Deep venous thrombosis

One meta-analysis examined the safety and efficacy of LMWH and heparinoids in 11 randomized trials of 3048 patients with acute ischemic stroke. It reported a reduction in the incidence of deep venous thrombosis (DVT) (odds ratio (OR) 0.27,... 

Spearman MP, Jungreis CA, Wehner JJ, Gerszten PC, Welch WC. Endovascular thrombolysis in deep venous thrombosis. Am J Neuroradiol 1997 18 502-506. 

Handeland G. F., Abildgaard U., Holm H. A Arresen E. Dose adjusted heparin treatment of deep venous thrombosis a comparison to unfractionated and low molecular weight heparin. Eur J Clin Pharmacol 1990 39, 107-12. 

Low-molecular-weight heparin or low-dose subcutaneous unfractionated heparin (5,000 units twice daily) is recommended for prevention of deep venous thrombosis in hospitalized patients with decreased mobility due to stroke and should be used in all but the most minor strokes. 

It is remarkable that most of the data collected from the available SERMs are unanimous in reproducing an estrogen agonistic profile in venous thrombogenesis. The vast clinical experience acquired with tamoxifen confirms an augmented risk for both deep venous thrombosis and pulmonary embolism. This increase, however, did not presuppose increased mortality in the overview of randomized trials of adjuvant tamoxifen for early breast cancer, where the one extra death per 5000 woman-years of tamoxifen attributed to pulmonary embolus was not statistically significant (Early Breast Cancer Trialists Collaborative Group 1998). 

Tamoxifen users present also a doubling incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) (118 vs. 62 cases). This increase is similar to that seen with HRT. There are some aspects of this side effect that should be commented on to improve the management of women eligible for tamoxifen treatment and at risk for DVT (Goldhaber 2005). In the subanalysis of the Italian study (Decensi et al. 2005), the venous thromboembolism definition included DVT, PE, and superficial phlebitis. Most of the VTE that the authors reported were, in fact, cases of superficial phlebitis, whereas the admitted definition of venous thromboembolism excludes this entity. Such conceptual differences, together with differences in age and background characteristics between the four studies, can explain the diversity in the incidences observed. 

Surgery patients - Adverse reactions 3% or more include the following pyrexia, nausea, constipation, skin reactions at injection site, vomiting, itching, insomnia, headache, dizziness, urinary tract infection, hypertension, anxiety, diarrhea, dyspepsia, edema, deep venous thrombosis. 

Heparin-induced thrombocytopenia Warfarin should be used with caution in patients with heparin-induced thrombocytopenia and deep venous thrombosis. 

DVT deep venous thrombosis Dz disease EC enteric-coated ECC 2005 Emergency Cardiac Care guidelines 2005 ECC emergency cardiac care ECG electrocardiogram ED Emergency department, Erectile dysfunction... 

A 75 year old man was examined on a routine visit 1 month after discharge from hospital for a myocardial infarction. No communication had been received from the hospital on the patients stay and management. The patient seemed well but had a few purpuric 1 cm round lesions on his hands. The doctor assessed these as senile purpura. He then noticed that there were several more on both legs. He felt that these were both more extensive than with senile purpura and in an unusual site. He questioned the patient about injury, which the patient denied. On ringing the hospital it was learned that the patient had had a deep venous thrombosis and was treated with warfarin. They apologised for not informing the doctor earlier ... 

I Unlabeled Uses Prevention of deep venous thrombosis, prevention and treatment of orthostatic hypotension, pulmonary thromboembolism... 

Administration of fibrinolytic drugs by the intravenous route is indicated in cases of pulmonary embolism with hemodynamic instability, severe deep venous thrombosis such as the superior vena caval syndrome, and ascending... 

The increased risk of thromboembolism associated with atrial fibrillation and with the placement of mechanical heart valves has long been recognized. Similarly, prolonged bed rest, high-risk surgical procedures, and the presence of cancer are clearly associated with an increased incidence of deep venous thrombosis and embolism. Antiphospholipid antibody syndrome is another important acquired risk factor. Drugs may function as synergistic risk factors in concert with inherited risk factors. 

I11 the therapy of deep venous thrombosis, heparin is commonly administered. This drug takes effect immediately to prevent further thrombus formation. However, heparin is regarded as a hazardous drug and possibly may be tlie leading cause of drug-related deaths 111 hospitalized patients who are relatively well. Usually administered intravenously, preferably by pump-dnven infusion at a constant rate rather than by intermittent injections, it sometimes may cause major bleeding, which is particularly hazardous if it is intracranial. The action of heparin can be terminated almost immediately by intravenous injection of protamine sulfate, but where there may be less urgency, vitamin Ki may be used. The vitamin preparation may be administered intravenously, intramuscularly, or subcutaneously. 

There is other evidence that transdermal estrogen replacement therapy has relatively little effect on hemostasis. In a case control study, 155 consecutive patients with a first documented episode of idiopathic venous thromboembolism, 92 of whom had had a pulmonary embolism and 63 a deep venous thrombosis, were compared with 381 healthy matched controls (88). Overall, 32 (21%) of the cases and 27 (7%) of the controls were current users of oral estrogen replacement therapy, whereas 30 (19%) cases and 93 (24%) controls were current users of transdermal estrogen replacement therapy. After adjustment for potential confounding variables, the odds ratios for venous thromboembolism in current users of oral and transdermal estrogen replacement therapy compared with non-users were 3.5 (95% Cl = 1.8, 6.8) and 0.9 (0.5, 1.6) respectively. Estimated risk for venous thromboembolism in current users of oral estrogen replacement therapy compared with transdermal users was 4.0 (1.9, 8.3). 

Force L, Barrufet P, Herreras Z, Bolibar I. Deep venous thrombosis and megestrol in patients with HIV infection. AIDS 1999 13(ll) 1425-6. 

Grunwald MR, Hofmann LV. Comparison of urokinase, alteplase, and reteplase for catheter-directed thrombolysis of deep venous thrombosis. J Vase Intern Radiol. 2004 15 347-352. 

Venous thromboembolism diagnosis and management of deep venous thrombosis. MedJAust. 2005 182 476-481. 

Ouriel K, Kaul AF, Leonard MC. Clinical and economic outcomes in thrombolytic treatment of peripheral arterial occlusive disease and deep venous thrombosis. J Vase Surg. 2004 40 971-977. 

The goal in the treatment of deep venous thrombosis and pulmonary embolism is the prevention of recurrent, fatal embolism. 

A red thrombus can form around a white thrombus as mentioned above or de novo in low-pressure veins, initially by adherence of platelets (as in arteries) but followed promptly by the process of blood coagulation so that the bulk of the thrombus forms a long tail consisting of a fibrin network in which red cells are enmeshed. These tails become detached easily and travel as emboli to the pulmonary arteries. Such emboli often arise from a deep venous thrombosis (DVT)—a thrombus in the veins of the legs or pelvis. Although all thrombi are mixed, the platelet nidus dominates the arterial thrombus and the fibrin tail the venous thrombus. Arterial thrombi cause serious disease by producing local occlusive ischemia venous thrombi, by giving rise to distant embolization. 

Elevated TAFI levels have been found in men with symptomatic coronary artery disease (142). TAFI is also reported to be a risk factor for deep venous thrombosis, A recent report on the high levels of TAFI in the acute phase of ischemic stroke revealed not only elevated levels but also an incremental increase in TAFI with the degree of neurologic deterioration (143). Therefore, the observation by Boffa et al. on the acute phase nature of this protein requires further validation, In addition, Juhan-Vague et al, stated that there is a correlation between TAFI levels and cardiovascular risk factors (144). Animal models may be needed to truly validate studies on TAFI upregulation and its relation to thrombosis. 

Abbreviations. DVT, deep venous thrombosis ESTEEM, Efficacy and Safety of the oral Thrombin inhibitor ximelagatran in combination with aspirin, in patiEnts with rEcent Myocardial damage ... 

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