Venous thromboses

Warfarin is used as an anticoagulant for preventing and treating deep venous thromboses and pulmonary embolism. Synonyms of this drug are cumadin, panwarfm, sofrain, wamerin, and others. 

Intravascular thrombosis As with other immunosuppressive therapies, arterial or venous thromboses of allografts and other vascular beds have been reported. 

Thrombophlebitis was recorded in 45% of patients treated for advanced ovarian cancer who also received intravenous interleukin-3 (14), and deep venous thromboses were reported in children treated with maintenance interleukin-3 for Diamond-Blackfan anemia (15). In addition, one smoking breast-cancer patient developed severe hypotension and cerebellar and superior mesenteric thrombosis after subcutaneous interleukin-3 administration (SEDA-19, 340). Collectively, these case reports suggest that interleukin-3 may contribute to the development of thrombosis, but a possible increased risk of thrombosis with interleukin-3 remains to be demonstrated. 

Supportive care may include hydration, enteral tube or parenteral nutrition, nasogastric suctioning for ileus, bowel and bladder care, prevention and treatment of decubitus ulcers, prevention and treatment of deep venous thromboses, intensive care, mechanical ventilation, treatment of secondary infections, and monitoring for impending respiratory failure (36,38). 

Indude tissue plasminogen activator (tPA, recombinant) and streptokinase (bacterial). Used IV for short-term emergency management of coronary thromboses in MI, deep venous thromboses, pulmonary embolism, and ischemic stroke (tPA). 

Infection of bone, known as osteomyelitis, remains one of the most serious clinical complications associated with open reduction and internal fracture fixation. Gonventional intravenous therapy with systemic antibiotics is the major modality of treatment employed by clinicians, but such therapy has inherent drawbacks. Long-term intravenous therapy often requires the use of indwelling intravenous lines which have the potential for serious morbidity including line infections and deep venous thromboses. In addition, dosing of the antibiotics may be as often as several times per day, which can lead to a decrease in patient compliance as well as increased risk of infection. Additionally, many systemic antibiotics have relatively narrow therapeutic windows, and their potential for toxicity requires close clinical monitoring. But even when drug toxicity and line-related complications are avoided, treatment of such infections has a less-than-impressive success record. - ... 

Necessary conditions comprise the second broad category of endocardial lead removal indications. These generally represent situations in which a lead is removed to directly prevent the development of a potential life-threatening problem. Examples of necessary indications are pacemaker pocket infection, chronic draining sinuses, erosions, venous thromboses, lead migration, device-device interference, and the necessity for lead replacement in the case of supernumerary leads in the setting of venous thrombosis. 

Hepatic venous thrombosis, also known as Budd-Chiari syndrome, is caused by hypercoagulable disorders precipitated by pregnancy, infection, and birth control medication. An acute painful abdomen, sudden enlargement of the liver, and the presence of ascites make up a triad of clinical symptoms that are important in the diagnosis of this syndrome. Myeloproliferative disorders such as polycythemia vera and paroxysmal nocturnal dyspnea were previously thought to be responsible. Factor V Leiden and prothrombin 20210 mutations are also known to be responsible, Other intraabdominal thromboses include portal vein thrombosis, mesenteric vein thrombosis and renal vein thrombosis. 

Computer tomography, especially when coupled with a contrast medium and in the form of CTAP, is an excellent tool for analyzing the venous blood flow and detecting any disturbances in inflow or outflow. Thrombosed hepatic veins are not visible the parenchyma is characterized by an inhomogeneous, patch-like enhancement. (s. fig. 39.6) MRI provides reliable evaluation by means of multiphase, contrast-enhanced, three-dimensional MR angiography. 

Three patients developed bUateral venous sinus thromboses after receiving asparaginase the diagnosis and follow-up of this complication have been succinctly reviewed (9). In another patient receiving asparaginase, central nervous system thrombosis was associated with a transient acquired type II pattern of von WiUebrand s disease (10). 

A 72-year-old woman with refractory sarcoidosis developed venous thrombosis at a catheter site and extensive multiple thromboses in small arteries in her legs after receiving a third dose of infliximab for severe enteropathy. Anticardiolipin antibodies were detected, but antinuclear and anti-double-stranded DNA antibodies were negative. 

Castner D. The efficacy of reteplase in the treatment of thrombosed hemodialysis venous catheters. Nephrol Nurs J 2001 28 403 04. 

Thromboses in arteries and veins are slightly different. Venous thrombi form in slow moving blood and contain a lot of fibrin. Arterial thrombi usually occur because of damage to artery walls and contain more platelets than fibrin. Formation of emboli is a risk in either case. 

Heparin-induced thrombocytopenia (platelet count <150,000/ml or a 50% decrease from the pretreatment value) occurs in about 0.5% of medical patients 5 to 10 days after initiation of therapy with standard heparin. The incidence of thrombocytopenia is lower with low-molecular-weight heparin. Thrombotic complications that can be life threatening or lead to amputation occur in about one-half of the affected heparin-treated patients and may precede the onset of thrombocytopenia. The incidence of heparin-induced thrombocytopenia and thrombosis is higher in surgical patients. Venous thromboembolism occurs most commonly, but arterial thromboses causing limb ischemia, myocardial infarction, and stroke also occur. Bilateral adrenal hemorrhage, skin lesions at the site of subcutaneous heparin injection, and a variety of systemic reactions may accompany heparin-induced thrombocytopenia. The development of IgG antibodies against complexes of heparin with... 

List the three major classes of anticlotting dmgs and compare their utility in venous and arterial thromboses. 

The pathophysiology of CVT is not completely clear. The predominant theory is that venous obstruction results in increased venous pressure, increased intracranial pressure, and increased cerebral blood volume. Increased venous pressure may result in vasogenic edema from breakdown of the blood brain barrier and extravasation of fluid into the extracellular space. Blood may also extravasate into the extracellular space. Decreased perfusion pressure and decreased cerebral blood flow may lead to the failure of the NaVKV ATPase pump and then to cytotoxic edema. Another theory is that higher pressure of thrombosed sinuses... 

This is in accord with the observations of Sherman (11), which were mentioned in the introduction, that a large proportion of erythroe3des in the venous circulation of persons with sickle cell anemia are sickled, but that very few have assumed the sidde forms in the venous circulation of individuals witih si emia. Presumably, then, the sickled cells in the blood of persons with sickle cell anemia cause thromboses, and eir increased fragility exposes them to the action of retieulo-endothelial cells which break them down, resulting in the anemia (1). 

CT of the pelvis is predominantly performed for cancer staging, which means that the CT examination should include the upper abdomen. Scanning of the pelvis during a specific perfusion phase is less critical than for the liver, which should be scanned during the portal venous phase 50-70 s after intravenous contrast medium injection. If the scans are obtained too early, there is the risk of overlooking thromboses due to incomplete enhancement of the pelvic veins. 

The behavior of sinus thrombosis may impact the natural history of an individual lesion. Cessation of venous hypertension by complete recanalization of the thrombosed sinus will interrupt the vicious circle and may lead to spontaneous cure of the disease. Progressive thrombosis or occlusion of the venous outflow channels may further increase venous hypertension, however, leading to an aggressive clinical course (Lawton et al. 1997). 

Occasionally, the vessel to be recanalized is thrombosed or obstructed, precluding venous access on the same side. In this case, contralateral venous access should be considered (87). In this instance, the desired electrode is passed via the contralateral subclavian vein, positioned, and subsequently tunneled back to the original pocket (Fig. 4.30). The contralateral puncture site requires a limited skin incision of about 1-2 cm. It is carried down to the surface of the pectoralis muscle. The pectoralis muscle is used for anchoring the electrode with its suture sleeve. The electrode is anchored and secured ouce it has been positioned. The proximal end of the electrode is then tunneled back to the original pocket... 

About 1% of all acute strokes or stroke-hke events are caused by cerebral venous thrombosis (CVT). Thromboses can be located in the intracranial dural sinuses, in the superficial cerebral veins or in the deep cerebral veins. 

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