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Zeitschriftenartikel zum Thema "Thromboembolism – Prevention – Control Embolism"
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Khasanov, R. Sh, und I. A. Kamalov. „Pulmonary embolism prevention in out-patients with malignancies during the first year of follow-up“. Kazan medical journal 96, Nr. 1 (15.02.2015): 13–16. http://dx.doi.org/10.17750/kmj2015-013.
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Aim. To decrease the one-year mortality rate in out-patients with malignancies undergoing periodic health examination.Methods. The study included 270 patients, who were examined and followed up. The main group included 140 patients, who monthly underwent ultrasonography of inferior vena cava branches during the first year of follow-up. The control group included 130 patients, in whom ultrasonography of inferior vena cava branches was performed only if clinical manifestations of venous thrombosis were registered.Results. Venous thrombosis was diagnosed in 35 patients of the main group, including 21 cases of venous thrombosis at very high risk for embolism. In control group, ultrasonography of inferior vena cava branches was performed in 13 patients who developed clinical manifestations of venous thromboembolic events, in whom 6 patients were diagnosed with deep vein thrombosis of the lower limbs, in 3 patients venous thrombosis was assessed as at very high risk for embolism. In 24 patients (21 in the main group and 3 in the control group), targeted measures to prevent pulmonary embolism were administered, including cava filter implantation, vein ligation above the venous thrombosis at very high risk for embolism site, and crossectomy. The rest of the patients were administered conservative prevention of thromboembolism. In the main group, no deaths associated with pulmonary embolism were registered. In the control group, 19 patients died due to developing pulmonary embolism.Conclusion. Preventive measures for pulmonary embolism, selected according to the results of timely ultrasound diagnosis of venous thrombosis, may reduce the one-year mortality rate in patients with cancer.
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Laporte-Simitsidis, Silvy, Bernard Tardy, Michel Cucherat, Andréa Buchmüller, Daphné Juillard-Delsart, Hervé Decousus und Patrick Mismetti. „Prevention of Venous Thromboembolism in Internal Medicine with Unfractionated or Low-molecular-weight Heparins: A Meta-analysis of Randomised Clinical Trials“. Thrombosis and Haemostasis 83, Nr. 01 (2000): 14–19. http://dx.doi.org/10.1055/s-0037-1613749.
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SummaryThe prevention of venous thromboembolic disease is less studied in medical patients than in surgery.We performed a meta-analysis of randomised trials studying prophylactic unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) in internal medicine, excluding acute myocardial infarction or ischaemic stroke. Deepvein thrombosis (DVT) systematically detected at the end of the treatment period, clinical pulmonary embolism (PE), death and major bleeding were recorded.Seven trials comparing a prophylactic heparin treatment to a control (15,095 patients) were selected. A significant decrease in DVT and in clinical PE were observed with heparins as compared to control (risk reductions = 56% and 58% respectively, p <0.001 in both cases), without significant difference in the incidence of major bleedings or deaths. Nine trials comparing LMWH to UFH (4,669 patients) were also included. No significant effect was observed on either DVT, clinical PE or mortality. However LMWH reduced by 52% the risk of major haemorrhage (p = 0.049).This meta-analysis, based on the pooling of data available for several heparins, shows that heparins are beneficial in the prevention of venous thromboembolism in internal medicine.
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Intiyanaravut, Tawan, Nimit Thongpulsawasdi, Napol Sinthuvanich und Sasikarn Songtaweesap. „Efficacy and safety of dabigatran for venous thrombosis prophylaxis after knee replacement surgery in Thai patients: a prospective non-randomized controlled trial“. Asian Biomedicine 13, Nr. 6 (25.06.2020): 217–23. http://dx.doi.org/10.1515/abm-2019-0064.
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AbstractBackgroundDabigatran, a direct oral anticoagulant, has been approved for the prevention of venous thromboembolism (VTE) after orthopedic surgery in many countries. The efficacy and safety of this agent were most studied in Western countries.ObjectiveTo assess the efficacy and safety of dabigatran in preventing venous thromboembolic diseases after total knee arthroplasty (TKA) in Asian patients.MethodsWe conducted a prospective nonrandomized controlled study in Thai patients undergoing TKA. Thirty-two patients received 220 mg of dabigatran once daily for 14 days as thromboprophylaxis and 32 patients in the control group received none. The primary efficacy outcome was deep vein thrombosis (DVT), which was identified by color Doppler ultrasonography and/or diagnosed pulmonary embolism (PE). The primary safety outcomes were major bleeding and clinically relevant nonmajor bleeding events.ResultsThere were no DVTs or PEs diagnosed in either group. The difference in the composite incidence of major and clinically relevant nonmajor bleedings between the dabigatran and control groups did not reach significant (6.2% vs. 0%, P = 0.15).ConclusionDabigatran might have no clear benefit for the prevention of VTE after TKA in Thai patients. We do not recommend the routine use of dabigatran as a chemical thromboprophylaxis after TKA in Thai patients. To determine the safety profile, further study with larger sample sizes is required.
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Ravikumar, Raveena, Katherine J. Williams, Adarsh Babber, Hayley M. Moore, Tristan RA Lane, Joseph Shalhoub und Alun H. Davies. „Neuromuscular electrical stimulation for the prevention of venous thromboembolism“. Phlebology: The Journal of Venous Disease 33, Nr. 6 (13.06.2017): 367–78. http://dx.doi.org/10.1177/0268355517710130.
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Objective Venous thromboembolism, encompassing deep vein thrombosis and pulmonary embolism, is a significant cause of morbidity and mortality, affecting one in 1000 adults per year. Neuromuscular electrical stimulation is the transcutaneous application of electrical impulses to elicit muscle contraction, preventing venous stasis. This review aims to investigate the evidence underlying the use of neuromuscular electrical stimulation in thromboprophylaxis. Methods The Medline and Embase databases were systematically searched, adhering to PRISMA guidelines, for articles relating to electrical stimulation and thromboprophylaxis. Articles were screened according to a priori inclusion and exclusion criteria. Results The search strategy identified 10 randomised controlled trials, which were used in three separate meta-analyses: five trials compared neuromuscular electrical stimulation to control, favouring neuromuscular electrical stimulation (odds ratio of deep vein thrombosis 0.29, 95% confidence interval 0.13–0.65; P = .003); three trials compared neuromuscular electrical stimulation to heparin, favouring heparin (odds ratio of deep vein thrombosis 2.00, 95% confidence interval 1.13–3.52; P = .02); three trials compared neuromuscular electrical stimulation as an adjunct to heparin versus heparin only, demonstrating no significant difference (odds ratio of deep vein thrombosis 0.33, 95% confidence interval 0.10–1.14; P = .08). Conclusion Neuromuscular electrical stimulation significantly reduces the risk of deep vein thrombosis compared to no prophylaxis. It is inferior to heparin in preventing deep vein thrombosis and there is no evidence for its use as an adjunct to heparin.
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Kulesh, A. A., D. A. Demin und O. I. Vinogradov. „Cryptogenic stroke. Part 1: Aorto-arterial embolism“. Meditsinskiy sovet = Medical Council, Nr. 4 (20.04.2021): 78–87. http://dx.doi.org/10.21518/2079-701x-2021-4-78-87.
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The article discusses the concept of embolic stroke from an unspecified source and the role of aorto-arterial embolism in its development. Potential causes of embolic cryptogenic stroke such as aortic atheromatosis, non-stenotic atherosclerosis of the cervical arteries, carotid web and intracranial atherosclerosis are discussed in detail. The discussion of each cause covers epidemiology, pathogenesis, and current approaches to diagnosis and secondary prevention. The diagnostic search is presented in the form of an algorithm. To identify aorto-arterial sources of embolism and to determine their clinical significance, a comprehensive examination including CT angiography with targeted assessment of the aortic arch, transesophageal echocardiography, MRI of the arterial wall and transcranial Doppler is required. When mechanical thrombectomy is performed, histological examination of the thromboembolus is advisable. Given that atherosclerosis is usually systemic, the search for a possible cause of aorto-arterial embolism should be a diagnostic priority in patients with cryptogenic stroke and other arterial (coronary, lower extremity) lesions. With regard to secondary prevention of cryptogenic stroke in the presence of potential sources of aorto-arterial embolism, the principle ‘the more embologenic the source, the more aggressive the prevention’ applies. The arsenal of secondary prevention includes strategies such as strict control of vascular risk factors, achieving target blood pressure, short- and medium-term dual antiplatelet therapy, and intensive hypolipidemic therapy. Surgical prophylaxis is warranted for stroke against a carotid background, the efficacy of which in non-stenotic atherosclerosis requires early evaluation in randomised trials. Each potential cause of cryptogenic stroke considered is illustrated by a clinical example.
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Grishchenko, O. V., und V. V. Bobrytska. „Thromboembolic complications prevention in the obstetric practice“. HEALTH OF WOMAN, Nr. 1(117) (28.02.2017): 19–24. http://dx.doi.org/10.15574/hw.2017.117.19.
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The objective: To evaluate the clinical efficacy and safety of Enoxaparin-Pharmex for the prevention of thrombotic complications (pulmonary embolism) in the postoperative period in patients with moderate risk of these complications. Patients and methods. The study included 50 women after a caesarean section had an average degree of risk of pulmonary embolism. Patients were divided into the main group (n=25) and control group (n=25) in accordance with the treatment: patients of the main group received postoperative Еnoxaparin- Pharmex, group comparisons enoxaparin sodium (brand foreign manufacturer’s). Patients in both groups received the drug at a dose of 20 mg for 5 days, 1 time per day subcutaneously. Results. The research data analysis showed identity results of hemostasiogram of patients in the main group and the comparison group, no side effects after treatment in both groups. Conclusion. The clinical studies suggest the drug Enoxaparin-Pharmex is effective, safe LMWH, which can be used to prevent troboembolic complications, including post-operative treatment in obstetric practice. Spectrum of Enoxaparin-Pharmex can be extended to the prevention and treatment of thromboembolic conditions of varying severity with appropriate doses of the drug. Key words: Enoxaparin-Pharmex, prevention of pulmonary embolism.
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Sukovatykh, Boris Semenovich, Mikhail Borisovich Sukovatykh und Sergey Olegovich Perkov. „Efficacy and Safety of New Oral Anticoagulants in the Prevention of Venous Thromboembolism after Orthopaedic Surgery“. Vestnik of Experimental and Clinical Surgery 10, Nr. 3 (19.11.2017): 212–17. http://dx.doi.org/10.18499/2070-478x-2017-10-3-212-217.
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Relevance. Despite of a specific prophylaxis, the thromboembolic complications occur in 20-25% of patients after orthopedic surgeries. In those who do not receive the prophylaxis the complications rate is even higher taking up to 45-70% thereby putting the complications into second place after infection complications.
Objective. To compare the efficacy and safety of dabigatran etaxilate and rivaroxaban in prophylaxis and treatment of the venous thromboembolism after hip and knee arthroplasty.
Materials and methods. An analysis of prophylaxis and treatment of venous thromboembolism in 104 patients who had had hip and knee arthroplasty has been accomplished. All patients were randomized into two groups. 51 patients were enrolled into the first (control) group where 220 mg per day dabigatran etexilat therapy was used. The second (investigated) group included 53 patients who received 10 mg per day rivaroxabane therapy. A year after surgery the quality of life of patients was assessed using CIVIQ-20 and SF-36 questioners.
Results and their discussion. Venous thromboembolic complications had occurred in 18 (17,3%) of patients equally in the first and second group. Isolated common femoral vein thrombosis was found in 8 (7,7%), and in 3 (2,9%) patients it was associated with pulmonary embolism. Popliteal and tibial vein thrombosis was detected in 7 (6,7%) patients. Internal bleeding complications were found in 9 (8,6%) patients with venous thrombosis. The complications were more common in a second group (higher by 1,7%). In 7 (6,7%) cases the complications had no clinical significance. Only in 2 (1,9%) patients (one case in each group) were documented severe hemorrhages, that needed hemostatic therapy. A year after surgery the quality of life of patients was assessed using specifically oriented CIVIQ-20 and SF-36 international questioners for chronic venous insufficiency. The evidence based differences between two groups were not discovered.
Conclusion. Dabigatran etexilate as well as rivaroxaban can be used for prophylaxis of the venous thromboembolism after orthopedic surgeries.
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Nurmohamed, M. T., A. M. van Riel, C. M. A. Henkens, M. M. W. Koopman, G. T. H. Que, P. D’Azemar, H. R. Büller et al. „Low Molecular Weight Heparin and Compression Stockings in the Prevention of Venous Thromboembolism in Neurosurgery“. Thrombosis and Haemostasis 75, Nr. 02 (1996): 233–38. http://dx.doi.org/10.1055/s-0038-1650250.
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SummaryPerioperative anticoagulant prophylaxis for postoperative venous thromboembolism (VTE) in neurosurgical patients has not gained wide acceptance due to the fear of intracranial bleeding. Physical methods give a worthwhile reduction of postoperative VTE but there still remains a substantial residual incidence. In other clinical indications, low molecular weight heparins have proven to be effective for prophylaxis of VTE when administered postoperatively, with the advantage of no bleeding enhancement during surgery.Therefore, we performed a multicentre, randomized, double-blind trial in neurosurgical patients to investigate the efficacy and safety of adding a low molecular weight heparin (LMWH), nadroparin, initiated postoperatively, to graduated compression stockings in the prevention of VTE. Deep-vein thrombosis was detected by mandatory venography. Bleeding was determined according to pre-defined objective criteria for major and minor episodes.An adequate bilateral venogram was obtained in 166 of 241 LMWH patients (68.9%) and 179 of 244 control patients (73.4%). A total of 31 of 166 LMWH patients (18.7%) and 47 of 179 control patients (26.3%) had VTE up to Day 10 postoperatively (p = 0.047). The relative risk reduction (RRR) was 28.9%. The rates for proximal deep-vein thrombosis/pulmonary embolism were 6.9% and 11.5% for the two groups, respectively (RRR: 40.2%; p = 0.065).Secondary analyses involved all VTE up to day 56 post-surgery which was detected in 33 patients of 241 in the LMWH group (13.7%) and 51 of 244 control patients (20.9%; RRR 34.5%; p = 0.018). The corresponding percentages for proximal deep-vein thrombosis/pulmonary embolism were 5.8% and 10.2% for the two groups, respectively, giving a RRR of 43.3%; p = 0.036. Major bleeding complications, during the treatment period, occurred in six low molecular weight heparin treated patients (2.5%) and in two control patients (0.8%); p = 0.087.A higher mortality was observed in the low molecular weight heparin group over the 56-day follow-up period (22 versus 10; p = 0.026). However, none of these deaths was judged by a blinded adjudication committee to be related to the study drug.In conclusion, this study demonstrates that the low molecular weight heparin, nadroparin, added to graduated compression stockings results in a clinically significant decrease in VTE without inducing any significant increase of major bleeding.
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Merino, Jose L., und Jose López-Sendón. „New Drugs for Thromboembolic Prevention in Atrial Fibrillation“. European Cardiology Review 6, Nr. 4 (2010): 64. http://dx.doi.org/10.15420/ecr.2010.6.4.64.
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Atrial fibrillation (AF) is the most frequent sustained arrhythmia and its prevalence is increasing in developed countries. This progressive increase and the negative impact of this arrhythmia on the patient’s prognosis make AF one of the main healthcare problems faced today. This has led to intense research into the main aspects of AF, one of them being thromboembolism prevention. AF patients have a four to five times higher risk of stroke than the general population. Several factors increase thromboembolic risk in patients with AF and the use of risk scores, such as the Congestive Heart Failure, Hypertension, Age Greater than 75, Diabetes, and Prior Stroke or Transient Ischemic Attack (CHADS2), have been used to identify the best candidates for anticoagulation. Antithrombotic drugs are the mainstay of therapy for embolic prevention. The clinical use of these drugs is based on the risk–benefit ratio, where benefit is the reduction of stroke and systemic embolic events and risk is mostly driven by the increase in bleeding events. Generally, antiplatelets are indicated for low-risk patients in light of the fact anticoagulants are the drug of choice for moderate- or high-risk patients. Vitamin K antagonists have been the only option for oral anticoagulation for the last 50 years. However, these drugs have many pharmacodynamic and pharmacokinetic problems. The problems of anticoagulation with vitamin K antagonists have led to the investigation of new drugs that can be administered orally and have a better dose–response relationship, a shorter half-life and, in particular, higher efficacy and safety without the need for frequent anticoagulation controls. The drugs that have been studied most thoroughly in patients with AF are inhibitors of the activated coagulation factor X and inhibitors of coagulation factor II (thrombin), including ximelagatran and dabigatran. In addition, non-pharmacological therapies have been developed to prevent recurrent embolism in certain patient populations.
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Spyropoulos, Alex C. „The management of venous thromboembolism in hospitalized patients with COVID-19“. Blood Advances 4, Nr. 16 (25.08.2020): 4028. http://dx.doi.org/10.1182/bloodadvances.2020002496.
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Abstract The high incidence of thromboembolic disease, and in particular venous thromboembolism (VTE), has emerged as an important consideration in hospitalized and critically ill patients with coronavirus disease 2019 (COVID-19). The coagulopathy of COVID-19 is postulated to result from interactions of the inflammatory and immune systems with the coagulation system, manifesting as a cytokine storm associated with hyperinflammation and coagulation and platelet activation. Unique characteristics of VTE in hospitalized and critically ill patients with COVID-19 include the high incidence of VTE (and especially pulmonary embolism) when compared with historical controls; the finding of in situ pulmonary embolism associated with microthrombi, which suggests a thrombotic microangiopathic process in addition to classic macrovessel disease; and, most important from a clinical perspective, the unusually high rate of VTE that has been reported despite standard thromboprophylaxis. This raises the possibility that intermediate or weight-based heparin dosing may be more effective than fixed dosing for thromboprophylaxis in high-risk subsets of patients hospitalized with COVID-19. There have been several guidance statements focusing on the management of VTE in hospitalized and critically ill patients with COVID-19, including the most recent statement by the Scientific and Standardization Committee of the International Society of Thrombosis and Haemostasis, which includes comprehensive guidance on the diagnosis, prevention, and treatment of VTE in this patient population. Ongoing randomized trials that address key clinical questions, especially more intense thromboprophylactic strategies and novel antithrombotic approaches, have the potential to reduce the morbidity and mortality from VTE in hospitalized and critically ill patients with COVID-19.
Dissertationen zum Thema "Thromboembolism – Prevention – Control Embolism"
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Gandara, Esteban. „Is an Intermediate Dose of LMWH Effective for Secondary Prevention of Recurrent Venous Thromboembolism in Pregnant Patients Diagnosed with Deep Vein Thrombosis or Pulmonary Embolism? Design of a Pilot Study“. Thèse, Université d'Ottawa / University of Ottawa, 2012. http://hdl.handle.net/10393/23388.
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Statement of the problem The primary objective of this thesis was to determine the best study design to evaluate the safety and effectiveness of an intermediate dose of low molecular weight heparin for secondary prevention of pregnancy associated VTE (PAVTE). An RCT was deemed unfeasible,so the use of a single arm study with prior evaluation of feasibility with a pilot study is proposed. // Methods - A systematic review was conducted to evaluate the efficacy of current strategies used for secondary prevention of PAVTE.A survey was used to elicit the non-inferiority margin. // Results - The pooled proportion of recurrent VTE in patients treated with full dose LMWH was 0.012(95% CI 0.006 to 0.02) and the rate of major bleeding was 0.025(95% CI=0.01 to 0.041). The non-inferiority margin was elicited at 2.5%. // Conclusions - Although a randomized controlled trial should be conducted whenever possible, in certain scenarios they are unfeasible. Therefore, an alternative study design should perhaps be used to evaluate the safety and efficacy of therapeutic strategies.
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Pessotti, Cristiane Felix Ximenes. „Estudo comparativo do uso do antiagregante plaquetário e anticoagulante oral na profilaxia de trombose em pacientes submetidos à operação cavopulmonar total com tubo extracardíaco: análise ecorcardiográfica, angiotomográfica, cintililográfica, laboratorial e clínica“. Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/5/5156/tde-07022014-160413/.
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Estudo prospectivo e randomizado de 30 pacientes, submetidos a derivação cavopulmonar total com tubo extracardíaco. Os dados refletem o período de 2008 a 2011, com seguimento de dois anos, por meio de avaliação clínica, laboratorial, ecocardiográfica, angiotomográfica e cintilográfica. Neste estudo, procuramos comparar a eficácia do ácido acetil salicílico (AAS) e da Varfarina na profilaxia da trombose na população estudada. Para tanto, analisamos alterações nos fatores de coagulação (VII, VIII e Proteína C ); ou nos dados clínicos que predispusessem a ocorrência de trombo no pós-operatório. Além disso, no pós-operatório, após a randomização (15 pacientes randomizados para receber Varfarina, Grupo I, e 15 pacientes randomizados para receber AAS, Grupo II), estudamos a interferência da fenestração na ocorrência de trombo; alterações hemodinâmicas que pudessem contribuir com a ocorrência de trombo (fluxo lento pelo tubo extracardíaco), por meio de ecocardiograma transesofágico realizado com até 10 dias de pós operatório, 3, 6, 12 e 24 meses de pós operatório. A presença do fenômeno tromboembólico era pesquisada, além dos ecocardiogramas acima citados, por meio de consultas clínicas realizadas com a mesma periodicidade e que avaliavam, ainda, efeitos colaterais ou complicações no uso de cada uma das drogas. Avaliamos também a viabilidade e aderência ao uso de cada uma delas. O seguimento contou igualmente com a realização de angiotomografia aos 6, 12 e 24 meses de pós-operatório para avaliação de alterações na parede interna do tubo, bem como trombos e cintilografia pulmonar, ventilação-perfusão para avaliar possível tromboembolismo pulmonar. Durante o seguimento, ocorreram dois óbitos, ambos no grupo em uso de Varfarina. Ao todo, durante os dois anos de seguimento, 33,3% dos pacientes apresentaram fenômeno tromboembólico. Sendo que, entre os paciente em uso de AAS, 46,7% apresentaram tal complicação e 20% entre os pacientes em uso de Varfarina (p=0,121). Com relação a avaliação pré-operatória, a ocorrência prévia de trombo e baixos níveis de proteína C da coagulação foram os únicos fatores que influenciaram no tempo de sobrevida livre de trombo, com valores de p de 0,035 e 0,047 respectivamente. Ao final de dois anos de seguimento, na avaliação angiotomográfica, 35,7% dos pacientes em uso de AAS tinham material hiper-refringente depositado em tubo extracardíaco com espessura superior a 2mm ( p= 0,082). Já na avaliação por cintilografia de ventilação-perfusão, dois pacientes apresentaram sinais de tromboembolismo pulmonar, ambos em uso de AAS (p=0,483), e um deles com evolução desfavorável do circuito tipo Fontan. Com relação a segurança e aderência ao tratamento, cinco pacientes tiveram dificuldade de aderência (só viabilizada por tratar-se de protocolo de estudo), entre eles, quatro em uso de Varfarina e apresentando INR variando de 1 a 6,4. Para comprovação numérica, com força estatística dos dados encontrados, uma força tarefa deve ocorrer para que se consiga um grupo maior de pacientes incluídos neste estudo. No entanto, a diferença entre os dois grupos na evolução livre de trombo nos dois primeiros anos de pós-operatório não pode, e nem deve, ser ignoradaProspective randomized trial of 30 patients who had undergone total cavopulmonary anastomosis via an extracardiac conduit. The data reflect the period between 2008 and 2011, with two-year follow-up, through clinical, laboratorial, echocardiographic, angiotomographic, and scintigraphic assessment. In this study, we aimed to compare the efficiency of ASA (Aspirin) and Warfarin in the preventive treatment of thrombosis in the tried population. For such, we\'ve analyzed changes in coagulation factors (VII, VIII and Protein C) or in the clinical data which would predispose the occurrence of postoperative thrombus. Moreover, during postoperative care, after randomization (15 patients randomly selected to be trated with Warfarin, referred to as Group I, and 15 patients randomly selected to be treated with ASA, referred to as Group II), we also studied the influence of fenestration in the occurrence of thrombus; hemodynamic variations which could contribute to the occurrence of thrombus (slow blood flow in the extracardiac conduit), with postoperative transesophageal echocardiogram being performed within 10 days, and thereafter 3, 6, 12 and 24 months. Besides the echocardiograms aforementioned, the presence of thromboembolic events was sought after by clinical appointments taking place with the same frequency, which evaluated, apart from thromboembolism, side effects or complications from the usage of each of the drugs. We\'ve also evaluated the compliance to and feasibility of each of them. Postoperative angiotomography was also performed during the follow-up, within 6, 12 and 24 months, for the evaluation of changes on the inside wall of the extracardiac conduit, as well as thrombi, and pulmonary ventilation/perfusion scintigraphy for assessment of pulmonary thromboembolism possibility. During the follow-up, two deaths were registered, both in the group being treated with Warfarin. Overall, in the two-year follow-up, 33,3% of the patients presented thromboembolic events. Among the group being treated with ASA, 46,7% presented such complication, whereas in the group being treated with Warfarin, 20% had the same complication (p=0,121). Regarding the preoperative evaluation, prior occurrence of thrombus and low levels of coagulation factor Protein C were the only variables which influenced living time without thrombus, with p-values of 0,035 and 0,047. At the end of the two-year follow-up, in the angiotomographic evaluation, 35,7% of patients treated with ASA presented material accumulation inside the extracardiac conduit, with over 2mm of thickness (p=0,082). As for the ventilation/perfusion scintigraphy, two patients presented traces of pulmonary thromboembolism, both treated with ASA (p=0,483), one of whom with unfavorable development of the Fontan circuit. Concerning safety and compliance to the treatment, five patients had difficulty to comply with the treatment (only viable for its trial nature), among those, four under treatment with Warfarin and presenting INR values ranging from 1 to 6,4. For quantitative verification, providing statistic value to the data, an effort must be made for a larger number of patients to be gathered and tried with this treatment. However, the difference in results concerning thrombus-free recovery between the two groups during the two years following surgery cannot, and must not, be ignored
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Moodley, Pramodhini. „Descriptive study of Venous Thromboembolic Disease in the adult population admitted to Tshepong Hospital comparing the proportion of HIV and non-HIV infected patients“. Thesis, 2019. https://hdl.handle.net/10539/28163.
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A research report submitted to the University of Witwatersrand, Johannesburg in fulfilment for the requirements of the degree of Master of Medicine 4 June 2019
Descriptive study of Venous Thromboembolic Disease in the adult population admitted to Tshepong Hospital comparing the proportion of HIV and non-HIV infected patientsBackground HIV and TB independently incur increased risk for venous thromboembolic disease (VTE): deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Data from high HIV and TB burden settings describing VTE is scarce. The Wells’ DVT and PE scores are widely used but their utility in these settings has not been reported on extensively. We therefore report clinical and treatment aspects of in-patients with newly diagnosed VTE to assess HIV and TB prevalence, and their Wells’ score. Setting Tshepong Hospital in the North West Province of South Africa. Methods A prospective cohort of adult in-patients with radiologically confirmed VTE were recruited. Demographics, presence of TB, HIV status, duration of treatment, CD4 count, viral load, VTE risk factors, and parameters to calculate the Wells’ score were collected. Results One hundred patients were recruited, of whom 59 were HIV-infected; 39 had TB disease and 32 were HIV/TB co-infected. Eighty -three patients had a DVT only; 11 patients had a PE, and six had both a DVT and PE. Eighteen of 42 patients on antiretroviral treatment (ART) were on treatment for less than six months. Twenty patients of 39 were on TB treatment for less than one month. The median DVT and PE Wells’ score in all sub-groups was 3.0 (IQR: 1.0-4.0) and 3.0 (IQR: 2.5-4.5), respectively. There were nine deaths. Conclusion HIV /TB co-infection appear to confer a risk for VTE, especially early after ART and/or TB treatment, and therefore require careful monitoring for VTE and early initiation of thrombo-prophylaxis.
E.K. 2019
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Chitsike, Rufaro Saeed. „The efficacy of low molecular weight heparin in the prevention of thromboembolic disease in pregnant patients with mechanical prosthetic heart valves“. Thesis, 2012. http://hdl.handle.net/10539/10956.
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Objective: To determine whether dosage adjustment of enoxaparin during pregnancy, in order to
maintain a peak anti-Xa of 1.0-1.2 U/ml, is safe for women with mechanical prosthetic heart
valves (MPHV).
Methods: This was a prospective observational study performed at Charlotte Maxeke
Johannesburg Academic Hospital from 2007 to 2009. 15 women with MPHVs were treated with
enoxaparin with dosage adjustment throughout pregnancy to achieve a peak anti-Xa of 1.0-1.2
U/ml. Main outcomes measured were prosthetic valve thrombosis, bleeding and maternal
mortality.
Results: There was no maternal mortality. None of the women developed valvular thrombosis
during pregnancy. Two women developed epistaxis and another developed spotting per vagina.
There was no foetal mortality.
Conclusion: Our data show that enoxaparin may be administered safely during pregnancy to
pregnant women with mechanical prosthetic heart valves when there is dosage adjustment
throughout pregnancy in order to maintain an anti-Xa of 1.0-1.2 U/ml.
5
„The study of pathogenesis of pulmonary fat embolization after intramedullary reaming and possible improvement in reaming technique“. 2000. http://library.cuhk.edu.hk/record=b6073246.
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Cheung Ngai man Edmund."August 2000."
Thesis (Ph.D.)--Chinese University of Hong Kong, 2000.
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Mode of access: World Wide Web.
Abstracts in English and Chinese.
6
„The effect of reaming on intramedullary pressure and marrow fat embolisation“. 1997. http://library.cuhk.edu.hk/record=b5889301.
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by Cheung Ngai Man, Edmund.Thesis (M.Phil.)--Chinese University of Hong Kong, 1997.
Includes bibliographical references (leaves 73-83).
Acknowledgments --- p.i
Abstract --- p.iii
List of Figures --- p.viii
List of Tables --- p.xi
Chapters
Chapter 1 --- Introduction --- p.1
Chapter 1.1 --- Intramedullary nailing --- p.1
Chapter 1.2 --- Reaming technique for intramedullary nailing --- p.3
Chapter 1.3 --- The relationship between pulmonary fat embolism and reaming technique --- p.7
Chapter 1.4 --- Objectives --- p.10
Chapter 2 --- Methodology --- p.12
Chapter 2.1 --- The measurement of the intramedullary pressure --- p.12
Chapter 2.1.1 --- Animal model --- p.12
Chapter 2.1.2 --- Intramedullary pressure measurement device --- p.12
Chapter 2.1.3 --- Operative procedure --- p.14
Chapter 2.1.4 --- Intramedullary pressure measurement --- p.16
Chapter 2.2 --- The measurement of the plasma lipids and marrow lipids --- p.19
Chapter 2.2.1 --- Samples collection --- p.19
Chapter 2.2.2 --- Lipid extraction --- p.19
Chapter 2.2.3 --- Thin layer chromatography --- p.20
Chapter 2.2.4 --- Methylation --- p.24
Chapter 2.2.5 --- Gas chromatographic analysis --- p.24
Chapter 2.3 --- The measurement of the pulmonary lipids and fat emboli --- p.27
Chapter 2.3.1 --- Pulmonary tissue collection --- p.27
Chapter 2.3.2 --- Preparation for measurement of pulmonary lipids --- p.27
Chapter 2.3.3 --- Fat emboli staining --- p.27
Chapter 2.3.4 --- Image analysis --- p.28
Chapter 2.4 --- Statistical analysis --- p.31
Chapter 3 --- Results --- p.32
Chapter 3.1 --- Intramedullary pressure measurement --- p.32
Chapter 3.2 --- The analysis of bone marrow lipids --- p.34
Chapter 3.3 --- The changes of the plasma lipids during reaming --- p.39
Chapter 3.4 --- The measurement of the pulmonary fat emboli --- p.44
Chapter 3.5 --- The relationship between the intramedullary pressure and plasma lipids and pulmonary fat intravasation --- p.52
Chapter 4 --- Discuss --- p.55
Chapter 4.1 --- The experimental design --- p.55
Chapter 4.2 --- The change of the intramedullary pressures --- p.57
Chapter 4.3 --- The application of the gas chromatography --- p.59
Chapter 4.4 --- The composition of bone marrow lipids --- p.62
Chapter 4.5 --- The changes of plasma lipids --- p.63
Chapter 4.6 --- The pulmonary fat embolisation --- p.65
Chapter 5 --- Conclusion --- p.69
Chapter 6 --- Future direction on this study --- p.71
References --- p.73
Appendix --- p.84
Chapter 1 --- The operation of the IM Press device --- p.84
Chapter 2 --- The calibration of the IM Press --- p.85
Chapter 3 --- The preparation of the internal standards for the lipid analysis --- p.89
Chapter 4 --- The composition of the bone marrow lipids --- p.91
Chapter 5 --- The composition of plasma lipids --- p.95
Chapter 6 --- The composition of pulmonary lipids --- p.101
Chapter 7 --- The measurement of the pulmonary fat emboli --- p.105
Bücher zum Thema "Thromboembolism – Prevention – Control Embolism"
1
Medicine, Consortium for Spinal Cord. Prevention of thromboembolism in spinal cord injury. 2. Aufl. Washington, DC: Paralyzed Veterans of America, 1999.
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2
National Library of Medicine (U.S.), Hrsg. Prevention of venous thrombosis and pulmonary embolism: January 1984 through January 1986, 250 citations in English. [Bethesda, Md: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health], 1986.
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3
1917-, Wessler Stanford, Becker Carl G und Nemerson Yale, Hrsg. The new dimensions of warfarin prophylaxis. New York: Plenum Press, 1987.
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4
Shukla, Vijay K. Low molecular weight heparins for major orthopedic surgery: A case for clinical outcomes. Ottawa, Ont: Canadian Coordinating Office for Health Technology Assessment, 1998.
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5
Sharnoff, J. G. Prevention of Venous Thrombosis and Pulmonary Embolism. Springer, 2011.
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6
Stansby, Gerard, Vish Bhattacharya und Patrick Kestevan. Prevention and Management of Venous Thromboembolism. Imperial College Press, 2015.
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7
C, Velmahos George, Kern Jack, United States. Agency for Healthcare Research and Quality. und Southern California Evidence-Based Practice Center/RAND., Hrsg. Prevention of venous thromboembolism after injury. Rockville, MD: Agency for Healthcare Research and Quality, 2000.
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8
Z, Goldhaber Samuel, Hrsg. Prevention of venous thromboembolism: Edited by Samuel Z. Goldhaber. New York: Dekker, 1993.
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9
F, Pérez-Gómez, Prentice C. R. M und Meyer Jürgen MD, Hrsg. Coronary thrombosis: Intracardiac thrombosis. New York, NY: Raven Health Care Communications, 1994.
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10
Perez-Gomez, F., C. R. M. Prentice und Jurgen Meyer. Coronary Thrombosis: Intracardiac Thrombosis. Raven Health Care Communications, 2001.
Den vollen Inhalt der Quelle findenBuchteile zum Thema "Thromboembolism – Prevention – Control Embolism"
1
Becker, Richard C., und Frederick A. Spencer. „Cardiac Chamber, Aortic, and Valvular Thromboembolism“. In Fibrinolytic and Antithrombotic Therapy. Oxford University Press, 2006. http://dx.doi.org/10.1093/oso/9780195155648.003.0009.
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The left-sided cardiac chambers (left atrium, left ventricle) and heart valves (mitral valve, aortic valve) (native, prosthetic) serve as potential niduses for systemic thromboembolism, including fatal or debilitating stroke. The ascending aortic is also recognized as a source for embolism (aortoembolism) and should be considered when a comprehensive patient evaluation is being undertaken. The pathogenesis of intracavitary mural thrombosis, much like venous thromboembolism, follows the construct of Virchow’s triad. The area of stasis is often provoked by chamber dilation, reduced performance, or impaired flow across an existing heart valve (e.g., left atrial dilation from mitral stenosis). Endothelial injury may follow either an acute (e.g., myocardial infarction) or chronic (e.g., dilated cardiomyopathy) cardiac process. In the case of aortoembolism, plaque rupture in areas of advanced atherosclerosis serves as the primary site for thrombus development. The third component, prothrombotic state, may be focal (areas of inflammation and necrosis) and/or systemic. Left ventricular mural thrombosis is diagnosed either echocardiographically or at the time of autopsy among patients with myocardial infarction (MI), especially in those with anterior infarction involving the ventricular apex. In large, nonrandomized clinical trials of anticoagulant therapy, researchers have reported an incidence of cerebral embolism of 2% to 4% among nontreated patients, frequently causing either severe neurologic deficits or death. Of these trials, two showed a statistically significant reduction in stroke with early anticoagulation, whereas the third trial demonstrated a positive trend (Davis and Irelant, 1986). A meta-analysis performed by Vaitkus and Barnathan (1993) supports the findings of three previous studies published in the early 1980s. The odds ratio for systemic embolism in the presence of echocardiographically demonstrated mural thrombus was 5.45 (95% confidence interval [CI] 3.02–9.83). The odds ratio of anticoagulation versus no anticoagulation in preventing embolism was 0.14 (95% CI 0.04–0.52) with an event rate difference of –0.33 (95% CI –0.50 to –0.16). The odds ratio of anticoagulation versus control in preventing mural thrombus formation was 0.32 (95% CI 0.20–0.52) and the event difference was –0.19 (95% CI 0.09–0.28).
2
MacCallum, Peter K., und Louise Bowles. „Thrombosis in pregnancy“. In Oxford Textbook of Medicine, herausgegeben von Catherine Nelson-Piercy, 2606–12. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198746690.003.0269.
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Pregnancy and the puerperium are associated with a 10-fold increase in the risk of venous thromboembolism, comprising deep vein thrombosis and pulmonary embolism, compared to the non-pregnant state. Pulmonary embolism has been the leading direct cause of maternal mortality in most of the United Kingdom’s triennial Confidential Enquiries into Maternal Deaths over the past 30 years, attesting to the importance of prevention and prompt diagnosis and treatment of venous thromboembolism during pregnancy and following delivery. The diagnosis of venous thromboembolism is challenging in pregnancy because it can be difficult to distinguish features of venous thromboembolism, such as leg swelling and breathlessness, from those of normal pregnancy, and there are no validated clinical scoring systems. All women should undergo risk assessment for venous thromboembolism in early pregnancy, at the time of hospital admission or change in clinical condition, and after delivery.
3
Keeling, David. „Therapeutic anticoagulation“. In Oxford Textbook of Medicine, herausgegeben von Jeremy Dwight, 3729–34. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198746690.003.0376.
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The main indications for therapeutic anticoagulation are venous thromboembolism, deep vein thrombosis, and pulmonary embolism, and the prevention of stroke in patients with atrial fibrillation or mechanical heart valves. Low-molecular-weight heparins have largely replaced unfractionated heparin in its treatment. Their much more predictable anticoagulant response combined with high bioavailability after subcutaneous injection means that the dose can be calculated by body weight and given subcutaneously without any monitoring or dose adjustment. Their widespread use resulted in most patients with deep vein thrombosis being managed as outpatients, and this is also increasingly the case for uncomplicated pulmonary embolism. Oral direct inhibitors of anticoagulation that specifically target thrombin or factor Xa are increasingly used to treat acute venous thromboembolism and for stroke prevention in atrial fibrillation.
4
Theron, Abrie. „Embolic disease“. In Obstetric Anaesthesia, 521–34. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780199688524.003.0020.
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Venous thromboembolism is the leading direct cause of maternal death. Therefore an understanding of the risk factors, clinical presentation, appropriate investigations (i.e. echocardiogram, V/Q Scan, or CT pulmonary angiography) and the treatment options available for managing patients with suspected and confirmed pulmonary embolism (PE) are essential knowledge on an obstetric unit. The chapter includes information on anticoagulation treatment options and the management of life-threatening PE, when thrombolysis or pulmonary embolectomy may be indicated. Amniotic fluid embolism is discussed, reviewing aetiology, pathophysiology, clinical features, diagnosis, and supportive management. Finally air embolism is discussed, also looking at aetiology, pathophysiology, clinical features, diagnosis, and management, emphasizing, however, that prevention is key.
5
van Mens, Thijs E., und Saskia Middeldorp. „Management of pulmonary embolism in pregnancy“. In ESC CardioMed, 2786–90. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0665.
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Pulmonary embolism, although rare, is a leading cause of maternal mortality. There is no strong evidence base for the diagnosis and management of pregnancy-related pulmonary embolism, hampering firm recommendations. In women with a suspicion of pulmonary embolism, the diagnosis is confirmed in 1 in 25–30 women only. However, imaging is always necessary to exclude pulmonary embolism, as no clinical decision rules or D-dimer-based strategies have been validated in pregnancy. Computed tomography pulmonary angiography and pulmonary scintigraphy are both suitable modalities, unless deep vein thrombosis is confirmed by compression ultrasonography of lower limb veins. Low-molecular-weight heparin (LMWH) in therapeutic doses is the treatment of choice during pregnancy, and anticoagulation should be continued until 6 weeks after delivery with a minimum total duration of 3 months. Use of LMWH or vitamin K antagonists does not preclude breastfeeding. Whether dosing should be based on weight or anti-Xa levels is unknown, and practices differ between centres. Management of delivery, including the type of anaesthesia if deemed necessary, requires a multidisciplinary approach, and several options are possible, depending on local preferences and patient-specific conditions. Prevention of pulmonary embolism with LMWH is indicated in all postpartum women with a history of venous thromboembolism, and in most women also during pregnancy.
6
Stone, Jeremy G., David M. Panczykowski und David O. Okonkwo. „The Management of Traumatic Brain Injury“. In Neurocritical Care, herausgegeben von Namir Khandker und Lori A. Shutter, 83–96. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199375349.003.0009.
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The management of traumatic brain injury necessitates a multidisciplinary approach with medical and surgical therapies employed based on rapid clinical assessment of injury severity and imaging characteristics. Therapy aims to prevent secondary brain injury through multifactorial interventions primarily focusing on prevention of cerebral hypoxemia and aggressive control of intracranial pressure (ICP). This chapter covers epidemiology, pathophysiology, clinical assessment, and both medical and surgical management of traumatic brain injury. Management topics include appropriate monitoring, first- and second-line therapy for ICP and cerebral perfusion pressure, hypoxia, seizure prophylaxis, hyperpyrexia, glycemic control, fluids and electrolytes, nutrition, and prophylaxis for venous thromboembolism and the gastrointestinal system.
Konferenzberichte zum Thema "Thromboembolism – Prevention – Control Embolism"
1
Hull, Russell D., und Gary E. Raskob. „TREATMENT OF DEEP VENOUS THROMBOSIS AND ECONOMIC ASPECTS“. In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1642968.
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Initial therapy with intravenous heparin, followed by long-term anticoagulant therapy for three months or more, is the treatment of choice for most patients with acute venous thrombosis. Inferior vena caval interruption, using a transvenously inserted filter, is the management of choice for preventing pulmonary embolism in patients in whom anticoagulant therapy is contraindicated, and in the very rare patient in whom anticoagulant therapy is ineffective. The role of thrombolytic therapy has not been completely resolved. It was hoped that thrombolytic therapy would minimize or prevent the post-phlebitic syndrome; unfortunately, this may not be the case because the critical factor in the development of the post-phlebitic syndrome appears to be venous valve damage, which occurs early in the formation of venous thrombosis. Thrombolytic therapy should be considered in selected patients with acute massive venous thrombosis (eg. the patient with phlegmasia cerulea dolens).Intravenous heparin administered in doses which prolong the activated partial thromboplastin time (APTT) to 1.5 to 2 times control is highly effective and is associated with a low frequency (2%) of recurrent venous thromboembolism. A recent randomized trial (1) in patients with proximal-vein thrombosis indicates that failure to achieve an adequate anticoagulant response (APTT > 1.5 times control) is associated with a high risk (20%) of recurrent venous thromboembolism. Therefore, sufficient heparin should be administered to maintain the APTT above 1.5 times the control value.Intravenous heparin is continued for 7 to 10 days, overlapped with oral anticoagulant therapy for 4 to 5 days before heparin is stopped. Multiple randomized clinical trials in patients with proximal-vein thrombosis indicate that when heparin is administered for 7 to 10 days, followed by adequate long-term anticoagulant therapy, the frequency of recurrent venous thromboembolism is very low (2%). An alternative approach is to commence heparin and oral anticoagulants together at the time of diagnosis, and to discontinue heparin on the fourth or fifth day. If this latter approach is effective, it would avoid 4 to 5 days of unnecessary hospitalization in many patients, and would markedly reduce the cost of initial heparin therapy. A recent randomized trial (2) in patients with submassive venous thromboembolism suggests that 4 to 5 days of initial heparin therapy is effective and safe, but this approach must be evaluated by further randomized clinical trials before it is routinely recommended.Recent clinical trials indicate that inadequate long-term therapy in patients with proximal-vein thrombosis results in a high frequency (40-50%) of recurrent venous thromboembolism and is cost-ineffective because of the diagnostic and treatment costs of recurrent venous thromboembolism (3). The risk of recurrence is markedly reduced to 2% by adequate long-term anticoagulant therapy with warfarin sodium or adjusted subcutaneous heparin; both of these approaches are markedly more cost-effective than inadequate long-term therapy (3). Oral anticoagulant therapy with warfarin sodium for three months (or longer in selected patients), is less expensive than adjusted subcutaneous heparin and is preferred in most patients with acute proximal-vein thrombosis. The risk of bleeding associated with oral anticoagulant therapy can be reduced to less than 5%, without loss of effectiveness for preventing recurrent venous thromboembolism, by adjusting the dose of warfarin sodium to achieve a less intense anticoagulant effect (PT 1.25 to 1.5 times control using a rabbit brain thromboplastin such as Simplastin or Dade-C, corresponding to an INR of 2.0 to 3.0). Less intense warfarin sodium therapy is the most cost-effective of the alternative long-term anticoagulant regimens (3). Adjusted dose subcutaneous heparin is an effective and safe alternative to warfarin sodium; although slightly more expensive, it is the long-term regimen of choice in pregnant patients, and in patients returning to geographically remote areas lacking the facilities for anticoagulant monitoring (in whom the dose is adjusted during the first few days of long-term therapy and then fixed). REFERENCES: (1) Hull R, Raskob G, Hirsh J et al. N Engl J Med 1986;315:1109-1114. (2) Gallus A, Jackaman J, Tillett J et al.Lancet 1986;2:1293-1296. (3) Hull R, Raskob G, Hirsh J, Sackett DL. JAMA 1984;252:235-239.
2
Boissel, J. P., J. C. Peyrieux, J. M. Destors, M. Lievre und P. Moleur. „PREVENTION OF SYSTEMIC THROMBO-EMBOLISM IN PATIENTS WITH ATHEROSCLEROTIC INTERMITTENT CLAUDICATION“. In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643461.
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Ticlopidine (TI), an anti-aggregating agent which inhibits the ADP-pathway has been tested in patients with intermittent claudication (IC) in 11 randomized clinical trials (RTCs).As expected, a significant reduction of cardio-vascular events (CVE) due to systemic thrombo-embolism was observed in the 2 larger. Reduction in the number of CVE due to systemic thromboembolism in any arterial bed was observed. This prompted us to confirm the hypothesis that TI was beneficial in preventing systemic thrombo-embolism in patients with IC. Four RCTs from the 11 were blindly selected on the basis on pre-set selection criteria : placebo controlled, more than 1 month duration, , less than 5 % lost-to-follow-up (index of quality), parallel groups, proven atherosclerotic disease. Meta-analysis was performed with 5 statistical methods which gave consistent findings : as compared to 311 patients on placebo, the 301 patients on TI have had a 66 % reduction in the number of CVE during the 6 months of follow-up (9.0 % to 3 % , p = 0.002). Walking distance, a secondary objective of meta-analysis, doubled in 42 % of the patients on TI as against 27 % (p = 0.0005).It was concluded that TI 250 mg b.i.d. prevents CVE in patients with atherosclerotic IC.
3
Lowe, O. DG. „RHEOLOGY AND VENOUS THROMBOEMBOLISM“. In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643990.
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Changes in the composition of the blood, venous stasis, and interaction of the blood with the vessel wall (Virchow's triad) all have rheological aspects which may promote venous thrombogenesis.Blood composition and rheology. Increasing levels of venous haematocrit and fibrinogen increase bulk blood viscosity, especially at low shear rates such as are encountered in veins, when red cell aggregation occurs. Static blood requires a minimum shear stress for flow (yield stress), which is also strongly dependent on haematocrit and fibrinogen levels. Increases in haematocrit and fibrinogen also promote platelet adhesion and aggregation. Polycythaemia carries an increased risk of venous thromboembolism, which can be reduced by lowering the haematocrit; conversely, anaemic patients (renal failure, pernicious anaemia) have a subnormal prevalence of pulmonary embolism at autopsy. Increased preoperative levels of haematocrit, fibrinogen and blood viscosity predicted postoperative deep vein thrombosis in some studies, but not in others: they have complex relationships to other risk factors and illnesses. Postoperative changes in haematocrit, fibrinogen and blood viscosity may also be relevant to thrombogenesis, as may haemoconcentration in leg veins.Venous flow disturbance and rheology. The flow behaviour of particles and cells in venous valve pockets has been studied by Karino: particles and cells were observed to leave mainstream flow and circulate in paired vortices in low-shear areas within the valve pockets. A cell-poor hypoxic area at the apex of the valve pocket may favour thrombogenesis. Valve pockets might therefore act as in vivo aggregometers, with optimal conditions for activated cells or coagulation products to promote platelet and red cell aggregation, which might be facilitated by increases in haematocrit or fibrinogen. Sevitt has observed cellular aggregates in valve pockets at autopsy, which might act as a nidus for thrombus initiation. Successive layers of thrombus will disturb flow steamlines, as well as generating procoagulant activity: hence a series of "aggregometers" might result in successive bursts of thrombosis and the layered structure of venous thrombi observed by Sevitt. Variations in haematocrit, fibrinogen and red cell aggregation may influence stasis of blood following venous occlusion by thrombus, and hence affect thrombotic extension; they may also influence residual lung perfusion following pulmonary embolism.Therapeutic aspects of rheology. Leg stockings and other physical methods of preventing deep vein thrombosis may improve flow disturbance in valve pockets, as well as in axial veins. The efficacy of perioperative dextran in prevention of venous thromboembolism may partly reflect haemodilution and its rheological consequences. Likewise, postoperative defibrination with ancrod reduced the incidence and extent of deep vein thrombosis after hip surgery, which may partly reflect reductions in plasma viscosity and red cell aggregation. Defibrination with ancrod reduced the haemodynamic disturbance, and the mortality, of experimental pulmonary embolism in dogs, possibly by increasing residual perfusion.. Similarly, improved perfusion after thrombolytic therapy of pulmonary embolism in man may reflect the rheological consequences of fibrinogen depletion, as well as thrombolysis.
4
Lowe, G. D. O. „EPIDEMIOLOGY AND RISK PREDICTION OF VENOUS THROMBOEMBOLISM“. In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1642965.
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Uses of epidemiology. Venous thromboembolism continues to be an important cause of death and disability in Western Countries. Its epidemiology may provide clues to etiology, e.g. the increased incidence in oral contraceptive users, and the low prevalence at autopsy in Central Africa or Japan compared to the U.S.A. A second use is the monitoring of time-trends: the diagnosis of pulmonary embolism increased during the 1970s, although the case fatality decreased. A third use is the identification and quantification of risk factors: these could be modified in the hope of prevention, or else used to select high risk groups for selective prophylaxis, e.g. during acute illness. Prevention is the only feasible approach to reducing the burden of venous thromboembolism, since most cases are not diagnosed, and since the value of current treatment is debatable.Case definition. Presents problems: clinical diagnosis is unreliable, and should if possible be supported by objective methods. Autopsy studies are performed on selected populations, at a decreasing rate; the frequency of thromboembolism depends on technique; and pathologists cannot be blinded and are open to bias. It can also be difficult to judge whether a patient dying with pulmonary embolism died from pulmonary embolism. 125I-fibrinogen scans indicate minimal disease, and now present ethical problems in screening due to risks of viral transmission. Venography is invasive and is not readily repeatable, which limits its use as a screening method. Plethysmography merits wider evaluation, since it is non-invasive, and sensitive to major thrombosis.Community epidemiology. Data on the community epidemiology are limited. The risk increases with age. When age is taken into account, there is little sex difference. Overweight in women, use of oral contraceptives and blood group A increase the risk: smoking, varicose veins, blood pressure, cholesterol and glucose do not, on current evidence. Long-term follow-up of patients with proven thromboembolism shows an increased risk of malignancy, hence occult cancer may also be a risk factor. Polycythaemia and certain congenital deficiencies (e.g. antithrombin III) are also well-recognised risk factors, although uncommon.Hospital epidemiology. Data on hospital epidemiology are derived largely from autopsy prevalence, and from short-term incidence of minimal thrombosis detected by 125I—fibrinogen scanning. Old, immobile and traumatised patients are most at risk. Previous thromboembolism, polycythaemia, antithrombin III deficiency, hip and leg fractures, elective hip and leg surgery, hemiplegia, paraplegia, and heart failure carry high risks, and merit consideration for routine prophylaxis. The risk in elective surgery precedes the operation, and increases with age, overweight, malignancy, varicose veins, non-smoking, and operative factors (duration, approach, general anaesthesia, intravenous fluids). Diabetics appear to have no extra risk. Combinations of clinical variables can be used to predict high risk groups for selective prophylaxis, but combination indices require further study. Laboratory variables may increase the predictability of deep vein thrombosis, but the results of published studies are conflicting, and the cost-effectiveness of laboratory prediction should be evaluated.
5
PLANES, A., N. VOCHELLZ und C. MANSAT. „PREVENTION OF DEEP VEIN THROMBOSIS (DVT) AFTER TOTAL HIP REPLACEMENT (THR) by ENOXAPARINE (LOVENOXR) : ONE DAILY INJECTION OF 40 MG VERSUS TWO DAILY INJECTIONS OF 20 MG“. In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643214.
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Venous thromboembolism is a common complication in patients undergoing THR. In a previous open study, Enoxaparine, a low-molecular-weight-heparin, in a dose of 40 mg/24 hrs by SC injection, had been shown to be efficient in preventing DVT in these patients. This treatment was not associated with an increased risk of bleeding. The present trial compares the efficiency and the risks of bleeding of two regimens : treatment A (2 daily subcutaneous (SC) injections of 20 mg of Enoxaparine) and treatment B (1 daily SC injection of 40 mg of Enoxaparine).118 patients, over 40 years, with a non traumatic hip disease, requiring THR, were included in a randomized, double blind trial. 59 patients received the treatment A. 59 patients received the treatment B. In both groups administration of 40 mg of Enoxaparine was begun 12 hours before operation. Patients were treated for 12-15 days, until bilateral ascending phlebography (BAP) had been completed.Lower limbs BAP were performed in 114 patients. The frequency of DVT is low and is not significantly different between the two regimens : a DVT was detected in 1 of 57 patients who received the treatment A and in 6 of 57 patients who received the treatment B (p = 0.11) . No pumonary embolism occurred in the 114 patients.There was no serious bleeding complication, and the two groups are not significantly different on this point. 3 patients in each group had an important hematoma of the thigh. None required a surgical treatment. Red cell transfusion requirements were 3.88 U ± 1.71 in the group A and 3.5 3 U ± 1.06 in the group B (p = 0.20). There was no significant difference in daily hemoglobin levels between the two groups.One daily injection of 40 mg of Enoxaparine was as effective as two daily SC injections of 20 mg of Enoxaparine in preventing DVT, in patients undergoins THR. The frequencies of bleeding complications were the same in each group.Enoxaparine (LOVENOXR) - PHARMUKA S.F.
6
Broekmans, A. W., F. J. M. der Meer und K. Briët. „TREATMENT OF CONGENITAL THROMBOTIC SYNDROMES“. In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643718.
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Hereditary antithrombin III deficiency,protein C deficiency, and protein S deficiency predispose to the occurrence of venous thrombotic disease at a relatively youngage and often without an apparent cause. These disorders inherit as an autosomal dominant trait. Heterozygotes are at risk fosuperficial thrombophlebitis, thrombosis atnearly every venous site, and pulmonary embolism. Homozygous protein C deficiency may present itself with a purpura fulminans syndrome shortly after birth.In the acute phase of venous thromboembolism heparin is effective for preventing extension of the thrombotic process, and pulmonary embolism. In patients with antithrombin III deficiency the concomittant useof antithrombin III concentrate is controversial, although some patients may requirehigher doses of heparin.Substitution therapy is only indicated in homozygous protein C deficient patientswith purpura fulminans. Fresh frozen plasma i.v. is the treatment of choice, in a dosage of 10 ml/kg once or twice daily. The current prothrombin complex concentrates may induce new skin lesions and disseminated intravascular coagulation. After the lesions have been healed(mostly in 4 to6 weeks)coumarin therapy may effectively prevent new episodes of purpura fulminans, provided the prothrombin time is kept within 2,5 - 4,0 INR. Heparin is ineffective for preventing purpura fulminans due to homozygous protein C deficiency.The thrombotic manifestations in heterozygotes are effectively prevented by coumarin therapy. This is supported by the observation that patients may remain free of thrombosis during long-term treatment and may have recurrences shortly after the withdrawal of the coumarin drug. The therapeutic range for the prothrombin time should be within 2,0 - 4,0 INR, target value 3,0 INR. In the initial phase of oral anticoagulant therapy protein C deficient patients are prone to the development of coumarin induced hemorrhagic skin (tissue) necrosis.In the patients studied in Leiden, it occurred in about 3% of the treated patients. Heparin appears to be ineffective for the prevention of coumarin-induced skin necrosis; high loading doses of coumarin should be avoided and the prothrombin timeshouldbe checked dialy during the initial phase of oral anticoagulant treatment. Tissue necrosis may contribute to bleeding complications after fibrinolytic therapy, ashas been observed in two protein C deficient patients.In clinical situations with an increased risk for thrombosis such as surgery and pregnancy, heparin (in-low-doses) alone orin combination with coumarins have been used succesfully for the prevention of thrombosis. The need for antithrombin III concentrates in patients with hereditary antithrombin III deficiency in such situations is not substantiated.Although anabolic steroids are capable to increase the plasma concentrations of antithrombin III and of protein C in the respective deficiency states, its efficacy in preventing thrombotic episodes remains to be established.An optimal strategy for preventing thrombosis in congenital thrombotic syndromes is to identify still asymptomatic patients. In case of antithrombin III, protein C, and protein S deficiency this search is feasible. During risk situations for thrombosis patients are to be protected against the development of thrombosis.In Leiden pregnant women with one of the deficiencies are treated from the 14th week of pregnancy, initially with a shortacting coumarin drug, after the 34th week withheparin s.c. b.i.d. at therapeutic dosages,and after delivery coumarin therapy is reTnstituted during 6 weeks. The use of oralcontraceptives should be avoided, unlesspatients are under coumarin treatment. As long as deficient patients remain asymptomatic no antithrombotic treatment is indicated. After the first documented thromboticincident patients are treated indefinitelywith oral anticoagulants.
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Breyer, H. G., R. Rahmanzadeh, P. Bacher und B. Werner. „LMW-HEPARIN VERSUS HEPARIN-DHE IN ORTHOPAEDIC SURGERY“. In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643689.
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The efficiancy and the side effects of a LMW heparin (FRAGMINR, KabiVitrum) and Heparin-DHE (Sandoz) have been compared in a randomized open prospective study of 120 patients (60/60) undergoing elective surgery on the lower limbs (total hip and knee replacement, corrective osteotomies). A radiofibrinogen uptake test (RFUT) was regularly done on all patients. Positive tests were controlled by ascending phlebography. The parameters, clinically obtained, included the intra-and postoperative blood loss, wound closure, and the incidence of haematoma. Hb, Hk, red and white blood cells, thrombocytes, total protein, aPTT, AT III, TT, and anti-Xy-activity were analyzed at the day before operation, the 2nd, 4th, and 6th day after operation.There were three positive RFUT in the group of LMW heparin (5 per cent), and there were six (10 per cent) in the control group. No pulmonary embolism occurred. In no case an operative treatment of deep vein thrombosis was done. There were no statistically significant differences in intra- and postoperative blood loss, and in the laboratory data, except the anti-Xa-activity, which was significantly higher in the LMW heparin group.The comparative study has shown, that a single daily injection of LMW heparin (FRAGMINR) is more effective than the two daily injections of the combination of UF heparin and DHE in order to prevent postoperative thromboembolism
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Pretice, C. R. M., und H. A. Townsend. „ANCROD PROPHYLAXIS AFTER SURGERY FOR FRACTURED NECK OF FEMUR: A STUDYOF FATAL PULMONARY EMBOLISM“. In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643685.
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A pilot multi-centre randomized controlledtrial was carried out to compare ancrod (Arvin, Knoll) versus no medical treatment in 453 patients having surgery for fractured neck of femur to assess prevention of fatal post-operative pulmonary embolism (PE).Ancrod was given subcutaneously by 5 daily injections starting immediately post-operatively; initially 4u/kg bw were given followed by 4 injections of 1u/kg bw, to reduce fibrinogen levels to 80mg/dl. The primary objective of the study was to record mortality due to PE, as shown by the DeathCertificate, within 3 months after surgery.Death Certificates were analysed by 2 medical assessors, unaware of the patient treatment group. Of 239 control patients, not given ancrod, there were 5 deaths due to PE and 2 deaths where PE may have been contributory. Total deaths were 30 (12.5%). In 214 ancrod treated patients there were 2 deaths due to PE and a further 3 where it may have been contributory. Total deaths were 31 (14.5%), not significantly different from the control group. Deaths from PE occurred between16 and 66 days after surgery. Although in this study there was abeneficial tendency for ancrod to reduce fatal PE it is likely that at least 6,000 patients would be needed to demonstrate that any drug significantly reduces by 50% the incidence of fatal PE compared to the control group. Wound infection was recorded in 16 patients in both groups. Wound haematomas were seen in 26 ancrod patients compared to 6 controls (p<0.02) but were not sufficiently serious to warrant re-exploration or prolonged hospital stay. The low mortality due to PE in our patients with fractured neck of femur (2%) is contrasted with the figures of Sevitt & Gallagher, 1959(8%). The low incidence of fatal PE in thehigh risk group studied here should be taken into account when assessing future antithrombotic prophylaxis after surgery. Advances in anaesthetics, surgery and rehabilitation may have contributed to the decline in fatal post-operative PE. Effective assessment of drugs for prophylaxis against post-operative venous thrombosis is best carried out by large scale simple controlled trials using fatal PE a the primary end point. Collaborative Centres were located in Portsmouth, Cape Town, Glasgow, Belfast and Leeds.
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Felez, J., R. Rodriguez-Pinto, A. Oliver, F. Velasco, I. de Diego, L. J. Steegmann und S. Martin. „MULTICENTRIC SPANISH STUDY OF BIOLOGICAL CAUSES OF DEEP VEIN THROMBOSIS“. In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643044.
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305 unselected patients under long-term oral anticoagulation treatment for having presented one o more ep^L sodes of deep vein thrombosis and/or pulmonary embolism, have been studied for the following anomalies: Dysfibrinogenemia, Lupus anticoagulant, Antithrombin-III deficiency, Protein C, Protein S, Heparin Cofactor II, and anomalies in the fibrinolytic components t-PA PAI and Plasminogen. Protein C antigen and activity as well as free Protein S antigen levels have been related to those found in a control group at different intensities of oral anticoagulantAs shown in the table this study, performed on unselected patients from the clinical point of view, has not only confirmed the presence of a previously known congenital defect in 16 patients (5%) but also has per miteed the identification of a previously unkown de- -feet in 45 patients (15%)Since the identification of a congenital abnormality permits to prevention of new thrombotic episodes and the identification of the afected members, these re- -suits support the convenience of performing such syste matic biological studies in patients suffering from thrombosis
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Neri Semeri, G. G., F. Rovelli, G. F. Gensini, S. Pirelli, M. Carnovali und A. Fortini. „FREVENTION OF MYOCARDIAL REINFARCTION BY LOW DOSE HEPARIN“. In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643597.
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The effectiveness of low dose heparin in the prevention of myocardial reinfarction was investigated in a multi centric randomized controlled study. After having given their, informed consent to undergo daily subcutaneous heparin adninistratian, 728 patients of both sex aged 50-75 years, who had suffered frcm a transmural myocardial infarction 6-18 months before the enrollment and were in the I or II NYHA class were randomized. 365 patients (control group) were an the therapy usually performed by the 21 experimental canters participating in the study and 363 (heparin group) were treated with subcutaneous calcium heparin (Calciparina®) 12,500 IU daily in addition to the usual therapy of the centers. Curing enrollment the balancement of the two grcups was periodically checked for age, sex, serum cholesterol, cigarette smoking, blood pressure, site of infarction, arrhythmias and drug regimen. The prospect!vely established end-points were: transmural reinfarctioi as primary end-point; general mortality and mortality for cardiovascular events as accessory end-points over a mean follow-up period of 24 nxnths. Statistical analysis was foreseen both on drug efficacy (EE) and intention to treat (IT) basis. Patients of both groups underwent periodical examinations during the study. Acherence to the therapy and bone mineral content (bone density by double isotope technique) were also checked. At the end of the study the balancement for the factors considered was satisfactory and the drop-outs were 7.7% in heparin group and 6.3% in control group (ns). In heparin group the re infarction rate was lcwer by 62.92% than in control group. At life table analysis the difference was statistically significant (p<0.05 DE and p=0.05 IT). Mortality rate was reduced by 47.61% (DE) in heparin group (p<0.05 at life table analysis). Cardiovascular mortality was not significantly reduced (−33.06%), but the mortality attributable to thromboembolism was reduced in heparin group (p<0.05). Sixty patients (16.5%) discontinued heparin treatment, but only in 23 patients (6.3%) suspension was due to side effects.