Pulmonary embolism thromboembolism

Q17 There are some major problems associated with oestrogen-replacement therapy. These include pulmonary embolism, thromboembolism, seizures, hepatic adenoma and risk of stroke. There is also now evidence of an increased incidence of breast, ovarian and endometrial cancer, which is related to the duration of HRT use. Approximately 14 in every 1000 women aged 50-64 years not using HRT develop breast cancer. Use of oestrogen-only HRT for five years in this age group increases the incidence of breast cancer to about 15.5 in every 1000 women this represents a relatively small increase in risk. 

Streptokinase + 35% +++/+ Infusion over 60 minutes 613 Pulmonary embolism, deep vein thrombosis, arterial thromboembol ism, clearance of an occluded arteriovenous catheter... 

Venous thromboembolism (VTE) is one of the most common cardiovascular disorders in the United States. VTE is manifested as deep vein thrombosis (DVT) and pulmonary embolism (PE) resulting from thrombus formation in the venous circulation (Fig. 7-1).1 It is often provoked by prolonged immobility and vascular injury and is most frequently seen in patients who have been hospitalized for a serious medical illness, trauma, or major surgery. VTE can also occur with little or no provocation in patients who have an underlying hypercoagulable disorder. 

DVT, deep vein thrombosis HIT, heparin-induced thrombocytopenia PAI-I, plasminogen activator inhibitor PE, pulmonary embolism SERM, selective estrogen receptor modulator VTE, venous thromboembolism. 

Venous thromboembolism most commonly develops in patients with identifiable risk factors (Table 7-1) during or following a hospitalization. Many, perhaps the majority of patients, have asymptomatic disease. Patients may die suddenly of pulmonary embolism. 

FIGURE 7-11. Treatment of venous thromboembolism. LMWH, low-molecular-weight heparin PE, pulmonary embolism SBP, systolic blood pressure UFH, unfractionated heparin VTE, venous thromboembolism. (Reproduced from Haines ST, Zeolla M, Witt DM. Venous thromboembolism. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 398, with permission.)... 

The WHI demonstrated an increased risk in venous thromboembolic disease in the HRT group (0.34%) compared with placebo (0.16%) (HR 2.11,95% Cl 1.58-2.82). This translates into an NNTH of approximately 555 and 18 more cases of venous thromboembolic events for every 10,000 women treated per year with HRT.3 The risk for deep vein thrombosis also was increased in the ERT arm of the WHI, but pulmonary embolism was not increased significantly.21... 

Venous thromboembolism (VTE) results from clot formation in the venous circulation and is manifested as deep vein thrombosis (DVT) and pulmonary embolism (PE). A DVT is a thrombus composed of cellular material (red and white blood cells, platelets) bound together with fibrin strands. A PE is a thrombus that arises from the systemic circulation and lodges in the pulmonary artery or one of its branches, causing complete or partial obstruction of pulmonary blood flow. 

FIGURE 14-2. Treatment of venous thromboembolism (VTE). (LMWH, low-molecular-weight heparin PE, pulmonary embolism SBP, systolic blood pressure UFH, unfractionated heparin.)... 

Estrogens have a dose-related effect in the development of venous thromboembolism (VTE) and pulmonary embolism. This is especially true in women with underlying hypercoagulable states or who have acquired conditions (e.g., obesity, pregnancy, immobility, trauma, surgery, and certain malignancies.)... 

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. 

Women who are lactating or who are or may become pregnant (see Warnings) women with active or a history of venous thromboembolic events, including deep vein thrombosis, pulmonary embolism, and retinal vein thrombosis hypersensitivity to raloxifene or other constituents of the drug. 

Venous thromboembolic events. An analysis of raloxifene-treated women showed an increased risk of venous thromboembolic events defined as DVT and pulmonary embolism. Other venous thromboembolic events could also occur. A less serious... 

Pleural effusion, pulmonary embolism, bone fracture, thromboembolic disorder,... 

It is used in venous thromboembolism, pulmonary embolism, atrial fibrillation and for prophylaxis after insertion of prosthetic heart valves. 

The risk of venous thromboembolism in women taking anastrozole is lower than that in women taking tamoxifen (1.6% versus 2.4%) (9), but still higher than in the untreated population. Cases of pulmonary embolism have been reported in an 80-year-old woman taking anastrozole (10) and a 72-year-old woman taking letrozole (11). 

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). 

Thrombotic (blood clot) events, and subsequent complications, are a leading cause of morbidity and mortality in the general population.1 In 2005, it was estimated that there were more than 900,000 total venous thromboembolism events in the United States,2 two thirds of which were acquired in hospital. More than 600,000 of those were nonfatal venous thromboembolism events. Nearly 300,000 were fatal events, including more than 2,200 cases of deep venous thrombosis and 294,000 cases of pulmonary embolism. The majority deaths (93%) were due to sudden fatal pulmonary embolism, or were a consequence of undiagnosed venous thromboembolism. It was estimated that 340,000 patients developed complications from venous thromboembolism, including 336,000 with postthrombotic syndrome and 3,300 with chronic thromboembolic pulmonary hypertension. 

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