Venous thromboembolism recurrent

Patients with acute stroke should be monitored intensely for the development of neurologic worsening, complications, and adverse effects from treatments. The most common reasons for clinical deterioration in stroke patients are (1) extension of the original lesion in the brain (2) development of cerebral edema and raised intracranial pressure (3) hypertensive emergency (4) infection (e.g., urinary and respiratory tract) (5) venous thromboembolism (6) electrolyte abnormalities and rhythm disturbances and (7) recurrent stroke. The approach to monitoring stroke patients is summarized in Table 13-3. 

Badaracco MA, Vessey MP. Recurrence of venous thromboembolic disease and use of oral contraceptives. BMJ 1974 1(901) 215—7. 

Eriksson H, Treatment of venous thromboembolism and longterm prevention of recurrence present treatment options and ximelagatran, Drugs 2004 64(suppl I ) 37—46. 

Eriksson H, Lundstrom T, Wahlander K, et al. Prognostic factors for recurrence of venous thromboembolism (VTE) or bleeding during long-term secondary prevention of VTE with ximelagatran. Thromb Haemost 2005 94 522-527. 

There is an association between the rare inborn recessive condition of homocystinemia and arterial and venous thrombosis, and observational data link coronary heart disease, stroke, and venous thromboembolism with increasing plasma homocysteine (Wald et al. 2002, 2004). This led to trials of foUc acid and pyridoxine supplementation to lower homocysteine levels (Hankey 2002 Hankey and Eikelboom 2005). Results from such trials have so far been disappointing the Vitamin Intervention for Stroke Prevention Study (VISP) and the Norwegian Vitamin Trial (NORVIT) (Toole et al. 2004 Bonaa et al. 2006) trials showed no treatment effect on recurrent stroke, coronary events or deaths. Preliminary results from the Study of Vitamins to Prevent Stroke (VITATOPS) trial have shown no evidence of reduced levels of iirflammation, endothelial dysfunction, or the hypercoagulability postulated to be increased by elevated homocysteine levels in patients with previous TIA or stroke treated with foUc acid, vitamin B12 and vitamin Bs... 

Hansson PO, Sorbo J, Eriksson H. Recurrent venous thromboembolism after deep vein thrombosis Incidence and risk factors. Arch Intern Med 2000 160 769-774. 

Ridker PM, Goldhaber SZ, Danielson E, et al. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med 2003 348 1425-1434. 

ADMINISTRATION AND MONITORING FuU-dose heparin therapy usually is administered by continuous intravenous infusion. Treatment of venous thromboembolism is initiated with a bolus injection of 5000 units, followed by 1200-1600 units/h delivered by an infusion pump. Therapy routinely is monitored by the aPTT the target is an elevation to 1.8-2.5 times the normal value. The risk of recurrence of thromboembolism is greater in patients who do not achieve a therapeutic level of anticoagulation within the first 24 hours. Initially, the aPTT should be measured and the infusion rate adjusted every 6 hours dose adjustments may be aided by use of a nomogram. Once a steady dosage schedule has been established, daily monitoring is sufficient. 

Cardiovascular A case of clozapine-induced recurrent puZmonafy thromboembolism in a 34-year-old male is reported, occurring after 3 and again after 7 years of treafment [104 ]. A further case in a 39-year-old male after 8 months treatment is described [105 ]. A fatal case of a 22-year-old male wifh multisystem venous thrombosis on clozapine for 2 years is reporfed [106 ]. 

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