE episodes unrelated to surgery are attributable to the synergistic action of acquired and inherited thrombotic risk factors. Based on these observations, we believe that severely affected CS patients should be screened for coagulation disorders and receive antithrombotic prophylaxis whenever they have concomitant prothrombotic risk factors.

  15. Venous Thromboembolism and Cerebrovascular Events in Patients with Giant Cell Arteritis: A Population-Based Retrospective Cohort Study.

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    Alberto Lo Gullo

    Full Text Available To investigate the incidence of venous thromboembolism (VTE and cerebrovascular events in a community-based incidence cohort of patients with giant cell arteritis (GCA compared to the general population.A population-based inception cohort of patients with incident GCA between January 1, 1950 and December 31, 2009 in Olmsted County, Minnesota and a cohort of non-GCA subjects from the same population were assembled and followed until December 31, 2013. Confirmed VTE and cerebrovascular events were identified through direct medical record review.The study population included 244 patients with GCA with a mean ± SD age at diagnosis of 76.2 ± 8.2 years (79% women and an average length of follow-up of 10.2 ± 6.8 years. Compared to non-GCA subjects of similar age and sex, patients diagnosed with GCA had a higher incidence (% of amaurosis fugax (cumulative incidence ± SE: 2.1 ± 0.9 versus 0, respectively; p = 0.014 but similar rates of stroke, transient ischemic attack (TIA, and VTE. Among patients with GCA, neither baseline characteristics nor laboratory parameters at diagnosis reliably predicted risk of VTE or cerebrovascular events.In this population-based study, the incidence of VTE, stroke and TIA was similar in patients with GCA compared to non-GCA subjects.

  16. Thromboprophylaxis and Incidence of Venous Thromboembolism in Patients With Hemophilia A or B Who Underwent High-Risk Orthopedic Surgeries.

    Science.gov (United States)

    Raza, Shahzad; Kale, Gautam; Kim, Daniel; Akbar, Syed A; Holm, Lisa; Naidzionak, Ulad; Hossain, Akm M; Dong, Xiang; Doll, Donald C; Freter, Carl E; Hopkins, Tamara

    2016-03-01

    Total hip replacement (THR) and total knee arthroplasty (TKA) carry a high risk of postoperative venous thromboembolism (VTE); therefore, anticoagulation prophylaxis is recommended in these patients. Unfortunately, there are no guidelines about VTE prophylaxis in patients with hemophilia who underwent these high-risk surgeries. To determine whether these patients have high risk of VTE, we conducted a retrospective study on patients with hemophilia who underwent elective THR/TKA at our institute from 2004 to 2012. Postoperatively, we collected information on duration and method of factor VIII/IX infusion, VTE-prophylaxis, and complications. There were 23 patients with hemophilia, 18 (78%) with hemophilia A and 5 (22%) with hemophilia B, who underwent high-risk surgeries (39% THR and 61% TKA). The VTE prophylaxis included sequential compression device, 12 (52%), and prophylactic enoxaparin, 1 (4%). Ten (43%) patients did not receive VTE prophylaxis. At 1-year follow-up, we did not find any evidence of clinical VTE in our patients. Better risk stratification is needed to identify patients who would benefit from pharmacological prophylaxis.

  17. Prevalence of thrombophilia according to age at the first manifestation of venous thromboembolism: results from the MAISTHRO registry.

    Science.gov (United States)

    Weingarz, Lea; Schwonberg, Jan; Schindewolf, Marc; Hecking, Carola; Wolf, Zsuzsanna; Erbe, Matthias; Weber, Adele; Lindhoff-Last, Edelgard; Linnemann, Birgit

    2013-12-01

    Thrombophilia is a well-established risk factor for a venous thromboembolic event (VTE), and it has been proposed that hereditary thrombophilia may substantially contribute to the development of VTE in young patients. We aimed to analyse the prevalence of thrombophilia with special regard to the age of VTE manifestation. The study cohort consisted of 1490 patients (58% females) with a median age 43 years at the time of their first VTE. At least one thrombophilic disorder was identified in 50·1% of patients. The probability of detecting a hereditary thrombophilia declined significantly with advancing age (from 49·3% in patients aged 20 years and younger to 21·9% in patients over the age of 70 years; P thrombophilia was more prevalent in unprovoked compared with risk-associated VTE (57·7% vs. 47·7%; P = 0·001). The decline in the prevalence of hereditary thrombophilia with older ages supports the use of a selected thrombophilia screening strategy dependent on age and the presence or absence of additional VTE risk factors.

  18. Practical aspects of treatment with target specific anticoagulants: initiation, payment and current market, transitions, and venous thromboembolism treatment.

    Science.gov (United States)

    Mahan, Charles E

    2015-04-01

    Target specific anticoagulants (TSOACs) have recently been introduced to the US market for multiple indications including venous thromboembolism (VTE) prevention in total hip and knee replacement surgeries, VTE treatment and reduction in the risk of stroke in patients with non-valvular atrial fibrillation (NVAF). Currently, three TSOACs are available including rivaroxaban, apixaban, and dabigatran with edoxaban currently under Food and Drug Administration review for VTE treatment and stroke prevention in NVAF. The introduction of these agents has created a paradigm shift in anticoagulation by considerably simplifying treatment and anticoagulant initiation for patients by giving clinicians the opportunity to use a rapid onset, rapid offset, oral agent. The availability of these rapid onset TSOACs is allowing for outpatient treatment of low risk pulmonary embolism and deep vein thrombosis which can greatly reduce healthcare costs by avoiding inpatient hospitalizations and treatment for the disease. Additionally with this practice, the complications of an inpatient hospitalization may also be avoided such as nosocomial infections. Single-agent approaches with TSOACs represent a paradigm shift in the treatment of VTE versus the complicated overlap of a parenteral agent with warfarin. Transitions between anticoagulants, including TSOACs, are a high-risk period for the patient, and clinicians must carefully consider patient characteristics such as renal function as well as the agents that are being transitioned. TSOAC use appears to be growing slowly with improved payment coverage throughout the US.

  19. Prevention of venous thromboembolism, 2nd edition: Korean Society of Thrombosis and Hemostasis Evidence-based Clinical Practice Guidelines.

    Science.gov (United States)

    Bang, Soo-Mee; Jang, Moon Ju; Kim, Kyoung Ha; Yhim, Ho-Young; Kim, Yeo-Kyeoung; Nam, Seung-Hyun; Hwang, Hun Gyu; Bae, Sung Hwa; Kim, Sung-Hyun; Mun, Yeung-Chul; Kim, Yang-Ki; Kim, Inho; Choi, Won-Il; Jung, Chul Won; Park, Nan Hee; Choi, Nam-Kyong; Park, Byung-Joo; Oh, Doyeun

    2014-02-01

    In 2010, we proposed the first Korean Guidelines for the Prevention of Venous Thromboembolism (VTE). It was applicable to Korean patients, by modifying the contents of the second edition of the Japanese guidelines for the prevention of VTE and the 8th edition of the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines. From 2007 to 2011, we conducted a nationwide study regarding the incidence of VTE after major surgery using the Health Insurance Review and Assessment Service (HIRA) database. In addition, we have considered the 9th edition of the ACCP Evidenced-Based Clinical Practice Guidelines, published in 2012. It emphasized the importance of clinically relevant events as opposed to asymptomatic outcomes with preferences for both thrombotic and bleeding outcomes. Thus, in the development of the new Korean guidelines, three major points were addressed: 1) the new guidelines stratify patients into 4 risk groups (very low, low, moderate, and high) according to the actual incidence of symptomatic VTE from the HIRA databases; 2) the recommended optimal VTE prophylaxis for each group was modified according to condition-specific thrombotic and bleeding risks; 3) guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and/or physician advice.

  20. Research progress in the application of inferior vena cava filter on acute venous thrombosis

    Institute of Scientific and Technical Information of China (English)

    Ioannis Stefanidis; George Galyfos; Stavros Kerasidis; Ioannis Stamatatos; Georgios Geropapas; Sotirios Giannakakis; Georgios Kastrisios; Gerasimos Papacharalampous; Chrisostomos Maltezos

    2015-01-01

    Anticoagulant therapy using heparins or per os vitamin K antagonists has been the treatment of choice in patients with venous thromboembolic disease for decades. However, the introduction of inferior vena cava (IVC) filters recently has provided new therapeutic choices appropriate for specific groups of patients with venous thromboembolic disease. This review aims to present all current evidence on the indications and precautions for the proper IVC filters utilization. There is still a great challenge in identifying the proper populations that would benefit from an IVC filter implantation or extraction. New randomized trials are needed to produce safe and clear guidelines of proper use.

  1. New insights into the mechanisms of action of aspirin and its use in the prevention and treatment of arterial and venous thromboembolism

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    Mekaj YH

    2015-09-01

    Full Text Available Ymer H Mekaj,1,2 Fetije T Daci,2 Agon Y Mekaj3 1Institute of Pathophysiology, Faculty of Medicine, University of Prishtina, 2Department of Hemostasis and Thrombosis, National Blood Transfusion Center of Kosovo, 3Clinic of Neurosurgery, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo Abstract: The antithrombotic action of aspirin has long been recognized. Aspirin inhibits platelet function through irreversible inhibition of cyclooxygenase (COX activity. Until recently, aspirin has been mainly used for primary and secondary prevention of arterial antithrombotic events. The aim of this study was to review the literature with regard to the various mechanisms of the newly discovered effects of aspirin in the prevention of the initiation and development of venous thrombosis. For this purpose, we used relevant data from the latest numerous scientific studies, including review articles, original research articles, double-blinded randomized controlled trials, a prospective combined analysis, a meta-analysis of randomized trials, evidence-based clinical practice guidelines, and multicenter studies. Aspirin is used in the prevention of venous thromboembolism (VTE, especially the prevention of recurrent VTE in patients with unprovoked VTE who were treated with vitamin K antagonists (VKAs or with non-vitamin K antagonist oral anticoagulants (NOACs. Numerous studies have shown that aspirin reduces the rate of recurrent VTE in patients, following cessation of VKAs or NOACs. Furthermore, low doses of aspirin are suitable for long-term therapy in patients recovering from orthopedic or other surgeries. Aspirin is indicated for the primary and secondary prevention as well as the treatment of cardiovascular diseases, including acute coronary syndrome, myocardial infarction, peripheral artery disease, acute ischemic stroke, and transient ischemic attack (especially in atrial fibrillation or mechanical heart valves. Aspirin can prevent or treat

  2. Prevalence of deep venous thrombosis in patients with acute exacerbation of chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    DUAN Sheng-chen; YANG Yuan-hua; LI Xu-yan; LIANG Xiao-ning; GUO Rui-jun; XIE Wan-mu; KUANG Tu-guang; DAI Hua-ping; WANG Chen

    2010-01-01

    Background Acute exacerbation of chronic obstructive pulmonary disease (COPD) is always associated with a high incidence and mortality. Because of the presence of some concomitant risk factors such as immobilization, bronchial superinfection, patients who are admitted for acute exacerbations of COPD are generally considered to be at moderate risk for the development of venous thromboembolism. In this study, we investigated the prevalence and the clinical manifestations of deep venous thrombosis (DVT) in patients with acute exacerbation of COPD.Methods From March 2007 to March 2009, 520 consecutive patients were included in this study. On admission, color Doppler ultrasound of lower extremities in all cases was performed for diagnosing DVT. Patients with DVT were compared with those without DVT from such aspects as demographics, symptoms, physical signs and risk factors.Results Among the 520 patients, DVT was found in 46 cases (9.7%). In patients with DVT, the duration of hospitalization was longer (P=0.01), and the mechanical ventilation requirement increased (P <0.001). Other indicators for patients with more possibility of DVT were immobility exceeding 3 days (P <0.001); pneumonia as concomitance (P=0.01); respiratory failure type Ⅱ (P=0.013); current smoking (P=0.001). Lower extremity pain was more common in DVT cases in comparison to those without DVT (34.8% vs. 15.2%, P=0.01 ).Conclusions The acute exacerbation of COPD patients, who were immobilized for over 3 days, complicated by pneumonia and had respiratory failure type Ⅱ, had a higher risk of DVT. In addition, DVT detection awareness should be increased in cases that had a lower extremity pain.

  3. Venous thromboembolism: Additional diagnostic value and radiation dose of pelvic CT venography in patients with suspected pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Reichert, Miriam, E-mail: Miriam.Reichert@umm.de [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Henzler, Thomas; Krissak, Radko; Apfaltrer, Paul [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Huck, Kurt [1st Department of Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim (Germany); Buesing, Karen [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Sueselbeck, Tim [1st Department of Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim (Germany); Schoenberg, Stefan O.; Fink, Christian [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany)

    2011-10-15

    Purpose: To assess the additional diagnostic value of indirect CT venography (CTV) of the pelvis and upper thighs performed after pulmonary CT angiography (CTA) for the diagnosis of venous thromboembolism (VTE). Materials and methods: In a retrospective analysis, the radiology information system entries between January 2003 and December 2007 were searched for patients who received pulmonary CTA and additional CTV of the pelvis and upper thighs. Of those patients, the radiology reports were reviewed for the diagnosis of pulmonary embolism (PE) and deep venous thrombosis (DVT) in the pelvic veins and veins of the upper thighs. In cases with an isolated pelvic thrombosis at CTV (i.e. which only had a thrombosis in the pelvic veins but not in the veins of the upper thigh) ultrasound reports were reviewed for the presence of DVT of the legs. The estimated radiation dose was calculated for pulmonary CTA and for CTV of the pelvis. Results: In the defined period 3670 patients were referred to our institution for exclusion of PE. Of those, 642 patients (353 men, 289 women; mean age, 65 {+-} 15 years, age range 18-98 years) underwent combined pulmonary CTA and CTV. Among them, PE was found in 227 patients (35.4%). In patients without PE CTV was negative in all cases. In patients with PE, CTV demonstrated pelvic thrombosis in 24 patients (3.7%) and thrombosis of the upper thighs in 43 patients (6.6%). Of those patients 14 (2.1%) had DVT in the pelvis and upper thighs. In 10 patients (1.5%) CTV showed an isolated pelvic thrombosis. Of those patients ultrasound reports were available in 7 patients, which revealed DVT of the leg veins in 5 cases (1%). Thus, the estimated prevalence of isolated pelvic thrombosis detected only by pelvic CTV ranges between 1-5/642 patients (0.1-0.7%). Radiation dose ranges between 4.8 and 9.7 mSv for additional CTV of the pelvis. Conclusion: CTV of the pelvis performed after pulmonary CTA is of neglectable additional diagnostic value for the

  4. Prophylaxis of venous and pulmonary thrombo-embolism. Profilaxis del tromboembolismo venoso y pulmonar. Conceptos actuales.

    Directory of Open Access Journals (Sweden)

    Hugo Jiménez Vázquez

    2004-04-01

    Full Text Available This bibliographical revision stands out the importance of the vein thromboembolism prevention in patients under different surgical and injuries procedures, wicked illnesses and medical conditions. The epidemiology, etiopatogenia and factors of risk of the deep vein thrombosis and the lung embolism are exposed in different categories of patient. Up to dates prophylactic methods are taken into account and compared their effectiveness and cautions according to the last studies on the topic.
    En esta revisión se destaca la importancia de la prevención de tromboembolismo venoso en pacientes bajo diferentes procedimientos quirúrgicos y traumatológicos, enfermedades malignas y condiciones médicas. Se exponen la epidemiología, etiopatogenia y factores de riesgo de la trombosis venosa profunda y el embolismo pulmonar en diferentes categorías de pacientes. Se tratan también los métodos profilácticos actualmente existentes y se compara su efectividad y precauciones de acuerdo a los últimos estudios sobre el tema.

  5. A sazonalidade do tromboembolismo venoso no clima subtropical de São Paulo Seasonal variation of venous thromboembolism in the subtropical climate of São Paulo, Brazil

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    Daniela Kleinfelder

    2009-03-01

    Full Text Available CONTEXTO: Os fatores desencadeantes da doença tromboembólica venosa vêm sendo cada vez melhor identificados. Causas externas podem influir na sua ocorrência, e algum destaque tem sido dado a fatores climáticos. Nada se sabe quanto a essa interferência em nossa latitude. OBJETIVOS: Analisar se há diferença na incidência do tromboembolismo venoso de acordo com as estações do ano, num hospital da cidade de São Paulo, Brasil, cujo clima é categorizado como subtropical. MÉTODOS: Foi realizado trabalho retrospectivo de levantamento de dados a partir de prontuários de pacientes cujo diagnóstico de internação ou óbito foi de trombose venosa profunda ou tromboembolismo pulmonar, no período de janeiro de 1996 a outubro de 2003, no Hospital da Beneficência Portuguesa de São Paulo. Para comparação e estudo, os casos foram agrupados em trimestres (primeiro trimestre = janeiro, fevereiro e março; segundo trimestre = abril, maio e junho; terceiro trimestre = julho, agosto e setembro; e quarto trimestre = outubro, novembro e dezembro e conforme sua ocorrência nos chamados meses quentes e frios, de acordo com a média de temperatura mensal (meses quentes = outubro a abril; meses frios = maio a setembro. RESULTADOS: Foram encontrados 955 casos de tromboembolismo venoso no período analisado. Foi utilizado o teste ANOVA para análise, que não revelou diferença estatisticamente significativa na incidência do tromboembolismo venoso de acordo com os trimestres. Quando analisados separadamente, também não se evidenciou significância estatística em relação ao tromboembolismo pulmonar e à trombose venosa profunda. Quando comparados os meses quentes e frios, observou-se aumento da incidência de trombose venosa profunda nos meses quentes (p BACKGROUND: The triggering factors of venous thromboembolic disease have been increasingly clarified. External causes may influence its occurrence, and some climactic factors have stood out. Nothing

  6. Clinical Study of Acute Vasoreactivity Testing in Patients with Chronic Thromboembolic Pulmonary Hypertension

    Science.gov (United States)

    Xu, Qi-Xia; Yang, Yuan-Hua; Geng, Jie; Zhai, Zhen-Guo; Gong, Juan-Ni; Li, Ji-Feng; Tang, Xiao; Wang, Chen

    2017-01-01

    Background: The clinical significance of acute vasoreactivity testing (AVT) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) remains unclear. We analyzed changes in hemodynamics and oxygenation dynamics indices after AVT in patients with CTEPH using patients with pulmonary arterial hypertension (PAH) as controls. Methods: We analyzed retrospectively the results of AVT in 80 patients with PAH and 175 patients with CTEPH registered in the research database of Beijing Chao-Yang Hospital between October 2005 and August 2014. Demographic variables, cardiopulmonary indicators, and laboratory findings were compared in these two subgroups. A long-term follow-up was conducted in patients with CTEPH. Between-group comparisons were performed using the independent-sample t-test or the rank sum test, within-group comparisons were conducted using the paired t-test or the Wilcoxon signed-rank test, and count data were analyzed using the Chi-squared test. Survival was estimated using the Kaplan-Meier method and log-rank test. Results: The rates of positive response to AVT were similar in the CTEPH (25/175, 14.3%) and PAH (9/80, 11.3%) groups (P > 0.05). Factors significantly associated a positive response to AVT in the CTEPH group were level of N-terminal pro-brain natriuretic peptide (≤1131.000 ng/L), mean pulmonary arterial pressure (mPAP, ≤44.500 mmHg), pulmonary vascular resistance (PVR, ≤846.500 dyn·s−1·m−5), cardiac output (CO, ≥3.475 L/min), and mixed venous oxygen partial pressure (PvO2, ≥35.150 mmHg). Inhalation of iloprost resulted in similar changes in mean blood pressure, mPAP, PVR, systemic vascular resistance, CO, arterial oxygen saturation (SaO2), mixed venous oxygen saturation, partial pressure of oxygen in arterial blood (PaO2), PvO2, and intrapulmonary shunt (Qs/Qt) in the PAH and CTEPH groups (all P > 0.05). The survival time in patients with CTEPH with a negative response to AVT was somewhat shorter than that in AVT

  7. Efficacy of FDG PET/CT Imaging for Venous Thromboembolic Disorders

    DEFF Research Database (Denmark)

    Hess, Søren; Madsen, Poul Henning; Iversen, Else Dalsgaard;

    2015-01-01

    VTE. PATIENTS AND METHODS: Fifteen patients with suspected deep venous thrombosis (DVT) and/or pulmonary embolism (PE) were included prospectively and underwent a whole-body FDG PET/CT. Patients were divided into 4 groups as follows: DVT+ (DVT proven by high clinical suspicion and positive compression...... ultrasound), DVT- (DVT ruled out by low clinical suspicion and negative compression ultrasound), PE+ (PE proven by high clinical suspicion and positive lung scintigraphy), and PE- (PE ruled out by low clinical suspicion and normal lung scintigraphy). Images were interpreted visually by 2 experienced nuclear...... medicine physicians independently and without knowledge of other imaging results. RESULTS: Seven DVT+, 6 DVT-, 6 PE+, and 1 PE- were included. Five patients were suspected of both DVT and PE. FDG PET/CT correctly diagnosed the presence or lack of DVT in all patients, whereas results are more ambiguous...

  8. Profilaxia para tromboembolismo venoso em um hospital de ensino Venous thromboembolism prophylaxis at a teaching hospital

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    Rafael de Melo Franco

    2006-06-01

    Full Text Available OBJETIVO: Verificar se a profilaxia da trombose venosa profunda está sendo utilizada de maneira correta e rotineira em um hospital de ensino. MÉTODOS E CASUÍSTICA: Foi realizado um estudo transversal de pacientes internados em sete setores (enfermarias do Conjunto Hospitalar de Sorocaba (Hospital de Ensino, no período de agosto de 2004 a agosto de 2005. Para estratificação do risco de trombose venosa profunda de cada paciente, foram pesquisados fatores clínicos e cirúrgicos, segundo o protocolo preconizado pela Sociedade Brasileira de Angiologia e Cirurgia Vascular. No período estudado, foram analisados 216 prontuários, dos quais 30 eram da cirurgia abdominal, 30 da cirurgia vascular, 30 da urologia, 31 da clínica médica, 31 da unidade de terapia intensiva, 31 da ortopedia e 33 da ginecologia/obstetrícia. RESULTADOS: Do total de pacientes, foi efetuada profilaxia para trombose venosa profunda em 57 (26%, sendo que, em 51 (89%, a execução foi de maneira correta e, em 6 (11%, não-preconizada. O método profilático mais utilizado foi o medicamentoso; 49 de 57 pacientes fizeram uso de heparina de baixo peso molecular. Também foi verificada a utilização de meias elásticas em cinco pacientes e deambulação precoce em sete. Já a compressão pneumática intermitente não foi utilizada em nenhum deles. CONCLUSÃO: De acordo com os resultados e com base no protocolo, concluiu-se que, no período da pesquisa, a profilaxia para trombose venosa profunda, no Conjunto Hospitalar de Sorocaba, foi executada rotineiramente e de forma adequada em apenas 23,6% (51 do total de 216 pacientes.OBJECTIVE: To verify whether deep venous thrombosis prophylaxis is being correctly and routinely used at a teaching hospital. METHODS: A cross-sectional study of hospitalized patients on seven sectors at Conjunto Hospitalar de Sorocaba (Hospital de Ensino was performed from August 2004 to August 2005. For the deep venous thrombosis risk stratification of

  9. New compounds in the management of venous thromboembolism after orthopedic surgery: focus on rivaroxaban

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    Lars Carl Borris

    2008-08-01

    Full Text Available Lars Carl BorrisDepartment of Orthopaedic Surgery, Åarhus University Hospital, Åarhus, DenmarkAbstract: Rivaroxaban (Xarelto® is a member of a new class of oral, direct (antithrombin-independent factor Xa inhibitors, which restrict thrombin generation both in vitro and in vivo. After oral administration the absorption is near 100%, the bioavailability is near 80%, and the elimination half-life is 5–9 hours with mixed excretion via the renal and fecal/biliary routes. The pharmacokinetics of rivaroxaban are predictable and consistent with a rapid onset of antithrombotic action within 2 hours after administration. Phase II clinical studies have been carried out in patients undergoing total hip arthroplasty (THA or total knee arthroplasty (TKA and a dose of 10 mg once daily for thromboprophylaxis was selected for further clinical development. The results of the phase III studies showed a significantly better antithrombotic efficacy of rivaroxaban compared with enoxaparin both in the short term (10–14 days in TKA patients and long term (35 ± 4 days in THA patients with a comparable safety. Symptomatic thromboembolic events were also significantly reduced with rivaroxaban. Liver enzyme elevation was seen in patients treated with rivaroxaban, but there was no indication of an increased risk of liver toxicity compared with enoxaparin. In conclusion, rivaroxaban is a potent and safe new compound for antithrombotic prophylaxis in orthopedic surgery.Keywords: deep vein thrombosis, oral direct factor Xa inhibitor, pulmonary embolism, rivaroxaban, thromboprophylaxis, total hip arthroplasty, total knee arthroplasty

  10. Pulmonary embolism risk stratification by European Society of Cardiology is associated with recurrent venous thromboembolism: Findings from a long-term follow-up study.

    Science.gov (United States)

    Zhang, Shuai; Zhai, Zhenguo; Yang, Yuanhua; Zhu, Jianguo; Kuang, Tuguang; Xie, Wanmu; Yang, Suqiao; Liu, Fangfang; Gong, Juanni; Shen, Ying H; Wang, Chen

    2016-01-01

    Venous thromboembolism (VTE) recurrence carries significant mortality and morbidity. Accurate risk assessment and effective treatment for patients with acute pulmonary embolism (PE) is important for VTE recurrence prevention. We examined the association of VTE recurrence with risk stratification and PE treatment. We enrolled 627 patients with a first episode of confirmed PE. Baseline clinical information was collected. PE severity was assessed by the European Society of Cardiology's (ESC) risk stratification, the simplified PE Severity Index (sPESI) and the Qanadli score of clot burden. Patients were followed for 1-5 years. The cumulative recurrent VTE and all-cause death were documented. The association between recurrent VTE and risk factors was analyzed. The cumulative incidences of recurrent VTE were 4.5%, 7.3%, and 13.9% at 1, 2, and 5 years of follow-up, respectively. The VTE recurrence was associated with higher (high- and intermediate-) risk stratification predicted by ESC model (HR 1.838, 95% CI 1.318-2.571, P<0.001), as well as with unprovoked PE (HR 2.809, 95% CI 1.650-4.781, P b 0.001) and varicose veins (HR 4.747, 95% CI 2.634-8.557, P<0.001). The recurrence was negatively associated with longer (≥6 months) anticoagulation (HR 0.473, 95% CI 0.285-0.787, P=0.004), especially in patients with higher risk (HR 0.394, 95% CI 0.211-0.736, P=0.003) and unprovoked PE (HR 0.248, 95% CI 0.122-0.504, P<0.001). ESC high-risk and intermediate-risk PE, unprovoked PE and varicose veins increase recurrence risk. Longer anticoagulation treatment reduces recurrence, especially in higher risk and unprovoked PE patients.

  11. Non-traumatic thoracic emergencies: CT venography in an integrated diagnostic strategy of acute pulmonary embolism and venous thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Ghaye, Benoit; Dondelinger, Robert F. [Department of Medical Imaging, University Hospital Sart Tilman, Domaine Universitaire du Sart Tilman B35, 4000 Liege (Belgium)

    2002-08-01

    Deep venous thrombosis and pulmonary embolism are the two aspects of venous thrombo-embolism. Investigation of lower limb veins has been part of various diagnostic algorithms in the past 15 years. Recently, the combination of CT venography (CTV) of lower limbs and abdominal veins together with CT angiography of the pulmonary arteries has allowed a complete examination of venous thrombo-embolism in one session. The technical aspects, imaging findings, venous anatomy on CT, interpretative pitfalls, results and advantages of CT venography are reviewed. (orig.)

  12. A Case Report: Cushing’s Disease Presenting with Polycythemia and Venous Thromboembolism

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    İnan Anaforoğlu

    2012-06-01

    Full Text Available We present the case of a woman with Cushing’s disease who had originally received a diagnosis of primary polycythemia. Her major complaints were headache, weakness, and blushing of the face. She had been admitted to another hospital about 6 months previously for same symptoms, and she received a diagnosis of polycythemia vera. Before planned bone marrow aspiration and biopsy could be performed, the patient developed a popliteal vein thrombosis; heterozygotic mutation of factor V Leiden (1691 GA had been identified. She was admitted to our hospital for bone marrow biopsy. Considering her physical examination and medical history which revealed facial plethora, moon-face, supraclavicular fullness, central obesity, purple striae at her abdomen, shoulder, and thighs, in addition to frontal balding, acne, hirsutism and infertility, she was evaluated for possible Cushing’s disease. A diagnosis of Cushing’s disease was made. Her haematological situation and clinical symptoms resolved after she underwent hypophysectomy for Cushing’s disease. Cushing’s disease is a possible cause of secondary erythrocytosis. Venous thrombosis can occur during the course of both Cushing’s syndrome and primary polycythemias. It is important to exclude such secondary causes of polycythemia before making a final diagnosis. Turk Jem 2012; 16: 43-5

  13. A randomized trial of rosuvastatin in the prevention of venous thromboembolism

    DEFF Research Database (Denmark)

    Glynn, Robert J; Danielson, Eleanor; Fonseca, Francisco A H;

    2009-01-01

    BACKGROUND: Controversy persists regarding the extent of shared pathways between arterial and venous thrombosis and whether treatments of known efficacy for one disease process have consistent benefits for the other. Observational studies have yielded variable estimates of the effect of statin......-reactive protein levels of 2.0 mg per liter or higher to receive rosuvastatin, 20 mg per day, or placebo. We followed participants for the first occurrence of pulmonary embolism or deep-vein thrombosis and performed analyses of the data on an intention-to-treat basis. RESULTS: During a median follow-up period of 1.......12 in the placebo group (hazard ratio, 0.77; 95% CI, 0.41 to 1.45; P=0.42), whereas the rates of deep-vein thrombosis only were 0.09 and 0.20, respectively (hazard ratio, 0.45; 95% CI, 0.25 to 0.79; P=0.004). Consistent effects were observed in all the subgroups examined. No significant differences were seen...

  14. Outpatient treatment of low-risk venous thromboembolism with monotherapy oral anticoagulation: patient quality of life outcomes and clinician acceptance

    Directory of Open Access Journals (Sweden)

    Kline JA

    2016-04-01

    Full Text Available Jeffrey A Kline,1,2 Zachary P Kahler,1,3 Daren M Beam1,2 1Department of Emergency Medicine, 2Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN, 3Department of Emergency Medicine, University of South Carolina Greenville School of Medicine, Greenville, SC, USA Background: Oral monotherapy anticoagulation has facilitated home treatment of venous thromboembolism (VTE in outpatients. Objectives: The aim of this study was to measure efficacy, safety, as well as patient and physician perceptions produced by a protocol that selected VTE patients as low-risk patients by the Hestia criteria, and initiated home anticoagulation with an oral factor Xa antagonist. Methods: Patients were administered the Venous Insufficiency Epidemiological and Economic Study Quality of life/Symptoms ques­tionnaire [VEINEs QoL/Sym] and the physical component summary [PCS] from the Rand 36-Item Short Form Health Survey [SF36]. The primary outcomes were VTE recurrence and hemorrhage at 30 days. Secondary outcomes compared psychometric test scores between patients with deep vein thrombosis (DVT to those with pulmonary embolism (PE. Patient perceptions were abstracted from written comments and physician perceptions specific to PE outpatient treatment obtained from structured survey. Results: From April 2013 to September 2015, 253 patients were treated, including 67 with PE. Within 30 days, 2/ 253 patients had recurrent DVT and 2/253 had major hemor­rhage; all four had DVT at enrollment. The initial PCS scores did not differ between DVT and PE patients (37.2±13.9 and 38.0±12.1, respectively and both DVT and PE patients had similar improvement over the treatment period (42.2±12.9 and 43.4±12.7, respectively, consistent with prior literature. The most common adverse event was menorrhagia, present in 15% of women. Themes from patient-written responses reflected satisfaction with increased autonomy. Physicians’ (N=116

  15. Direct oral anticoagulants in the treatment of venous thromboembolism, with a focus on patients with pulmonary embolism: an evidence-based review.

    Science.gov (United States)

    Gómez-Outes, Antonio; Suárez-Gea, M Luisa; Lecumberri, Ramón; Terleira-Fernández, Ana Isabel; Vargas-Castrillón, Emilio

    2014-01-01

    Pulmonary embolism (PE) is a relatively common cardiovascular emergency. PE and deep vein thrombosis (DVT) are considered expressions of the same disease, termed as venous thromboembolism (VTE). In the present review, we describe and meta-analyze the efficacy and safety data available with the direct oral anticoagulants (DOAC; dabigatran, rivaroxaban, apixaban, edoxaban) in clinical trials testing these new compounds in the acute/long-term and extended therapy of VTE, providing subgroup analyses in patients with index PE. We analyzed ten studies in 35,019 randomized patients. A total of 14,364 patients (41%) had index PE. In the acute/long-term treatment of VTE, the DOAC showed comparable efficacy in preventing recurrent VTE to standard treatment in patients with index PE (risk ratio [RR]: 0.88; 95% confidence interval [CI]: 0.70-1.11) and index DVT (RR: 0.93; 95% CI: 0.75-1.16) (P for subgroup differences =0.76). VTE recurrence depending on PE anatomical extension and presence/absence of right ventricular dysfunction was only reported in two trials, with results being consistent with those obtained in the overall study populations. In the single trial comparing extended therapy of VTE with DOAC versus warfarin, the point estimate for recurrent VTE tended to disfavor the DOAC in patients with index PE (RR: 2.05; 95% CI: 0.83-5.03) and in patients with index DVT (RR: 1.11; 95% CI: 0.49-2.50) (P for subgroup differences =0.32). In trials that compared DOAC versus placebo for extended therapy, the reduction in recurrent VTE was consistent in patients with PE (RR: 0.15; 95% CI: 0.01-1.82) and in patients with DVT (RR: 0.25; 95% CI: 0.10-0.61) (P for subgroup differences =0.71). The DOAC were associated with a consistently lower risk of clinically relevant bleeding (CRB) than standard treatment of acute VTE and higher risk of CRB than placebo for extended therapy of VTE regardless of index event. In summary, the DOAC were as effective as, and safer than, standard

  16. Clinical significance of recurrent venous thromboembolism Significância clínica de tromboembolismo venoso recorrente

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    Nicos Labropoulos

    2010-06-01

    Full Text Available Recurrent venous thromboembolism is a significant problem leading to increased morbidity and mortality. It has a high impact on patients' quality of life and imposes a great financial burden on society. Cumulative recurrence has been reported as 40% at 10 years, while the chance of developing postthrombotic signs and symptoms in the lower extremities almost quadruples when ipsilateral. There is also a higher chance of developing pulmonary hypertension. Important factors for recurrence are unprovoked episodes of deep vein thrombosis, malignancy and older age. The evidence for other factors is controversial. Accurate diagnosis and treatment tailored to the patients' history, thrombotic events and risk factors are necessary to optimize management and prevent recurrence.O tromboembolismo venoso recorrente é um problema importante que leva ao aumento da morbimortalidade. Impõe forte impacto à qualidade de vida dos pacientes e grande carga financeira para a sociedade. Acredita-se que a recorrência cumulativa atinja 40% em 10 anos, enquanto que a chance de desenvolver sinais e sintomas pós-trombóticos nas extremidades inferiores quase quadruplica no caso de trombose ipsilateral. Há também uma maior chance do desenvolvimento de hipertensão pulmonar. Fatores importantes para a recorrência são: episódios não provocados de trombose venosa profunda, malignidade e idade avançada. As evidências relacionadas a outros fatores são controversas. Diagnóstico preciso e tratamento adaptado ao histórico dos pacientes, aos eventos trombóticos e aos fatores de risco são necessários para otimizar o manejo e prevenir a recorrência.

  17. Efficacy and safety of the new oral anticoagulants in the treatment of venous thromboembolic complications: meta-analysis

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    V. I. Petrov

    2016-01-01

    Full Text Available Aim. Analysis of the efficacy and safety of the new oral anticoagulants (NOACs in the management of venous thromboembolism (VTE.Material and methods. This meta-analysis of randomized controlled trials (RCTs was made in accordance with the instructions “Preferred reporting items for systematic reviews and meta-analyses (PRISMA”.Results. The meta-analysis included 5 RCTs. NOACs were as effective as vitamin K antagonists (VKAs in preventing recurrent symptomatic VTE (RR=0.93; 95% CI 0.77-1.12; p=0.44. The incidence of recurrent thrombosis (RR=0.82; 95% CI 0.63-1.08; p=0.16 and deep vein thrombosis ± fatal or nonfatal pulmonary embolism (RR=1.06; 95% CI 0.81-1.40; p=0.66 was comparable in the groups of comparison. Meta-analysis of the safety of the NOACs suggested significant reduction of risk of major bleeding as compared with standard therapy (RR=0.54; 95% CI 0.42-0.69; р<0.00001. The incidence of all types of bleeding was significantly lower with NOACs (RR=0.70; 95% CI 0.51-0.95; p=0.02. All-cause mortality rate was comparable between the groups (RR=0.93; 95% CI 0.76-1.13; p=0.46.Conclusions. NOACs are as effective as the standard therapy, at that they are much safer in VTE treatment.

  18. Incidence of Venous Thromboembolic Events in Mandated Risk Assessment versus Optional DVT Prophylaxis Era at a Large Tertiary Cancer Center.

    Science.gov (United States)

    Kukar, Moshim; Asaro, Joseph; Aquino, Anthony; Groman, Adrienne; Skitzki, Joseph; Kane, John M

    2015-09-01

    Cancer patients are thought to be at high risk for venous thromboembolic events (DVT/PE). Beginning in October 2007, our tertiary cancer center instituted "mandated risk assessment" computerized DVT prophylaxis order entry, for all hospital admissions with an option for active opt out by the physician with a stated reason. Retrospective review of all DVT/PE events within 30 days of a hospital admission [any inpatient admission (IA) and outpatient surgery (OPS)] in comparable "optional (O)" (January 2005-September 2007) vs "mandated risk assessment (M)" (October 2007-May 2010) DVT prophylaxis order eras. Patient demographics, admission details, type of prophylaxis, treatment, and outcome were also analyzed. There were 16,363 for the O (11,944 IA/4,419 OPS) and 17,757 for the M (12,957 IA/4,800 OPS) DVT prophylaxis order eras. The number of DVT/PE events in the O era was 67 (prevalence 0.41%) versus 102 for the M era (prevalence 0.57%), P = 0.037. In the DVT/PE patients, DVT prophylaxis had been ordered during the index admission in 66 per cent for O versus 83 per cent for M (P = 0.008). Low-molecular-weight heparin was increasingly used in M era (33% vs 16%, P = 0.009). There was also no difference between O vs M era for status at DVT/PE diagnosis (outpatient 36% vs 24%) or associated symptoms. There were no deaths attributable to DVT/PE in the O era versus 3 deaths in the M era. Although DVT prophylaxis use improved with "mandated risk assessment" ordering, the DVT/PE incidence did not decrease. It may be difficult to overcome the surprisingly low baseline prevalence and multiple risk factors in this population.

  19. Risk of venous thromboembolism in people admitted to hospital with selected immune-mediated diseases: record-linkage study

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    Handel Adam E

    2011-01-01

    Full Text Available Abstract Background Venous thromboembolism (VTE is a common complication during and after a hospital admission. Although it is mainly considered a complication of surgery, it often occurs in people who have not undergone surgery, with recent evidence suggesting that immune-mediated diseases may play a role in VTE risk. We, therefore, decided to study the risk of deep vein thrombosis (DVT and pulmonary embolism (PE in people admitted to hospital with a range of immune-mediated diseases. Methods We analysed databases of linked statistical records of hospital admissions and death certificates for the Oxford Record Linkage Study area (ORLS1:1968 to 1998 and ORLS2:1999 to 2008 and the whole of England (1999 to 2008. Rate ratios for VTE were determined, comparing immune-mediated disease cohorts with comparison cohorts. Results Significantly elevated risks of VTE were found, in all three populations studied, in people with a hospital record of admission for autoimmune haemolytic anaemia, chronic active hepatitis, dermatomyositis/polymyositis, type 1 diabetes mellitus, multiple sclerosis, myasthenia gravis, myxoedema, pemphigus/pemphigoid, polyarteritis nodosa, psoriasis, rheumatoid arthritis, Sjogren's syndrome, and systemic lupus erythematosus. Rate ratios were considerably higher for some of these diseases than others: for example, for systemic lupus erythematosus the rate ratios were 3.61 (2.36 to 5.31 in the ORLS1 population, 4.60 (3.19 to 6.43 in ORLS2 and 3.71 (3.43 to 4.02 in the England dataset. Conclusions People admitted to hospital with immune-mediated diseases may be at an increased risk of subsequent VTE. Our findings need independent confirmation or refutation; but, if confirmed, there may be a role for thromboprophylaxis in some patients with these diseases.

  20. Venous thromboembolism-related mortality and morbidity in King Fahd General Hospital, Jeddah, Kingdom of Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Abo-El-Nazar Essam

    2011-01-01

    Full Text Available Background: Venous thromboembolism (VTE is a serious and underestimated potentially fatal disease with an effective prophylactic antithrombotic therapy that is usually underused. Objectives: The primary study objective is to determine the percentage of VTE patients who received prophylactic antithrombotic therapy according to ACCP guidelines. Secondary study objectives are determining prevalence of confirmed VTE mortality among all cause hospital mortalities, measuring adherence to anticoagulation treatment after discharge and number of VTE events among those patients. Methods: During the period from first of July 2008 till 30 of June 2009, we collected all hospital deaths, all patients with confirmed VTE diagnosis at King Fahd General Hospital, Jeddah, Kingdom of Saudi Arabia. Only patients with confirmed VTE diagnosis were included in the analysis. Results: Five hundred cases with clinical diagnosis of VTE were identified. Out of them 178 were confirmed to be VTE. 36.5% of them received prophylactic antithrombotic therapy. Case fatality rate was 20.8% representing 1.9% of hospital deaths. Case fatality rate was 31% and 3.1% for patients who did not receive thromboprophylaxis and patients who received it, respectively ( P < 0.0001. 66.3% and 33.7% of confirmed VTE cases occurred in surgical and medical patients respectively. Only 44.1% of surgical patients and 21.7% of medical patients received prophylaxis ( P < 0.01. Case fatality rate is 11% for surgical patients and 40% for medical patients (P < 0.001. Of 141 survived cases, 118 (83.7% were adherent to anticoagulation therapy after discharge. Conclusions: VTE prophylaxis guideline is not properly implemented and extremely underutilized. Mortality from VTE is significantly higher in patients who did not receive VTE prophylaxis. In the absence of regular post-mortem practice VTE related mortality rate would be difficult to estimate and likely will be underestimated. Health authorities should

  1. 脊柱术后静脉血栓栓塞的危险因素分析%Analysis on risk factors of venous thromboembolism after spine surgery

    Institute of Scientific and Technical Information of China (English)

    陈剑平; 钱锐; 张潼; 朱道信; 郭朝阳

    2012-01-01

    目的 分析脊柱术后静脉血栓栓塞患者的病例特点,分析其发生的危险因素.方法 分析2008年1月~2010年12月脊柱疾病住院手术治疗者静脉血栓栓塞发生的危险因素.结果 单因素分析结果表明,年龄、既往静脉血栓栓塞病史、糖尿病、神经损伤、下肢瘫痪、卧床时间、抗凝治疗与术后静脉血栓栓塞有关.多因素Logistic回归分析显示,既往有静脉血栓栓塞病史、卧床时间长是术后静脉血栓栓塞的危险因素、抗凝治疗是保护因素.结论 脊柱术后有下肢深静脉血栓形成甚至发生肺栓塞的风险,预防性应用抗凝剂,减少卧床时间可降低其发生率.%OBJECTIVE To retrospectively review cases of patients with venous thromboembolism after spine surgery and ana lyze the risk factors of occurrence. METHODS From Jan 2008 to Dec 2010, the data of 556 patients with spinal surgery were studied. Risk factors were analyzed with univariate analysis and multivariate logistic regression analysis. RESULTS Thirty-nine patients happened venous thromboembolism after operation. Univariate analysis demonstrated that many factors were correlated with ocurrence, such as age, previous history of venous thrombosis, history of diabetes, and nerve damage, lower limb paralysis , time in bed, anticoagulant therapy. Multivariate logistic regression analysis showed previous history of venous thrombosis, long time in bed, and anticoagulant therapy were the significant protective factors for venous thromboembolism ocunence. CONCLUSION Spinal surgery has lower extremity deep venous thrombosis or pulmonary embolism risk. Prophylactic use of anticoagulants and reducing time in bed can reduce its incidence.

  2. Prevention of venous thromboembolism with an oral factor Xa inhibitor, YM150, after total hip arthroplasty. A dose finding study (ONYX-2)

    DEFF Research Database (Denmark)

    Eriksson, B I; Turpie, A G G; Lassen, M R

    2010-01-01

    BACKGROUND: Anticoagulant prophylaxis substantially reduces the risk of venous thromboembolism (VTE) after major orthopedic surgery. The direct factor Xa inhibitor YM150 is currently under investigation for the prevention of VTE, stroke and ischemic vascular events in patients after orthopedic......, 60 or 120 mg) (double-blind) or preoperative subcutaneous (open label) enoxaparin (40 mg) for 5 weeks. The primary efficacy endpoint comprised VTE diagnosed by mandatory bilateral venography or verified symptomatic deep vein thrombosis (DVT) plus all deaths up to 9 days after surgery. The primary...

  3. 静脉血栓栓塞性疾病规范性药物治疗%Standardization drug therapy of venous thromboembolism

    Institute of Scientific and Technical Information of China (English)

    张福先; 李海磊

    2011-01-01

    静脉血栓栓塞性疾病(VTE)包括深静脉血栓形成(DVT)和肺栓塞(PE).抗凝是VTE的基础治疗.目前国内大多数VTE的抗凝方案是普通肝素或低分子质量肝素继以口服维生素K拮抗剂.近些年来新的口服抗凝药相继问世,包括直接凝血酶抑制剂,如达比加群、Xa因子抑制剂和利伐沙班.这些药物可以固定剂量口服而不需要监测.循证医学支持个性化的抗凝方案.目前临床上可供选择的溶栓药物包括链激酶、尿激酶和阿替普酶.对于急性中央型DVT推荐行导管直接溶栓,以减轻症状和血栓后综合征的发生.在抗凝治疗的同时可酌情给予抗血小板药物和改善微循环药物.%Venous thromboembolism (VTE) is a spectrum of diseases that includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Anticoagulant treatment is the mainstay of therapy for VTE. Unfractionated heparin (UFH) or low molecular weight heparin (LMWH) followed by vitamin K antagonists have been the treatment of choice for most patients with VTE in China. Over the last years, new oral anticoagulant agents including direct factor lla inhibitors, such as dabigatran and direct factor Xa inhibitors, such as rivaroxaban have been developed. The drugs are taken orally at fixed daily doses and do not require laboratory monitoring. According to evidence-based medicine, individual anticoagulation is recommended. So far, the available thrombolytic agents are streptokinase, urokinase and alteplase. In selected patients with extensive acute proximal DVT, catheter-directed thrombolysis (CDT) is recommended to reduce acute symptoms and postthrombotic morbidity. Antiplatelet agents and microcirculation improvement drugs could be used after anticoagulation.

  4. Maternal smoking, obesity, and risk of venous thromboembolism during pregnancy and the puerperium: a population-based nested case-control study

    DEFF Research Database (Denmark)

    Larsen, Torben Bjerregaard; Sørensen, Henrik Toft; Gislum, Mette

    2007-01-01

    BACKGROUND: Smoking and obesity are associated with adverse pregnancy outcomes. The aim of the present study was to examine the association between smoking, obesity (BMI>30), and risk for venous thromboembolism (VTE) during pregnancy and the puerperium. MATERIALS AND METHODS: In a population......) for VTE as a measure of relative risk. RESULTS: Smoking and obesity were associated with increased risk of VTE during pregnancy and the puerperium (adjusted OR 2.7 (95% CI: 1.5, 4.9) and 5.3 (95% CI: 2.1, 13.5), respectively). Obesity appeared to be associated with a higher risk of pulmonary embolism...... (adjusted OR: 14.9 (95% CI: 3.0, 74.8) than of deep venous thrombosis (adjusted OR: 4.4, 95% CI: 1.6, 11.9). CONCLUSION: Smoking and obesity are risk factors for VTE in pregnancy and the puerperium....

  5. Clinical Application of D dimer in Venous Thromboembolism%D二聚体测定在静脉血栓栓塞中的临床应用

    Institute of Scientific and Technical Information of China (English)

    李恒; 张凯; 黄津; 王毅

    2011-01-01

    @@ 静脉血栓栓塞(venous thromboembolism ,VTE)是临床常见的血栓性疾病,其中最主要的是深静脉血栓栓塞症(deep venous thrombosis ,DVT)和肺栓塞(pulmonary embolism ,PE),因其发病率和致死率均高而倍受国内外医者之重视.D二聚体(D-dimer,D-D)是经凝血酶及因子作用的交联纤维蛋白经纤溶酶降解后产生的终末产物,是反映体内凝血和纤溶的理想分子标志物之一.

  6. Prophylaxis and management of venous thromboembolism in patients with myeloproliferative neoplasms: consensus statement of the Haemostasis Working Party of the German Society of Hematology and Oncology (DGHO), the Austrian Society of Hematology and Oncology (ÖGHO) and Society of Thrombosis and Haemostasis Research (GTH e.V.).

    Science.gov (United States)

    Kreher, Stephan; Ochsenreither, Sebastian; Trappe, Ralf U; Pabinger, Ingrid; Bergmann, Frauke; Petrides, Petro E; Koschmieder, Steffen; Matzdorff, Axel; Tiede, Andreas; Griesshammer, Martin; Riess, Hanno

    2014-12-01

    Patients with Philadelphia chromosome-negative myeloproliferative neoplasms (MPN) like polycythemia vera and essential thrombocythemia are at increased risk of arterial and venous thrombosis. Strategies of prevention may consist of platelet aggregation inhibitors and/or cytoreductive agents depending on the underlying disease and the individual risk. Clinical evidence for management of acute venous thromboembolic events in MPN patients is limited. Modality and duration of therapeutic anticoagulation after venous thrombosis has to be evaluated critically with special regard to the increased risk for spontaneous bleeding events associated with the underlying diseases. Both for therapy of the acute event and for secondary prophylaxis, low-molecular-weight heparins should preferentially be used. A prolongation of the therapeutic anticoagulation beyond the usual 3 to 6 months can only be recommended in high-risk settings and after careful evaluation of potential risks and benefits for the individual patient. New direct oral anticoagulants (NOAC) should not preferentially be used due to lack of clinical experience in patients with MPN and potential drug interactions (e.g. with JAK inhibitors). Consequent treatment of the underlying myeloproliferative disease and periodical evaluation of the response to therapy is crucial for optimal secondary prophylaxis of thromboembolic events in those patients.

  7. Diagnostic usefulness of dual-energy computed tomography in evaluation of the severity of acute pulmonary thromboembolism

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Sung Min; Beak, Jang Mi; Yoon, Yeon Hong; Kim, Yun Hyeon [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of); Seon, Hyun Ju [Dept. of Radiology, Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of); Lee, Seung Jin [Dept. of Radiology, Chonnam National University Bitgoeul Hospital, Gwangju (Korea, Republic of)

    2015-01-15

    To evaluate the usefulness of dual-energy computed tomography (DECT) in severity assessment of patients with acute pulmonary thromboembolism (APTE). We evaluated 61 patients diagnosed as APTE from 2011 to 2012 in a retrospective analysis of the severity assessment indices according to Criteria by European Society of Cardiology as well as pulmonary CT angiographic obstruction score (OS) and lung perfusion index (pulmonary perfusion defect score; DS) by DECT. The correlation between OS, DS and the severity of pulmonary thromboembolism was evaluated using logit analysis. Patients with high OS also showed significantly higher DS values (p < 0.001). There was a significant correlation between both the OS and DS values and the severity of the pulmonary thromboembolism using simple sequence logit analysis (p < 0.001). However, only the DS value showed a very high correlation with the severity of pulmonary thromboembolism using multiple sequence logit analysis. DECT provides a more useful marker for the diagnosis and severity assessment of pulmonary thromboembolism by checking the degree of lung perfusion as well as determining the existence of APTE in patients with suspected pulmonary thromboembolism.

  8. d‐Dimer Levels Over Time and the Risk of Recurrent Venous Thromboembolism: An Update of the Vienna Prediction Model

    Science.gov (United States)

    Eichinger, Sabine; Heinze, Georg; Kyrle, Paul A.

    2014-01-01

    Background Patients with unprovoked venous thromboembolism (VTE) can be stratified according to their recurrence risk based on their sex, the VTE location, and d‐dimer measured 3 weeks after anticoagulation by the Vienna Prediction Model. We aimed to expand the model to also assess the recurrence risk from later points on. Methods and Results Five hundred and fifty‐three patients with a first VTE were followed for a median of 68 months. We excluded patients with VTE provoked by a transient risk factor or female hormone intake, with a natural inhibitor deficiency, the lupus anticoagulant, or cancer. The study end point was recurrent VTE, which occurred in 150 patients. d‐Dimer levels did not substantially increase over time. Subdistribution hazard ratios (95% confidence intervals) dynamically changed from 2.43 (1.57 to 3.77) at 3 weeks to 2.27 (1.48 to 3.48), 1.98 (1.30 to 3.02) , and 1.73 (1.11 to 2.69) at 3, 9, and 15 months in men versus women, from 1.84 (1.00 to 3.43) to 1.68 (0.91 to 3.10), 1.49 (0.79 to 2.81) , and 1.44 (0.76 to 2.72) in patients with proximal deep vein thrombosis or pulmonary embolism compared with calf vein thrombosis, and from 1.30 (1.07 to 1.58) to 1.27 (1.06 to 1.51), 1.20 (1.02 to 1.41), and 1.13 (0.95 to 1.36) per doubling d‐dimer. Using a dynamic landmark competing risks regression approach, we generated nomograms and a web‐based calculator to calculate risk scores and recurrence rates from multiple times after anticoagulation. Conclusions Risk of recurrent VTE after discontinuation of anticoagulation can be predicted from multiple random time points by integrating the patient's sex, location of first VTE, and serial d‐dimer measurements. PMID:24385451

  9. Oral contraceptives and venous thromboembolic disease. Analyses of the UK General Practice Research Database and the UK Mediplus database.

    Science.gov (United States)

    Farmer, R D; Lawrenson, R A; Todd, J C; Williams, T J; MacRae, K

    1999-01-01

    The results of three independent studies of venous thromboembolic disease (VTE) and oral contraceptives are reviewed together with two further cohort/case-control studies which we conducted using the MediPlus and General Practice Research Database (GPRD) databases. These latter studies jointly involved 395 cases and uniquely examined the association between VTE and individual combined oral contraceptive (COC) formulations. The two studies yielded very similar results. Crude incidence rates for idiopathic VTE of 4.6 and 3.8 were found per 10,000 exposed woman-years (EWY), in the MediPlus and GPRD studies respectively. Incidence rates increased markedly with age, and in both databases the rates amongst users of levonorgestrel products were lower than those amongst users of desogestrel and gestodene products. A case fatality rate of 3% and a mortality rate of 10 per million EWY were estimated. Odds ratios (OR) were calculated for confounding variables and different COC formulations. Both database studies indicated an excess of current smokers and women with high body mass indices amongst cases. There were significantly more cases with asthma in the GPRD study and cases who had been using their COC for less than a year. No statistically significant differences between COC formulations were found in the analyses where controls were matched to cases by practice and year of birth in both the MediPlus and GPRD studies. In the GPRD study we also ran a study where controls were matched by practice and within 5 year age bands. In this study the OR were consistently higher for the newer or 'third generation' products than when controls were matched by year of birth. However only the acne formulation/OC containing cyproterone acetate and 35 microg ethinyloestradiol yielded a significant OR of 2.3. It may be concluded that improvements in prescribing are paramount as the results strongly indicate that overweight women and those who smoke are at a greater risk of VTE. Further

  10. An economic evaluation of venous thromboembolism prophylaxis strategies in critically ill trauma patients at risk of bleeding.

    Directory of Open Access Journals (Sweden)

    T Carter Chiasson

    2009-06-01

    Full Text Available BACKGROUND: Critically ill trauma patients with severe injuries are at high risk for venous thromboembolism (VTE and bleeding simultaneously. Currently, the optimal VTE prophylaxis strategy is unknown for trauma patients with a contraindication to pharmacological prophylaxis because of a risk of bleeding. METHODS AND FINDINGS: Using decision analysis, we estimated the cost effectiveness of three VTE prophylaxis strategies-pneumatic compression devices (PCDs and expectant management alone, serial Doppler ultrasound (SDU screening, and prophylactic insertion of a vena cava filter (VCF -- in trauma patients admitted to an intensive care unit (ICU with severe injuries who were believed to have a contraindication to pharmacological prophylaxis for up to two weeks because of a risk of major bleeding. Data on the probability of deep vein thrombosis (DVT and pulmonary embolism (PE, and on the effectiveness of the prophylactic strategies, were taken from observational and randomized controlled studies. The probabilities of in-hospital death, ICU and hospital discharge rates, and resource use were taken from a population-based cohort of trauma patients with severe injuries (injury severity scores >12 admitted to the ICU of a regional trauma centre. The incidence of DVT at 12 weeks was similar for the PCD (14.9% and SDU (15.0% strategies, but higher for the VCF (25.7% strategy. Conversely, the incidence of PE at 12 weeks was highest in the PCD strategy (2.9%, followed by the SDU (1.5% and VCF (0.3% strategies. Expected mortality and quality-adjusted life years were nearly identical for all three management strategies. Expected health care costs at 12 weeks were Can$55,831 for the PCD strategy, Can$55,334 for the SDU screening strategy, and Can$57,377 for the VCF strategy, with similar trends noted over a lifetime analysis. CONCLUSIONS: The attributable mortality due to PE in trauma patients with severe injuries is low relative to other causes of mortality

  11. Aspirin combined with mechanical measures to prevent venous thromboembolism after total knee arthroplasty: a randomized controlled trial

    Institute of Scientific and Technical Information of China (English)

    Jiang Yi; Du Hui; Liu Jian; Zhou Yixin

    2014-01-01

    Background Venous thromboembolism (VTE) is an important complication after major orthopedic surgery.Pharmaceutical methods represent the main strategy of VTE prevention.The use of aspirin in VTE prevention is still controversial worldwide,especially in China.The purpose of this study was to evaluate the role of aspirin combined with mechanical measures in the prevention of VTE after total knee arthroplasty (TKA).Methods Between January 2012 and May 2013 and in accordance with the inclusion criteria,120 patients undergoing TKA were randomly allocated to two groups.To prevent VTE,patients in group A received aspirin combined with mechanical measures postoperatively,while patients in group B received low-molecular-weight heparin (LMWH) sodium and rivaroxaban sequentially in combination with mechanical measures postoperatively.All surgeries were performed by one surgeon using a posterior-stabilized cemented prosthesis.The two groups were followed up and compared for the incidence of deep vein thrombosis (DVT) by duplex ultrasound scan and clinical VTE events.The adverse events,the blood loss index,and the cost of VTE prevention were also compared.Results DVT was detected in 10 of 60 patients in group A (16.7%,95% CI:7.3%-26.1%) compared with 11 of 60 in group B (18.3%,95% CI:8.5%-27.8%) (P=0.500).There is no statistical evidence supporting the inferior effect of aspirin in preventing DVT as compared with the other medications.There were no cases of symptomatic VTE or death during the follow-up period.Area of ecchymosis was lower in group A than in group B,and the differences were statistically significant.Patients in group A had the lower blood loss index as compared with patients in group B.No transfusion cases were found in both groups.The differences were statistically significant.The cost of VTE prevention analysis indicated a cost reduction using aspirin in group A compared with using LMWH and rivaroxaban in group B.Conclusion Aspirin combined with

  12. Diagnóstico por imagem do tromboembolismo pulmonar agudo Imaging of acute pulmonary thromboembolism

    Directory of Open Access Journals (Sweden)

    C. Isabela S. Silva

    2004-10-01

    Full Text Available O diagnóstico do tromboembolismo pulmonar agudo é baseado na probabilidade clínica, uso do dímero D (quando disponível e na avaliação por imagem. Os principais métodos de imagem utilizados no diagnóstico são representados por cintilografia ventilação-perfusão, angiografia pulmonar e tomografia computadorizada (TC. Na última década vários estudos têm demonstrado que a TC espiral apresenta elevada sensibilidade e especificidade no diagnóstico de tromboembolismo pulmonar agudo. Uma melhor avaliação das artérias pulmonares tornou-se possível com a recente introdução dos equipamentos de TC espirais com multidetectores. Vários pesquisadores têm sugerido que a angiografia pulmonar por TC espiral deve substituir a cintilografia na avaliação de pacientes com suspeita clinica de tromboembolismo pulmonar agudo. Os autores discutem os principais métodos de imagem utilizados no diagnóstico de tromboembolismo pulmonar agudo enfatizando o papel da TC espiral.The diagnosis of acute pulmonary thromboembolism is based on the clinical probability, use of D-dimer (when available and imaging. The main imaging modalities used in the diagnosis are ventilation-perfusion (V/Q, scintigraphy, angiography, and computed tomography (CT. In the last decade several studies have demonstrated that spiral CT has a high sensitivity and specificity in the diagnosis of acute pulmonary thromboembolism. The evaluation of the pulmonary arteries has further improved with the recent introduction of multidetector spiral CT scanners. Various investigators have suggested that spiral CT pulmonary angiography should replace scintigraphy in the assessment of patients whose symptoms are suggestive of acute PE. This article discusses the role of the various imaging modalities in the diagnosis of acute pulmonary thromboembolism with emphasis on the role of spiral CT.

  13. Venous Thromboembolism Anticoagulation Therapy

    Institute of Scientific and Technical Information of China (English)

    刘泽霖

    2009-01-01

    @@ VTE of the main treatment for anticoagulant thera-py, anticoagulant therapy drug of choice for low molecu-lar weight heparin (LMWH) for the overwhelming major-ity of clinicians agree that long-term oral anticoagulant therapy is still Vit. K antagonist (mainly warfarin).

  14. Venous thromboembolism in women

    DEFF Research Database (Denmark)

    Group, ESHRE Capri Workshop; Skouby, Sven Olaf

    2013-01-01

    is associated with an inherited thrombophilia in men and women. Changes in the coagulation system and in the risk of clinical VTE in women also occur during pregnancy, with the use of reproductive hormones and as a consequence of ovarian stimulation when hyperstimulation syndrome and conception occur together...... therapy (HRT) increases the VTE risk 2- to 4-fold. There is a synergistic effect between thrombophilia and the various reproductive risks. Prevention of VTE during pregnancy should be offered to women with specific risk factors. In women who are at high risk, CHC and HRT should be avoided. CONCLUSIONS...

  15. Hospitalized ulcerative colitis patients have an elevated risk of thromboembolic events

    Institute of Scientific and Technical Information of China (English)

    Jennifer Y Wang; Jonathan P Terdiman; Eric Vittinghoff; Tracy Minichiello; Madhulika G Varma

    2009-01-01

    AIM: To compare thromboembolism rates between hospitalized patients with a diagnosis of ulcerative colitis and other hospitalized patients at high risk for thromboembolism. To compare thromboembolism rates between patients with ulcerative colitis undergoing a colorectal operation and other patients undergoing colorectal operations. METHODS: Data from the National Hospital Discharge Survey was used to compare thromboembolism rates between (1) hospitalized patients with a discharge diagnosis of ulcerative colitis and those with diverticulitis or acute respiratory failure, and (2) hospitalized patients with a discharge diagnosis of ulcerative colitis who underwent colectomy and those with diverticulitis or colorectal cancer who underwent colorectal operations. RESULTS: Patients diagnosed with ulcerative colitis had similar or higher rates of combined venous thromboembolism (2.03%) than their counterparts with diverticulitis (0.76%) or respiratory failure (1.99%), despite the overall greater prevalence of thromboembolic risk factors in the latter groups. Discharged patients with colitis that were treated surgically did not have significantly different rates of venous or arterial thromboembolism than those with surgery for diverticulitis or colorectal cancer. CONCLUSION: Patients with ulcerative colitis who do not undergo an operation during their hospitalization have similar or higher rates of thromboembolism than other medical patients who are considered to be high risk for thromboembolism.

  16. A prospective cohort study on the absolute risks of venous thromboembolism and predictive value of screening asymptomatic relatives of patients with hereditary deficiencies of protein S, protein C or antithrombin

    NARCIS (Netherlands)

    Mahmoodi, B. K.; Brouwer, J-L P.; Ten Kate, M. K.; Lijfering, W. M.; Veeger, N. J. G. M.; Mulder, A. B.; Kluin-Nelemans, H. C.; van der Meer, J.

    2010-01-01

    Background: Absolute risks of venous thromboembolism (VTE) in protein S-, protein C-, or antithrombin-deficient subjects are mainly based on retrospective data. Screening asymptomatic relatives of these patients is disputed, though studies addressing this issue have yet to be conducted. Methods: We

  17. A prospective cohort study on the absolute risks of venous thromboembolism and predictive value of screening asymptomatic relatives of patients with hereditary deficiencies of protein S, protein C or antithrombin.

    NARCIS (Netherlands)

    Mahmoodi, B.K.; Brouwer, J.L.P.; Kate, M.K. Ten; Lijfering, W.M.; Veeger, N.J.; Mulder, A.B.; Kluin-Nelemans, H.C.; Meer, J. van der

    2010-01-01

    BACKGROUND: Absolute risks of venous thromboembolism (VTE) in protein S-, protein C-, or antithrombin-deficient subjects are mainly based on retrospective data. Screening asymptomatic relatives of these patients is disputed, though studies addressing this issue have yet to be conducted. METHODS: We

  18. The use of long-term low-molecular weight heparin for the treatment of venous thromboembolism in palliative care patients with advanced cancer : a case series of sixty two patients

    NARCIS (Netherlands)

    Noble, Sir; Hood, K.; Finlay, I. G.

    2007-01-01

    The advantages of low-molecular weight heparin (LMVVH) over warfarin, in the treatment of cancer associated venous thromboembolism (VTE) are well reported. However the studies supporting LMWH include few patients representative of the palliative care population. Although LMWH has advantages over war

  19. Direct oral anticoagulants in the treatment of venous thromboembolism, with a focus on patients with pulmonary embolism: an evidence-based review

    Directory of Open Access Journals (Sweden)

    Gómez-Outes A

    2014-11-01

    Full Text Available Antonio Gómez-Outes,1 Mª Luisa Suárez-Gea,1 Ramón Lecumberri,2 Ana Isabel Terleira-Fernández,3,4 Emilio Vargas-Castrillón3,41Division of Pharmacology and Clinical Evaluation, Medicines for Human Use, Spanish Agency for Medicines and Medical Devices (AEMPS, Madrid, Spain; 2Department of Hematology, University Clinic of Navarra, Pamplona, Spain; 3Department of Clinical Pharmacology, Hospital Clínico, Madrid, Spain; 4Department of Pharmacology, Universidad Complutense, Madrid, SpainAbstract: Pulmonary embolism (PE is a relatively common cardiovascular emergency. PE and deep vein thrombosis (DVT are considered expressions of the same disease, termed as venous thromboembolism (VTE. In the present review, we describe and meta-analyze the efficacy and safety data available with the direct oral anticoagulants (DOAC; dabigatran, rivaroxaban, apixaban, edoxaban in clinical trials testing these new compounds in the acute/long-term and extended therapy of VTE, providing subgroup analyses in patients with index PE. We analyzed ten studies in 35,019 randomized patients. A total of 14,364 patients (41% had index PE. In the acute/long-term treatment of VTE, the DOAC showed comparable efficacy in preventing recurrent VTE to standard treatment in patients with index PE (risk ratio [RR]: 0.88; 95% confidence interval [CI]: 0.70–1.11 and index DVT (RR: 0.93; 95% CI: 0.75–1.16 (P for subgroup differences =0.76. VTE recurrence depending on PE anatomical extension and presence/absence of right ventricular dysfunction was only reported in two trials, with results being consistent with those obtained in the overall study populations. In the single trial comparing extended therapy of VTE with DOAC versus warfarin, the point estimate for recurrent VTE tended to disfavor the DOAC in patients with index PE (RR: 2.05; 95% CI: 0.83–5.03 and in patients with index DVT (RR: 1.11; 95% CI: 0.49–2.50 (P for subgroup differences =0.32. In trials that compared DOAC

  20. AVE5026, a new hemisynthetic ultra-low-molecular-weight heparin for the prevention of venous thromboembolism in patients after total knee replacement surgery

    DEFF Research Database (Denmark)

    Lassen, Michael Rud; Dahl, O E; Mismetti, P

    2009-01-01

    BACKGROUND: AVE5026 is a new hemisynthetic ultra-low-molecular-weight heparin, with a novel anti-thrombotic profile resulting from high anti-factor (F)Xa activity and residual anti-FIIa activity. AVE5026 is in clinical development for venous thromboembolism (VTE) prevention, a frequent complication......-daily doses of AVE5026 (5, 10, 20, 40, or 60 mg) or enoxaparin 40 mg in the calibrator arm. The primary efficacy end point was VTE until post-operative day 11, defined as deep vein thrombosis (DVT) detected by bilateral venography, symptomatic DVT, non-fatal pulmonary embolism (PE) and VTE-related death......: The safety and efficacy results of this study suggest that a AVE5026 dose of between 20 and 40 mg presents an adequate benefit-to-risk ratio....

  1. Independent predictors of poor vitamin K antagonist control in venous thromboembolism patients. Data from the EINSTEIN-DVT and PE studies.

    Science.gov (United States)

    Kooistra, Hilde A M; Gebel, Martin; Sahin, Kurtulus; Lensing, Anthonie W A; Meijer, Karina

    2015-11-25

    Vitamin K antagonists (VKA) are used to prevent recurrent disease in patients with venous thromboembolism (VTE). Their efficacy and safety depend on individual time in therapeutic range (iTTR) and variability of International Normalised Ratios (INR). We aimed to identify independent predictors of poor VKA control > 28 days. In a prospective cohort of 3825 VTE patients, separate logistic regression analyses were performed to identify predictors of low iTTR (first quartile) and instability (iTTR median). Subsequently, the association between these predictors and clinical outcomes was investigated. Weight  28 days, which showed some similarities but did not fully overlap. Early VKA control was of additional value for prediction of both, but had to be interpreted in the context of VKA type.

  2. Novos anticoagulantes orais no tromboembolismo venoso e fibrilhação auricular New oral anticoagulants in the treatment of venous thromboembolism and atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Luís Silvestre

    2012-03-01

    Full Text Available Os antagonistas da vitamina K foram, durante mais de 50 anos, os únicos anticoagulantes orais disponiveis. A imprevisibilidade da farmacocinética e farmacodinâmica desta classe de fármacos, responsável pela dificuldade na sua utilização, conduziu à necessidade do desenvolvimento de novas moléculas anticoagulantes. Estão actualmente diponíveis os resultados dos estudos de novos anticoagulantes orais no tromboembolismo venoso e na fibrilhação auricular, que se revêem neste trabalho.For more than 50 years, vitamin K antagonists were the only oral anticoagulants available. The unpredictability of its pharmacokinetics and pharmacodynamics, responsible for its difficult clinical management, has raised the need of new anticoagulants. Results of trials involving the new anticoagulants in venous thromboembolism and atrial fibrillation are now available and reviewed in this paper.

  3. Venous thromboembolism prophylaxis in meningioma surgery - a population based comparative effectiveness study of routine mechanical prophylaxis with or without preoperative low molecular weight heparin

    DEFF Research Database (Denmark)

    Sjåvik, Kristin; Bartek, Jiri; Solheim, Ole;

    2015-01-01

    OBJECT: Venous thromboembolism (VTE) is a serious complication after intracranial meningioma surgery. To what extent systemic prophylaxis with pharmacotherapy is beneficial with respect to VTE risk, or associated with increased risk of bleeding and postoperative hemorrhage, remains debated....... The current study aimed to clarify the risk-benefit of prophylactic pharmacotherapy initiated the evening before craniotomy for meningioma. METHODS: In a Scandinavian population-based cohort we conducted a retrospective review of 979 operations for intracranial meningioma between 2007 and 2013 at three...... neurosurgical centers with population-based referral. We compared two different treatment strategies analyzing frequencies of VTE and proportions of postoperative intracranial hematomas requiring surgery or intensified subsequent observation or care (ICU or other intensified observation and/or treatment). One...

  4. Clozapine-Induced Late Agranulocytosis and Severe Neutropenia Complicated with Streptococcus pneumonia, Venous Thromboembolism, and Allergic Vasculitis in Treatment-Resistant Female Psychosis

    Directory of Open Access Journals (Sweden)

    Christina Voulgari

    2015-01-01

    Full Text Available Clozapine is a second-generation antipsychotic agent from the benzodiazepine group indicated for treatment-resistant schizophrenia and other psychotic conditions. Using clozapine earlier on once a case appears to be refractory limits both social and personal morbidity of chronic psychosis. However treatment with second-generation antipsychotics is often complicated by adverse effects. We present a case of a 33-year-old Caucasian woman with a 25-year history of refractory psychotic mania after switching to a 2-year clozapine therapy. She presented clozapine-induced absolute neutropenia, agranulocytosis, which were complicated by Streptococcus pneumonia and sepsis. Clozapine-induced thromboembolism of the common femoral and right proximal iliac vein, as well as allergic vasculitis, was diagnosed. She achieved full remission on granulocyte-colony stimulating factor and specific antibiotic treatment. Early detection of severe clozapine-induced absolute neutropenia and agranulocytosis enabled the effective treatment of two among its most severe complications. Additional evidence to the previously reported possible causal relation between clozapine and venous thromboembolism is offered. Finally, clozapine-induced allergic vasculitis is confirmed as a late adverse effect of clozapine therapy.

  5. The frequencies of FV Leiden and FII G20210A mutations in patients with different clinical manifestations of venous thromboembolism: Experience from large Serbian cohort

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    Tomić Branko

    2016-01-01

    Full Text Available Venous thromboembolism is a multifactorial disorder with two manifestations: deep-vein thrombosis and pulmonary embolism. Pulmonary embolism is usually considered as the complication of deep-vein thrombosis, but there are reported cases of isolated pulmonary embolism. FV Leiden and FII G20210A mutations are most common genetic risk factors for the venous thromboembolism. Several studies reported "FV Leiden paradox": lower prevalence of FV Leiden mutation among patients with isolated pulmonary embolism than among those with deep-vein thrombosis. The aim of this study was to determine FV Leiden and FII G20210A mutations frequency in thrombophilic patients in Serbian population. We tested prevalence of these mutations carriers in 1427 individuals divided in three groups of patients (with deep-vein thrombosis, deep-vein thrombosis/ pulmonary embolism and isolated pulmonary embolism and control group. All subjects were tested for these mutations using PCR-RFLP analysis. Detected frequency of FV Leiden heterozygous carriers in patients with isolated pulmonary embolism was 6.9% (for FII G20210A 11.6%, while in other two groups of patients with deep-vein thrombosis and deep vein thrombosis/pulmonary embolism, frequency was 18.6% (for FII G20210A mutation were 11.6% and 8.3%, respectively. Our results showed that FV Leiden mutation is less frequent in patients with isolated pulmonary embolism than in patients with deep-vein thrombosis or deep-vein thrombosis accompanied with pulmonary embolism, confirming "FV Leiden paradox". On the other hand, detected frequency of FII G20210A mutation carriers was similar in all three groups of patients. [Projekat Ministarstva nauke Republike Srbije, br. 173008

  6. Multicentre validation of the Geneva Risk Score for hospitalised medical patients at risk of venous thromboembolism. Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE).

    Science.gov (United States)

    Nendaz, M; Spirk, D; Kucher, N; Aujesky, D; Hayoz, D; Beer, J H; Husmann, M; Frauchiger, B; Korte, W; Wuillemin, W A; Jäger, K; Righini, M; Bounameaux, H

    2014-03-03

    There is a need to validate risk assessment tools for hospitalised medical patients at risk of venous thromboembolism (VTE). We investigated whether a predefined cut-off of the Geneva Risk Score, as compared to the Padua Prediction Score, accurately distinguishes low-risk from high-risk patients regardless of the use of thromboprophylaxis. In the multicentre, prospective Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE) cohort study, 1,478 hospitalised medical patients were enrolled of whom 637 (43%) did not receive thromboprophylaxis. The primary endpoint was symptomatic VTE or VTE-related death at 90 days. The study is registered at ClinicalTrials.gov, number NCT01277536. According to the Geneva Risk Score, the cumulative rate of the primary endpoint was 3.2% (95% confidence interval [CI] 2.2-4.6%) in 962 high-risk vs 0.6% (95% CI 0.2-1.9%) in 516 low-risk patients (p=0.002); among patients without prophylaxis, this rate was 3.5% vs 0.8% (p=0.029), respectively. In comparison, the Padua Prediction Score yielded a cumulative rate of the primary endpoint of 3.5% (95% CI 2.3-5.3%) in 714 high-risk vs 1.1% (95% CI 0.6-2.3%) in 764 low-risk patients (p=0.002); among patients without prophylaxis, this rate was 3.2% vs 1.5% (p=0.130), respectively. Negative likelihood ratio was 0.28 (95% CI 0.10-0.83) for the Geneva Risk Score and 0.51 (95% CI 0.28-0.93) for the Padua Prediction Score. In conclusion, among hospitalised medical patients, the Geneva Risk Score predicted VTE and VTE-related mortality and compared favourably with the Padua Prediction Score, particularly for its accuracy to identify low-risk patients who do not require thromboprophylaxis.

  7. Endovascular Interventions for Acute and Chronic Lower Extremity Deep Venous Disease: State of the Art.

    Science.gov (United States)

    Sista, Akhilesh K; Vedantham, Suresh; Kaufman, John A; Madoff, David C

    2015-07-01

    The societal and individual burden caused by acute and chronic lower extremity venous disease is considerable. In the past several decades, minimally invasive endovascular interventions have been developed to reduce thrombus burden in the setting of acute deep venous thrombosis to prevent both short- and long-term morbidity and to recanalize chronically occluded or stenosed postthrombotic or nonthrombotic veins in symptomatic patients. This state-of-the-art review provides an overview of the techniques and challenges, rationale, patient selection criteria, complications, postinterventional care, and outcomes data for endovascular intervention in the setting of acute and chronic lower extremity deep venous disease. Online supplemental material is available for this article.

  8. Profilaxia de tromboembolismo venoso em pacientes com lesão cerebral traumática Venous thromboembolism prophylaxis in patients with traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Tanya L. Zakrison

    2012-12-01

    Full Text Available Traumatismo crânio-encefálico (TCE, com hemorragia intracraniana associada (HIC ocorre com frequência em trauma. Pacientes vítimas de trauma também estão em alto risco de desenvolver complicações venosas tromboembólicas (TEV. Heparina de Baixo Peso Molecular (HBPM é utilizada em pacientes de trauma, como profilaxia para reduzir o risco de eventos de TEV. Ainda não está claro, no entanto, se a HBPM é segura para uso em pacientes com trauma com HIC por receio da progressão do hematoma. O Clube de Revista "Telemedicina Baseada em Evidências: Cirurgia do Trauma e Emergência (TBE-CiTE" realizou uma apreciação crítica de três estudos recentes e mais relevantes no tocante ao momento de início da profilaxia, à segurança e ao uso de HBPM em pacientes com trauma e HIC. Especificamente, três estudos foram revisados: i uma revisão crítica da literatura sobre o tema, ii um estudo multicêntrico, estudo de coorte retrospectivo avaliando a segurança de HBPM em pacientes com trauma, e com HIC e iii um estudo piloto randomizado, avaliando a viabilidade e as taxas de eventos de progressão de HIC, servindo como base para futuros ensaios clínicos randomizados (ECR sobre o tema. Alguns resultados são conflitantes, com o maior nível de evidência sendo o ECR piloto demonstrando a segurança para o uso precoce de HBPM no TCE associado com HIC. Grande parte desta pesquisa, porém, foi gerada por um único centro e, consequentemente, carece de validade externa. Além disso, as recomendações clínicas não podem ser geradas com base em estudos-piloto. Diretrizes baseadas em evidências e recomendações não podem ser feitas, neste momento, até a realização de outros estudos sobre este assunto desafiador.Traumatic brain injury (TBI with associated intracranial hemorrhage (ICH occurs frequently in trauma. Trauma patients are also at high risk of developing venous thromboembolic (VTE complications. Low Molecular Weight Heparin (LMWH is

  9. Pulmonary thromboembolism associated with renal insufficiency due to renal artery thrombosis

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    Vučičević-Trobok Jadranka

    2002-01-01

    Full Text Available Pulmonary thromboembolism is a clinical and pathophysiological condition caused by occlusion of pulmonary arteries by thrombotic embolus. Deep venous thrombosis needn't necessarily be evident. Acute renal insufficiency is a syndrome manifested by rapid decrease or even complete urinary retention which may be due to obturation of renal arteries by a thrombus. The condition is clinically manifested by hematuria, oliguria, anuria and death due to uremia. Case Report The patient had a history of disease and a chest X-ray finding both irrelevant for establishing the working diagnosis. Blood gas analysis presented prominent hypoxemia with hyperventilation and ECG finding exhibited right heart overload, pointing to pulmonary thromboembolism. On the third day of treatment with heparin, the patient developed hematuria, oliguria and excessive elevation of nitrogen in blood as a sign of acute renal insufficiency, leading to fatal outcome. Autopsy revealed deep venous thrombosis of the left femoral vein, with massive pulmonary thromboembolism and thrombosis of both femoral arteries, inducing acute renal failure. Discussion Although the patient had a typical radiologic presentation of pulmonary thromboembolism, treatment with heparin was initiated on the basis of his blood gas analysis and ECG findings. Deep venous thrombosis was not clinically evident and acute renal failure could not be explained during patient's lifetime. Conclusion This is a rare case of acute renal failure due to a rare occurrence of bilateral acute thrombosis of renal arteries.

  10. Pregnancy after catheter-directed thrombolysis for acute iliofemoral deep venous thrombosis

    DEFF Research Database (Denmark)

    Jørgensen, M; Broholm, R; Bækgaard, N

    2013-01-01

    To assess the safety and efficacy of low-molecular-weight heparin (LMWH) in pregnancy and puerperium in women with previous acute iliofemoral deep venous thrombosis (DVT) treated with catheter-directed thrombolysis (CDT).......To assess the safety and efficacy of low-molecular-weight heparin (LMWH) in pregnancy and puerperium in women with previous acute iliofemoral deep venous thrombosis (DVT) treated with catheter-directed thrombolysis (CDT)....

  11. Tissue factor pathway inhibitor relates to fibrin degradation in patients with acute deep venous thrombosis

    DEFF Research Database (Denmark)

    Sidelmann, Johannes J; Bladbjerg, Else-Marie; Gram, Jørgen

    2008-01-01

    Reduced concentration of tissue factor pathway inhibitor is a risk factor for development of deep venous thrombosis, whereas elevated concentrations of tissue factor pathway inhibitor are observed in patients with acute myocardial infarction and disseminated intravascular coagulation. Presently, we...... studied the association between inflammation, endothelial cell perturbation, fibrin degradation and the concentration of tissue factor pathway inhibitor in patients suspected for acute deep venous thrombosis. We determined the tissue factor pathway inhibitor -33T/C polymorphism, free and total tissue...... factor pathway inhibitor, C-reactive protein, von Willebrand factor and D-Dimer in 160 consecutive patients admitted to hospital with a tentative diagnosis of acute deep venous thrombosis. Deep venous thrombosis was identified in 57 patients (18 distal and 39 proximal). The distribution of the tissue...

  12. Thromboembolism in Patients with Cancer.

    Science.gov (United States)

    Büyükçelik, Abdullah; Akbulut, Hakan

    2004-03-01

    One hundred and forty years ago, Armand Trousseau described phlegmasia alba dolens as a sign of internal malignancy. Nowadays, it is commonly believed that the presence malignant tumaor increases the risk of venous thromboembolism (i.e deep vein thrombosis and pulmonary embolism) However, cancer is usually associated with other factors such as old age, extensive surgery,immobility, etc., which may predispose to thromboembolism. The majority of thrombotic events occur in the venous system; the incidence of arterial thrombosis is much lower.Recurrent thromboembolism in cancer patients frequently and diminishes the quality of life of the patients.Furthermore, if the thromboembolism is massive, destipte of early and aggressive treatment, it may result in death. In this article, we review thromboembolic complications in cancer patients.

  13. Risk of venous thromboembolism after total hip and knee replacement in older adults with comorbidity and co-occurring comorbidities in the Nationwide Inpatient Sample (2003-2006

    Directory of Open Access Journals (Sweden)

    Katz Jeffrey N

    2010-09-01

    Full Text Available Abstract Background Venous thromboembolism is a common, fatal, and costly injury which complicates major surgery in older adults. The American College of Chest Physicians recommends high potency prophylaxis regimens for individuals undergoing total hip or knee replacement (THR or TKR, but surgeons are reluctant to prescribe them due to fear of excess bleeding. Identifying a high risk cohort such as older adults with comorbidities and co-occurring comorbidities who might benefit most from high potency prophylaxis would improve how we currently perform preoperative assessment. Methods Using the Nationwide Inpatient Sample, we identified older adults who underwent THR or TKR in the U.S. between 2003 and 2006. Our outcome was VTE, including any pulmonary embolus or deep venous thrombosis. We performed multivariate logistic regression analyses to assess the effects of comorbidities on VTE occurrence. Comorbidities under consideration included coronary artery disease, congestive heart failure (CHF, chronic obstructive pulmonary disease (COPD, diabetes, and cerebrovascular disease. We also examined the impact of co-occurring comorbidities on VTE rates. Results CHF increased odds of VTE in both the THR cohort (OR = 3.08 95% CI 2.05-4.65 and TKR cohort (OR = 2.47 95% CI 1.95-3.14. COPD led to a 50% increase in odds in the TKR cohort (OR = 1.49 95% CI 1.31-1.70. The data did not support synergistic effect of co-occurring comorbidities with respect to VTE occurrence. Conclusions Older adults with CHF undergoing THR or TKR and with COPD undergoing TKR are at increased risk of VTE. If confirmed in other datasets, these older adults may benefit from higher potency prophylaxis.

  14. Atypical Presentation of Disseminated Intravascular Coagulation with Synchronous Peripheral Venous Thromboembolism and Arterial Gangrene in a Pancreatic Cancer Patient: A Case Report

    Directory of Open Access Journals (Sweden)

    Tulay Kus

    2015-05-01

    Full Text Available Context Cancer is a prothrombotic state and anticancer therapies are often complicated by vascular events. The risk of developing thromboembolic events is substantially increased in patients with pancreatic cancer. One possible presentation of vascular events in pancreatic cancer is disseminated intravascular coagulation (DIC. Case report In our case a patient with a diagnosis of pancreatic cancer initially presented with thrombosis and received low molecular weight heparin (LMWH in addition to standard chemotherapy regimen. He was thought to have DIC by assessment of clinical and laboratory findings. Conclusion Clinically, thrombosis was first located in the left femoral vein and encountered at right femoral artery after three weeks. This pattern was an unusual presentation of DIC. Subclinical DIC is common in patients presenting with pancreatic cancer and is considered a ‘poor’ prognostic factor. Acute DIC, on the other hand is a potentiallymortal condition.

  15. 肿瘤患者PICC导管相关静脉血栓形成影响因素Meta分析%Risk factors of venous thromboembolism associated with peripherally inserted central catheters among cancer patients:a

    Institute of Scientific and Technical Information of China (English)

    于瑞; 陈利芬

    2016-01-01

     目的:综合分析肿瘤患者PICC导管相关静脉血栓形成的危险因素,为预防PICC导管相关静脉血栓形成提供理论依据。方法:计算机检索Web of Science、PubMed、Cochrane Library、OVID EBM Reviews、 CNKI、万方数据、CBM及VIP,并辅以手工检索、文献追溯等方法收集符合标准的文献,采用Stata 12.1软件进行合并分析。结果:纳入符合标准的文献6篇,合计样本量1277例,其中血栓组253例,对照组1024例,血栓发生率为19.81%。Meta分析结果显示,化疗史、糖尿病、高血压、COPD、活动量减少与PICC导管相关静脉血栓形成有关。结论:化疗史、糖尿病、高血压、COPD、活动量减少是PICC导管相关静脉血栓形成的危险因素。%Objective: To analyze the risk factors of venous thromboembolism associated with peripherally inserted central catheters (PICC) among cancer patients, and to provide theoretical basis for prevention venous thromboembolism associated with PICC among cancer patients. Methods: We searched the related papers from the Web of Science, PubMed, Cochrane Library, OVID EBM Reviews, CNKI, Wan Fang Databases, CBM and VIP. The Stata 12.1 software was used to conduct the meta-analysis. Results: Six studies were included in the study. The sample size was 1277 with 253 cases in venous thromboembolism group and 1024 cases in control group. The incidence rate of venous thromboembolism associated with PICC was 19.81%. Meta-analysis showed that the risk factors were history of chemotherapy, diabetes, hypertension, COPD, and less activity. Conclusion: The risk factors of venous thromboembolism associated with PICC among cancer patients are history of chemotherapy, diabetes, hypertension, COPD, and less activity.

  16. Safety and efficacy of direct oral anticoagulants compared to warfarin for extended treatment of venous thromboembolism -a systematic review and meta-analysis

    DEFF Research Database (Denmark)

    Sindet-Pedersen, Caroline; Pallisgaard, Jannik Langtved; Olesen, Jonas Bjerring;

    2015-01-01

    OBJECTIVE: To examine and compare the safety and efficacy of extended treatment with dabigatran, apixaban, rivaroxaban and warfarin in patients with unprovoked venous thromboembolism. METHODS: PubMed and Embase were searched for randomized clinical trials reporting on the use of direct oral...... in the study. 5 studies were included in the meta-analysis. Results from the meta-analysis showed that the extended use of DOACs and warfarin significantly decreased the risk of recurrent VTE with 83 % when compared placebo. Warfarin (RR: 0.03, CI: 0.00-0.49) and dabigatran (RR: 0.08, CI: 0.03-0.27) showed......-analysis that dabigatran was non-inferior to VKA for the prevention of recurrent VTE (HR: 1.44, CI: 0.78-2.64, p=0.01 for noninferiority) and decreased the risk of NMCRB compared to VKA (RR: 0.58, CI: 0.43-0.77). CONCLUSION: Extended treatment with both warfarin and DOACs are effective in preventing recurrent VTE and does...

  17. Treatment of venous thromboembolism – effects of different therapeutic strategies on bleeding and recurrence rates and considerations for future anticoagulant management

    Directory of Open Access Journals (Sweden)

    Hass Bastian

    2012-12-01

    Full Text Available Abstract Effective treatment of venous thromboembolism (VTE strikes a balance between prevention of recurrence and bleeding complications. The current standard of care is heparin followed by a vitamin K antagonist such as warfarin. However, this option is not without its limitations, as the anticoagulant effect of warfarin is associated with high inter- and intra-patient variability and patients must be regularly monitored to ensure that anticoagulation is within the narrow target therapeutic range. Several novel oral anticoagulant agents are in the advanced stages of development for VTE treatment, some of which are given after an initial period of heparin treatment, in line with current practice, while others switch from high to low doses after the initial phase of treatment. In this review we assess the critical considerations for treating VTE in light of emerging clinical data for new oral agents and discuss the merits of novel treatment regimens for patients who have experienced an episode of deep vein thrombosis or pulmonary embolism.

  18. The efficacy and safety of pharmacological prophylaxis of venous thromboembolism following elective knee or hip replacement: systematic review and network meta-analysis.

    Science.gov (United States)

    Cohen, Alexander; Drost, Pieter; Marchant, Nick; Mitchell, Stephen; Orme, Michelle; Rublee, Dale; Simon, Teresa A; Sutton, Alex

    2012-11-01

    The present systematic review was conducted to assess the efficacy and safety of apixaban versus other anticoagulants, for the prevention of venous thromboembolism (VTE) following total hip replacement (THR) and total knee replacement (TKR) surgery. Electronic databases were interrogated to identify relevant randomized controlled trials. A series of direct/indirect comparisons and a network meta-analysis were conducted. Indirect comparisons found that the odds ratio of "all VTE and all-cause death" were significantly higher for dabigatran than for apixaban in patients with THR (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.50-4.21) and TKR (OR, 1.72; 95% CI, 1.22-2.42). Rivaroxaban showed similar efficacy to apixaban in patients with THR and TKR (OR, 0.69; 95% CI, 0.38-1.25 and OR, 0.83; 95% CI, 0.57-1.19, respectively). No significant differences were observed in bleeding outcomes between treatments. The novel anticoagulants apixaban, rivaroxaban, and dabigatran demonstrated similar or improved efficacy and similar safety compared with current therapies in this indication.

  19. Acute Mesenteric Venous Thrombosis with a Vaginal Contraceptive Ring

    Directory of Open Access Journals (Sweden)

    Wesley Eilbert

    2014-07-01

    Full Text Available Mesenteric venous thrombosis is a rare cause of abdominal pain, which if left untreated may result in bowel infarction, peritonitis and death. The majority of patients with this illness have a recognizable, predisposing prothrombotic condition. Oral contraceptives have been identified as a predisposing factor for mesenteric venous thrombosis in reproductive-aged women. In the last fifteen years new methods of hormonal birth control have been introduced, including a transdermal patch and an intravaginal ring. In this report, we describe a case of mesenteric venous thrombosis in a young woman caused by a vaginal contraceptive ring. [West J Emerg Med. 2014;15(4:395-397.

  20. Acute Portomesenteric Venous Thrombosis following Laparoscopic Small Bowel Resection and Ventral Hernia Repair

    Directory of Open Access Journals (Sweden)

    Bhradeev Sivasambu

    2015-01-01

    Full Text Available Acute portomesenteric venous thrombosis is a rare but life-threatening complication of laparoscopic surgery that has been described in literature. Prompt diagnosis and early initiation of treatment are vital to prevent life-threatening complications such as mesenteric ischemia and infarction. A 51-year-old lady had laparoscopic small bowel resection and primary anastomosis with ventral hernia repair 4 weeks earlier for partial small bowel obstruction. Her postoperative period was uneventful and she was discharged home. Four weeks after surgery she developed watery diarrhea and generalized abdominal pain for four-day duration. A computed tomography of the abdomen revealed portomesenteric venous thrombosis although a computed tomography of abdomen before surgery 4 weeks back did not show any portomesenteric venous thrombosis. We are reporting a case of acute portomesenteric venous thrombosis as a complication of laparoscopic surgery.

  1. Dabigatran for the prevention and treatment of thromboembolic disorders.

    Science.gov (United States)

    Enriquez, Andres; Baranchuk, Adrian; Redfearn, Damian; Simpson, Christopher; Abdollah, Hoshiar; Michael, Kevin

    2015-05-01

    Dabigatran, an oral direct thrombin inhibitor, was the first of a new class of drugs referred to as non-vitamin K oral anticoagulants. Dabigatran is better than warfarin for stroke prevention in non-valvular atrial fibrillation (dose of 150 mg twice a day), non-inferior to enoxaparin for venous thromboembolism prevention after orthopedic surgery and non-inferior to warfarin in preventing recurrence after acute venous thromboembolism. The safety profile is similar to standard anticoagulants, with significant reduction observed in intracranial hemorrhage. Other advantages include a rapid onset of action and a predictable pharmacokinetic profile, allowing a fixed-dose regimen without the need for routine anticoagulation monitoring. In the event of bleeding, general support measures are recommended and if severe, the use of non-specific hemostatic agents such as prothrombin complex concentrates and recombinant factor VIIa must be considered. A specific reversal agent (idarucizumab) is in development.

  2. Plasma Vitamin D Status and Its Correlation with Risk Factors of Thrombosis, P-selectin and hs-CRP Level in Patients with Venous Thromboembolism; the First Study of Iranian Population.

    Science.gov (United States)

    Entezari-Maleki, Taher; Hajhossein Talasaz, Azita; Salarifar, Mojtaba; Hadjibabaie, Molouk; Javadi, Mohammad Reza; Bozorgi, Ali; Jenab, Yaser; Boroumand, Mohammad Ali; Gholami, Kheirollah

    2014-01-01

    Low plasma level of vitamin D is linked to the increased risk of cardiovascular diseases such as hypertension, diabetes, dyslipidemia and peripheral vascular diseases. Vitamin D deficiency is a worldwide problem that involves Iranian population. To the best of our knowledge, this was the first investigation on venous thromboembolism (VTE) subjects that assessed the correlation of vitamin D level with plasma P-selectin, hs-CRP, and risk factors of thrombosis. In this prospective pilot study, patients with diagnosis of acute deep vein thrombosis and/ or pulmonary embolism were enrolled. All patients' clinical data, demographics and risk factors of thrombosis were evaluated. Plasma level of P-selectin and hs-CRP were measured by ELISA method. Radio immune assay method was used to determine plasma level of 25-hydroxy vitamin D (25(OH) D). In this study, 60 subjects were included. The mean ± SD plasma 25-hydroxy vitamin D level (25(OH) D) of participants was 21.4 ± 14.6 ng/mL. The vitamin D deficiency was detected in 60% of patients. No significant relation was found between the plasma 25(OH)D level and P-selectin and hs-CRP. In multiple regression analysis, there was a significant relationship between the level of 25(OH)D and the patients' age (beta = 0.452; p = 0.001), diabetes (beta = 0.280; p = 0.036) and positive family history of cardiovascular diseases (beta = 0.373; p = 0.003). Vitamin D deficiency is a frequent problem in Iranian VTE patients. Moreover, Plasma level of vitamin D is not associated with P-selectin and hs-CRP in VTE patients.

  3. Continuous veno venous hemofiltration in treatment of acute necrotizing pancreatitis

    Institute of Scientific and Technical Information of China (English)

    谢红浪; 季大玺; 龚德华; 刘芸; 徐斌; 周红; 刘志红; 黎磊石; 李维勤; 全竹富; 黎介寿

    2003-01-01

    Objective To investigate the effectiveness of using continuous veno venous hemofiltration (CVVH) in the treatment of acute necrotizing pancreatitis (ANP). Methods Thirteen ANP patients were involved in this study, including 4 females and 9 males, averaging 50.6±10.8 years old. CT scans upon admission revealed 33% necrosis involving the body of the pancreas in 2 patients, 67% necrosis in 3 patients and 100% necrosis in the other 8; the CT severity score was 8.9±2.1. CVVH was maintained for at least 72 hours and the AN69 hemofilter (1.2 m2) was changed every 24 hours. The ultrafiltration rate during CVVH was 2993.9±983.0 ml/h, the blood flow rate was 250-300 ml/min, and the substitute fluid was infused in a pre-diluted manner. Low molecular weight heparin was used as anticoagulant. Results CVVH was well tolerated in all the patients. Bloody abdominal cavity drainage fluid was observed in 2 patients, but no other side-effects related with CVVH were observed. Two patients died of systemic fungal infections and another died of intracranial fungi infection, resulting in an ICU mortality of 23.1%. Ten of the patients survived in the ICU, but one of them died for other reasons unrelated to the SAP before discharge. The APACHE Ⅱ score before CVVH was 15.2±6.5, but decreased significantly to 8.1±5.3, 7.5±4.9 and 8.0±5.2 at the 24th, 48th and 72nd hour after CVVH, respectively (P<0.01). Serum concentration of IL-1β and TNFα decreased to the trough at the 6th hour after a new hemofilter was used and increased slowly to pre-CVVH levels 12 hours later. After CVVH had ceased, the serum levels of two cytokines increased to their peaks at the 120th hour and decreased eventually at the 144th hour. The sieving coefficient (SC) of IL-1β and TNFα was 0.33±0.11 and 0.16±0.08. Conclusion CVVH offered therapeutic options for ANP and was well tolerated resulting in clearance of IL-1β and TNFα; CVVH at early stages of SAP may contribute to the improvement of outcome.

  4. 孕产期易栓症与肺栓塞的诊治%The diagnosis and treatment of thrombophilia and pulmonary venous thromboembolism

    Institute of Scientific and Technical Information of China (English)

    王谢桐; 李善玲

    2013-01-01

    The maternal hypercoagulable state is a physiological preparation for delivery. However, this hypercoagulability is associated with an increased risk of venous thromboembolism (VTE). VTE is a leading cause of maternal mortality. Inherited and acquired thrombophilia is the risk factor related to VTE. Although new understandings of pathogenic factors of thrombophilia in terms of gene level have been achieved, universal screening for thrombophilia in pregnancy is not reasonable in the clinical setting. Risk assessment should be done to establish the need for thromboprophylaxis during pregnancy and the postpartum period. All pregnant women with thrombophilia should undergo individualized prophylaxis strategies. However, the prophylactic anticoagulation regimen is controversial. The VTE preventive treatment object, time,and method are still not unified. There is insufficient evidence to support initiation of prophylactic anticoagulation. Pulmonary embolism (PE) is progressing rapidly with high false-negative and false-positive results. It is crucial to reinforce the knowledge of PE. If PE is suspected,treatment with anticoagulation should be started immediately. However, anticoagulant drugs have no clinical criteria. Bleeding will occur with excessive dosage while thromboembolism will recur with inadequate dosage.%妊娠期血液高凝状态是分娩的生理准备,但血液高凝状态使静脉血栓栓塞(venous thrombo embolism,VTE)的危险性增加,围产期VTE已成孕产妇死亡主要原因.易栓症是VTE的危险因素,发病因素包括遗传性和获得性.尽管目前已从基因水平对易栓症的发病因素有了新的认识,但对妊娠期易栓症的全面筛查在临床上是不合理的.因此对孕产妇整个妊娠期及产后的血栓形成的危险因素进行评估,据其情况提供个体化的预防措施是关键.但是血栓的预防性抗凝治疗目前尚有争议,对VTE预防性治疗对象、时机以及方法尚未统一,是否启动

  5. [Thromboembolism in travelers].

    Science.gov (United States)

    Bihari, I; Sándor, T

    2001-11-11

    The association between long haul travel and the risk of venous thromboembolism are suspected for long time. Mostly air travel related thrombosis series have been reported in the literature. Risk factors can be classified as: 1. travel related factors (coach position, immobilization, prolonged air travel, narrow seat and room, diuretic effect of alcohol, insufficient fluid intake, dehydration, direct pressure on leg veins, rare inspiration). 2. air plane related risk factors (low humidity, relative hypoxia, stress). 3. patient related factors (hereditary and acquired thrombophylia, previous deep venous thrombosis, age over 40, recent surgery or trauma, gravidity, puerperium, oestrogen containing pills, varicosity, chronic heart disease, obesity, fever, diarrhoea, vomiting, smoking). No patient related factors were found in some cases. To reduce the hazards air travellers are rightly concerned to know the level of the risk and the airlines should be responsible for this information. People should discuss with their physician what prophlylactic measures should be taken, such as compression stockings or low molecular weight heparin. Not only flight but car, bus and train travellers are also at risk of developing venous thromboembolism. Long haul travel alone is a separate risk factor for venous thromboembolism.

  6. Red cell distribution width and other red blood cell parameters in patients with cancer: association with risk of venous thromboembolism and mortality.

    Directory of Open Access Journals (Sweden)

    Julia Riedl

    Full Text Available Cancer patients are at high risk of developing venous thromboembolism (VTE. Red cell distribution width (RDW has been reported to be associated with arterial and venous thrombosis and mortality in several diseases. Here, we analyzed the association between RDW and other red blood cell (RBC parameters with risk of VTE and mortality in patients with cancer.RBC parameters were measured in 1840 patients with cancers of the brain, breast, lung, stomach, colon, pancreas, prostate, kidney; lymphoma, multiple myeloma and other tumor sites, that were included in the Vienna Cancer and Thrombosis Study (CATS, which is an ongoing prospective, observational cohort study of patients with newly diagnosed or progressive cancer after remission. Primary study outcome is occurrence of symptomatic VTE and secondary outcome is death during a maximum follow-up of 2 years.During a median follow-up of 706 days, 131 (7.1% patients developed VTE and 702 (38.2% died. High RDW (>16% was not associated with a higher risk of VTE in the total study cohort; in competing risk analysis accounting for death as competing variable the univariable subhazard ratio (SHR was 1.34 (95% confidence interval [CI]: 0.80-2.23, p = 0.269. There was also no significant association between other RBC parameters and risk of VTE. High RDW was associated with an increased risk of mortality in the total study population (hazard ratio [HR, 95% CI]: 1.72 [1.39-2.12], p<0.001, and this association prevailed after adjustment for age, sex, hemoglobin, leukocyte and platelet count (HR [95% CI]: 1.34 [1.06-1.70], p = 0.016.RDW and other RBC parameters were not independently associated with risk of VTE in patients with cancer and might therefore not be of added value for estimating risk of VTE in patients with cancer. We could confirm that high RDW is an independent predictor of poor overall survival in cancer.

  7. Cost-effectiveness analysis of apixaban compared to low-molecularweight heparins and vitamin k antagonists for treatment and secondary prevention of venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Isabel Elías

    2016-05-01

    Full Text Available Objective: Cost-effectiveness analysis of a 6-month treatment of apixaban (10 mg/12h, first 7 days; 5 mg/12h afterwards for the treatment of the first event of venous thromboembolism (VTE and prevention of recurrences, versus low-molecular-weight heparins/vitamin K antagonists treatment (LMWH/VKA. Material and methods: A lifetime Markov model with 13 health states was used for describing the course of the disease. Efficacy and safety data were obtained from AMPLIFY and AMPLIFY-EXT clinical trials; health outcomes were measured as life years gained (LYG and quality-adjusted life years (QALY. The chosen perspective of this analysis has been the Spanish National Health System (NHS. Drugs, management of VTE and complications costs were obtained from several Spanish data sources (€, 2014. A 3% discount rate was applied to health outcomes and costs. Univariate and probabilistic sensitivity analyses (SA were performed in order to assess the robustness of the results. Results: Apixaban was the most effective therapy with 7.182 LYG and 5.865 QALY, versus 7.160 LYG and 5.838 QALYs with LMWH/VKA. Furthermore, apixaban had a lower total cost (€13,374.70 vs €13,738.30. Probabilistic SA confirmed dominance of apixaban (led to better health outcomes with less associated costs in 89% of the simulations. Conclusions: Apixaban 5 mg/12h versus LMWH/VKA was an efficient therapeutic strategy for the treatment and prevention of recurrences of VTE from the NHS perspective.

  8. A genome-wide association study for venous thromboembolism: the extended cohorts for heart and aging research in genomic epidemiology (CHARGE) consortium.

    Science.gov (United States)

    Tang, Weihong; Teichert, Martina; Chasman, Daniel I; Heit, John A; Morange, Pierre-Emmanuel; Li, Guo; Pankratz, Nathan; Leebeek, Frank W; Paré, Guillaume; de Andrade, Mariza; Tzourio, Christophe; Psaty, Bruce M; Basu, Saonli; Ruiter, Rikje; Rose, Lynda; Armasu, Sebastian M; Lumley, Thomas; Heckbert, Susan R; Uitterlinden, André G; Lathrop, Mark; Rice, Kenneth M; Cushman, Mary; Hofman, Albert; Lambert, Jean-Charles; Glazer, Nicole L; Pankow, James S; Witteman, Jacqueline C; Amouyel, Philippe; Bis, Joshua C; Bovill, Edwin G; Kong, Xiaoxiao; Tracy, Russell P; Boerwinkle, Eric; Rotter, Jerome I; Trégouët, David-Alexandre; Loth, Daan W; Stricker, Bruno H Ch; Ridker, Paul M; Folsom, Aaron R; Smith, Nicholas L

    2013-07-01

    Venous thromboembolism (VTE) is a common, heritable disease resulting in high rates of hospitalization and mortality. Yet few associations between VTE and genetic variants, all in the coagulation pathway, have been established. To identify additional genetic determinants of VTE, we conducted a two-stage genome-wide association study (GWAS) among individuals of European ancestry in the extended cohorts for heart and aging research in genomic epidemiology (CHARGE) VTE consortium. The discovery GWAS comprised 1,618 incident VTE cases out of 44,499 participants from six community-based studies. Genotypes for genome-wide single-nucleotide polymorphisms (SNPs) were imputed to approximately 2.5 million SNPs in HapMap and association with VTE assessed using study-design appropriate regression methods. Meta-analysis of these results identified two known loci, in F5 and ABO. Top 1,047 tag SNPs (P ≤ 0.0016) from the discovery GWAS were tested for association in an additional 3,231 cases and 3,536 controls from three case-control studies. In the combined data from these two stages, additional genome-wide significant associations were observed on 4q35 at F11 (top SNP rs4253399, intronic to F11) and on 4q28 at FGG (rs6536024, 9.7 kb from FGG; P FGG locus were not completely explained by previously reported variants. Loci at or near SUSD1 and OTUD7A showed borderline yet novel associations (P FGG loci for VTE. Future studies are warranted to better characterize the associations with F11 and FGG and to replicate the new candidate associations.

  9. Treatment of venous thromboembolism with rivaroxaban in relation to body weight. A sub-analysis of the EINSTEIN DVT/PE studies.

    Science.gov (United States)

    Di Nisio, Marcello; Vedovati, Maria C; Riera-Mestre, Antoni; Prins, Martin H; Mueller, Katharina; Cohen, Alexander T; Wells, Philip S; Beyer-Westendorf, Jan; Prandoni, Paolo; Bounameaux, Henri; Kubitza, Dagmar; Schneider, Jonas; Pisters, Ron; Fedacko, Jan; Fontes-Carvalho, Ricardo; Lensing, Anthonie W A

    2016-09-27

    The pharmacokinetics of oral rivaroxaban are highly predictable and only affected to a limited extent by bodyweight; therefore, dose adjustments for bodyweight are not required. However, this raises concerns among physicians for potential under- or overdosing. This substudy of the randomised EINSTEIN DVT and EINSTEIN PE trials, which compared rivaroxaban with enoxaparin/vitamin K antagonist (VKA) therapy, aimed to determine the incidence of major bleeding in patients with a low bodyweight and recurrent venous thromboembolism (VTE) in patients with a high bodyweight during rivaroxaban or enoxaparin/VKA therapy. More than 8,000 patients with objectively diagnosed deep-vein thrombosis or pulmonary embolism were included. Adjusted hazard ratios for recurrent VTE and bleeding were calculated using the Cox proportional hazards model. Analyses were performed for both the first 21 days of treatment and the whole treatment period. For rivaroxaban recipients, there was no association between bodyweight or body mass index (BMI) and risk of recurrent VTE (ptrend=0.87 and 0.62, respectively), major bleeding (ptrend=0.24 and 0.36, respectively) or clinically relevant bleeding (ptrend=0.17 and 0.63, respectively). Major bleeding events were numerically lower in rivaroxaban patients across all bodyweight and BMI categories. Hazard ratios for rivaroxaban vs enoxaparin/VKA were similar in all bodyweight and BMI categories, both during the first 21 days and the whole treatment period. The fixed-dose rivaroxaban regimen is not associated with an increased risk of major bleeding or recurrent VTE in patients with either a low or high bodyweight. A high BMI was not associated with an increased risk of recurrent VTE during anticoagulation.

  10. Activated protein C resistance in patients following venous thromboembolism receiving rivaroxaban versus vitamin K antagonists: assessment using Russell viper venom time-based assay.

    Science.gov (United States)

    Goralczyk, Tadeusz; Wojtowicz, Katarzyna B; Undas, Anetta

    2016-09-15

    Activated protein C resistance (APC-R) is assessed as part of thrombophilia screening, preferably in patients not taking oral anticoagulants. Rivaroxaban is known to alter some APC-R assays. To our knowledge, there have been no reports on the effect of rivaroxaban on the Russell viper venom time (RVVT)-based APC-R assay in real-life patients. In 168 consecutive outpatients suspected of having venous thromboembolism because of thrombophilia, APC-R was determined using the RVVT-based ProC Ac R assay (Siemens, Marburg, Germany). Patients receiving rivaroxaban or vitamin K antagonists were eligible. We measured rivaroxaban concentrations using the anti-Xa Biophen DiXal assay (Hyphen Biomed, Neuville-Sur-Oise, France) and factor V Leiden using the real-time PCR. APC-R was detected in 23 (28%) patients on rivaroxaban (n = 81) administrated 2-48 h since the blood draw, 15 (28%) patients on vitamin K antagonists (n = 54), and in four (12%) patients off anticoagulation (n = 33). Compared with nonanticoagulated patients, APC-R ratios were similar in patients on rivaroxaban, without any correlation with rivaroxaban concentrations (from 0 to 303 μg/l). None of the patients on rivaroxaban were found to have false-negative or false-positive APC-R ratios. Rivaroxaban concentrations up to 300 μg/l do not affect results of the ProC Ac R RVVT-based assay, which could be recommended in patients referred to a clinic for thrombophilia screening in whom the time since the last dose of rivaroxaban is uncertain.

  11. Clinical presentation and course of bleeding events in patients with venous thromboembolism, treated with apixaban or enoxaparin and warfarin. Results from the AMPLIFY trial.

    Science.gov (United States)

    Bleker, Suzanne M; Cohen, Alexander T; Büller, Harry R; Agnelli, Giancarlo; Gallus, Alexander S; Raskob, Gary E; Weitz, Jeffrey I; Curto, Madelyn; Sisson, Melanie; Middeldorp, Saskia

    2016-11-30

    Apixaban, a direct acting oral anticoagulant (DOAC), was found to be non-inferior to and safer as enoxaparin followed by warfarin for treatment of venous thromboembolism (VTE) in the AMPLIFY trial. Information is needed on how bleeding events with DOACs present and develop. In this post-hoc analysis, the clinical presentation and course of all major and clinically relevant non major (CRNM) bleeding events in the AMPLIFY trial were blindly classified by three investigators, using pre-designed classification schemes containing four categories. Odds ratios (OR) for classifying as category three or four (representing a more severe clinical presentation and course) were calculated between apixaban and enoxaparin/warfarin. In total, 63 major and 311 CRNM bleeding events were classified. Of the major bleeds, a more severe clinical presentation occurred in 28.5 % of apixaban versus 44.9 % of enoxaparin/warfarin related recipients (OR 0.49, 95 % confidence interval [CI] 0.14-1.78). A severe clinical course was observed in 14.3 % and in 12.2 %, respectively (OR 1.19, 95 %CI 0.21-6.69). Of the CRNM bleeding events, a more severe clinical presentation and extent of clinical care was found in 25 % of apixaban recipients compared to 22.7 % in the enoxaparin/warfarin group (OR 1.13, 95 %CI 0.65-1.97). The clinical presentation and course of major and CRNM bleeds were similar in apixaban and enoxaparin/warfarin treated patients. This finding should reassure physicians and patients that even in the absence of a specific reversal agent, apixaban is a convenient and safe choice for VTE.

  12. Predictive accuracy of 29-comorbidity index for in-hospital deaths in US adult hospitalizations with a diagnosis of venous thromboembolism.

    Directory of Open Access Journals (Sweden)

    James Tsai

    Full Text Available BACKGROUND: Venous thromboembolism (VTE, comprising deep vein thrombosis (DVT and pulmonary embolism (PE, is a significant source of mortality and morbidity worldwide. By analyzing data of the 2010 Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality (AHRQ, we evaluated the predictive accuracy of the AHRQ's 29-comorbidity index with in-hospital death among US adult hospitalizations with a diagnosis of VTE. METHODS: We assessed the case-fatality and prevalence of comorbidities among a sample of 153,518 adult hospitalizations with a diagnosis of VTE that comprised 87,605 DVTs and 65,913 PEs (with and without DVT. We estimated adjusted odds ratios and 95% confidence intervals with multivariable logistic regression models by using comorbidities as predictors and status of in-hospital death as an outcome variable. We assessed the c-statistics for the predictive accuracy of the logistic regression models. RESULTS: In 2010, approximately 41,944 in-hospital deaths (20,212 with DVT and 21,732 with PE occurred among 770,137 hospitalizations with a diagnosis of VTE. When compared separately to hospitalizations with VTE, DVT, or PE that had no corresponding comorbidities, congestive heart failure, chronic pulmonary disease, coagulopathy, liver disease, lymphoma, fluid and electrolyte disorders, metastatic cancer, other neurological disorders, peripheral vascular disorders, pulmonary circulation disorders, renal failure, solid tumor without metastasis, and weight loss were positively and independently associated with 10%-125% increased likelihoods of in-hospital death. The c-statistic values ranged from 0.776 to 0.802. CONCLUSION: The results of this study indicated that comorbidity was associated independently with risk of death among hospitalizations with VTE and among hospitalizations with DVT or PE. The AHRQ 29-comorbidity index provides acceptable to excellent predictive accuracy for in-hospital deaths among adult

  13. Risk of venous thromboembolism from oral contraceptives containing gestodene and desogestrel versus levonorgestrel: a meta-analysis and formal sensitivity analysis.

    Science.gov (United States)

    Hennessy, S; Berlin, J A; Kinman, J L; Margolis, D J; Marcus, S M; Strom, B L

    2001-08-01

    Controversy exists regarding whether oral contraceptives (OCs) containing desogestrel and gestodene are associated with an increased risk of venous thromboembolism (VTE) versus OCs containing levonorgestrel. We were interested in synthesizing the available data, exploring explanations for mixed results, and characterizing the degree of uncontrolled confounding that could have produced a spurious association. We performed a meta-analysis and formal sensitivity analysis of studies that examined the relative risk of VTE for desogestrel and gestodene versus levonorgestrel. Twelve studies, all observational, were included. The summary relative risk (95% CI) was 1.7 (1.3-2.1; heterogeneity p = 0.09). If real, the incremental risk of VTE would be about 11 per 100,000 women per year. An association was present when accounting for duration of use and when restricted to the first year of use in new users. However, in the sensitivity analysis, the association abated in many, but not all, scenarios in which an unmeasured confounding factor increased the risk of VTE three to fivefold and in nearly all examined scenarios in which the factor increased the risk 10-fold. The summary relative risk of 1.7 does not appear to be caused by depletion of susceptibles, but is sensitive to a modest degree of unmeasured confounding. Whether such confounding occurred is unknown. However, given this sensitivity, this issue probably cannot be settled unequivocally with observational data. In the absence of a definitive answer, this apparent increased risk, together with its uncertainty and small magnitude and its important consequences, should be considered when selecting an OC for a given woman.

  14. Admission rates for emergency department patients with venous thromboembolism and estimation of the proportion of low risk pulmonary embolism patients: a US perspective

    Science.gov (United States)

    Singer, Adam J.; Thode, Henry C.; Peacock, W. Frank

    2016-01-01

    Objective Introduction of target specific anticoagulants and recent guidelines encourage outpatient management of low risk patients with venous thromboembolism. We describe hospital admission rates over time for patients presenting to US emergency departments (EDs) with deep vein thrombosis (DVT) and pulmonary embolism (PE) and estimate the proportion of low-risk PE patients who could potentially be managed as outpatients. Methods We performed a structured analysis of the National Hospital Ambulatory Medical Care Survey (a nationally representative weighted sampling of US ED visits) database for the years 2006–2010 including all adult patients with a primary diagnosis of DVT or PE. Simplified pulmonary embolus scoring index (sPESI) scores were determined in patients with PE to identify low risk patients. Results There were an estimated 652,000 and 394,000 ED visits for DVT and PE over the 5-year period (0.17%). Mean (SE) age was 59 (1.3), 50% were female, and 40% were > 65 years. Admission rates for DVT and PE were 52% and 90% respectively with no significant changes over time. In patients with DVT, predictors for admission were age (odds ratio, 1.03 per year of age [95% confidence interval, 1.01 to 1.05]) and race (odds ratio, 4.1 [95% confidence interval, 0.9 to 19.8] for Hispanics and 2.9 [1.2 to 7.4] for Blacks). Of all ED patients with PE, 51% were low risk based on sPESI scores. Conclusion Admission rates for DVT and PE have remained high and unchanged, especially with PE, minorities, and in older patients. Based on sPESI scores, up to half of PE patients might be eligible for early discharge or outpatient therapy.

  15. Testing for inherited thrombophilia and consequences for antithrombotic prophylaxis in patients with venous thromboembolism and their relatives. A review of the Guidelines from Scientific Societies and Working Groups.

    Science.gov (United States)

    De Stefano, Valerio; Rossi, Elena

    2013-10-01

    The clinical penetrance of venous thromboembolism (VTE) susceptibility genes is variable, being lower in heterozygous carriers of factor V Leiden and prothrombin 20210A (mild thrombophilia), and higher in the rare carriers of deficiencies of antithrombin, protein C or S, and those with multiple or homozygous abnormalities (high-risk thrombophilia). The absolute risk of VTE is low, and the utility of laboratory investigation for inherited thrombophilia in patients with VTE and their asymptomatic relatives has been largely debated, leading to the production of several Guidelines from Scientific Societies and Working Groups. The risk for VTE largely depends on the family history of VTE. Therefore, indiscriminate search for carriers is of no utility, and targeted screening is potentially more fruitful. In patients with VTE inherited thrombophilia is not scored as a determinant of recurrence, playing a minor role in the decision of prolonging anticoagulation; indeed, a few guidelines consider testing worthwhile to identify carriers of high-risk thrombophilia, particularly those with a family history of VTE. The identification of the asymptomatic carrier relatives of the probands with VTE and thrombophilia could reduce cases of provoked VTE, offering them primary antithrombotic prophylaxis during risk situations. In most guidelines, this is considered justified only for relatives of probands with a deficiency of natural anticoagulants or multiple abnormalities. Counselling the asymptomatic female relatives of individuals with VTE and/or thrombophilia before pregnancy or the prescription of hormonal treatments should be administered with consideration of the risk driven by the type of thrombophilia and the family history of VTE.

  16. Depressive symptoms as a novel risk factor for recurrent venous thromboembolism: a longitudinal observational study in patients referred for thrombophilia investigation.

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    Roland von Känel

    Full Text Available BACKGROUND: Increasing evidence suggests that psychosocial factors, including depression predict incident venous thromboembolism (VTE against a background of genetic and acquired risk factors. The role of psychosocial factors for the risk of recurrent VTE has not previously been examined. We hypothesized that depressive symptoms in patients with prior VTE are associated with an increased risk of recurrent VTE. METHODS: In this longitudinal observational study, we investigated 271 consecutive patients, aged 18 years or older, referred for thrombophilia investigation with an objectively diagnosed episode of VTE. Patients completed the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D. During the observation period, they were contacted by phone and information on recurrent VTE, anticoagulation therapy, and thromboprophylaxis in risk situations was collected. RESULTS: Clinically relevant depressive symptoms (HADS-D score ≥ 8 were present in 10% of patients. During a median observation period of 13 months (range 5-48, 27 (10% patients experienced recurrent VTE. After controlling for sociodemographic and clinical factors, a 3-point increase on the HADS-D score was associated with a 44% greater risk of recurrent VTE (OR 1.44, 95% CI 1.02, 2.06. Compared to patients with lower levels of depressive symptoms (HADS-D score: range 0-2, those with higher levels (HADS-D score: range 3-16 had a 4.1-times greater risk of recurrent VTE (OR 4.07, 95% CI 1.55, 10.66. CONCLUSIONS: The findings suggest that depressive symptoms might contribute to an increased risk of recurrent VTE independent of other prognostic factors. An increased risk might already be present at subclinical levels of depressive symptoms.

  17. Pathogenesis of Thromboembolism and Endovascular Management

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    Sasan Behravesh

    2017-01-01

    Full Text Available Venous thromboembolism (VTE, a disease that includes deep venous thrombosis (DVT and pulmonary embolism (PE, is associated with high mortality, morbidity, and costs. It can result in long-term complications that include postthrombotic syndrome (PTS adding to its morbidity. VTE affects 1/1000 patients, costs $13.5 billion annually to treat, and claims 100,000 lives annually in the US. The current standard of care for VTE is anticoagulation, though thrombolysis may be performed in patients with PE and threatened limb. This review discusses pathogenesis and medical treatment of VTE and then focuses on endovascular treatment modalities. Mechanical- and catheter-directed thrombolysis (CDT is discussed, as well as patient selection criteria, and complications. The first prospective study (CaVenT comparing CDT with anticoagulation alone in acute DVT, despite study shortcomings, corroborates the existing literature indicating improved outcomes with CDT. The potential of the ongoing prospective, multicenter, randomized ATTRACT trial is also highlighted.

  18. Pathogenesis of Thromboembolism and Endovascular Management

    Science.gov (United States)

    Behravesh, Sasan; Hoang, Peter; Nanda, Alisha; Wallace, Alex; Sheth, Rahul A.; Deipolyi, Amy R.; Memic, Adnan; Naidu, Sailendra

    2017-01-01

    Venous thromboembolism (VTE), a disease that includes deep venous thrombosis (DVT) and pulmonary embolism (PE), is associated with high mortality, morbidity, and costs. It can result in long-term complications that include postthrombotic syndrome (PTS) adding to its morbidity. VTE affects 1/1000 patients, costs $13.5 billion annually to treat, and claims 100,000 lives annually in the US. The current standard of care for VTE is anticoagulation, though thrombolysis may be performed in patients with PE and threatened limb. This review discusses pathogenesis and medical treatment of VTE and then focuses on endovascular treatment modalities. Mechanical- and catheter-directed thrombolysis (CDT) is discussed, as well as patient selection criteria, and complications. The first prospective study (CaVenT) comparing CDT with anticoagulation alone in acute DVT, despite study shortcomings, corroborates the existing literature indicating improved outcomes with CDT. The potential of the ongoing prospective, multicenter, randomized ATTRACT trial is also highlighted. PMID:28154761

  19. Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a contemporary view of the published literature.

    Science.gov (United States)

    Ende-Verhaar, Yvonne M; Cannegieter, Suzanne C; Vonk Noordegraaf, Anton; Delcroix, Marion; Pruszczyk, Piotr; Mairuhu, Albert T A; Huisman, Menno V; Klok, Frederikus A

    2017-02-01

    The incidence of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) is relevant for management decisions but is currently unknown.We performed a meta-analysis of studies including consecutive PE patients followed for CTEPH. Study cohorts were predefined as "all comers", "survivors" or "survivors without major comorbidities". CTEPH incidences were calculated using random effects models.We selected 16 studies totalling 4047 PE patients who were mostly followed up for >2-years. In 1186 all comers (two studies), the pooled CTEPH incidence was 0.56% (95% CI 0.1-1.0). In 999 survivors (four studies) CTEPH incidence was 3.2% (95% CI 2.0-4.4). In 1775 survivors without major comorbidities (nine studies), CTEPH incidence was 2.8% (95% CI 1.5-4.1). Both recurrent venous thromboembolism and unprovoked PE were significantly associated with a higher risk of CTEPH, with odds ratios of 3.2 (95% CI 1.7-5.9) and 4.1 (95% CI 2.1-8.2) respectively. The pooled CTEPH incidence in 12 studies that did not use right heart catheterisation as the diagnostic standard was 6.3% (95% CI 4.1-8.4).The 0.56% incidence in the all-comer group probably provides the best reflection of the incidence of CTEPH after PE on the population level. The ∼3% incidences in the survivor categories may be more relevant for daily clinical practice. Studies that assessed CTEPH diagnosis by tests other than right heart catheterisation provide overestimated CTEPH incidences.

  20. Preventative and tharapeutic investigation and risk evaluation of hospitalized patients with venous thromboembolism%住院患者静脉血栓形成的风险评估和防治

    Institute of Scientific and Technical Information of China (English)

    舒周伍; 吴贤仁; 郑莉; 陈小华

    2009-01-01

    Objective To investigate the epidemiology of venous thromboembolism risk factors in hospitalized patients in department of cardiology,tumor,gerontism and orthopaedics. To analyze the frequency and category of protective measure. Methods The clinical data of 200 inpatients with high risk fators of venous thromboembolism were analyzed, the data including demography, sociology and information of prevention and cure. Results The patient with high risk fators of venous thromboembolism is a great deal ,with a ratio of male to female as 1.5 : 1. A peak of incidence was found at 60 to 79 years of age. The frequent risk factors include tumor, severe infection, congestive heart failure and ischemic stroke. The proportion of patients with high risk fator of venous thromboembolism is 7. 4%. The distribution of risk factor in different department is diverse. The ratio of adopting prophylactic anticoagulation correctly is very low. Conclusion The ratio of VTE cases in hospitalized patients is increasing,but the ratio of adopting correct therapy is very low. Clinical doctors have insufficient cognition yet. The clinical cognition and the prevention and cure of VTE should be strengthened urgently.%目的 了解心内科、肿瘤科、老年科及骨科住院患者静脉血栓栓塞性疾病(VTE)危险因素及预防措施.方法 对有VTE高危因素的200例患者的人口学、社会学特征及防治情况等进行分析.结果 具有VTE高危因素的患者中,男女比例为1.5∶1,发病高峰期为60~79岁;最常见的危险因素为肿瘤、严重感染、骨折、充血性心力衰竭及缺血性脑卒中,其中有VTE高危因素的占7.4%;各科危险因素分布不一;老年科、肿瘤科、骨科患者无一例接受抗凝治疗.结论 VTE好发于老年男性,各科危险因素不一.预防性抗凝治疗的比率很低,对于静脉血栓栓塞性疾病的认识和防治急待加强.

  1. The increased risk of venous thromboembolism and the use of third generation progestagens: role of bias in observational research. The Transnational Research Group on Oral Contraceptives and the Health of Young Women.

    Science.gov (United States)

    Lewis, M A; Heinemann, L A; MacRae, K D; Bruppacher, R; Spitzer, W O

    1996-07-01

    A matched case-control study was undertaken in 10 centers in Germany and the United Kingdom to explore the association of current use of major combination oral contraceptives with the occurrence of venous thromboembolism. The cases recruited were 505 women aged 16-44 years with venous thromboembolism, controls were 1877 women (at least 3 controls per case) matched for 5-year age group and region without VTE. The main outcome measures were odds ratios derived by comparing current use of a specific oral contraceptive or group of OC against current use of other groups or against no current use of OC. The odds ratios (95% confidence intervals) for venous thromboembolism were: for third generation products (low dose ethinyloestradiol, gestodene and desogestrel) versus second generation products (low dose ethinyloestradiol, no gestodene and desogestrel, 1.5 (1.1 to 2.0), for third versus second generation products with norgestimate included in third generation, 1.6 (1.2 to 2.2). The odds ratios for current use for women aged 16-44 of specific progestagens versus levonorgestrel-containing compounds were 1.7 (1.1 to 2.6) for gestodene, 1.8 (1.2 to 2.6) for desogestrel, 1.9 (1.0 to 3.6) for norgestimate and 1.3 (0.7 to 2.5) for progestagen-only pills. For women aged 25 to 44 likely to be exposed to any of these progestagens, odds ratios for the comparison of progestagens versus levonorgestrel showed a successive increase by market introduction ranging from 1.5 (0.9 to 2.5) for desogestrel with 30 micrograms oestrogen content (introduced 1981) to 2.8 (1.3 to 6.5) for desogestrel with 20 micrograms oestrogen content (introduced 1992) significant in linear trend analysis (p = 0.00012). The influence of norgestimate classification as third or second generation product does not significantly alter the results regarding the association of third generation products and venous thromboembolism. A direct comparison of current use of norgestimate (which is primarily metabolized to

  2. Placing of tunneled central venous catheters prior to induction chemotherapy in children with acute lymphoblastic leukemia

    DEFF Research Database (Denmark)

    Handrup, Mette Møller; Møller, Jens Kjølseth; Frydenberg, Morten

    2010-01-01

    BACKGROUND: Tunneled central venous catheters (CVCs) are inevitable in children with acute lymphoid leukemia (ALL). The aim of this study was to evaluate the risk of CVC-related complications in children with ALL in relation to timing of catheter placement and type of catheter. PROCEDURE: All chi...

  3. Successful Endovascular Repair of an Iatrogenic Perforation of the Superficial Femoral Artery Using Self-Expanding Nitinol Supera Stents in a Patient with Acute Thromboembolic Limb Ischemia

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    Tom Eisele

    2016-01-01

    Full Text Available The treatment of acute thromboembolic limb ischemia includes well-established surgical thrombectomy procedures and, in recent times, also percutaneous rotational thrombectomy using Straub Rotarex® system. This modality not only enables efficient treatment of such thrombotic occlusion but also in rare cases may imply the risk of perforation of the occluded artery. Herein, we report the case of a perforation of the superficial femoral artery (SFA in an elderly female patient with thromboembolic limb ischemia. The perforation was successfully treated by implantation of self-expanding nitinol Supera stents and without the need for implantation of a stent graft.

  4. A case of severe pulmonary thromboembolism in a young male with klinefelter syndrome.

    Science.gov (United States)

    Kang, Byung-Soo; Cho, Deok-Kyu; Koh, Won-Jun; Yoo, Seung-Hoon; Won, Ki-Bum; Cho, Yun-Hyeong; Hwang, Eui-Seock; Koh, Jong-Hoon

    2012-08-01

    A young male patient diagnosed with Klinefelter syndrome was admitted to our hospital via the emergency room with chief complaints of acute chest pain and dyspnea. Pulmonary thromboembolism was diagnosed from his chest CT images. His symptoms improved after he underwent thrombolysis and anticoagulation treatment. Klinefelter syndrome has a tendency towards hypercoagulability due to hormonal imbalance and one or more inherited thromophilic factors. Thus, Klinefelter syndrome patients with a past medical history of venous thromboembolism require continuous oral anticoagulation therapy for a period of at least six months.

  5. Role of IVC Filters in Endovenous Therapy for Deep Venous Thrombosis: The FILTER-PEVI (Filter Implantation to Lower Thromboembolic Risk in Percutaneous Endovenous Intervention) Trial

    Energy Technology Data Exchange (ETDEWEB)

    Sharifi, Mohsen, E-mail: seyedmohsensharifi@yahoo.com [Arizona Cardiovascular Consultants (United States); Bay, Curt [A.T. Still University, Arizona School of Health Sciences (United States); Skrocki, Laura; Lawson, David; Mazdeh, Shahnaz [Arizona Cardiovascular Consultants (United States)

    2012-12-15

    Objectives: The purpose of this study was to evaluate the necessity of and recommend indications for inferior vena cava (IVC) filter implantation during percutaneous endovenous intervention (PEVI) for deep venous thrombosis (DVT).BackgroundPEVI has emerged as a powerful tool in the management of acute proximal DVT. Instrumentation of extensive fresh thrombus is potentially associated with iatrogenic pulmonary embolism (PE). The true frequency of this complication has not been studied in a randomized fashion. We evaluated IVC filter implantation during PEVI for DVT. Methods: A total of 141 patients with symptomatic proximal DVT undergoing PEVI for symptomatic DVT were randomized to receive an IVC filter (70 patients) or no filter (71 patients; control group). The anticoagulation and PEVI regimen were similar between the two groups. Patients with development of symptoms suggestive of PE underwent objective testing for PE. Results: PE developed in 1 of the 14 symptomatic patients in the filter group and 8 of the 22 patients in the control group (P = 0.048). There was no mortality in any group. Three patients (4.2%) in the control group had transient hemodynamic instability necessitating resuscitory efforts. Predictors of iatrogenic PE were found to be PE at admission; involvement of two or more adjacent venous segments with acute thrombus; inflammatory form of DVT (severe erythema, edema, pain, and induration); and vein diameter of {>=}7 mm with preserved architecture. Conclusions: IVC filter implantation during PEVI reduces the risk of iatrogenic PE by eightfold without a mortality benefit. A selective approach may be exercised in filter implantation during PEVI.

  6. Acutely altered hemodynamics following venous obstruction in the early chick embryo.

    Science.gov (United States)

    Stekelenburg-de Vos, Sandra; Ursem, Nicolette T C; Hop, Wim C J; Wladimiroff, Juriy W; Gittenberger-de Groot, Adriana C; Poelmann, Robert E

    2003-03-01

    In the venous clip model specific cardiac malformations are induced in the chick embryo by obstructing the right lateral vitelline vein with a microclip. Clipping alters venous return and intracardiac laminar blood flow patterns, with secondary effects on the mechanical load of the embryonic myocardium. We investigated the instantaneous effects of clipping the right lateral vitelline vein on hemodynamics in the stage-17 chick embryo. 32 chick embryos HH 17 were subdivided into venous clipped (N=16) and matched control embryos (N=16). Dorsal aortic blood flow velocity was measured with a 20 MHz pulsed Doppler meter. A time series of eight successive measurements per embryo was made starting just before clipping and ending 5h after clipping. Heart rate, peak systolic velocity, time-averaged velocity, peak blood flow, mean blood flow, peak acceleration and stroke volume were determined. All hemodynamic parameters decreased acutely after venous clipping and only three out of seven parameters (heart rate, time-averaged velocity and mean blood flow) showed a recovery to baseline values during the 5h study period. We conclude that the experimental alteration of venous return has major acute effects on hemodynamics in the chick embryo. These effects may be responsible for the observed cardiac malformations after clipping.

  7. Frecuencia e incidencia de la tromboembolia venosa en un hospital general Frequency and incidence of venous thromboembolism in a general hospital

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    Juan A. Mazzei

    2005-08-01

    Full Text Available El objetivo de este estudio fue determinar la frecuencia y la incidencia de la tromboembolia venosa (TEV, objetivamente diagnosticada, en un hospital universitario argentino. Se utilizó un diseño retrospectivo, observacional y longitudinal. Se analizaron las historias clínicas de todos los pacientes mayores de 16 años que habían egresado o fallecido en las unidades de internación clínica, obstétrica y quirúrgica del Hospital de Clínicas José de San Martín con el diagnóstico de TEV durante un período de 24 meses. La frecuencia y la incidencia de TEV fueron 0.92% y 0.40% (intervalo de confianza de 95% (IC95%: 0.37 a 0.42% respectivamente. La incidencia más alta de TEV se presentó en la novena década de la vida (0.80%; IC95%: 0.78% a 0.82%. Solamente el 31% de los pacientes que desarrollaron TEV durante la internación habían recibido tromboprofilaxis con heparina. La mortalidad intrahospitalaria global de los pacientes con TEV fue 19%.The objective of this study was to determine the frequency and incidence of venous thromboembolism (VTE in an Argentine universitary hospital. We used a longitudinal, retrospective, observational design. Participants were all over-16 year patients who were discharged or died in clinical, obstetrical and surgical units in the Hospital de Clínicas José de San Martín during a 24 month period between July 1, 2001 and June 30, 2003, with a diagnosis on release of VTE. VTE frequency reached 0.92% and incidence was 0.40%; 95% confidence interval (95% CI: 0.37 to 0.42%. Incidence was highest in the 9th decade of life (0.80%; 95% CI: 0.78% to 0.82%. Only 31% of patients who developed VTE during hospitalization had received thromboprophylaxis. Total in-hospital mortality of VTE patients was 19%.

  8. Venous thromboembolism in adults screened for sickle cell trait: a population-based cohort study with nested case–control analysis

    Science.gov (United States)

    Little, Iain; Vinogradova, Yana; Orton, Elizabeth; Kai, Joe; Qureshi, Nadeem

    2017-01-01

    Objective To determine whether sickle cell carriers (‘sickle cell trait’) have an increased risk of venous thromboembolism (VTE). Design Cohort study with nested case–control analysis. Setting General population with data from 609 UK general practices in the Clinical Practice Research Datalink (CPRD). Participants All individuals registered with a CPRD general practice between 1998 and 2013, with a medical record of screening for sickle cell between 18 and 75 years of age. Main outcomes measures Incidence of VTE per 10 000 person-years (PY) among sickle cell carriers and non-carriers; and adjusted OR for VTE among sickle cell carriers compared with non-carriers. Results We included 30 424 individuals screened for sickle cell, with a follow-up time of 179 503 PY, identifying 55 VTEs in 6758 sickle cell carriers and 125 VTEs in 23 666 non-carriers. VTE incidence among sickle cell carriers (14.9/10 000 PY; 95% CI 11.4 to 19.4) was significantly higher than non-carriers (8.8/10 000 PY; 95% CI 7.4 to 10.4). Restricting analysis to confirmed non-carriers was non-significant, but performed on a small sample. In the case–control analysis (180 cases matched to 1775 controls by age and gender), sickle cell carriers remained at increased risk of VTE after adjusting for body mass index, pregnancy, smoking status and ethnicity (OR 1.78, 95% CI 1.18 to 2.69, p=0.006), with the greatest risk for pulmonary embolism (PE) (OR 2.27, 95% CI 1.17 to 4.39, p=0.011). Conclusions Although absolute numbers are small, in a general population screened for sickle cell, carriers have a higher incidence and risk of VTE, particularly PE, than non-carriers. Clinicians should be aware of this elevated risk in the clinical care of sickle cell carriers, or when discussing carrier screening, and explicitly attend to modifiable risk factors for VTE in these individuals. More complete primary care coding of carrier status could improve analysis. PMID:28360235

  9. Do children with central venous line (CVL dysfunction have increased risk of symptomatic thromboembolism compared to those without CVL-dysfunction, while on cancer therapy?

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    Halton Jacqueline

    2012-07-01

    Full Text Available Abstract Background Thromboembolism (TE and infection are two common complications of central venous line (CVL. Thrombotic CVL-dysfunction is a common, yet less studied, complication of CVL. Two retrospective studies have reported significant association of CVL-dysfunction and TE. Recent studies indicate association of CVL-related small clot with infection. Infection is the most common cause of non-cancer related mortality in children with cancer. We and others have shown reduced overall survival (OS in children with cancer and CVL-dysfunction compared to those without CVL-dysfunction. Despite these observations, to date there are no prospective studies to evaluate the clinical significance of CVL-dysfunction and it’s impact on the development of TE, infection, or outcome of children with cancer. Study design This is a prospective, analytical cohort study conducted at five tertiary care pediatric oncology centers in Ontario. Children (≤ 18 years of age with non-central nervous system cancers and CVL will be eligible for the study. Primary outcome measure is symptomatic TE and secondary outcomes are infection, recurrence of cancer and death due to any cause. Data will be analyzed using regression analyses. Discussion The overall objective is to delineate the relationship between CVL-dysfunction, infection and TE. The primary aim is to evaluate the role of CVL-dysfunction as a predictor of symptomatic TE in children with cancer. We hypothesize that children with CVL-dysfunction have activation of the coagulation system resulting in an increased risk of symptomatic TE. The secondary aims are to study the impact of CVL-dysfunction on the rate of infection and the survival [OS and event free survival (EFS] of children with cancer. We postulate that patients with CVL-dysfunction have an occult CVL-related clot which acts as a microbial focus with resultant increased risk of infection. Further, CVL-dysfunction by itself or in combination with

  10. Acute cytomegalovirus infection complicated by venous thrombosis: a case report

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    Parola Philippe

    2005-08-01

    Full Text Available Abstract Background CMV-induced vasculopathy and thrombosis have been reported, but they are rare conditions usually encountered in immunocompromised patients. However more and more complications of CMV infections are recognized in immunocompetent patients. Case presentation We present a case report of a previously healthy adult with cytomegalovirus infection that was complicated by tibiopopliteal deep venous thrombosis and in whom Factor V Leiden heterozygous mutation was found. Conclusion This new case report emphasizes the involvement of cytomegalovirus in induction of vascular thrombosis in patients with predisposing risk factors for thrombosis. It is necessary to screen for CMV infection in patients with spontaneous thrombosis and an history of fever.

  11. A vascular laboratory protocol for improving and managing after-hours suspected acute deep venous thrombosis.

    Science.gov (United States)

    Martin, Angela H; Eckert, George; Lemmon, Gary W; Sawchuk, Alan; Dalsing, Michael C

    2014-04-01

    This study reviews the clinical and workforce impact of a suggested protocol designed for the management of suspected acute deep venous thrombosis (DVT) in patients seen after standard vascular laboratory business hours. The protocol included the use of Wells score, D-dimer and a single dose of therapeutic anticoagulant to defer venous duplex ultrasound (VDU) testing until routine business hours unless contraindicated. Information was collected on medical history, physical exam and the timing of any diagnostic studies and treatment provided. Over 15% of studies done after-hours were deemed unnecessary by our protocol and in every individual the results were negative for an acute DVT. There were no adverse events from a one-time dose of anticoagulant. Limiting emergency VDU coverage to evaluate for acute DVT based on a management protocol can eliminate unnecessary after-hours VDU testing without having a negative impact on patient care.

  12. Prevention of Venous Thromboembolism in Major Orthopedic Surgery: Bayesian Network Meta-Analysis of 21 Randomized Trials Evaluating Unfractionated Heparins, Low-Molecular Weight Heparins, and New Oral Anticoagulants

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    Andrea Messori

    2014-09-01

    Full Text Available Background: In major orthopedic surgery, prevention of venous thromboembolism has been based on Unfractionated Heparins (UFHs over the past decades, then on Low-Molecular Weight Heparins (LMWHs, and on New Oral Anticoagulants (NOACs more recently. To summarize the comparative effectiveness of UFHs, LMWHs, and NOACs in this clinical indication, we applied Bayesian network meta-analysis to the clinical material (randomized studies published in two previous reviews focused on this issue.. Objectives: Our end-point was a composite of venous thromboembolism and pulmonary embolism.. Materials and Methods: Our analysis was based on standard Bayesian network meta-analysis (random-effect model.. Results: The analysis included 21 randomized trials for a total of 21,805 patients. Our results showed that the degree of effectiveness did not differ among UFHs, LMWHs, and NOACs. Although some trends emerged from an in-depth analysis of these data (e.g. according to the histogram of rankings, no significant differences were found (P > 0.05. Moreover, two agents among LMWHs proved to be adequately supported by randomized trials (enoxaparin and dalteparin, while limited evidence was available for other agents of this class.. Conclusions: Our synthesis of the effectiveness data can be useful as an overall reference in this area and can also contribute to defining the place of further innovative treatments for this clinical indication..

  13. Suspected pulmonary embolism and deep venous thrombosis: A comprehensive MDCT diagnosis in the acute clinical setting

    Energy Technology Data Exchange (ETDEWEB)

    Salvolini, Luca [Radiology Department, ' Umberto I' Hospital - Ospedali Riuniti - ' Politecnica delle Marche' University, Via Conca, 60020 Ancona (Italy)], E-mail: lucasalvolini@alice.it; Scaglione, Mariano [Emergency and Trauma CT Section, Department of Radiology, Cardarelli Hospital, Via G. Merliani 31, 80127 Naples (Italy); Giuseppetti, Gian Marco; Giovagnoni, Andrea [Radiology Department, ' Umberto I' Hospital - Ospedali Riuniti - ' Politecnica delle Marche' University, Via Conca, 60020 Ancona (Italy)

    2008-03-15

    Both pulmonary arterial and peripheral venous sides of venous thromboembolism (VTE) can now be efficiently and safely investigated by multi-detector CT (MDCT) at the same time by a combined CT angiography/CT venography protocol. In the emergency setting, the use of such a single test for patients suspected of suffering from VTE on a clinical grounds may considerably shorten and simplify diagnostic algorithms. The selection of patients to be submitted to MDCT must follow well-established clinical prediction rules in order to avoid generalized referral to CT on a generic clinical suspicion basis and excessive population exposure to increased ionizing radiation dose, especially in young patients. Clinical and anatomical wide-panoramic capabilities of MDCT allow identification of underlying disease that may explain patients' symptoms in a large number of cases in which VTE is not manifest. The analysis of MDCT additional findings on cardiopulmonary status and total thrombus burden can lead to better prognostic stratification of patients and influence therapeutic options. Some controversial points such as optimal examination parameters, clinical significance of subsegmentary emboli, CT pitfalls and/or possible falsely positive diagnoses, and outcome of untreated patients in which VTE has been excluded by MDCT without additional testing, must of course be taken into careful consideration before the definite role of comprehensive MDCT VTE 'one-stop-shop' diagnosis in everyday clinical practice can be ascertained.

  14. Central Venous Line and Acute Neurological Deficit: A Case Series

    Directory of Open Access Journals (Sweden)

    SeyedHossein Ahmadi

    2015-10-01

    Full Text Available Central venous catheter (CVC insertion is a practical way to assess patients hemodynamic specially in cardiovascular surgery but this relatively simple junior level procedure is not risk free and its common reported complications include; pneumothorax, hydrothorax, hemothorax, local hematoma, cardiac tamponade, vascular injury, thrombosis, embolism, and catheter disruption. Here in this article we are going to present 6 patients with very unusual presentation of CVC complication which was neurological deficit presented by agitation , unconsciousness, disorientation to time and place and  hemiparesis. All patients undergone neurologic consult and brain computed tomography. Final diagnosis was brain ischemic damage and finally we kept them on conservative management; fortunately we did not have any permanent damage.

  15. Mesenteric venous thrombosis after prolonged air travel-a case report

    Institute of Scientific and Technical Information of China (English)

    Joaqun Salas-Coronas; Jos L Serrano-Carrillo; Ana B Lozano-Serrano; Jos C Snchez-Snchez; Leticia Miras-Lucas; Rosario Prez-Moyano

    2014-01-01

    We present a case of acute mesenteric venous thrombosis after a long distance flight in a traveller presenting with abdominal pain, diarrhoea and vomiting within 48 h of prolonged immobility situation. Venous thrombosis in the lower limbs and venous thromboembolism has been clearly associated with prolonged air travel (economy class syndrome). Thrombosis was diagnosed by computed tomography of the abdomen, and after starting anticoagulant therapy with acenocumarol, symptoms yielded completely in a few weeks. The study of thrombophilia was negative, although the existence of two first-degree relatives (mother and grandmother) with a history of venous thrombosis with a history of venous thrombosis makes it likely a situation of inherited thrombophilia. Although exceptional, mesenteric venous thrombosis should be considered in travellers with acute abdominal pain after prolonged air travel when there are thrombophilic conditions.

  16. Mesenteric venous thrombosis after prolonged air travel-a case report

    Directory of Open Access Journals (Sweden)

    Joaquín Salas-Coronas

    2014-07-01

    Full Text Available We present a case of acute mesenteric venous thrombosis after a long distance flight in a traveller presenting with abdominal pain, diarrhoea and vomiting within 48 h of prolonged immobility situation. Venous thrombosis in the lower limbs and venous thromboembolism has been clearly associated with prolonged air travel (economy class syndrome. Thrombosis was diagnosed by computed tomography of the abdomen, and after starting anticoagulant therapy with acenocumarol, symptoms yielded completely in a few weeks. The study of thrombophilia was negative, although the existence of two first-degree relatives (mother and grandmother with a history of venous thrombosis with a history of venous thrombosis makes it likely a situation of inherited thrombophilia. Although exceptional, mesenteric venous thrombosis should be considered in travellers with acute abdominal pain after prolonged air travel when there are thrombophilic conditions.

  17. Venous Thromboembolism and Marathon Athletes

    Science.gov (United States)

    ... Search Donate Circulation My alerts Sign In Join Facebook Twitter Home About this Journal Editorial Board General Statistics Circulation Doodle → Blip the Doodle Information for Advertisers Author Reprints Commercial Reprints Customer Service and Ordering ...

  18. Catheter-directed Thrombolysis in Acute Superior Vena Cava Syndrome Caused by Central Venous Catheters.

    Science.gov (United States)

    Cui, Jie; Kawai, Tasuo; Irani, Zubin

    2015-01-01

    Indwelling central venous catheters have been reported to increase the risk of superior venous cava (SVC) syndrome. This case report describes the development of acute SVC syndrome in a 28-year-old woman with end-stage renal disease implanted with a left-side hemodialysis reliable outflow graft and a right-side double lumen hemodialysis catheter via internal jugular veins. Her symptoms were not alleviated after catheter removal and systemic anticoagulation therapy. She was eventually treated with catheter-directed thrombolysis and a predischarge computer tomographic venogram on postthrombolytic procedure day 7 showed patent central veins and patient remained asymptomatic. This case demonstrates that catheter-directed thrombolysis can be safely employed to treat refractory catheter-induced acute SVC syndrome in end-stage renal disease patients.

  19. Catheter-Directed Thrombolysis via Small Saphenous Veins for Treating Acute Deep Venous Thrombosis.

    Science.gov (United States)

    Yang, Bin; Xu, Xiao-Dong; Gao, Peng; Yu, Ji-Xiang; Li, Yu; Zhu, Ai-Dong; Meng, Ran-Ran

    2016-08-23

    BACKGROUND There is little data comparing catheter-directed thrombolysis (CDT) via small saphenous veins vs. systematic thrombolysis on complications and efficacy in acute deep venous thrombosis patients. The aim of our study was to compare the efficacy and safety of CDT via the small saphenous veins with systematic thrombolysis for patients with acute deep venous thrombosis (DVT). MATERIAL AND METHODS Sixty-six patients with acute DVT admitted from June 2012 to December 2013 were divided into 2 groups: 27 patients received systemic thrombolysis (ST group) and 39 patients received CDT via the small saphenous veins (CDT group). The thrombolysis efficiency, limb circumference differences, and complications such as post-thrombotic syndrome (PTS) in the 2 groups were recorded. RESULTS The angiograms demonstrated that all or part of the fresh thrombus was dissolved. There was a significant difference regarding thrombolysis efficiency between the CDT group and ST group (71.26% vs. 48.26%, P=0.001). In both groups the postoperative limb circumference changes were higher compared to the preoperative values. The differences between postoperative limb circumferences on postoperative days 7 and 14 were significantly higher in the CDT group than in the ST group (all Pdeep venous thrombosis.

  20. Catheter-directed thrombolysis in the treatment of acute deep venous thrombosis: a meta-analysis.

    Science.gov (United States)

    Zheng, J J; Zhang, Z H; Shan, Z; Wang, W J; Li, X X; Wang, S M; Li, Y-X; Cheng, G-S

    2014-07-24

    We performed a meta-analysis for systematic evaluation of the status quo of catheter thrombolysis for the treatment of acute lower limb deep vein thrombosis in China. We searched the China Biomedical bibliographic database (CBM), China National Knowledge Infrastructure (CNKI), Weipu full-text electronic journals, Wanfang full-text database, and Medline (1990 through June 2011) for clinical randomized controlled trials of catheter-directed thrombolysis and superficial venous thrombolysis to compare their efficacies for the treatment of acute deep vein thrombosis. The results were analyzed by using the Cochrane-recommended RevMan 4.2 software package, and the odds ratio (OR) was used as the combined measure of efficacy. The search retrieved 8 randomized controlled trials, and meta-analysis using the total rate of effective treatment as the clinical observation index found that the combined OR for the catheter thrombolysis group versus the superficial venous thrombolysis group was significant (P venous thrombolysis for the treatment of acute deep vein thrombosis in the lower limb in Chinese individuals. However, the included trials were only of medium quality, so more rational and scientific clinical trials are needed to validate this conclusion.

  1. Clinical analysis of cancer patients with venous thromboembolism%恶性肿瘤并发静脉血栓栓塞症的临床分析

    Institute of Scientific and Technical Information of China (English)

    蒲纯; 许小毛; 乔力松; 杨鹤; 金金

    2016-01-01

    目的:分析并发静脉血栓栓塞症( VTE)恶性肿瘤患者的原发肿瘤种类、分期、分化程度等,以识别高危患者,提高防治意识,减少VTE的发生。方法回顾性分析北京医院2003年1月至2013年1月期间并发静脉血栓栓塞症的恶性肿瘤患者的年龄、性别、基础疾病、原发肿瘤种类、病理类型、分化程度、TNM分期、化疗方案及预后等临床信息。结果在所有18531例恶性肿瘤患者中,280例并发VTE,其中男性157例,女性123例,年龄(66.60±12.60)岁。包括单纯肺栓塞( PTE)41例,单纯下肢深静脉血栓形成(DVT)189例,PTE合并DVT 50例。肺癌82例,消化道肿瘤78例,泌尿系肿瘤32例,妇科肿瘤27例,血液科肿瘤27例,乳腺癌12例,其他部位肿瘤22例。相比未并发VTE肿瘤患者,并发VTE多见于肺癌、妇科肿瘤和其他肿瘤患者,差异有统计学意义(P<0.05)。151例(53.9%)并发VTE肿瘤患者病理类型为腺癌;206例(73.6%)患者发生VTE时,肿瘤处于进展期;247例有明确TNM分期患者中Ⅲ~Ⅳ期患者187例(66.8%);144例有明确病理组织分化程度报告,中、低度分化程度者120例(85.4%)。至随访结束,共有130例患者死亡,中位生存时间为(24.0±7.8)个月,明确诊断VTE后3,6,9,12个月的累积死亡率分别为46.9%、69.2%、80.0%和82.3%。导致死亡的主要原因是肿瘤本身、肺栓塞和感染。结论肿瘤与VTE密切相关,腺癌、进展期肿瘤、分化程度低的肿瘤患者和化疗方案中含铂类药物者更易发生VTE,临床医师应注意对这部分患者进行VTE风险评估,采取必要的预防措施,减少VTE的发生。%Objective To identify the clinical features of cancer patients with venous thromboembolism ( VTE) , including types , stages and differentiation of the primary cancers , in order to identify

  2. Genetic risk factors in patients with deep venous thrombosis, a retrospective case control study on Iranian population

    OpenAIRE

    Hosseini, Soudabeh; Kalantar, Ebrahim; Hosseini, Maryam Sadat; Tabibian, Shadi; Shamsizadeh, Morteza; Dorgalaleh, Akbar

    2015-01-01

    Background Venous thromboembolism (VTE) could be manifested as deep venous thrombosis (DVT) or pulmonary embolism (PE). DVT is usually the more common manifestation and is usually formation of a thrombus in the deep veins of lower extremities. DVT could occur without known underlying cause (idiopathic thrombosis) which could be a consequence of an inherited underlying risk factor or could be a consequence of provoking events, such as trauma, surgery or acute illness (provoked thrombosis). Our...

  3. Prevalence, Pattern of Presentation, Risk Factors and Outcome of Acute Mesenteric Venous Thrombosis in Taif Province,

    Directory of Open Access Journals (Sweden)

    Mohamed Al Saeed*, Mohamed Hatem*Aseel Abu Duruk*Hala A Mohamed**,

    2013-07-01

    Full Text Available Background and aim of the study: Mesenteric venous thrombosis has a global incidence of 10-15% of all cases of mesenteric ischemia; however reports from high altitude provinces of Saudi Arabia as Taif and Aseer recorded an incidence above 60%. The aim of this study is to record the incidence, pattern of presentation, risk factors; diagnostic tools and outcome of treatment in a single center (King Abdul Aziz Specialist Hospital Taif, Saudi Arabia.Material and method: In this retrospective chart review study, we reviewed the records and data of all patients presented to King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia from January 2009 to January 2013 and their final diagnosis were proved to be acute mesenteric venous thrombosis. Traumatic, postoperative and non occlusive cases were excluded from the study.Results:Sixteen patients with final diagnosis of acute mesenteric venous thrombosis were included in this study, out of 26 patients (61.5% presented and diagnosed as acute occlusive mesenteric ischemia. Males were more affected than females. The mean age of the patients was 55±13.4 years. The mean duration of symptoms was 4.9±1.4 days.The most common presenting symptoms were; abdominal pain followed by nausea, vomiting, anorexia, bloody diarrhea and fever. The most prevalent physical findings was tachycardia followed by ileus, 5 patients presented by marked peritoneal signs 3 of them were shocked. Multiple risk factors were detected in all patients. Laboratory findings were not conclusive and diagnosis was established by CT angiography in most of the patients. During operation, all patients were found to have a segment of infarction of the small intestine and in one of them the cecum was involved. Resection of the gangrenous parts was done for all patients. Second look operation was performed in 25% of patients. The total mortality was 18.75%. Conclusion: Acute mesenteric venous thrombosis is the most common cause of acute occlusive

  4. Cost-effectiveness analysis of early veno-venous hemofiltration for severe acute pancreatitis in China

    Institute of Scientific and Technical Information of China (English)

    Kun Jiang; Xin-Zu Chen; Qing Xia; Wen-Fu Tang; Lei Wang

    2008-01-01

    AIM: To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis (SAP) in China.METHODS: We carried out a search of Pub-Medline and Chinese Biomedical Disk database. Controlled clinical trials on Chinese population were included in the analysis. The four decision branches that were analyzed were: continuous or long-term veno-venous hemofiltration (CWH/LWH), short-term veno-venous hemofiltration (SWH), SWH plus peritoneal dialysis (PD), and non-hemofiltration control group. The effectiveness of the technique was determined by survival rate, complications prevention and surgery preservation. The total cost of hospitalization was also assessed.RESULTS: The SWH only technique was the least costly modality, $5809 (44449 RMB), and was selected as the baseline treatment modality. SWH only arm achieved the lowest C/E ratio in terms of overall survival, complications prevention and surgery preservation. In incremental cost-effectiveness analysis, the CWH/ LVVH only and the control arms were inferior to other techniques. Sensitivity analysis showed SWH only and SWH plus PD arms overlapped in C/survival ratio.CONCLUSION: The role of early veno-venous hemofiltration as an alternative therapy for SAP remains controversial. However, we propose that early use of short-term high-volume veno-venous hemofiltration would have a beneficial impact on the management of SAP.

  5. AVE5026, a new hemisynthetic ultra-low-molecular-weight heparin for the prevention of venous thromboembolism in patients after total knee replacement surgery--TREK: a dose-ranging study

    DEFF Research Database (Denmark)

    Lassen, M R; Dahl, O E; Mismetti, P

    2009-01-01

    BACKGROUND: AVE5026 is a new hemisynthetic ultra-low-molecular-weight heparin, with a novel anti-thrombotic profile resulting from high anti-factor (F)Xa activity and residual anti-FIIa activity. AVE5026 is in clinical development for venous thromboembolism (VTE) prevention, a frequent complication......-daily doses of AVE5026 (5, 10, 20, 40, or 60 mg) or enoxaparin 40 mg in the calibrator arm. The primary efficacy end point was VTE until post-operative day 11, defined as deep vein thrombosis (DVT) detected by bilateral venography, symptomatic DVT, non-fatal pulmonary embolism (PE) and VTE-related death......: The safety and efficacy results of this study suggest that a AVE5026 dose of between 20 and 40 mg presents an adequate benefit-to-risk ratio....

  6. Correlation between arterial and venous blood gas analysis parameters in patients with acute exacerbation of chronic obstructive pulmonary disease

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    Novović Miloš

    2012-01-01

    Full Text Available Introduction. Arterial blood gas (ABG analyses have an important role in the assessment and monitoring of the metabolic and oxygen status of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD. Arterial puncture could have a lot of adverse effects, while sampling of venous blood is simpler and is not so invasive. Objective. The aim of this study was to evaluate whether venous blood gas (VBG values of pH, partial pressure of carbon dioxide (PCO2, partial oxygen pressure (PO2, bicarbonate (HCO3, and venous and arterial blood oxygen saturation (SO2 can reliably predict ABG levels in patients with acute exacerbation of COPD. Methods. Forty-seven patients with a prior diagnosis of COPD were included in this prospective study. The patients with acute exacerbation of this disease were examined at the General Hospital EMS Department in Prijepolje. ABG samples were taken immediately after venous sampling, and both were analyzed. Results. The Pearson correlation coefficients between arterial and venous parameters were 0.828, 0.877, 0.599, 0.896 and 0.312 for pH, PCO2, PO2, HCO3 and SO2, respectively. The statistically significant correlation between arterial and venous pH, PCO2 and HCO3, values was found in patients with acute exacerbation of COPD (p<0.001. Conclusion. When we cannot provide arterial blood for analysis, venous values of the pH, Pv,CO2 and HCO3 parameters can be an alternative to their arterial equivalents in the interpretation of the metabolic status in patients with acute exacerbation of COPD, while the values of venous Pv,O2 and Sv,O2 cannot be used as predictors in the assessment of oxygen status of such patients.

  7. Congestive kidney failure in cardiac surgery: the relationship between central venous pressure and acute kidney injury.

    Science.gov (United States)

    Gambardella, Ivancarmine; Gaudino, Mario; Ronco, Claudio; Lau, Christopher; Ivascu, Natalia; Girardi, Leonard N

    2016-11-01

    Acute kidney injury (AKI) in cardiac surgery has traditionally been linked to reduced arterial perfusion. There is ongoing evidence that central venous pressure (CVP) has a pivotal role in precipitating acute renal dysfunction in cardiac medical and surgical settings. We can regard this AKI driven by systemic venous hypertension as 'kidney congestive failure'. In the cardiac surgery population as a whole, when the CVP value reaches the threshold of 14 mmHg in postoperative period, the risk of AKI increases 2-fold with an odds ratio (OR) of 1.99, 95% confidence interval (95% CI) of 1.16-3.40. In cardiac surgery subsets where venous hypertension is a hallmark feature, the incidence of AKI is higher (tricuspid disease 30%, carcinoid valve disease 22%). Even in the non-chronically congested coronary artery bypass population, CVP measured 6 h postoperatively showed significant association to renal failure: risk-adjusted OR for AKI was 5.5 (95% CI 1.93-15.5; P = 0.001) with every 5 mmHg rise in CVP for patients with CVP <9 mmHg; for CVP increments of 5 mmHg above the threshold of 9 mmHg, the risk-adjusted OR for AKI was 1.3 (95% CI 1.01-1.65; P = 0.045). This and other clinical evidence are discussed along with the underlying pathophysiological mechanisms, involving the supremacy of volume receptors in regulating the autonomic output in hypervolaemia, and the regional effect of venous congestion on the nephron. The effect of CVP on renal function was found to be modulated by ventricular function class, aetiology and acuity of venous congestion. Evidence suggests that acute increases of CVP should be actively treated to avoid a deterioration of the renal function, particularly in patients with poor ventricular fraction. Besides, the practice of treating right heart failure with fluid loading should be avoided in favour of other ways to optimize haemodynamics in this setting, because of the detrimental effects on the kidney function.

  8. Sporadic multicentric right atrial and right ventricular myxoma presenting as acute pulmonary thromboembolism

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    Satyajit Singh

    2016-01-01

    Full Text Available Multicentric cardiac myxoma is a rare syndrome; usually it is familial. We report a rare case of sporadic right atrium (RA and right ventricle (RV myxoma in a 26-year-old female presenting to our hospital for the evaluation of sudden onset of dyspnea and left precordial pain attributed to the embolization of degenerating tumor fragments to the pulmonary artery (PA. The exact incidence of sporadic multicentric RA and RV myxoma presenting as acute pulmonary embolism is unknown as multicentric RA and RV myxoma are very rare. Myxomas presenting as pulmonary embolism is <10%. Majority of cardiac myxomas present as exertional dyspnea, chest pain, positional syncope, fever, weight loss and other constitutional symptoms. Any young patient presenting with acute onset dyspnea with multiple cardiac masses may have tumor embolization to the PA diagnosis with transthoracic echocardiography and high-resolution computed tomography of thorax, fast-tracks patient transfer for urgent cardiac surgery to prevent further embolization.

  9. Novos anticoagulantes para a profilaxia do tromboembolismo venoso em cirurgias ortopédicas de grande porte New anticoagulants for the prophylaxis of venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Ricardo de Alvarenga Yoshida

    2011-06-01

    novos inibidores diretos do fator Xa e inibidores do fator IIa.After about 50 years of experience with heparin and vitamin K antagonists (VKA, research and clinical studies of new anticoagulants have recently evolved . Although traditional anticoagulants have proven to be clinically useful, they have important limitations in terms of laboratory control, complications, side effects and interactions with medications and food. .Unfractionated heparin interacts with plasma proteins and the vascular wall, may trigger thrombocytopenia, can only be administered parenterally, requires control by the laboratory test of partial thromboplastin time, may cause osteoporosis and alopecia when used for long periods and it is produced from biological sources. VKA have the advantage of being administered orally, but the control (made by the international normalized ratio can be difficult in some cases, since they have delayed onset of action and metabolism and a narrow therapeutic window. They also interact with foods and with a large number of medications, can cause skin necrosis in patients with antithrombin and protein C and S deficiencies and may induce fetal changes when prescribed in pregnancy. In the 1980´s the low-molecular-weight heparins were developed and proved to be an evolution over unfractionated heparin, because of their greater bio-availability, fixed dose per body weight, no need for laboratory control, subcutaneous administration, lower risk of heparin-induced thrombocytopenia, and efficacy and safety similar to unfractionated heparin. Over the last decade, a series of new anticoagulants have appeared in the market and shown promising results in several situations of venous thromboembolism prophylaxis and treatment. In the present review, the new low-molecular-weight heparins, ultra-low molecular weight heparin, pentasaccharides and the new direct inhibitors of factor Xa and factor IIa.are addressed.

  10. THE RUSSIAN DATA OF INTERNATIONAL ENDORSE REGISTER (EPIDEMIOLOGIC INTERNATIONAL DAY FOR THE EVALUATION OF PATIENTS AT RISK OF VENOUS THROMBOSIS IN ACUTE HOSPITAL CARE SETTING

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    V. A. Sulimov

    2008-01-01

    Full Text Available Aim. To estimate a risk factor frequency of venous thromboembolism (VTE in patients urgently hospitalized in hospitals, and also to estimate of patients part having effective prevention of VTE.Material and methods. ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk of Venous Thrombosis in Acute Hospital Care Setting is the international register. Patients of 40 years and older hospitalised in therapeutic departments as well as patients of 18 years and older hospitalised in surgical departments (358 hospitals in 32 countries were included in the register. The case history analysis of all patients was performed for estimation of risk VTE and evaluation of preventive therapy quality according to American College of Chest Physicians (ACCP Recommendation 2004.Results. Totally 68 183 patients (including 30 827 (45% surgical patients and 37 356 (55% therapeutic patients were enrolled in Global ENDORSE Register. Russian centers enrolled 4 788 patients (including 2 829 (59% surgical patients and 1 959 (41% therapeutic patients. Totally 35 329 (51,8% patients enrolled in Global ENDORSE Register (64,4% of surgical patients (19 842 and 41,5% of therapeutic patients (15 487 had VTE risks. In Russia 2 188 enrolled patients (45,7% had VTE risks (52% of surgical patients (1 470 and 36,7% of therapeutic patients (718. Totally 17 732 (50,2% patients enrolled in Global Register ENDORSE and having VTE risks received VTE preventive therapy according to АССР Recommendations 2004. In Russia 521 (23,8% patients enrolled in Global ENDORSE Register and having VTE risks received VTE preventive therapy according to АССР Recommendations 2004. It is more than 2 times less in comparison with world level (р<0.001.Conclusion. There are a lot of patients with VTE risks in hospitals. It is necessary to improve preventive therapy of VTE due to better hospital management and more active use of АССР Recommendations 2004.

  11. Acute posttraumatic pediatric cerebral venous thrombosis: Case report and review of literature

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    Al-Wala Awad

    2014-01-01

    Full Text Available Background : Pediatric cerebral venous thrombosis (CVT is a common sequelae of infection, coagulopathies, and dehydration in the pediatric population. Acute posttraumatic CVT is an uncommon etiology of pediatric CVT that presents a unique management challenge. There are no established guidelines outlining the treatment of this small subset of patients. Case Description: We present a case of a 12-year-old boy with posttraumatic CVT who was safely treated with anticoagulation therapy, and had resolution of his symptoms and radiographic improvement within 3 days of therapy. The relevant literature is reviewed. Conclusion : Anticoagulation therapy may be safely used in the treatment of acute posttraumatic CVT in pediatric patients, and may reduce the incidence of clot propagation, hospitalization time, and cost of treatment.

  12. Acute Brachial Artery Thrombosis in a Neonate Caused by a Peripheral Venous Catheter

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    Simon Berzel

    2014-01-01

    Full Text Available This case describes the diagnostic testing and management of an acute thrombosis of the brachial artery in a female neonate. On day seven of life, clinical signs of acutely decreased peripheral perfusion indicated an occlusion of the brachial artery, which was confirmed by high-resolution Doppler ultrasound. Imaging also showed early stages of collateralization so that surgical treatment options could be avoided. Unfractionated heparin was used initially and then replaced by low-molecular-weight heparin while coagulation parameters were monitored closely. Within several days, brachial artery perfusion was completely restored. Acetylsalicylic acid was given for additional six weeks to minimize the risk of recurring thrombosis. If inadequately fixated in a high-risk location, a peripheral venous catheter can damage adjacent structures and thus ultimately cause arterial complications.

  13. Nursing for patients with acute or chronic pulmonary deep venous thrombosis%急、慢性肺血栓栓塞症患者的护理

    Institute of Scientific and Technical Information of China (English)

    张平; 姜波; 季颖群; 赵广东; 张中和

    2007-01-01

    @@ 静脉血栓栓塞症(venous thromboembolism,VTE)是把深静脉血栓栓塞症(deep venous thrombosis,DVT)和肺栓塞(pulmonary embolism,PE)作为整体理解,肺栓塞是来自全身静脉系统或右心的栓子游离后阻塞肺动脉或其分支引起的肺循环和呼吸功能障碍的临床综合征.

  14. Acute deep venous thrombosis of the upper extremity as demonstrated by scintigraphy with {sup 99m}Tc-apcitide

    Energy Technology Data Exchange (ETDEWEB)

    Dunzinger, A.; Piswanger-Soelkner, J.; Lipp, R. [Medical Univ. Graz (Austria). Div. of Nuclear Medicine; Hafner, F.; Brodmann, M. [Medical Univ. Graz (Austria). Div. of Angiology

    2008-07-01

    With an incidence of 0.7% inhabitants per year, acute deep venous thrombosis (DVT) is a common occurrence (20). Its incidence in the upper extremities, however, is not as precisely known; the literature reports that 1% to 10% of all DVT cases involve the upper limbs. Acute DVT of upper limb is mainly iatro-genic following interventions like implantation of pacemakers or central venous catheters, and is more likely to occur in obese patients or those with malignant diseases. Life-threatening pulmonary embolism (PE) may occur if acute DVT remains undetected. The presented case report demonstrates the feasibility of {sup 9}9mTc-apcitide scintigraphy for diagnosis of acute DVT of the upper limb and exclusion of PE in a single examination.

  15. An unexpected case of venous and pulmonary thrombo-embolism in a patient treated with thalidomide for refractory erythema nodosum leprosum: a case report

    Directory of Open Access Journals (Sweden)

    Chamara Ratnayake

    2011-01-01

    Full Text Available Abstract Recent literature reports an increased incidence of venous thrombosis following thalidomide use in the treatment of diseases with disease-related thrombotic risks such as malignancy, as well as concomitant use with chemotherapy and/or systemic corticosteroids. We report a case of deep vein thrombosis (DVT and pulmonary embolism (PE following thalidomide use in a patient with erythema nodosum leprosum (ENL reaction who was concurrently treated with prednisolone, as well as a review of relevant literature.

  16. CATCH: A randomized trial comparing tinzaparin versus warfarin for treatment of acute venous thromboembolism (VTE) in cancer patients

    NARCIS (Netherlands)

    Lee, Agnes Y.; Bauersachs, Rupert; Janas, Mette S.; Jarner, Mikala F.; Kamphuisen, Pieter W.; Meyer, Guy; Paz-Ares, Luis; Khorana, Alok A.

    2012-01-01

    Background: VTE is a major cause of morbidity and mortality in cancer patients. LMWHs have been shown to be superior to warfarin in one randomized study, but adequately powered confirmatory studies have not been conducted and warfarin continues to be widely used for treatment of cancer-associated VT

  17. Association of deep venous thrombosis with calf vein diameter in acute hemorrhagic stroke.

    Science.gov (United States)

    Ogata, Toshiyasu; Yasaka, Masahiro; Wakugawa, Yoshiyuki; Kitazono, Takanari; Okada, Yasushi

    2013-10-01

    We investigated the association between the development of deep venous thrombosis (DVT) and calf vein diameter in patients with acute hemorrhagic stroke. We measured the maximum diameter of paralytic side posttibial veins (PTVs) and peroneal veins (PVs) in 49 patients with intracerebral hemorrhage on admission and at 2 weeks after stroke onset by ultrasonography. We also examined for the presence or absence of DVT, and then analyzed the association of DVT with the maximum vein diameter. At 2 weeks after stroke, DVTs were detected in PTVs in 7 patients and in PVs in 6 patients. The maximum calf vein diameters at 2 weeks were significantly greater in patients with DVT compared with those without DVT (PTV, P = .033; PV, P = .015). Although calf vein diameter at admission did not influence the future incidence of DVT in patients with intracerebral hemorrhage, the presence of DVT was associated with calf vein dilatation.

  18. Has incentive payment improved venous thrombo-embolism risk assessment and treatment of hospital in-patients? [v1; ref status: indexed, http://f1000r.es/8k

    Directory of Open Access Journals (Sweden)

    Sue Child

    2013-02-01

    Full Text Available This paper focuses on financial incentives rewarding successful implementation of guidelines in the UK National Health Service (NHS. In particular, it assesses the implementation of National Institute for Health and Clinical Excellence (NICE venous thrombo-embolism (VTE guidance in 2010 on the risk assessment and secondary prevention of VTE in hospital in-patients and the financial incentives driving successful implementation introduced by the Commissioning for Quality and Innovation for Payment Framework (CQUIN for 2010-2011. We systematically compared the implementation of evidence-based national guidance on VTE prevention across two specialities (general medicine and orthopaedics in four hospital sites in the greater South West of England by auditing and evaluating VTE prevention activity for 2009 (i.e. before the 2010 NICE guideline and late 2010 (almost a year after the guideline was published. Analysis of VTE prevention activity reported in 816 randomly selected orthopaedic and general medical in-patient medical records was complemented by a qualitative study into the practical responses to revised national guidance. This paper’s contribution to knowledge is to suggest that by financially rewarding the implementation of national guidance on VTE prevention, paradoxes and contradictions have become apparent between the ‘payment by volume system’ of Healthcare Resource Groups and the ‘payment by results’ system of CQUIN.

  19. Leukocytic Response and Peripheral Venous Blood Lymphocyte Apoptosis as a Marker of Tissue Ischemia in Acute Massive Blood Loss

    Directory of Open Access Journals (Sweden)

    N. V. Borovkova

    2013-01-01

    Full Text Available Objective: to estimate the level of peripheral venous blood lymphocyte apoptosis and intraoperative hypoxia in victims with acute massive blood loss. Subjects and methods. Twenty-two patients with open and close chest and abdominal traumas complicated by acute massive blood loss were examined. All the patients were emergently operated on to stop bleeding. Tissue metabolism was evaluated from gases, acid-base parameters, and plasma lactate, glucose, potassium, and sodium levels. Apoptosis of mononuclear cells was studied and dead leukocytes were counted using flow cytometry. Results. Preoperatively, the victims were found to have venous hypoxemia, hyperlactatemia, hyperglycemia, moderate leukocytosis, and higher dead leukocyte counts. There were also raised counts of lymphocytes coming into the process of apoptosis. A significant relationship was found between monocyte counts and hypoxia values. At the end of surgery, oxygen balance values became stable and exerted an effect on the count of leukocytes, the relative level of granulocytes, the relative and absolute counts of dead and damaged leukocytes, and the concentration of lymphocytes in the victims’ venous blood during the early stages of apoptosis, as evidenced by nonlinear regression models. Conclusion. The indicators of immunocompetent cell apoptosis and the count of venous blood dead leukocytes along with lactate levels and venous hypoxemia parameters reflect the degree of tissue hypoxia and may be used as specific markers.

  20. Analysis of clinical characteristics of 96 patients with acute superior mesenteric venous thrombosis

    Directory of Open Access Journals (Sweden)

    Wen-hui LIU

    2015-06-01

    Full Text Available Objective To investigate the clinical characteristics of patients suffering from acute superior mesenteric venous thrombosis (ASMVT. Methods Clinical data of 96 ASMVT patients admitted to the PLA General Hospital from January 2000 to December 2013 were retrospectively analyzed. Clinical characteristics and death-associated risk factors were studied, and the influence of treatment strategy and thrombosis location on patients' outcome were analyzed. Results The patients were divided into survival group (n=83 and death group (n=13 according to the outcome. The mean age was 46.9 years old, and the ratio of male/female was 3:1. Thirty-nine patients presented isolated superior mesenteric venous thrombosis (SMVT and fiftyseven patients presented combined SMVT. In the death group, higher incidence of severe acute pancreatitis and isolated SMVT were found than the survival group (P<0.01, P=0.004. The patients were again divided into laparotomy group, interventional thrombolysis group, and conservative treatment group according to treatment modality. The interval between symptom onset and treatment was shorter, the incidence of isolated SMVT and mortality rate were higher in the laparotomy group compared with those in interventional thrombolysis group and conservative treatment group. There was no death in the conservative treatment group. In comparison with the combined SMVT group, more patients in the isolated SMVT group presented peritoneal signs and less with history of splenectomy (P<0.001, P=0.002. The proportion of patients with laparotomy and bowel necrosis in the isolated SMVT group was higher than those in the combined SMVT group (P=0.023, P=0.012. Conclusions Patients with isolated SMVT are more likely to have peritoneal signs and bowel necrosis, surgical treatment is mandatory. Patients with combined SMVT often have a history of splenectomy. ASMVT patients with severe pancreatitis may present higher mortality rate. DOI: 10.11855/j

  1. Thromboembolic complications in the nephrotic syndrome: pathophysiology and clinical management.

    Science.gov (United States)

    Singhal, Rajni; Brimble, K Scott

    2006-01-01

    Patients with the nephrotic syndrome are at increased risk of developing venous and arterial thromboembolism, the most common of which is renal vein thrombosis. There are several unanswered or controversial issues relating to the nephrotic syndrome and thromboembolism, which include the mechanism of thromboembolism, and optimal diagnostic and anticoagulant management strategies. This review will discuss several of these issues: the epidemiology and clinical spectrum of thromboembolic disease occurring in patients with the nephrotic syndrome; the pathophysiology of the hypercoagulable state associated with the nephrotic syndrome; the diagnosis of renal vein thrombosis in the nephrotic syndrome; and the evidence for prophylactic and therapeutic anticoagulation strategies in such patients.

  2. 骨科领域静脉血栓栓塞症的预防%Prevention of venous thromboembolism in orthopedics

    Institute of Scientific and Technical Information of China (English)

    邱贵兴; 王炜

    2011-01-01

    @@ 骨科手术涉及创伤、应激、制动、长期卧床等多种因素,易发生深静脉血栓形成(deep venous thrombosis,DVT),并可因此继发肺栓塞导致死亡,是骨科领域较严重的并发症,应当引起高度的重视.自2004年起,中华医学会骨科学分会组织全国范围内的骨科专家进行相关课题的调研,参考了2004年美国胸科医师协会(American College of Chest Physician,ACCP)发表的第7版等大量国内外文献,起草并发表了.

  3. 中央型急性期下肢DVT置管溶栓与外周溶栓的比较%Outcomes of anticoagulation and thrombolysis for acute deep venous thrombosis via central venous catheter and peripheral venous injection

    Institute of Scientific and Technical Information of China (English)

    朱少问; 郑小兵; 冯翔

    2013-01-01

    目的:比较中央型急性期DVT经外周静脉溶栓与局部置管溶栓治疗的效果,以指导临床治疗.方法:通过回顾性分析我院及江苏南通大学附属医院2010年9月~2012年7月期间收治的共42例下肢深静脉血栓形成患者的临床资料,按照治疗方法分为置管溶栓组(A组)、外周溶栓组(B组).其中外周溶栓组共20例,左侧13例,右侧6例,双侧1例.置管溶栓组共22例,左侧15例,右侧6例,双侧1例.通过监测患者临床症状,测量下肢周径变化比较两组治疗效果.结果:置管溶栓治疗方法具有平均起效时间快、总溶栓疗程短、溶栓药物总剂量低、并发症发生率及PTS发生率低等优点,而远期复发率与外周溶栓组无明显差异.结论:置管溶栓治疗方法优于外周溶栓治疗.%Objective :To compare the curative efficacy of anticoagulation and thrombolysis for acute deep venous thrombosis( DVT ) via central venous catheter management or peripheral venous management for summary of the clinical experience. Methods :The clinical data were reviewed in 42 patients with DVT undergone treatment respectively in our institution and the Affiliated Hospital of Nantong University between Sept. 2010 and Jul. 2012. The patients were randomized into either group A( n=22; 15 were symptoms of left lower extremity,6 of right and 1 of both extremities ) by thrombolytic therapy via central venous catheter or group B( n =20; 13 were acute episode of left lower limb, 6 of right and 1 of both lower limbs. ) managed with peripheral venous anticoagulation and thrombolysis. Two groups of patients were assessed for the curative efficacy by observing the relief of clinical symptoms and measuring the changes of the limb circumference. Results:Thrombolytic therapy for acute DVT via central venous catheter demonstrated advantages by earlier effects, shortened therapy duration, requirement of lower drug dosage, fewer incidence of complications and risk of developing the

  4. Extended-duration rivaroxaban thromboprophylaxis in acutely ill medical patients: MAGELLAN study protocol

    NARCIS (Netherlands)

    A.T. Cohen; T.E. Spiro; H.R. Büller; L. Haskell; D. Hu; R. Hull; A. Mebazaa; G. Merli; S. Schellong; A. Spyropoulos; V. Tapson

    2011-01-01

    Patients with acute medical illnesses are at increased risk of venous thromboembolism (VTE), a significant cause of morbidity and mortality. Thromboprophylaxis is recommended in these patients but questions remain regarding the optimal duration of therapy. The aim of this study is to determine wheth

  5. [Tactics of the patients management in continuing acute thrombosis of deep veins].

    Science.gov (United States)

    Prasol, V A; Mishenina, E V; Okley, D V

    2015-03-01

    Experience of active tactics of treatment application in 18 patients, suffering an acute thrombosis in system of lower vena cava, is presented. Possibilities were estimated and efficacy of active surgical tactics proved in continuing deep vein thrombosis on early stage were estimated. Active tactics, using catheter--governed thrombolysis, permits to escape pulmonary thromboembolism and to reduce a severity of further chronic venous insufficiency.

  6. Pulmonary thromboembolism in children

    Energy Technology Data Exchange (ETDEWEB)

    Babyn, Paul S.; Gahunia, Harpal K. [Hospital for Sick Children, Department of Pediatric Diagnostic Imaging, Toronto, ON (Canada); Massicotte, Patricia [Stollery Children' s Hospital and University of Alberta, Departments of Pediatric Hematology and Cardiology, Edmonton, AB (Canada)

    2005-03-01

    Pulmonary thromboembolism (PTE) is uncommonly diagnosed in the pediatric patient, and indeed often only discovered on autopsy. The incidence of pediatric PTE depends upon the associated underlying disease, diagnostic tests used, and index of suspicion. Multiple risk factors can be found including: peripartum asphyxia, dyspnea, haemoptysis, chest pain, dehydration, septicemia, central venous lines (CVLs), trauma, surgery, ongoing hemolysis, vascular lesions, malignancy, renal disease, foreign bodies or, uncommonly, intracranial venous sinus thrombosis, burns, or nonbacterial thrombotic endocarditis. Other types of embolism can occur uncommonly in childhood and need to be recognized, as the required treatment will vary. These include pulmonary cytolytic thrombi, foreign bodies, tumor and septic emboli, and post-traumatic fat emboli. No single noninvasive test for pulmonary embolism is both sensitive and specific. A combination of diagnostic procedures must be used to identify suspect or confirmed cases of PTE. This article reviews the risk factors, clinical presentation and treatment of pulmonary embolism in children. It also highlights the current diagnostic tools and protocols used to evaluate pulmonary embolism in pediatric patients. (orig.)

  7. Pulmonary Thromboembolism in Klinefelter%u2019s Syndrome Patient with Deficient of Protein C

    OpenAIRE

    Mehmet Yigit

    2013-01-01

    Klinefelter syndrome (KS) is a common genetic disorder caused by one or more supernumerary X chromosomes. KS poses an increased risk for venous thromboembolic events such as deep venous thrombosis and pulmonary embolism. Klinefelter syndrome is prone to hypercoagulability due to hormonal imbalance and one or more inherited thrombophilic factors. Therefore, patients with KS having a medical history of venous thromboembolism require chest computed tomographic (CT) images and oral anticoagulatio...

  8. Acute venous thrombosis as complication and clue to diagnose a SAPHO syndrome case. A case report.

    Science.gov (United States)

    Rosero, A; Ruano, R; Martin, M; Hidalgo, C; Garcia-Talavera, J

    2013-01-01

    This report concerns a male adult admitted for sternal and left arm pain, who was diagnosed and treated for acute deep venous thrombosis in the left subclavian and axillary veins. X-ray and a hybrid single photon emission tomography and computed tomography (SPECT-CT) scintigraphy scan revealed high intensity uptake in both sternoclavicular joints, which corresponded to hyperostosis, thereby suggesting a SAPHO syndrome. Upon reviewing the patient's medical history, we found dermatological pustulosis disease and an intermittent sternal chest pain untreated since 10 years ago. In the biochemical study we found erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) elevation, hyperglobulinemia, and mild anaemia. Initial treatment included nonsteroidal anti-inflammatory drugs (NSAIDs) with low response, which then changed to methotrexate, sulfasalazine, and prednisone. The patient's pain was controlled almost completely in 10 months. A control bone scan revealed a marked decrease in intensity of bone deposits according to clinical response. To our knowledge, there are only a few cases of SAPHO and thrombosis and none are followed up with a bone SPECT-CT scan.

  9. Thrombosis and its significance after experimental pulmonary thromboembolism

    Institute of Scientific and Technical Information of China (English)

    季颖群; 张中和; 张平

    2003-01-01

    Objective To study thrombosis and its significance after acute experimental pulmonary thromboembolism. Methods The acute pulmonary thromboembolism (PTE) model of rabbits was established by intravenous injection of autologous blood clots (0.04 g/kg) which were stabilized in temperature-controlled (70℃) distilled water for 10 min. The process of thrombosis was observed grossly and microscopically. The Quick's method was used to examine the coagulability of blood and radioimmunoassay was employed to measure the level of plasma thromboxane A2 and endothelin. Results Thrombotic propensity was observed at 1 h, fresh thrombus started to form and the blood coagulation system was activated at 24 h following clots infusion. Emboli were completely or partly dissolved at 5 d and appeared to organize at both 10 d and 14 d after clots were infused. Venous plasma thromboxane A2 concentration began to increase at 5 min (2489.59±714.68 ng/L) and reached its maximum at 15 min (2545.46±590.58 ng/L) then declined at 60 min after clot infusion (P<0.001, respectively, vs 626.59±510.02 ng/L of pre-clot). The level of endothelin in both arterial and venous blood increased at 5 d post-clot infusion (840.74±154.19 ng/L, 230.35±52.39 ng/L, respectively) compared to the one before infusion (602.66±453.26 ng/L, 148.01±53.28 ng/L, respectively, P<0.05).Conclusions Thrombosis occurs after autologous-blood-clot-induced PTE. The interactions between thrombus formation, fibrinolysis and organization determines the consequences of emboli. Abnormalities of endothelin metabolism and the increment of thromboxane A2 may play an important role in PTE.

  10. Acutely altered hemodynamics following venous obstruction in the early chick embryo

    NARCIS (Netherlands)

    S. Stekelenburg-de Vos (Sandra); N.T.C. Ursem (Nicolette); W.C.J. Hop (Wim); J.W. Wladimiroff (Juriy); A.C. Gittenberger-de Groot (Adriana); R.E. Poelmann (Robert)

    2003-01-01

    textabstractIn the venous clip model specific cardiac malformations are induced in the chick embryo by obstructing the right lateral vitelline vein with a microclip. Clipping alters venous return and intracardiac laminar blood flow patterns, with secondary effects on the mechanical

  11. Experimental Study of Thrombolytic Therapy in Acute Pulmonary Thromboembolism%急性肺血栓栓塞溶栓治疗的动物实验研究

    Institute of Scientific and Technical Information of China (English)

    姜琴华; 许雯; 李国平; 陈彦凡; 王良兴; 陈少贤

    2012-01-01

    Objective: To establish an animal model of acute pulmonary thromboembolism that may be used for throm-bolyitc therapy study. Methods; Twenty-four Japanese rabbits were randomly divided into Urokinase group (group UK) , control group (group C) and sham operation group (group S). Acute pulmonary embolism models of rabbits were established with injection of autologous blood clots through the right heart catheters. Haemodynamic monitoring were performed by introducing heart catheter through right jugular vein. The ultrastructures of lung tissue were observed by electronic microscope. Results: ( 1) Radionuclide lung perfusion scan showed radio activity defect or attenuation after embolization and radioactivity filling after thromblysis. (2)PAMP was increased after embolization in both group UK and group C(P < 0.01) and decreased immediately at 1 hour after UK administration in group UK (P <0. 01), there were no significant changes in PAMP of group C after embolization with time. (3) Histopathologic analysis showed pulmonary hemorrhage and consolidation in group UK,the swelling and karyopyknosis of capillary endothelium were observed in group UK. The injuries of endotheliums and type II alveolar cells in group UK were more severe than those in group C. Conclusion:The way of establishment of model is simple. The physiological changes of experimental model accord with the acute pulmonary thromboembolisms. It provides a good experiment model for thrombolyitc therapy in pulmonary thromboembolism.%目的:建立一种良好的适合进行溶栓治疗实验研究的急性肺血栓栓塞动物模型.方法:24只日本大耳白兔,随机分为尿激酶溶栓组(UK组)、模型组(C组)、假手术组(S组),经右心导管注入条柱状自体血栓,心导管法监测血流动力学,制备急性肺血栓栓塞实验模型.在血流动力学和核素肺灌注扫描的基础上观察溶栓疗效,采用透射电镜法观察肺组织超微结构.结果:(1)肺栓

  12. Estudo comparativo entre rivaroxaban e enoxaparina na profilaxia de tromboembolismo venoso profundo em pacientes submetidos à artroplastia total do quadril Comparative study between rivaroxaban and enoxaparin in deep venous thromboembolism prophylaxis in patients submitted to total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Pedro Silva Kanan

    2008-08-01

    profunda e tromboembolismo pulmonar.OBJECTIVE: To compare the effectiveness and safety of rivaroxaban to those of enoxaparin for the prophylaxis of deep venous thrombosis (DVT after total hip arthroplasty. METHODS: From September 2006 to April 2007, at the Orthopedics and Traumatology Clinic of the Hospital Complex of the Santa Casa of Porto Alegre, State of Rio Grande do Sul, a randomized, double-blind clinical trial was carried out in which 67 patients were selected (n = 67, all of them submitted to total hip arthroplasty (ATQ. Of these patients, two were excluded for lack of adherence to the prophylaxis proposed after hospital release (n = 65. One of the groups was given subcutaneous 40 mg enoxaparin 6 hours to 8 hours before surgery, and after surgery a placebo pill was added, for once a day oral intake, during the first 32 to 36 days. The other group was given oral 10 mg rivaroxaban, once a day, during the first 32 to 36 post-operative days. In order to have the double-blind feature of the study, a subcutaneous placebo injection was given 6 hours to 8 hours before surgery and on the 32 to 36 days following surgery. The main outcome aimed at was the effectiveness in preventing DVT, which was evaluated by bilateral venography carried out between days 32 and 36 after surgery, or through documented symptoms of deep venous thrombosis or pulmonary thromboembolism (PTE. The secondary outcome studied was administration safety, that was evaluated through major bleeding or liver toxicity. RESULTS: Rivaroxaban and enoxaparin showed similar results (the differences were not statistically significant when compared for the reduction of DVT incidence till the 36th post-operative day. There was no difference in blood loss and liver toxicity when the drugs were compared. CONCLUSION: In patients submitted to total hip arthroplasty, rivaroxaban showed as effective and safe as enoxaparin to prevent deep venous thrombosis and pulmonary thromboembolism.

  13. Risk of venous thromboembolism associated with single and combined effects of Factor V Leiden, Prothrombin 20210A and Methylenetethraydrofolate reductase C677T: a meta-analysis involving over 11,000 cases and 21,000 controls

    Science.gov (United States)

    Simone, B; De Stefano, V; Leoncini, E; Zacho, J; Martinelli, I; Emmerich, J; Rossi, E; Folsom, AR; Almawi, WY; Scarabin, PY; den Heijer, M; Cushman, M; Penco, S; Vaya, A; Angchaisuksiri, P; Okumus, G; Gemmati, D; Cima, S; Akar, N; Oguzulgen, KI; Ducros, V; Lichy, C; Fernandez-Miranda, C; Szczeklik, A; Nieto, JA; Torres, JD; Le Cam-Duchez, V; Ivanov, P; Cantu, C; Shmeleva, VM; Stegnar, M; Ogunyemi, D; Eid, SS; Nicolotti, N; De Feo, E; Ricciardi, W; Boccia, S

    2014-01-01

    BACKGROUND Genetic and environmental factors interact in determining the risk of venous thromboembolism (VTE). The risk associated with the polymorphic variants G1691A of factor V (Factor V Leiden,FVL), G20210A of prothrombin (PT20210A) and C677T of methylentetrahydrofolate reductase (C677T MTHFR) genes has been investigated in many studies. METHODS We performed a pooled analysis of case-control and cohort studies investigating in adults the association between each variant and VTE, published on Pubmed, Embase or Google through January 2010. Authors of eligible papers, were invited to provide all available individual data for the pooling. The Odds Ratio (OR) for first VTE associated with each variant, individually and combined with the others, were calculated with a random effect model, in heterozygotes and homozygotes (dominant model for FVL and PT20210A; recessive for C677T MTHFR). RESULTS We analysed 31 databases, including 11,239 cases and 21,521 controls. No significant association with VTE was found for homozygous C677T MTHFR (OR: 1.38; 95% confidence intervals [CI]: 0.98–1.93), whereas the risk was increased in carriers of either heterozygous FVL or PT20210 (OR=4.22; 95% CI: 3.35–5.32; and OR=2.79;95% CI: 2.25–3.46, respectively), in double hterozygotes (OR=3.42; 95%CI 1.64-7.13), and in homozygous FVL or PT20210A (OR=11.45; 95%CI: 6.79-19.29; and OR: 2.79; 95%CI: 2.25 – 3.46, respectively). The stratified analyses showed a stronger effect of FVL on individuals ≤45 years (p-value for interaction = 0.036) and of PT20210A in women using oral contraceptives (p-value for interaction = 0.045). CONCLUSIONS In this large pooled analysis, inclusive of large studies like MEGA, no effect was found for C677T MTHFR on VTE; FVL and PT20210A were confirmed to be moderate risk factors. Notably, double carriers of the two genetic variants produced an impact on VTE risk significantly increased but weaker than previously thought. PMID:23900608

  14. Prethrombotic state gene predictions and diagnosis of venous thromboembolism after large traumatic surgery including orthopedic joint replacement and implant placement%骨科关节置换、植入物置入等较大创伤型手术后静脉血栓前状态的基因预测诊断

    Institute of Scientific and Technical Information of China (English)

    王强; 赵学凌

    2012-01-01

    BACKGROUND: At present, we pay more attention on the early genetic diagnosis of venous thromboembolism after traumatic or orthopedic surgery.OBJECTIVE: To summarize the mature gene research used to diagnosis the venous thromboembolism after orthopedic surgery.METHODS: CNKI database and PubMed database (2000-01/2011-01) were searched through Web with the key words of “venous thrombosis, deep venous thrombosis, pulmonary embolism, genes, diagnosis” or “thrombosis, DVT, PE, gene”.RESULTS AND CONCLUSION: Recent clinical and basic research showed that venous thromboembolism was a typical polygenic hereditary disease. And we also found some mutant gene related to high blood coagulation was closely related with venous thrombosis. These mutant gene included prothrombinase V, antithrombin Ⅲ, protein C, protein S, plasminogen, fibrinogen, heparin cofactor Ⅱ, thrombomodulin and prothrombinase Ⅻ. Understanding of the hereditary pathogenic gene mechanism for venous thromboembolism was in favor of early diagnosis and treatment and reduced the harm.%背景:目前创伤或骨科手术后的静脉血栓栓塞症早期基因诊断日益受到重视.目的:综述目前用于预测诊断骨科术后静脉血栓栓塞症较为成熟的一些基因的研究进展.方法:通过网络检索CNKI和PubMed数据库等2000-01/2011-01关于骨科术后静脉血栓基因诊断的文章,在标题和摘要中以"静脉血栓形成,深静脉血栓,肺栓塞,基因,诊断"或"thrombosis;DVT;PE;gene"为关键词.结果与结论:近年来临床和基础研究证实,骨科术后的静脉血栓栓塞症是人类典型的多基因遗传性疾病,至今发现了一些和血液高凝有关的突变基因与静脉血栓形成有密切关系,分别是:凝血因子V,抗凝血酶Ⅲ,蛋白C,蛋白S,纤溶酶原,纤维蛋白原,肝素辅因子Ⅱ,血栓调节蛋白和凝血因子Ⅻ.了解骨科术后静脉血栓栓塞症的遗传性致病基因机制,有利于早诊断、早治疗,降低其危害.

  15. Upper limb arterial thromboembolism

    DEFF Research Database (Denmark)

    Andersen, L V; Lip, Gregory Y.H.; Lindholt, J S;

    2013-01-01

    The aim of this review is to focus on risk factors, risk-modifying drugs and prognosis for upper limb arterial thromboembolism, and the relationship between upper limb arterial thromboembolism and atrial fibrillation (AF).......The aim of this review is to focus on risk factors, risk-modifying drugs and prognosis for upper limb arterial thromboembolism, and the relationship between upper limb arterial thromboembolism and atrial fibrillation (AF)....

  16. Combined CT Angiography and CT Venography in Thromboembolic disease: clinical impact; Angio TC y flebo TC combinados en el diagnostico de la enfermedad tramboembolica: impacto clinico

    Energy Technology Data Exchange (ETDEWEB)

    Bouzas, R.; Migueles, Y.; Gomez, S.; Mallo, R.; Garcia-Tejedor, J. L.; Diaz Vega, M. J. [Complejo Hospitalario Xerar-Cies. Vigo. Pontevedra (Spain)

    2002-07-01

    Combined CT Venography and Pulmonary Angiography was described in 1998 as a tool for diagnostic Thromboembolic Disease. The purpose is to relate our own experience with this technique in a population with suspected pulmonary embolism. 46 consecutive patients with suspected pulmonary embolism underwent combined CT Venography after Pulmonary CT Angiography to depict Deep Venous Thrombosis (DVT). CT Venography where obtained with a 3 minutes delay from injection, without additional intravenous contrast, from upper abdomen to fibular head. A prospective study from emergency reports where used. The reports where aimed by nine different radiologist at diary emergency room (images where not retrospective review). We report if a pulmonary embolus or deep venous thrombus or another alternative diagnostic where done. An endo luminal thrombus in any pulmonary arteries was assessed as a positive study for PE. A Thrombus in the leg veins or in an abdominal vein without diminished size of vein was assessed as an acute DVT. In those patients with a CT negative to Thromboembolic Disease was the clinician who decide if more proves where needed. Those patients without evidence in CT of Thromboembolic Disease where asked for symptoms related to the episode in a 3 months period after initial CT. Patients free of symptoms for 3 months without anticoagulation therapy where considered true negative for CT. CT shows Thromboembolic Disease in 23 of 46 patients. 21PE, 14 DVT 2 of 14 patients with DVT don't show PE, CT excluded thromboembolic disease in 23 patients and in 15 of those patients an alternative diagnostic was shown. In 22 of those 23 patients CT excluded correctly Thromboembolic Disease. One patient result in a false negative CT, Pulmonary Angiography of that patient shows us a subsegmentary embolus. (Author) 9 refs.

  17. Venous thrombosis: an overview

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, C.W.

    1986-07-01

    Venous thromboembolic disease contributes to morbidity and mortality in certain groups of hospitalized patients, particularly those who have undergone surgery. Although principles of treatment have changed relatively little during the past 20 years, significant advances have been made in the diagnosis of deep vein thrombosis (DVT). Venography, once the only reliable diagnostic technique, has been largely replaced by noninvasive tests: impedance plethysmography, venous Doppler, /sup 125/I-radiofibrinogen-uptake test, and phleborheography. Virchow's triad of stasis, vessel injury, and hypercoagulability remains a valid explanation of the pathogenesis of thrombus formation, but laboratory and clinical data have refined our knowledge of how these factors interact to result in clinically significant disease. Knowledge of the natural history of venous thrombosis, plus heightened awareness of the long-term morbidity and expense associated with the postphlebitic syndrome, have led to increased interest in preventing DVT. Clinically and economically, venous thrombosis is best managed by prevention. 61 references.

  18. INCREASED RISK OF THROMBOEMBOLISM AS A RESULT OF HIGH THROMBIN PRODUCTION IS ASSOCIATED WITH SHORT ACTIVATED PARTIAL THROMBOPLASTIN TIME IN CANCER PATIENTS ON AND AFTER CHEMOTHERAPY: A PROSPECTIVE STUDY IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Indranil

    2014-06-01

    Full Text Available : To investigate wheather cancer patients during and following chemotherapy with short activated partial thromboplastin times (aPTTs have increased thrombin generation and are at increased risk for thromboembolism, this prospective study was designed. Routine coagulation specimens of such patients were screened for the presence of short or normal aPTT for 5-month period, and, accordingly, 250 specimens were collected. Prothrombin fragment F1+2 (F1+2 was measured to evaluate thrombin activation, and a second aPTT was performed with a different reagent. Clinical history were obtained from medical records after conclusion of sample collection. 6 to12months later, patients were questioned on thromboembolic events during the previous 18 months by questionnaire. F1+2 and the incidence of venous thromboses were elevated significantly in the short aPTT group. Patients with acute bleeding had short aPTTs, but 36% of these also had thromboembolic events during the 18 months proximal to blood collection. These findings were confirmed with the second aPTT reagent. Patients with short aPTTs have increased thrombin generation and are at increased risk for thromboembolism, mainly venous thromboses, despite the fact that a short aPTT can occur in the acute setting of bleeding.

  19. Venous and arterial thromboembolism : prevention and prognosis

    NARCIS (Netherlands)

    Pasha, Sharif Mohammed

    2015-01-01

    This thesis is a journey in the vascular medicine. Chapter 1 is a general introduction. Chapter 2 is a meta-analysis on the diagnosis of pulmonary embolism on the emergency ward. Chapter 3 is a meta-analysis on the occurence of contrast induced nephropathy in patients suspected for pulmonary embolis

  20. [Venous thromboembolism: an urgent call for action].

    Science.gov (United States)

    Páramo, José A; Lecumberri, Ramón

    2009-10-17

    Thousands of individuals suffer from deep vein thrombosis (DVT) all over the world, and many will die from its main complication, pulmonary embolism (PE). An important problem is that the diagnose is easy to overlook because the signs and symptoms are often difficult to recognize. Why do DVT and PE remain such a serious problem, particularly given the availability of effective strategies for preventing and treating them? The answer lays primarily in the failure to consistently use evidence-based interventions in high-risk individuals and in the lack of adherence to the different prophylactic interventions. In order to impact the incidence and burden of DVT/PE and increase public awareness, implementation of electronic alerts and evidence-based approaches, and scientific translational research are required. The commitment of all levels of governments as well as public and private institutions will be crucial to reduce the incidence of DVT, a leading cause of death.

  1. Venous pCO(2) and pH can be used to screen for significant hypercarbia in emergency patients with acute respiratory disease.

    Science.gov (United States)

    Kelly, Anne-Maree; Kyle, Elizabeth; McAlpine, Ross

    2002-01-01

    This prospective study of patients with acute respiratory illness or potential ventilatory compromise compared pCO(2) and pH on an arterial and a venous blood sample with the aims of determining whether venous pH and pCO(2) can replace arterial values in the management of patients with acute respiratory disease and to determine whether there is a cut-off level of venous pCO(2) that can accurately screen for significant hypercarbia (pCO(2) > 50 mm Hg). Data were analyzed using bias plot and receiver operator characteristic (ROC) curve methods. There were 196 sample-pairs analyzed; 56 (29%) had significant hypercarbia. For pH, there was very good agreement with venous samples being an average of 0.034 pH units lower than arterial samples. With respect to pCO(2), there was only fair agreement, with the pCO(2) on average 5.8 mm Hg higher in venous samples and 95% limits of agreement -8.8 to +20.5 mm Hg. The ROC curve analysis showed that a venous pCO(2) level of 45 mm Hg was a potential screening cutoff (sensitivity for the detection of hypercarbia of 100%, specificity 57%). This study shows that venous pH is an acceptable substitute for arterial measurement but there is not sufficient agreement for venous pCO(2) to be able to replace arterial pCO(2) in the clinical evaluation of ventilatory function. Venous pCO(2) may be able to be used as a screening test for hypercarbia using a screening cut-off of 45 mm Hg.

  2. Veno-venous extracorporeal membrane oxygenation in a patient with severe acute respiratory failure – case report

    Science.gov (United States)

    Dec, Paweł Łukasz; Lesińska, Anna Justyna; Bocheńska, Anna; Wasilewski, Piotr; Feldyk, Grzegorz; Kubisa, Anna; Pieróg, Jarosław; Bielewicz, Michał; Grodzki, Tomasz

    2015-01-01

    Acute respiratory failure resistant to conventional pulmonary therapy often requires intensive medical care. In rare cases, ventilator therapy proves insufficient, and only the option of employing veno-venous extracorporeal membrane oxygenation (ECMO V-V) remains. The present article describes the case of a 23-year-old patient who experienced severe acute respiratory distress syndrome with associated multiple organ failure. The patient was admitted to the pulmonary ward of the Alfred Sokołowski Regional Pulmonary Hospital in Szczecin-Zdunowo with suspected pneumonia of unknown etiology. After the initial 5 days of diagnostics at the pulmonary ward, the patient required a further 97 days of hospital treatment and spent 63 days at the Intensive Care Unit. There, he underwent ECMO V-V therapy lasting 22 days, which resulted in the improvement of his arterial blood gas parameters and clinical condition. PMID:26336483

  3. Venous Sampling

    Science.gov (United States)

    ... Physician Resources Professions Site Index A-Z Venous sampling Venous sampling is a diagnostic procedure that uses ... the limitations of venous sampling? What is venous sampling? Venous sampling is a diagnostic procedure that involves ...

  4. [Present and future in the management of venous vascular diseases].

    Science.gov (United States)

    Gavorník, Peter; Dukát, Andrej; Gašpar, Ľudovít; Gavorníková, Eva

    2015-02-01

    The prevalence and the incidence of chronic and acute venous vascular disease has been shown to be globally very high, in both industrialized and developing countries. Chronic venous diseases of lower extremities are being an integral part of the third millennium's deadly angiopandemy, at the present time. The rate of the most severe cases with advanced stage of venous failure is approximately twice as high in the population (2.1 %) as has been assumed so far. Among venoactive drugs (VAD), micronized purified flavonoid fraction (MPFF) of diosmin hesperidin remains the agent with the highest degree of recommendation and it also indicated to pharmacotherapeutical support of leg ulcer healing, along with sulodexide and pentoxifylline. Compressive sclerotherapy, liquid or foam, is a safe and effective invasive method to treat telangiectasias, reticular varicose veins and subcutaneous varicose veins. Direct oral anticoagulants (DOAC) represent one of the therapeutic and preventive options of deep venous thrombosis (DVT) and of venous thromboembolism (VTE) with a limitation in patients with malignant conditions and in pregnancy. The most effective is triple simultaneous pharmaco-kinezio-mechano-phlebothromboemboloprophylaxis. Superficial vein thromboses longer than 5 cm are indicated to anticoagulant therapy too.

  5. Early thromboembolic events ≤1week after fast-track total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer C; Kehlet, Henrik; Laursen, Mogens Berg

    2016-01-01

    IntroductionThromboembolic events (TEE) are serious complications after total hip (THA) and knee arthroplasty (TKA), with reported in-hospital incidences of about 0.5?1% for venous thromboembolic events (VTE) and 0.2% for myocardial infarctions (MI) and stroke. However, little data exist on in...

  6. Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Results From an International Prospective Registry

    NARCIS (Netherlands)

    J. Pepke-Zaba; M. Delcroix; I. Lang; E. Mayer; P. Jansa; D. Ambroz; C. Treacy; A.M. D'Armini; M. Morsolini; R. Snijder; P. Bresser; A. Torbicki; B. Kristensen; J. Lewczuk; I. Simkova; J.A. Barbera; M. de Perrot; M.M. Hoeper; S. Gaine; R. Speich; M.A. Gomez-Sanchez; G. Kovacs; A.M. Hamid; X. Jaies; G. Simonneau

    2011-01-01

    Background-Chronic thromboembolic pulmonary hypertension (CTEPH) is often a sequel of venous thromboembolism with fatal natural history; however, many cases can be cured by pulmonary endarterectomy. The clinical characteristics and current management of patients enrolled in an international CTEPH re

  7. [Massive pulmonary artery thromboembolism after removal of sphenoid wing meningioma (clinical case with good outcome)].

    Science.gov (United States)

    Lubnin, A Iu; Konovalov, A N; Markina, M S; Goriachev, A S

    2004-01-01

    The paper describes a clinical case of the severe potentially fatal postoperative complication--massive pulmonary thromboembolism--in a patient after uncomplicated removal of meningioma of the wing of os basilare. It also describes the problems in the diagnosis, treatment, prevention of perioperative deep venous thrombosis of the shin and subsequent pulmonary thromboembolism in neurosurgery patients.

  8. Effect of preoperative donation of autologous blood on venous thromboembolism disease after total hip replacement%术前自体血采集预防髋关节置换术后血栓性疾病的作用

    Institute of Scientific and Technical Information of China (English)

    鲁宁; 杨阳; Alejandro González Della Valle; Eduardo A.Salvati

    2013-01-01

    Objective:To evaluate the effect of preoperative donation of autologous bood on venous thromboembolism (VTE) after total hip arthroplasty (THA). Methods:Between Jan. 2007 and March. 2010,912 consecutive patients who had THAs performed in Hosptal for Special Surgery were collected,excluded patients with thrombocytopenia or pre-exising bleeding diathesis and patients for whom epidural analgesia was not possible. Among them, there were 428 males and 484 females with an average age of (65.28±11.90) years (ranged from 24 to 93 years). Among them, 835 cases (91.3%) had osteoarthritis, 32 cases (3.6%) had osteonerrosis,20 cases (2.3%) had dysplasia,20 cases (2.2%) had rheumatoid arthritis,and 5 cases (0.6%) had other diagnoses. The surgeries were performed under hypotensive epidural anestheisa (mean arterial pressure between 45 to 55 mm Hg) and through a posterolateral approach,minimizing the duration of femoral vein obstruction and reducing the load of intramedullary content to the venous system by repeated pulsatile lavage and aspiration of the femoral canal. The lower extremity was in the neutral position while working on the acetabulum and flexed and internally rotated while working on the femur. Whenever possible, the lower extremity was extended to a neutral position to restore femoral venous flow. Patients received one bolus of unfractionated intravenous heparin (10 to 15 U/kg), 1 to 2 minutes before femoral canal preparation. All patients were followed up at least 3 months postoperatively. No patient was lost to followed-up. Results: Seven hundreds and fifty-two patients donated autologous blood before THA, 160 did not donate autologoud blood. The incidence of clinical symop-tomatic VTE was 1.3 %(11/912). Among the 11 patients with clinical symoptomatic VTE,5 donated blood pre - operation (0.66%,5/752) and 6 did not donate pre-operation (3.8%,6/160). The rate ofVTE after THA between autologous blood donation and no blood donation was statistically significant (

  9. Fatores de risco e profilaxia para tromboembolismo venoso em hospitais da cidade de Manaus Risk factors and prophylaxis for venous thromboembolism in hospitals in the city of Manaus, Brazil

    Directory of Open Access Journals (Sweden)

    Edson de Oliveira Andrade

    2009-02-01

    Full Text Available OBJETIVO: Identificar e classificar os fatores de risco para tromboembolismo venoso (TEV em pacientes internados, avaliando as condutas médicas adotadas para a profilaxia da doença. MÉTODOS: Estudo observacional, de corte transversal no período de janeiro a março de 2006, envolvendo uma população de pacientes internados em três hospitais na cidade de Manaus (AM. A estratificação do risco para TEV foi feita com base nos critérios da Sociedade Brasileira de Angiologia e Cirurgia Vascular e da International Union of Angiology. Foram avaliados variáveis sobre os fatores de risco clínicos, cirúrgicos e medicamentosos, assim como os métodos profiláticos para TEV. Os dados foram analisados estatisticamente, adotando-se um alfa de 5% e IC95%. Os dados qualitativos foram analisados pelo teste do qui-quadrado e os dados quantitativos pelo teste t de Student. RESULTADOS: Foram estudados 1.036 pacientes num total de 1.051 internações, sendo 515 (49,7% homens e 521 (50,3% mulheres. Um total de 23 de fatores de risco para TEV foram identificados (número total de eventos, 2.319. O risco estratificado para TEV foi de 50,6%, 18,6% e 30,8% das internações para risco alto, moderado e baixo, respectivamente. Em 73,3% das internações, não foram adotadas medidas profiláticas não-medicamentosas durante o período do estudo, e em 74% das internações que apresentavam risco moderado ou alto, não foram adotadas quaisquer medidas terapêuticas medicamentosas. CONCLUSÕES: Este estudo evidenciou que, na população estudada, os fatores de risco foram frequentes e que medidas profiláticas não foram utilizadas para pacientes com riscos potenciais de desenvolverem TEV e suas complicações.OBJECTIVE: To identify and classify risk factors for venous thromboembolism (VTE in hospitalized patients, as well as to evaluate medical practices regarding prophylaxis for the disease. METHODS: An observational cross-sectional study, carried out between

  10. Influence of continuous veno-venous hemofiltration on the course of acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Hong-Li Jiang; Wu-Jun Xue; Da-Qing Li; Ai-Ping Yin; Xia Xin; Chun-Mei Li; Ju-Lin Gao

    2005-01-01

    AIM: To investigate whether continuous veno-venous hemofiltration (CWH) in different filtration rate to eliminate cytokines would result in different efficiency in acute pancreatitis, whether the saturation time of filter membrane was related to different filtration rate, and whether the onset time of CWH could influence the survival of acute pancreatitis.METHODS: Thirty-seven patients were classified into four groups randomly. Group 1 underwent low-volume CVVH within 48 h of the onset of abdominal pain (early CVVH,n = 9). Group 2 received low-volume CVVH after 96 h of the onset of abdominal pain (late CVVH, n = 10). Group 3underwent high-volume CWH within 48 h of the onset of abdominal pain (early CWH, n = 9). Group 4 received high-volume CWH after 96 h of theonset of abdominal pain (late CVVH, n = 9). CVVH was sustained for at least 72 h. Blood was taken before hemofiltration, and ultrafiltrate was collected at the start of CWH and every 12 h during CVVH period for the purpose of measuring the concentrations of TNF-α, IL-1β and IL-6. The concentrations of TNF-α, IL-1β and IL-6 were measured by swine-specific El ISA. The Solartron 1 255 B frequency response analyzer (British) was used to observe the resistance of filter membrane.RESULTS: The survival rate had a significant difference (94.44% vs68.42%, P<0.01) high-volume and low-volume CVVH patients. The survival rate had also a significant difference (88.89% vs 73.68%, P<0.05) between early and late CWH patients. The hemodynamic deterioration (MAP, HR, CVP) was less severe in groups 4 and 1 than that in group 2, and in group 3 than in group 4. The adsorptive saturation time of filters membranes was 120-180 min if the filtration rate was 1 000-4 000 mL/h. After the first, second and third new hemofilters were changed,serum TNF-α concentrations had a negative correlation with resistance (r: -0.91, -0.89, and -0.86, respectively in group 1; -0.89, -0.85, and -0.76, respectively in group 2;-0.88, -0.92, and

  11. Diagnostic accuracy of point-of-care testing for acute coronary syndromes, heart failure and thromboembolic events in primary care: a cluster-randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Diemand Albert

    2011-03-01

    Full Text Available Abstract Background Evidence of the clinical benefit of 3-in-1 point-of-care testing (POCT for cardiac troponin T (cTnT, N-terminal pro-brain natriuretic peptide (NT-proBNP and D-dimer in cardiovascular risk stratification at primary care level for diagnosing acute coronary syndromes (ACS, heart failure (HF and thromboembolic events (TE is very limited. The aim of this study is to analyse the diagnostic accuracy of POCT in primary care. Methods Prospective multicentre controlled trial cluster-randomised to POCT-assisted diagnosis and conventional diagnosis (controls. Men and women presenting in 68 primary care practices in Zurich County (Switzerland with chest pain or symptoms of dyspnoea or TE were consecutively included after baseline consultation and working diagnosis. A follow-up visit including confirmed diagnosis was performed to determine the accuracy of the working diagnosis, and comparison of working diagnosis accuracy between the two groups. Results The 218 POCT patients and 151 conventional diagnosis controls were mostly similar in characteristics, symptoms and pre-existing diagnoses, but differed in working diagnosis frequencies. However, the follow-up visit showed no statistical intergroup difference in confirmed diagnosis frequencies. Working diagnoses overall were significantly more correct in the POCT group (75.7% vs 59.6%, p = 0.002, as were the working diagnoses of ACS/HF/TE (69.8% vs 45.2%, p = 0.002. All three biomarker tests showed good sensitivity and specificity. Conclusion POCT confers substantial benefit in primary care by correctly diagnosing significantly more patients. Trial registration DRKS: DRKS00000709

  12. Cerebral sinus venous thromboses in children with acute lymphoblastic leukaemia - a multicentre study from the Nordic Society of Paediatric Haematology and Oncology

    DEFF Research Database (Denmark)

    Ranta, Susanna; Tuckuviene, Ruta; Mäkipernaa, Anne

    2014-01-01

    We present a prospective multicentre cohort of 20 children with acute lymphoblastic leukaemia (ALL) and cerebral sinus venous thrombosis (CSVT). The study covers a period of 5 years and comprises 1038 children treated according to the Nordic Society of Paediatric Haematology and Oncology (NOPHO...

  13. Clinical Analysis of 84 Elderly Patients With Acute Pulmonary Thromboembolism%老年急性肺血栓栓塞症84例临床分析

    Institute of Scientific and Technical Information of China (English)

    张文艳; 韩晋英; 刘亚明

    2013-01-01

    Objective:To summarize the clinical characteristics of acute pulmonary thromboembolism in elderly patients,in order to improve the level of diagnosis and treatment.Methods:Clinical feature,theatment and prognosis of 84 cases aged over 60 yrars old with acute pulmonary thromboembolism were analyzed retrospectively.Results:Deep vein thromboembolism was found in 84 cases. Hypertension(43/84),Coronary heart disease (36/84),Cerebrovascular disease (28/84),diabetes(19/84),Permanent af(17/84),hyperlipidem ia(16/84),Congestive heart failure(15/84)and obesity(14/84) were the most common risk factors.The common symptoms were dyspnea (57/84),cough(30/84),chest pain(15/84),palpitation(17/84),faint(11/84),haemoptysis(10/84),fidgety(4/84),Breathing cardiac arrest(3/84), lower limb asymmetric swelling (29/84).75 patients appeared hypoxemia,62 patients d-dimer increases, 49 cases (ecg abnormalities, 78 cases of the CT pulmonary angiography diagnosis, 79 patients of low molecular heparin and warfarin anticoagulant therapy, 9 patients give thrombolysis treatment, the treatment improved 73 cases, 11 cases death.Conclusion:The incidence of PTE in older crowd is higher, the most common risk factors for chronic basic diseases and brake, the majority of the patient lacks specific symptoms and signs of VTE for high-risk patients take positive prevention measures, and do early diagnosis and early treatment is to reduce the old PTE mortality and improve the prognosis of the key.%  目的:总结老年肺血栓栓塞症的临床特点,提高诊治水平.方法:回顾性分析84例≥60岁的急性肺血栓栓塞症住院患者的临床表现及治疗转归.结果:84例老年急性肺栓塞患者中有44例下肢深静脉血栓形成,占52.4%,发生肺栓塞的基础病疾及危险因素为高血压(43/84)、冠心病(36/84)、脑血管病(28/84)、糖尿病(19/84)、永久性房颤(17/84)、高血脂症(16/84)、充血性心力衰竭(15/84)、肥胖(14/84)等.患者主

  14. Red cell distribution width and other red blood cell parameters with venous thromboembolism and mortality risk of patients with cancer%癌症患者红细胞分布宽度和其他的血红细胞参数与静脉血栓栓塞和死亡风险的相关性

    Institute of Scientific and Technical Information of China (English)

    杨文惠

    2015-01-01

    Objective:To analyze the correlation of red cell distribution width(RDW) and other red blood cell(RBC) parameters with venous thromboembolism risk and mortality rate in patients with cancer.Methods:RBC parameters of 1840 patients with cancer were detected.The main research result was the occurrence of venous thromboembolism(VTE) symptoms,and the secondary outcome was followed up for 2 years of death.Results:High RDW(more than 16%) and other red blood cells parameters were not associated with VET risk.High RDW increased the mortality risk.Conclusion:RDW and other RBC parameters have no independent correlation with VET risk of patients with cancer.And high RDW was a independent predictor of poor survival in patients with cancer.%目的:分析癌症患者红细胞分布宽度(RDW)及其他血红细胞(RBC)参数与静脉血栓栓塞风险和死亡率的相关性。方法:检测1840例癌症患者的RBC参数,主要研究结果是静脉血栓栓塞(VTE)症状的发生、次要结局是随访2年死亡。结果:高RDW(>16%)及其他血红细胞参数与VET风险无明显关联。高RDW增加死亡风险。结论:RDW及其他RBC参数与癌症患者VET风险无独立相关,而高RDW是癌症患者生存较差的独立预示因素。

  15. The Risk of Thromboembolism in Users of Antidepressants and Antipsychotics

    DEFF Research Database (Denmark)

    Adelborg, Kasper; Sundbøll, Jens; Videbech, Poul

    2017-01-01

    Arterial and venous thromboembolism are common causes of morbidity and mortality in the Western world. Mental disorders are also highly prevalent with a lifetime risk of experiencing any psychiatric disease ranging between 32 % and 37 %. Depression and schizophrenia may increase the risk...

  16. ABO Blood Group and Risk of Thromboembolic and Arterial Disease

    DEFF Research Database (Denmark)

    Vasan, Senthil K; Rostgaard, Klaus; Majeed, Ammar

    2016-01-01

    BACKGROUND: ABO blood groups have been shown to be associated with increased risks of venous thromboembolic and arterial disease. However, the reported magnitude of this association is inconsistent and is based on evidence from small-scale studies. METHODS AND RESULTS: We used the SCANDAT2 (Scand...

  17. Atypical presentation of priapism in a patient with acute iliocaval deep venous thrombosis secondary to May-Thurner syndrome.

    Science.gov (United States)

    Alhalbouni, Saadi; Deem, Samuel; Abu-Halimah, Shadi; Sadek, Betro T; Mousa, Albeir

    2013-08-01

    We report on a 42-year-old male who presented with priapism, severe scrotal swelling, and left lower extremity pain and swelling. Initial management of priapism failed, and he was noted to have both cavernosal and glandular venous obstruction. Computed tomography (CT) was performed and identified extensive acute thrombosis involving the distal inferior vena cava and the left iliac veins. Pharmacomechanical thrombolysis (PMT) was started over the course of two days. At completion of thrombolysis, the culprit lesion in the left common iliac vein was treated with angioplasty and stenting. His postoperative course was uneventful, and his priapism as well as the scrotal and leg swelling improved. He was discharged home on full anticoagulation. To our knowledge, this is the first available description of this rare presentation along with a literature review of the underlying vascular etiology for priapism.

  18. Impact of Initial Central Venous Pressure on Outcomes of Conservative versus Liberal Fluid Management in Acute Respiratory Distress Syndrome

    Science.gov (United States)

    Semler, Matthew W.; Wheeler, Arthur P.; Thompson, B. Taylor; Bernard, Gordon R.; Wiedemann, Herbert P.; Rice, Todd W.

    2016-01-01

    Objective In acute respiratory distress syndrome (ARDS), conservative fluid management increases ventilator-free days without affecting mortality. Response to fluid management may differ based on patients’ initial central venous pressure (CVP). We hypothesized initial CVP would modify the effect of fluid management on outcomes. Design Retrospective analysis of the Fluid and Catheter Treatment Trial, a multicenter randomized trial comparing conservative to liberal fluid management in ARDS. We examined the relationship between initial CVP, fluid strategy, and 60-day mortality in univariate and multivariable analysis. Setting Twenty acute care hospitals. Patients Nine hundred and thirty-four ventilated ARDS patients with a CVP available at enrollment, 609 without baseline shock (for whom fluid balance was managed by study protocol). Interventions None. Measurements and Main Results Among patients without baseline shock, those with initial CVP > 8 mmHg experienced similar mortality with conservative and liberal fluid management (18% versus 18%, p=0.928), whereas those with CVP ≤8 mmHg experienced lower mortality with a conservative strategy (17% versus 36%, p=0.005). Multivariable analysis demonstrated an interaction between initial CVP and the effect of fluid strategy on mortality (p=0.031). At higher initial CVPs, the difference in treatment between arms was predominantly furosemide administration, which was not associated with mortality (p=0.122). At lower initial CVPs, the difference between arms was predominantly fluid administration, with additional fluid associated with increased mortality (p=0.013). Conclusions Conservative fluid management decreases mortality for ARDS patients with a low initial central venous pressure. In this population, the administration of intravenous fluids appears to increase mortality. PMID:26741580

  19. Implanted central venous catheter-related acute superior vena cava syndrome: management by metallic stent and endovascular repositioning of the catheter tip

    Energy Technology Data Exchange (ETDEWEB)

    Qanadli, S.D.; Mesurolle, B.; Sissakian, J.F.; Chagnon, S.; Lacombe, P. [Service de Radiologie, Hopital Ambroise Pare, 92 - Boulogne (France)

    2000-08-01

    We describe a case of a 49-year-old woman with stage-IIIB lung adenocarcinoma who experienced an acute superior vena cava syndrome related to an implanted central venous catheter without associated venous thrombosis. The catheter was surgically implanted for chemotherapy. Superior vena cava syndrome appeared after the procedure and was due to insertion of the catheter through a subclinical stenosis of the superior vena cava. Complete resolution of the patient's symptoms was obtained using stent placement and endovascular repositioning of the catheter tip. (orig.)

  20. Prevention and treatment of venous thromboembolism in elderly patients after joint replacement%老年人关节置换术后静脉血栓栓塞症的防治

    Institute of Scientific and Technical Information of China (English)

    费建文; 姜俊杰; 周冬梅; 唐燕; 康丽君; 戴红

    2012-01-01

    Objective To explore the relationship between the prothrombotic state and blood coagulation-fibrinolysis system changes with deep venous thrombosis(DVT)in aged patients after total joint arthroplasty,and to propose preventive measures.Methods 400 patients who underwent total hip or knee replacement from January 2003 to June 2011 were classified into suspected DVT(n=200 cases)and non-suspected DVT(n=200 cases)according to Well's clinical scoring system.The patients were divided into 4 subgroups based on the measures to prevent DVT:low molecular weigh heparin group,intermittent pneumatic bag compression group,combined above measures group,control group who refused any preventive measures.Plasma thrombin-antithrombin complex(TAT),plasmin-α2 antiplasmin complex(PAP)were determined preoperatively.Venous Doppler ultrasound was performed before surgery,4 d and 10 d after surgery to detect the presence of DVT.Results Totally 71 cases(17.8%)were diagnosed as DVT and 5 cases(1.3%)as pulmonary thromboembolism(PTE).The incidence of DVT in suspected DVT group(28.5%,57 cases)was lower than in non-suspected DVT group(7.0 %,14 cases)(x2 =31.66,P< 0.01).Among patients with suspected DVT,the DVT prevalence in combined measures group(2.0 %,1 cases)was decreased than in low molecular weigh heparin group(14.0%,7 cases),intermittent pneumatic bag compression (34.0%,17 cases)and control groups(64.0%,32 cases)(x2=4.89,17.34,18.01,all P<0.05).In the patients with non-suspected DVT,the DVT prevalence in combined measures group(0.0%)was lower than in control group(24.0 %,12 cases)(x2 =13.64,P<0.01).The average preoperative level of TAT[(9.63±3.06)μg/L]in patients with DVT was higher than without DVT[(2.59±0.87)μg/L](t=35.70,P<0.01),while PAP level in patients with DVT[(38.52± 21.13)μg/L]was reduced than without DVT[69.75±30.26)μg/L](t=8.27,P<0.01).Conclusions The levels of TAT and PAP before total hip or knee replacement are predictive for lower

  1. Recanalization of Acute and Subacute Venous and Synthetic Bypass-Graft Occlusions With a Mechanical Rotational Catheter

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    Wissgott, Christian, E-mail: cwissgott@wkk-hei.de; Kamusella, Peter; Andresen, Reimer [Westkuestenklinikum Heide-Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Institute of Diagnostic and Interventional Radiology/Neuroradiology (Germany)

    2013-08-01

    PurposePercutaneous mechanical thrombectomy (PMT) is now established as an alternative treatment of acute arterial occlusions in addition to fibrinolysis and surgical thrombectomy. The objective of this retrospective study was the investigation of a rotational atherothrombectomy catheter in terms of safety and efficacy in the treatment of acute and subacute femoropopliteal bypass occlusions.Materials and MethodsForty-two patients (average age 65.8 {+-} 9.1 years) with acute (<14 days [n = 31]) and subacute (14-42 days [n = 11]) femoropopliteal bypass occlusions were treated consecutively with a rotational debulking and removal catheter (Straub Rotarex). The average occlusion length was 28.4 {+-} 2.9 (24-34) cm. Thirty-four (81 %) patients underwent venous bypass, and 8 (19 %) patients underwent polytetrafluoroethylene bypass.ResultsThe technical success rate was 97.6 % (41 of 42). In 1 patient, blood flow could not be restored despite the use of the atherothrombectomy system. The average catheter intervention time was 6.9 {+-} 2.1 (4-9) min. Ankle-brachial index increased from 0.39 {+-} 0.13 to 0.83 {+-} 0.11 at discharge and to 0.82 {+-} 0.17 after 1 month (p < 0.05). There were a total of 2 (4.8 %) peri-interventional complications: One patient developed a distal embolism, which was successfully treated with local lysis, and another patient had a small perforation at the distal anastomosis, which was successfully treated with a stent.ConclusionPMT with the Rotarex atherothrombectomy catheter represents a safe and effective option in the treatment of acute and subacute femoropopliteal bypass occlusions because it can quickly restore blood flow.

  2. Estudo de vigilância epidemiológica da profilaxia do tromboembolismo venoso em especialidades cirúrgicas de um hospital universitário de nível terciário Study of epidemiological surveillance of venous thromboembolism prophylaxis in surgical specialties of a school tertiary referral hospital

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    Augusto Diogo-Filho

    2009-03-01

    tromboembolismo venoso, verifica-se adesão incompleta por parte dos profissionais médicos da especialidade, expondo os pacientes a complicações graves.CONTEXT: Postoperative venous thromboembolism is a frequent and severe disease that can lead to pulmonary embolism and post thrombotic syndrome. Although the venous thromboembolism prophylaxis is a proven strategy, an unsuitable indication is observed. OBJECTIVE: To verify the indication of prophylaxis with heparin among patients of several surgical specialties of a School Tertiary Referral Hospital. METHODS: It was accomplished a prospective study during 10 consecutive days in each month, from September to December of 2005, with 360 patients surgically treated in the specialties: General Surgery, Gynecology, Neurosurgery, Ortopedy and Traumatology, Urology and Angiology and Vascular Surgery, identifying risk factors for the development of venous thromboembolism (VTE and the use of heparin prophylaxis according to the recommendations of the Brazilian Society of Angiology and Vascular Surgery. RESULTS: Three hundred and fifty seven patients were evaluated, 24 (6,7%, 128 (35,9% and 205 (57,4% were included in low risk, medium risk and high risk for venous thromboembolism, respectively. One hundred and eighty four patients (51,5% of the sample received prophylactic heparin. Heparin was used in 73,3% of the patients of General Surgery, 16,7% of Gynecology, 50,0% of Neurosurgery, 32,5% of Ortopedy and Traumatology, 37,3% of Urology and 97,7% of Angiology and Vascular Surgery. Only 38,3% of medium risk and 64,4% of high risk patients received prophylactic heparin. Heparin was suitably used in 77,6% of medium risk and in 63,6% of high risk patients. Thrombocytopenia, minor bleeding and major bleeding occurred in 3 (1,6%, 12 (6,5% and 2 (1,1% of the patients, respectively. Thromboembolic complications occurred in 6 (1,7% cases. CONCLUSION: Although the indications of prophylactic heparin to venous thromboembolism are well known, we