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1
Sáez, Giménez Berta. "Venous thromboembolism after lung transplantation." Doctoral thesis, Universitat Autònoma de Barcelona, 2018. http://hdl.handle.net/10803/666689.
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La enfermedad tromboembólica es una complicación frecuente tras el trasplante de órgano
sólido y, específicamente, tras el trasplante pulmonar. Los objetivos de nuestro trabajo fueron:
describir los factores de riesgo de la enfermedad tromboembólica, evaluar el impacto de un
protocolo de profilaxis extendido y describir los perfiles de coagulación antes y hasta 1 año
tras el trasplante pulmonar.
Con dicho objetivo llevamos a cabo dos estudios; el primero compara retrospectivamente una
cohorte estudio (n=138) que recibió profilaxis con enoxaparina 90 días post-trasplante y una
cohorte control histórica (n= 195) que recibió profilaxis únicamente durante el período de
hospitalización post-trasplante. El segundo estudio, es un estudio prospectivo para describir el
perfil de coagulación de 48 pacientes previamente al trasplante, en las primeras 24-72 horas
post-trasplante, a las 2 semanas, 4 meses y 1 año post-trasplante.
La incidencia de enfermedad tromboembólica en nuestra población fue del 15.3% (95% IC:
11.6-19.4). El tiempo medio del trasplante al evento fue de 40 (p25-75, 14-112) días. En este
estudio, los factores de riesgo que se asociaron a la enfermedad tromboembólica fueron el
género masculino y la enfermedad pulmonar intersticial difusa como enfermedad de base. La
profilaxis extendida con enoxaparina no disminuyó la incidencia de enfermedad
tromboembólica.
En el estudio que describe los perfiles de coagulación transcurrido 1 año tras el trasplante
pulmonar, encontramos que la mayor parte de marcadores de un estado procoagulante se
normalizan a las 2 semanas del trasplante; sin embargo, al año todavía encontramos algunos
pacientes niveles alterados de factor VIII y factor de Von Willebrand. Los pacientes que
presentaron alguna complicación trombótica en los primeros 4 meses tras el trasplante, tenían
niveles más elevados de factor VIII a las 2 semanas.
Se necesitarán estudios multicéntricos con mayor tamaño muestral para poder diseñar
estrategias profilácticas adecuadas.Venous thromboembolism is a frequent complication after solid organ transplantation and, specifically, after lung transplantation. The objectives of this study were to describe risk factors for venous thromboembolism, to assess the impact of an extended prophylaxis protocol and to describe coagulation profiles before and up to 1 year after lung transplantation. We performed 2 studies. The first study compared a cohort (n=138) that received 90-day extended prophylaxis with enoxaparin and a historical control cohort (n= 195) that received prophylaxis only during post-transplant hospitalization. The second study is a prospective study to describe the coagulation profiles of 48 patients before lung transplantation and at 24- 72 hours, 2 weeks, 4 months and 1 year after lung transplantation. The cumulative incidence of venous thromboembolism was 15.3% (95% CI: 11.6-19.4). Median time from transplant to the event was 40 (p25-75, 14-112) days. In this study, the risk factors associated with venous thromboembolism were male gender and interstitial lung disease. Ninety-day extended prophylaxis did not reduce the incidence of VTE. In the second study to describe coagulation profiles up to 1 year after lung transplantation, we found that most markers of a procoagulant state normalize at 2 weeks after lung transplantation and that abnormal values of factor VIII and Von Willebrand factor persist at 1 year. Patients with venous thromboembolism at 4 months had higher values of factor VIII at 2 weeks. Larger, multicenter studies are needed to confirm these results and to design appropriate prophylactic strategies.
2
Parkin, Lianne, and n/a. "Risk factors for venous thromboembolism." University of Otago. Dunedin School of Medicine, 2008. http://adt.otago.ac.nz./public/adt-NZDU20080513.145314.
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Background: Many risk factors for venous thromboembolism have been identified, but two particular exposures - the use of combined oral contraceptives and long-distance air travel - have generated considerable concern in recent years. In contrast, a possible link between venous thromboembolism and a third exposure - the use of psychotropic drugs - was first raised in the 1950s, but has received surprisingly little attention. Information about all three exposures and the risk of fatal events is limited. These risks were examined in three inter-related national population-based studies.
Methods: The underlying study population included all men and women aged 15 - 59 years who died in New Zealand between 1990 and 2000, for whom the underlying cause of death was pulmonary embolism.
The potential associations between fatal pulmonary embolism and the use of oral contraceptives and psychotropic drugs were explored in a general practice records-based case-control study. Non-users were the reference category for all analyses. Contraceptive supply data were used to estimate the absolute risk of death from pulmonary embolism in users of oral contraceptives.
A second case-control study, in which computer-assisted telephone interviews were undertaken with the next of kin of cases who had been resident in New Zealand, and with sex and age-matched controls randomly selected from the electoral roll, investigated the possible association between long-distance air travel and fatal pulmonary embolism.
Finally, the absolute risk of dying from pulmonary embolism following a long-distance flight was estimated in a descriptive study based on official migration data and deaths in recent air travellers.
Results: The adjusted odds ratio for use of any oral contraceptive in the three months before the index date (the onset of the fatal episode) was 13.1 (95% CI 4.4 - 39.0). The odds ratio for formulations containing desogestrel and gestodene was about three times higher than the point estimate for levonorgestrel products; preparations containing cyproterone acetate appeared to carry the highest risk. The estimated absolute risk of fatal pulmonary embolism in current users of oral contraceptives was 10.5 (95% CI 6.2 - 16.6) per million woman-years.
The adjusted odds ratio for current use of any antipsychotic was 13.3 (95% CI 2.3 - 76.3). Low-potency antipsychotics carried a 20-fold increase in risk; thioridazine was the main drug involved. Antidepressant use was also associated with a significantly increased risk (adjusted odds ratio 4.9 [95% CI 1.1 - 22.5]).
Compared with non-travellers, people who had undertaken a flight of more than eight hours� duration in the preceding four weeks were eight times more likely to die from pulmonary embolism (odds ratio 7.9 [95% CI 1.1 - 55.1]). The absolute risk of fatal pulmonary embolism following air travel of more than eight hours was 1.3 (95% CI 0.4 - 3.0) per million arrivals.
Conclusions: The present research was the first to have estimated the relative risks of fatal pulmonary embolism in relation to three exposures: oral contraceptive use in a population in which preparations containing desogestrel and gestodene preparations were widely used, conventional antipsychotics, and long-distance air travel. The findings were consistent with previous, and subsequent, studies of non-fatal events. Increased risks of fatal pulmonary embolism in users of antidepressants, and in people with an intellectual disability, have not been described previously and warrant further investigation. Referral and diagnostic biases are very unlikely in these studies of fatal events, and other types of bias and possible confounding are considered unlikely explanations for the findings.
3
Law, Wei-bong, and 羅緯邦. "The development of a clinical guideline on risk assessment and relatedpreventive measures of thromboembolism for adult surgical patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46582381.
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4
Kelly, James Anthony. "Venous thromboembolism after acute ischaemic stroke." Thesis, King's College London (University of London), 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.405599.
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Chay, Wang George. "Thrombo-embolic complications and coagulation factor abnormalities in Chinese children after Fontan-type operation." Click to view the E-thesis via HKUTO, 2003. http://sunzi.lib.hku.hk/hkuto/record/B31971544.
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6
Hettiarachchi, Rohan Jagath Kumara. "Venous thromboembolism, cancer and low molecular weight heparin." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2000. http://dare.uva.nl/document/84386.
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Kraaijenhagen, Roderik A. "The etiology, diagnosis and treatment of venous thromboembolism." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2000. http://dare.uva.nl/document/84205.
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8
Chay, Wang George, and 蔡旺. "Thrombo-embolic complications and coagulation factor abnormalities in Chinese children after Fontan-type operation." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B31971544.
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9
Beutel, Bernhard. "Preventing venous thromboembolism at a district hospital : a quality improvement study." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/97180.
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Thesis (MFamMed)--Stellenbosch University, 2013.ENGLISH ABSTRACT: Background: Pulmonary embolism (PE) is the most common preventable cause of hospital deaths, and almost all hospitalised patients have at least one risk factor for venous thrombo-embolism (VTE). Despite the availability of highly effective thromboprophylaxis in prevent-ing VTE, numerous studies worldwide have demonstrated its under-utilization. The aim of this study was to review and improve the utilization of thromboprophylaxis in the prevention of VTE in hospitalized patients at Oudtshoorn district hospital. Method: A quality improvement cycle (QIC). Retrospective analysis of files of adult patients admitted to the male and female wards at Oudtshoorn district hospital was performed prior to and after a 5 month intervention phase. The target standards for the QIC were: 1) Availability of a written hospital policy on VTE prevention; 2) Every adult admission should have a for-mal VTE risk assessment documented; 3) Every adult admission who is at risk for VTE should receive thromboprophylaxis. Results: Thirty eight percent of adult patients admitted to Oudtshoorn hospital, excluding the maternity ward, were at risk of developing VTE. There was no written hospital policy on VTE prevention. This was developed and made available during the intervention. In the pre-intervention group there were no patients who had a documented VTE risk assessment. The post intervention group showed a considerable increase with 45.2% having had a completed VTE risk assessment on admission (p<0.00001). In the pre-intervention group only 4.6 per-cent of patients who were at risk of VTE received thromboprophylaxis. There was a statisti-cally significant difference in the number of patients at risk who received thromboprophylax-is in the post-intervention group where 36% of these patients received thromboprophylaxis (p<0.00001). Conclusions: The study identified a major shortcoming in the prevention of VTE in those patients at risk who were admitted to Oudtshoorn district hospital. An intervention as part of a quality improvement cycle has been able to demonstrate a significant improvement in the detection of patients who are at risk of VTE and a subsequent improvement in appropriate thromboprophylaxis. A number of barriers to their implementation have been identified and need to be addressed. This QIC may in time be of value to assist other district hospitals in addressing the issue of VTE prevention.
AFRIKAANSE OPSOMMING: No abstract available.
10
Patel, Rajesh Kantilal. "Risk factors for venous thromboembolism in the black population." Thesis, King's College London (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.416109.
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Wolde, Marije ten. "Management of venous thromboembolism etiology, diagnosis, prognosis and treatment /." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2003. http://dare.uva.nl/document/87021.
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12
Vink, Roel. "Management of antithrombotic therapy in venous and arterial thromboembolism." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2004. http://dare.uva.nl/document/88049.
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13
Obel, Owen A. "Thromboembolism in nonvalvular artrial fibrillation : haemodynamic and haematologic mechanisms." Thesis, St George's, University of London, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.546790.
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Brosseron, Lise Soares Barbosa. "Pulmonary thromboembolism and sudden unexpected death. Medico-legal review." Master's thesis, Faculdade de Medicina da Universidade do Porto, 2010. http://hdl.handle.net/10216/60805.
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Brosseron, Lise Soares Barbosa. "Pulmonary thromboembolism and sudden unexpected death. Medico-legal review." Dissertação, Faculdade de Medicina da Universidade do Porto, 2010. http://hdl.handle.net/10216/60805.
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16
Cheung, Katharine Lana. "Chronic Kidney Disease and the Risk of Venous Thromboembolism." ScholarWorks @ UVM, 2018. https://scholarworks.uvm.edu/graddis/879.
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Chronic kidney disease (CKD) affects more than 30 million adults in the U.S. and is strongly associated with cardiovascular events and mortality. Venous thromboembolism (VTE) is the third leading vascular disease, affects up to 900,000 Americans each year and contributes to as many as 100,000 deaths annually. The relationship of CKD and VTE has been described in patients receiving dialysis, kidney transplants recipients and in nephrotic syndrome, however, data supporting the association of VTE in mild to moderate CKD is conflicted. The overall goal of this research was to study the association of CKD and VTE and to understand the mechanisms of this association. To accomplish this goal we studied participants of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a nationally representative cohort of 30,239 blacks and whites in the U.S..
The first chapter provides a review of the state-of-the science on CKD and VTE and potential mechanisms for this association. We focus on factor VIII as a potential mediator of VTE risk in CKD by reviewing the biochemistry and epidemiology linking factor VIII and CKD.
In Chapter 2, we use a cohort study design and a competing risk analysis to determine the risk of VTE with albuminuria (ACR) and with various equations for estimated glomerular filtration rate (eGFR). There was no association of ACR and VTE and the risk of VTE was similar among eGFR equations. Compared to a normal eGFR (>90 ml/min/1.73m2), eGFR < 45 ml/min/1.73m2 was associated with a two-fold risk of VTE. The association of eGFR and unprovoked VTE was similar to the association with provoked VTE. The population attributable fraction of CKD (eGFR<60 ml/min/1.73m2) was modest at 5%.
In Chapter 3, we utilize a case-cohort study to determine if biomarkers of inflammation (C-reactive protein) and procoagulation (Factor VIII and D-dimer) attenuate the risk of VTE in CKD. These biomarkers were higher in lower kidney function and were also strongly associated with VTE. Adjustment for factor VIII fully attenuated the risk of VTE in CKD, thus factor VIII is a potential mediator of the association of CKD and VTE. We assessed whether lifestyle factors and medications mitigate the risk of VTE in those with and without CKD. Exercise frequency and use of statins were associated with reduced risk of VTE in the presence and absence of CKD, but normal BMI was associated with reduced VTE risk only in those without CKD.
We conclude that CKD is a risk factor for VTE, and findings shed light on the mechanisms of this association. Interventions that might lower VTE risk in CKD patients include exercise and statin therapy, but not weight loss. Factor VIII is a potential mediator of VTE in CKD and deserves further study. We suggest several avenues for future research to explore the relationship of Factor VIII and CKD.
17
Schellong, Sebastian M., and Benjamin A. Schmidt. "New Therapeutic Approaches in Pulmonary Embolism." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-133529.
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Pulmonary embolism as a part of venous thromboembolic disease has a broad spectrum of clinical presentations from minimal disease to life-threatening right heart failure. Therapy has to be guided by the risk associated with the individual clinical state of the patient. As long as hemodynamics are entirely stable, anticoagulation is given in order to prevent early or late recurrence, thereby allowing for endogeneous thrombolysis and recovery. In hemodynamically instable patients, i.e. patients under cardiopulmonary resuscitation or in shock, there is the need for a rapid reduction of thrombus mass in order to restore right ventricular function. Systemic thrombolysis is the most feasible modality to reduce the thrombus burden of the pulmonary circulation in the short term. For hemodynamically stable patients with right ventricular dysfunction as assessed by echocardiography, there is still some controversy as to whether thrombolysis improves the long-term outcome. At the least, thrombolysis may positively modify the short-term course of acute disease in patients with an extremely low risk of bleeding. When the acute phase has been overcome, secondary prophylaxis with vitamin K antagonists has to be given. The duration of secondary prophylaxis requires an individual assessment of both the risk of recurrence and the risk of bleeding. In the near future, new anticoagulant drugs such as direct thrombin and factor Xa inhibitors will offer new treatment modalities for the acute phase as well as for secondary prophylaxisDieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich
18
Ho, Wai Khoon. "The incidence of venous thromboembolism : a prospective, community-based study." University of Western Australia. School of Medicine and Pharmacology, 2009. http://theses.library.uwa.edu.au/adt-WU2010.0031.
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Venous thromboembolism (VTE), comprising deep venous thrombosis (DVT) and pulmonary embolism (PE), is a common and preventable cause of morbidity among individuals and hospital in-patient mortality. Further, it imposes a substantial burden upon the community and its health care system and economy. Studies performed in Western societies suggest that the annual incidence of DVT is about 0.8 to 1.2 per 1,000, PE about 0.3 to 0.6 per 1,000, and VTE about 1.0 to 1.8 per 1,000. However, it is not known if these estimates can be generalised to the Australian population because of differences in ethnic composition and other risk factors for VTE among the different populations. In this thesis, I undertook a prospective, community-based cohort study over a 13-month period in 2003 2004 to determine the incidence and crude event rate of symptomatic, objectively verified VTE in north-east metropolitan Perth. The study population was broadly representative of the national Australian population in terms of age, sex and ethnic distribution. Cases were identified through multiple overlapping sources. The incidence of DVT, PE and VTE in the community were 0.52 (95% confidence interval, CI: 0.41 0.63), 0.31 (95% CI: 0.22 0.40) and 0.83 (95% CI: 0.69 0.97) per 1000 per year, respectively. The annual incidence of DVT, adjusted to the World Standard population, was 0.35 (95% CI: 0.26 0.44) per 1000, PE 0.21 (95% CI: 0.14 0.28) per 1000 and VTE 0.57 (95% CI: 0.47 0.67) per 1000. The crude event rate for VTE was 0.85 (95% CI: 0.71 0.99) per 1000 per year. These findings suggest that the incidence of DVT, PE and VTE are lower than in other Western societies studied. Possible reasons include a lower prevalence of exposure to causal risk factors (genetic and environmental) and incomplete case ascertainment. Knowledge of the local incidence and event rate allows health planners to allocate appropriate resources and evaluate cost-effective preventive measures.
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Rao, Deepa Prema. "The role of growth arrest-specific 6 in venous thromboembolism /." Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=112349.
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Background. Growth-arrest specific 6 (gas6) is a novel vitamin-K dependent protein whose role in venous thromboembolism was recently characterized in murine models. Gas6 is suggested to be a prothrombotic protein capable of mediating thrombus stability. However, the association between gas6 and venous thromboembolism has yet to be elucidated in humans. The present work aims to delineate the existence of such an association in humans and propose a mechanism by which gas6 expression is related to venous thromboembolic disease.Methods. To analyze the association between gas6 and venous thromboembolism, a highly specific ELISA method was used to measure plasma gas6 levels in 306 patients with a history of deep-vein thrombosis (DVT) and 89 control volunteers. Medication history, comorbid conditions and DVT characteristics were documented for the purposes of statistical analyses. Median gas6 levels were compared between the subgroups, and prevalence rate ratios were calculated. Human umbilical vein endothelial cells were used to measure the effect of gas6 treatment on the expression of various mediators of coagulation. Murine thrombosis models were developed to serve as in vivo models for thrombosis.
Results. The median levels of gas6 were 28.21 ng/ml in patients compared to 26.15 ng/ml in controls (p=0.01). After adjustment for age, sex, comorbidity and medications, DVT patients had a PRR of 2.5 (95% CI 1.36 to 4.61, p=0.003) compared with controls. Within the DVT subgroup, median gas6 levels were significantly higher in those with cancer-associated (vs. unprovoked or secondary) DVT (p<0.001) and in those with more extensive DVT (p=0.037), while levels were significantly lower in those taking warfarin (vs. no warfarin) (p=0.03). Preliminary results with endothelial cell cultures are inconclusive with regards to the effect of gas6 on endothelium derived mediators of coagulation.
Conclusions. Elevated plasma gas6 is associated with venous thromboembolism. The etiology of the clot influences detected levels of gas6, with the highest levels seen in cancer-patients. Furthermore, increasing clot burden correlates with elevated levels of gas6. A mechanistic explanation for how gas6 modulates this association is in its preliminary stages, and is worth pursuing.
20
Hurtt, Callie. "Outcomes for Epithelial Ovarian Cancers Diagnosed with Concomitant Venous Thromboembolism." Thesis, The University of Arizona, 2016. http://hdl.handle.net/10150/603656.
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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.Background and Significance Most large studies on venous thromboembolism (VTE) incidence in gynecologic cancer focus on prevention and management of postoperative VTE. Treatment for preexisting VTE at the time of diagnosis of epithelial ovarian cancer (EOC) includes careful risk assessments, weighing the benefits of debulking and risks of anticoagulation in the setting of a new VTE and new EOC diagnosis, respectively. We aimed to describe perioperative and cancer survival outcomes associated with concomitant diagnoses. Research Question To describe short‐term perioperative outcomes and overall survival (OS) among women who present with VTE at initial EOC diagnosis. Methods Women presenting with VTE within 30 days prior to EOC diagnosis between 1/2/2003 and 12/30/2011 who had primary debulking surgery (PDS) or chemotherapy (CT) alone were included. Descriptive statistics and the Kaplan‐Meier method were used to estimate OS from time of EOC diagnosis, with patient characteristics and process‐of‐care variables retrospectively abstracted. Results Of the 36 women with VTE within 30 days prior to EOC diagnosis, 28 (77.8%; mean age 64.2 years) underwent PDS and 8 (22.2%; mean age 61.4 years) received CT alone. Eastern Cooperative Oncology Group (ECOG) performance status (PS) was ≤2 in 85.7% (n=24) of PDS patients compared to 62.5% (n=5) of CT patients. Advanced stage (III/IV) disease was diagnosed in 71.4% (n=20) of PDS group; all CT patients were advanced stage. Among those who underwent PDS, 26 (92.9%) had a preoperative IVC filter placed; 1 (12.5%) in the CT group received an IVC filter. Perioperative bleeding complications were 7.2% in the PDS group. Within the PDS group, median OS was 25.6 months while the CT group had median OS of 4.5 months.ConclusionsPreoperative VTE in EOC patients can be safely managed with low rates of bleeding complications. Poor OS in CT group may reflect worse overall health or more aggressive cancer. Median OS was notably shorter than previously published; IVC filter utilization on oncologicoutcomes in EOC warrants further investigation.
21
Uehara, Kyokun. "A novel detachable filter to prevent thromboembolism during endovascular surgery." Kyoto University, 2013. http://hdl.handle.net/2433/174756.
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Holmes, Valerie Anne. "Early markers of haemostasis in normal pregnancy." Thesis, University of Ulster, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.274405.
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Кононенко, Микола Григорович, Николай Григорьевич Кононенко, Mykola Hryhorovych Kononenko, О. М. Степанченко, and І. В. Брага. "Клінічна картина тромбоемболії мезентеріальних судин." Thesis, Вид-во СумДУ, 2005. http://essuir.sumdu.edu.ua/handle/123456789/7307.
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Elms, Mervyn John. "Measurement of crosslinked fibrin degradation products in disseminated intravascular coagulation and thrombosis : an assay utilizing monoclonal antibodies." Thesis, Queensland University of Technology, 1986. https://eprints.qut.edu.au/36711/1/36711_Elms_1986.pdf.
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The objective of the research program presented in this thesis
was to develop a simple and specific immunological assay for
the measurement of rnolecilar fr agments produced during the
enzymatic lysis of f i brin. This would establi sh a significan t
contribution to the laboratory diagnosis of disseminated
intravascu lar coagulation and thromboembolism .
iii.
Lysis of blood clots i n t he circulation (fibrinolysis), produces
unique mo lecular fragments which are detectable i n t he blood
plasma. These fragments are unique as a resu l t of y - y
cova l ent crosslinki ng between adjacent f ibrin molecul es and
are not presen t on the parent mo l ecule fibr i nogen . D dimer
(D-D) is t he basic fragment and i s freque ntly compl exed non covalently
wi t h fragment E to produce D dimer E. Other
fragments also resu l t from t he lysis of crosslinked fibrin
and i nclude Y-D , Y-Y, X- Y and h i gher molecular weight
fragments up to and exceeding 106 daltons . Present immunol
ogical me t hods cannot different i ate these y- y f ragments
from fibrinogen or its deriva tives wh i ch a r e pre sent in the
absence of intravascular blood c l otting .
During t he past f i ve years several workers in Britain, Europe
and Amer i ca have reported attempts to produce antibodies tha t
will react with f ibrin derivatives and not fibr i nogen or its
degradation products . The resu l ts of these st udies have been
d i sappoi nt i ng because they have f ailed to totally remove
crossreactivi ty with f i brinogen .
In this present study , a monoclonal antibody specific for
crosslinked fibrin has been developed . This antibody has
been used in both enzyme immunoassay and latex agglutination
procedures for the measurement of crosslinked fibrin
derivatives (measured as D dimer equivalents) in proven cases
of dissemi nated intravascu lar coagulation and tnromboembolism.
Low levels ( <240 ng/ml ) of crosslinked fibrin derivatives
were fo und in normal subjects . In contrast, significantly
elevated levels were detected in all proven cases of
d i sseminated intravascular coagul ation and deep vein thrombosis
and in the majority of cases of proven pulmonary embolism . The presence of crosslinked fibrin derivatives in disseminated
intravascular coagulation was also demonstrated using a
sodium dodecyl sulphate (SDS) pol yacrylamide gel electrophoresis
technique . Plasma levels of crosslinked fibrin
derivatives were also used to assess the predictive value
in the diagnosis of deep vein thrombosis and pulmonary
embolism in patients subjected to venography and l ung scan .
The immunoassays developed and described in this thesis are
rapid , speci fic and sensit ive . They provide the basis for
clear distinction between the breakdown products o f
fibrinogen and fibrin which is essential in the accurate
evaluation of thrombotic disorders.
These novel assays therefore have a unique diagnostic
potential which has already attracted significant international
interest.
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Suchon, Pierre. "Identification de variants génétiques associés à la thrombose veineuse." Thesis, Aix-Marseille, 2017. http://www.theses.fr/2017AIXM0658/document.
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La maladie thromboembolique veineuse (MTEV) résulte de l’interaction entre des facteurs environnementaux et génétiques. Cinq anomalies constitutionnelles constituent le bilan de thrombophilie (BT) : les déficits en AT, PC et PS, le facteur V Leiden et la mutation de la prothrombine. Seule la moitié des déficits « présumés » en PS trouvent une explication moléculaire. Dans le premier article, seuls les patients présentant une mutation délétère du gène de la PS (PROS1) étaient à risque de MTEV. Seuls des taux <30%, permettaient de dépister les mutations délétères. La mutation Heerlen située sur PROS1 est réputée neutre. Dans le second article, la mutation Heerlen était associée à un risque de MTEV de 6,57. De récentes études ont identifié une trentaine de polymorphismes associés à la MTEV. Cependant, leur impact dans les familles présentant un facteur biologique de risque est méconnu. De même, l’impact de facteurs environnementaux tels que l’obésité et le tabagisme est mal évalué dans ces familles. Dans le troisième article, la prise en compte de 5 facteurs de risque fréquents à effet faible (obésité, tabac, groupe sanguin et deux polymorphismes situés sur F11 et FGG) en complément du dépistage de l’anomalie familiale permettait de mieux caractériser le risque individuel. Nous avons testé la même stratégie dans une population spécifique de femmes sous contraceptifs oraux combinés (4ème article). Trois facteurs de risque fréquents (groupe sanguin, obésité et un polymorphisme de F11) étaient associés à un OR de 13 lorsqu’ils étaient combinés. Au total, la prise en compte de facteurs de risque fréquents à effet faible, permettait une meilleure évaluation du risque individuelVenous thromboembolism (VT) results from the interaction between environmental and genetic factors. Five inherited hemostatic defects are part of the thrombophilia screening (TS): AT, PC and PS deficiencies, factor V Leiden and prothrombin mutation. A molecular defect is identified in only half of assumed PS deficiencies. In the first article, only detrimental mutations (DM) located on PROS1 (PS gene) increased VT risk. Only free PS levels below 30% enabled the identification of DM. PS Heerlen mutation located within PROS1 has been considered neutral for a long time. In the second article, the association between PS Heerlen and VT has been tested in a sample of 4173 patients with VT history and 5970 healthy individuals. PS Heerlen was associated with a 6.57 increased risk of VT. Recent genome wide association studies identified nearly 30 polymorphisms associated with VT. However, the impact of such polymorphisms in families with known defects is uncertain. We therefore tested in a third article the association between 11 selected polymorphisms, obesity, smoking and VT in 651 families with known thrombophilia. Considering 5 common risk factors (obesity, smoking, ABO blood group, two polymorphisms located on FGG and F11) together with the TS resulted in a better assessment of VT risk in individuals from families with thrombophilia. We then applied the same strategy in a sample of women using combined oral contraceptives. Three common risk factors (non-O blood groups, obesity and a polymorphism located on F11), when combined, were associated with a 13 OR. In conclusion, considering common risk factors improved the individual assessment of VT risk
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Lee, Jung-Ah. "A review of the management of patients at risk for or diagnosed with venous thromboembolism (VTE) at an academic medical center, and the cost-effectiveness of diagnostic strategies for VTE /." Thesis, Connect to this title online; UW restricted, 2008. http://hdl.handle.net/1773/7224.
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Coleman, Craig I., Jan Beyer-Westendorf, Thomas J. Bunz, Charles E. Mahan, and Alex C. Spyropoulos. "Postthrombotic Syndrome in Patients Treated With Rivaroxaban or Warfarin for Venous Thromboembolism." Sage, 2018. https://tud.qucosa.de/id/qucosa%3A35470.
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Postthrombotic syndrome (PTS) is a frequent complication of venous thromboembolism (VTE). Using MarketScan claims data from January 2012 to June 2015, we identified adults with a primary diagnosis code for VTE during a hospitalization/emergency department visit, ≥6 months of insurance coverage prior to the index event and newly started on rivaroxaban or warfarin within 30 days of the index VTE. Patients with <4-month follow-up postindex event or a claim for any anticoagulant during 6-month baseline period were excluded. Differences in baseline characteristics between rivaroxaban and warfarin users were adjusted for using inverse probability of treatment weights based on propensity scores. Patients were followed for the development of PTS starting 3 months after the index VTE. Cox regression was performed and reported as hazard ratios with 95% confidence intervals (CIs). In total, 10 463 rivaroxaban and 26 494 warfarin users were followed for a mean of 16 ± 9 (range, 4-39) months. Duration of anticoagulation was similar between cohorts (median = 6 months). Rivaroxaban was associated with a 23% (95% CI: 16-30) reduced hazard of PTS versus warfarin. Rivaroxaban was associated with a significant risk reduction in symptoms of PTS compared to warfarin in patients with VTE treated in routine practice.
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Lindmarker, Per. "Treatment of deep vein thrombosis and risk of recurrent venous thromboembolism /." Stockholm, 1998. http://diss.kib.ki.se/1998/91-628-3211-5/.
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Räsänen, Noora. "Venous Thromboembolism after Thoracotomy and Lung LobectomyIn Patients with Lung Malignancy." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-73520.
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Background: Venous thromboembolism, manifesting as deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant source of morbidity and mortality and a cause of postoperative complications after invasive surgery. These adverse events are more likely to occur in high risk patients, such as those with cancer or undergoing major surgery with the highest incidence peak taking place within the first month after surgery. Despite the issue being globally recognized, a lack of consensus regarding guidelines for prophylaxis post-discharge still exists. Aim: To determine the incidence of venous thromboembolism within a 30-day postoperative period after thoracotomy and lung lobectomy for lung malignancy, to assess a correlation of the above with administered prophylactic treatment. Method: A retrospective cohort study was conducted as a review of medical records of all patients, appertaining to Örebro county, who had undergone thoracotomy and lung lobectomy for lung cancer or secondary malignant tumor in the lung, during 2015-2017 at the department of Cardiothoracic and Vascular Surgery, Örebro University Hospital. An internally validated register was used to identify the patient population and partial collection of the data. Results: Of the 67 included patients 50,8% were men and the mean age of the population was 67,5 years. The VTE prevalence during the 30-day postoperative period was 1,5%. A total of 59,7% of the patients received thrombosis prophylaxis preoperatively, 98,1% postoperatively and 11,9 % after hospital discharge. Conclusion: The VTE prevalence of 1,5% in this study may suggest the current postoperative prophylactic regiment successful, yet VTE remains a clinically significant complication, and the need for well-defined guidelines is evident.
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Hickey, Benjamin. "Venous blood flow, thromboembolism and below knee cast immobilisation for trauma." Thesis, Cardiff University, 2017. http://orca.cf.ac.uk/107891/.
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Venous thromboembolism (VTE) has a background incidence of between 0.7 and 2.69 per 1000 per year (L. N. Roberts et al., 2013). Risk factors are either permanent or transient. Permanent risk factors include thrombophilia (80 x increase risk if homozygous for factor V Leiden), cancer (58 x increase risk if metastatic cancer or diagnosis within last 3 months), increasing age (risk doubles for each decade over age 40 years), family or personal history of deep vein thrombosis (2-3 x increase risk) and increasing body mass index (2 x increase for BMI > 35 kg/m2 in comparison with BMI < 20 kgm2) (Y.-H. Kim & Kim, 2007) (Blom, Doggen, Osanto, & Rosendaal, 2005) (Anderson & Spencer, 2003) (Decramer, Lowyck, & Demuynck, 2008) (Holst, Jensen, & Prescott, 2010). Transient risk factors include surgery (165 x risk in first 6 weeks after total hip or knee replacement, equating to 2% symptomatic VTE rate) (Sweetland et al., 2009). Foot and ankle procedures including ankle fracture fixation, hindfoot fusion and 1st metatarsal osteotomy are associated with 18x, 8x and 2x increase VTE risk respectively (Jameson et al., 2011). Other transient risk factors include postpartum state (21-84 x increase in first 6 weeks), use of oral contraceptive pill or hormone replacement therapy (at least 2 x risk) and lower limb cast immobilization (Jackson, Curtis, & Gaffield, 2011) (Grodstein et al., 1996). Within 90 days of lower limb cast treatment, asymptomatic DVT affects between 4 and 40% of patients, symptomatic DVT affects 1 in 250, symptomatic pulmonary embolism affects 1 in 500, with fatal pulmonary embolism affecting 1 in 15,000 (Jameson et al., 2014). It is apparent that patients will therefore have a differing risks depending on their permanent and transient risks. The types of VTE include asymptomatic events, for which the relevance is not fully understood (often used in studies as a surrogate for symptomatic events). Symptomatic below knee DVT (approximately 20% propagate to become above knee) (Philbrick & Becker, 1988). Symptomatic above knee DVT (affecting popliteal vein or more proximal), which are 4 times more likely to occur (Baglin et al., 2010). Pulmonary embolism can also occur. The clinical relevance of DVT is that 6% of patients will have severe post thrombotic syndrome (venous ulceration, swelling, itching) at 10 years after the event, with 66% of patients displaying some signs (Schulman et al., 2006). Uncomplicated DVT does not appear to impact on quality of life, however if DVT is complicated by post thrombotic syndrome, patients will have significantly reduced quality of life, mental and physical health. Simple non fatal PE reduces physical health and if it is complicated by pulmonary hypertension (affecting approximately 2%) it results in significantly reduced quality of life, mental and physical health (Ghanima, Wik, Tavoly, Enden, & Jelsness-Jørgensen, 2017) (Lubberts, Paulino Pereira, Kabrhel, Kuter, & DiGiovanni, 2016). In view that VTE has significant effects on patients quality of life, it is important to try and prevent it. In order to develop strategies for preventing DVT in patients with lower limb injury treated with leg cast, it is important to investigate the relative contributions of injury, stasis and immobility to thrombogenesis. I start by performing systematic review of the literature to determine whether thromboprophylaxis reduces symptomatic venous thromboembolism in patients with below knee cast treatment for foot and ankle trauma. A systematic review of randomised controlled trials of thromboprophylaxis in patients with foot and ankle injuries treated with cast immobilization was performed, searching MEDLINE and EMBASE from inception to June 2015 (B. A. Hickey, Watson, et al., 2016b). Outcomes of interest were VTE (asymptomatic and symptomatic DVT and PE) and bleeding. 3 reviewers used a data extraction form and assessed the literature according to the Cochrane risk of bias tool. Statistical analysis was performed using RevMan. 7 studies of chemical thromboprophylaxis were included, all except one used venography to assess for DVT, with one study using venous ultrasound. 2 studies reported on mechanical thromboprophylaxis, neither reported symptomatic DVT events. Neither study of mechanical thromboprophylaxis found a reduction in asymptomatic DVT in the intervention group. Funnel plot of studies of chemical thromboprophylaxis suggested no publication bias. Pooled symptomatic DVT occurred in 1.58% of patients in the control group, with 0.43% sustaining symptomatic PE. At meta analysis, symptomatic DVT was reduced in the low molecular weight heparin chemical thromboprophylaxis group (OR 0.29, CI 0.09-0.95). Chemical thromboprophylaxis did not influence PE. There was one non-fatal retroperitoneal haemorrhage (major bleed), which equated to 0.11% (1 in 886). Based on these findings, 11 symptomatic VTE events would be prevented for every 1 major bleed. These findings are comparable with the recent Cochrane review, which included 2 additional studies and a total of 2924 participants. Meta analysis found reported a reduction of VTE in the LMWH chemical thromboprophylaxis group (OR 0.40, 95% CI 0.21-0.76) (Zee, van Lieshout, van der Heide, Janssen, & Janzing, 2017). In order to develop strategies for prediction and prevention of VTE in patients with foot and ankle injury treated with cast immobilization, it is necessary to consider why venous thrombosis occurs in these patients. As previously discussed, patients may have permanent risk factors, which may influence hypercoagulability. The transient risk factors of injury and cast treatment may also influence risk by causing endothelial dysfunction and venous stasis (Virchow, 1856). Several important mechanisms for prevention of venous stasis have previously been found. Weight bearing is important; with Gardner et al (1990) reporting that 30ml of venous contrast was pumped out of the foot during weight bearing (Gardner & Fox, 1983). This is not always possible for a patient with foot and ankle injury treated with a cast, because they may be non-weight bearing. For patients who are non-weight bearing, it is still possible to influence venous flow. For example, Elsner et al (2007) previously found that movement of the 1st metatarsophalangeal joint increased popliteal vein flow from 13 to 39 cm/s (Elsner, Schiffer, Jubel, Koebke, & Andermahr, 2007). In patients without leg casts, intermittent pneumatic compression of the leg or thigh to prevent venous stasis was found to be effective in reducing DVT and PE in a meta analysis of over 16, 000 patients (RR 0.43, 95% CI 0.36-0.52) (Ho & Tan, 2013). It therefore seems that this is a viable mechanism. Furthermore, Whitelaw et al (2001) found that none of the IPC devices studied resulted in significantly better calf pump function when compared with simple passive or active ankle movements (Whitelaw et al., 2001). To assess the influence of toe and ankle movement on venous stasis, I examine the effect of these movements on venous velocities measured at the popliteal vein with ultrasound. To determine whether this is a viable strategy for prevention of DVT, I then assess the impact of application of below knee cast on venous velocities. In this proof of principle study, 20 healthy volunteers were recruited (B. A. Hickey, Morgan, Pugh, & Perera, 2014). All had measurement of calf pump function in the un-casted leg whilst seated, using ultrasound at the popliteal vein. Baseline and peak velocities were measured during active toe movement (dorsiflexion and plantarflexion) and during ankle movement (dorsiflexion and plantarflexion). A below knee cast was then applied and measurements were repeated. Mean resting baseline venous velocity was 10 cm/s, which remained unchanged when the below knee cast was applied.There was approximately 5-fold increase in venous velocities with active toe movement (mean 54 cm/s for toe dorsiflexion, mean 50 cm/s for toe plantarflexion), and 10 fold increase from baseline with ankle movements (mean 115 cm/s ankle dorsiflexion, mean 87 cm/s ankle plantarflexion). All were statistically significant. When the below knee cast was applied, there was no statistically significant decrease in the peak velocities achieved during movement excepting for ankle dorsiflexion (isometric), however this was still increased approximately 8 times compared with baseline (88 cm/s). It was therefore apparent that venous stasis did not occur when a below knee cast was applied to healthy volunteers and that active toe movement may have a role in preventing stasis in patients with injury, with subsequent reduction in DVT.
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Douglas, Randi M., and Lauren N. Parker. "Evaluation of post-operative venous thromboembolism prophylaxis in lung transplant patients." The University of Arizona, 2012. http://hdl.handle.net/10150/623605.
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Class of 2012 AbstractSpecific Aims: The purpose of this study was to evaluate the effectiveness of various post-operative prophylaxis methods in lung transplant patients by comparing the incidence of venous thromboembolism (VTE) before and after the implementation of a standardized hospital order set at the University of Arizona Medical Center (UAMC) in April 2007. Methods: Paper and electronic medical charts were retrospectively reviewed if patients had a lung transplant date between October 31, 2003 – October 31, 2010. A computerized database was used to collect demographic data, length of stay (LOS), comorbid conditions, prophylaxis type (including dose/frequency), and date/type of thromboembolic events in the post-operative period prior to discharge and up to 1-year post- discharge. Main Results: Ninety-two patient charts were included in the study with 35 charts in the pre-order set (“Before”) group and 57 charts in the post- order set (“After”) group. All baseline characteristics were similar between groups except age (mean age difference 8.1 yrs, p=0.003), use of mycophenolate (Before n=24, After n=54; p=0.002), and use of medications that increase risk of VTE (Before n=6, After n=2; p=0.05). The April 2007 protocol significantly increased the number of patients receiving any method of prophylaxis (p<0.0001). However, receiving prophlyaxis did not significantly reduce event rates or readmissions due to VTE. Conclusions: Although implementation of the April 2007 protocol did not significantly reduce VTE event rates and readmissions, VTE prophylaxis should continue to remain a priority. Adherence to the implemented protocol may reduce the number of patients left without effective methods of prophylaxis.
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Douglas, Randi M., Lauren N. Parker, Michael Katz, and Richard Cosgrove. "Evaluation of Post-Operative Venous Thromboembolism Prophylaxis in Lung Transplant Patients." The University of Arizona, 2012. http://hdl.handle.net/10150/614466.
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Class of 2012 AbstractSpecific Aims: The purpose of this study was to evaluate the effectiveness of various post-operative prophylaxis methods in lung transplant patients by comparing the incidence of venous thromboembolism (VTE) before and after the implementation of a standardized hospital order set at the University of Arizona Medical Center (UAMC) in April 2007. Methods: Paper and electronic medical charts were retrospectively reviewed if patients had a lung transplant date between October 31, 2003 – October 31, 2010. A computerized database was used to collect demographic data, length of stay (LOS), comorbid conditions, prophylaxis type (including dose/frequency), and date/type of thromboembolic events in the post-operative period prior to discharge and up to 1-year post-discharge. Main Results: Ninety-two patient charts were included in the study with 35 charts in the pre-order set (“Before”) group and 57 charts in the post-order set (“After”) group. All baseline characteristics were similar between groups except age (mean age difference 8.1 yrs, p=0.003), use of mycophenolate (Before n=24, After n=54; p=0.002), and use of medications that increase risk of VTE (Before n=6, After n=2; p=0.05). The April 2007 protocol significantly increased the number of patients receiving any method of prophylaxis (p<0.0001). However, receiving prophlyaxis did not significantly reduce event rates or readmissions due to VTE. Conclusions: Although implementation of the April 2007 protocol did not significantly reduce VTE event rates and readmissions, VTE prophylaxis should continue to remain a priority. Adherence to the implemented protocol may reduce the number of patients left without effective methods of prophylaxis.
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Lee, Adrian P. S. "Therapy and venous thromboembolism in glioblastoma: a clinical and molecular study." Thesis, The University of Sydney, 2019. https://hdl.handle.net/2123/22600.
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Glioblastomas are high grade brain tumours with a median survival of approximately 1 year. Amplification of the oncogene EGFR is a common aberration. This thesis assessed the hypothesis that EGFR is an effective target for glioblastoma treatment. A Cochrane review was undertaken that systematically analysed 9 clinical trials in glioblastoma patients that included EGFR targeting therapies. It concluded that the addition of EGFR therapies to standard of care provided no overall survival benefits. Venous thromboembolisms (VTEs) are highly prevalent amongst glioblastomas. Prophylaxis is not recommended, and thus early identification of at-risk patients and initiation of treatment may be beneficial. EGFR enhances activation of the coagulation cascade by upregulating pro-coagulant factors like Tissue Factor (TF). This thesis examined the hypothesis that EGFR-driven glioblastomas have more VTE events and this leads to poorer survival. A retrospective study of 330 glioblastoma patients diagnosed between 2009 and 2014 found no association between VTE incidence and tumour EGFR status or survival. However, a positive correlation was identified between VTE and tumor uPAR expression (p=0.032). An unexpected finding was a positive correlation between overall survival and tumor TF expression (p=0.028). In further work, gene expression profiling of glioblastomas from an independent cohort of 26 patients, 50% of whom developed VTE, identified collagen as an alternative initiator of thrombus formation and confirmed the importance of extracellular matrix in facilitating these malignant activities. Findings from this thesis do not support anti-EGFR therapies in glioblastoma. This thesis identified the potential of uPAR as a predictive biomarker for VTE. It provides support for further investigation of biomarkers that may contribute to a VTE risk assessment for glioblastomas, permitting early identification and intervention of at-risk patients to change their disease outcome.
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Remancus, Kelly. "Examining Venous Thromboembolism Post-Operative Orthopedic Care Using Electronic Order Sets." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3828.
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Venous thromboembolism (VTE) is a serious health concern of patients undergoing orthopedic surgery. Analysis of the study site semiannual reports from January 2014 through March 2015 indicated 10 VTE events in 546 orthopedic cases. The community hospital was classed as an outlier performing in the bottom 10th percentile when compared to other hospitals. To standardize the ordering of VTE prophylaxis, the hospital developed a postoperative electronic VTE order set. The purpose of this project was to assess the difference in orthopedic VTE occurrences in the postoperative total hip arthroplasty (THA) patients before and after the implementation of the electronic VTE order set. The goal of the project was to use an electronic retrospective chart review to evaluate if the order set implementation influenced the adherence to ordering mechanical and pharmacological prophylaxis in the THA patient. Differences in the ordering of VTE prophylaxis and VTE outcomes were evaluated using a retrospective review of 325 preimplementation order set cases and 406 postimplementation order set cases. This evaluation demonstrated that appropriate pharmacological prophylaxis ordering increased and orthopedic VTE occurrences decreased after the standardized electronic order set was implemented. Social change occurred through the empowerment of clinicians when empirical evidence was provided for use at the point of care, which positively impacted patient outcomes undergoing a common surgical procedure. VTE is no longer considered a routine postoperative orthopedic complication as technology-enabled solutions have proven to be appropriate tools to combat and prevent postoperative VTE complications.
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Labiche, Eppie Ann. "Venous Thromboembolism Prevention Education for Practitioners in the Acute Care Setting." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6597.
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During the last several decades, venous thromboembolism (VTE) has been identified as a preventable health condition. The gaps in clinical practice have led to an increased incidence of VTE. The lack of using existing evidence-based VTE prevention guidelines in practice has limited the implementation of VTE risk assessment stratifications and affected the appropriateness and timeliness of addressing pharmacologic and mechanical prophylaxis. The purpose of the scholarly project was to educate practitioners on existing VTE prevention practice guidelines. The practice-focused question explored whether an educational learning activity on evidence-based VTE prevention guidelines improved the awareness, knowledge, and compliance with existing evidence-based VTE guidelines of practitioners that assess and treat patients at risk for VTE. The theoretical framework for the project was Lewin's change process theory. A total of 38 participants comprised registered nurses (82%), physicians (5%), nurse practitioners (2%), and nonclinical personnel (11%). A program evaluation was provided to determine the effectiveness of the project. The findings showed that practitioners participated in the learning activity to improve knowledge (48%), increase VTE awareness (43%), and would change the management and treatment of patients at risk for VTE (39%). Hospitalized patients at risk for VTE can benefit from the results of this project through a change in clinical practice that might decrease the incidence of VTE and potentially bring about social change by reducing the number of preventable deaths.
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Lapidus, Lasse. "Thromboembolism following orthopaedic surgery : outcome and diagnostic procedures after prophylaxis in lower limb injuries /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-111-1/.
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Emerson, Michael. "Endogenous nitric oxide and platelet function in in vivo models of thromboembolism." Thesis, King's College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.300152.
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Schellong, Sebastian M., and Benjamin A. Schmidt. "New Therapeutic Approaches in Pulmonary Embolism." Karger, 2003. https://tud.qucosa.de/id/qucosa%3A27512.
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Pulmonary embolism as a part of venous thromboembolic disease has a broad spectrum of clinical presentations from minimal disease to life-threatening right heart failure. Therapy has to be guided by the risk associated with the individual clinical state of the patient. As long as hemodynamics are entirely stable, anticoagulation is given in order to prevent early or late recurrence, thereby allowing for endogeneous thrombolysis and recovery. In hemodynamically instable patients, i.e. patients under cardiopulmonary resuscitation or in shock, there is the need for a rapid reduction of thrombus mass in order to restore right ventricular function. Systemic thrombolysis is the most feasible modality to reduce the thrombus burden of the pulmonary circulation in the short term. For hemodynamically stable patients with right ventricular dysfunction as assessed by echocardiography, there is still some controversy as to whether thrombolysis improves the long-term outcome. At the least, thrombolysis may positively modify the short-term course of acute disease in patients with an extremely low risk of bleeding. When the acute phase has been overcome, secondary prophylaxis with vitamin K antagonists has to be given. The duration of secondary prophylaxis requires an individual assessment of both the risk of recurrence and the risk of bleeding. In the near future, new anticoagulant drugs such as direct thrombin and factor Xa inhibitors will offer new treatment modalities for the acute phase as well as for secondary prophylaxis.Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
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Ansari, Mohammed Toseef. "Changes in coagulation, fibrinolysis, and endothelial perturbation markers in the lower limb venous blood associated with prolonged cramped sitting in healthy adult male volunteers in a simulation of prolonged travel." Click to view the E-thesis via HKUTO, 2005. http://sunzi.lib.hku.hk/hkuto/record/B31556991.
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Romão, Felipe Gazza [UNESP]. "Análise do perfil hemostático e do risco tromboembólico em cães submetidos ao tratamento com prednisona." Universidade Estadual Paulista (UNESP), 2012. http://hdl.handle.net/11449/89245.
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Os distúrbios trombóticos e tromboembólicos aparentemente são menos comuns em felinos e caninos do que em humanos. A trombose foi reconhecida clinicamente associada a algumas doenças, como o hiperadrenocorticismo (HAC). Vários fármacos podem alterar o equilíbrio hemostático; dentre elas a prednisona, corticosteroide amplamente utilizado na medicina veterinária principalmente por seus efeitos imunossupressivos e anti-inflamatórios. Além disso, sabe-se que o hipercortisolismo pode estimular a formação de trombos pelo aumento de fatores de coagulação e diminuição da fibrinólise. O objetivo do presente estudo, portanto, foi demonstrar o efeito da prednisona sobre o perfil hemostático. Para tanto, foram constituídos dois grupos experimentais, sendo o grupo I, composto de 10 cães hígidos que receberam a dose de 1,0 mg/kg/BID por 15 dias, e ogrupo II, composto de 10 cães hígidos que receberam a dose de 2,0 mg/kg/BID por 15 dias. Houve diminuição significativa dos níveis de antitrombina em ambos os grupos, aumento da agregação plaquetária e diminuição do fator de von Willebrand no grupo II. Não foram observadas alterações estatisticamente significativas em relação ao tempo de sangramento da mucosa oral (TSMO), tempo de protrombina (TP), tempo de tromboplastina parcial ativada (TTPA), tempo de trombina (TT), contagem plaquetária, e dos valores de fibrinogênio, fator VIII e produtos de degradação da fibrina (PDFs) em nenhum dos grupos. Pode-se concluir que a prednisona pode aumentar o risco tromboembólico especialmente por diminuição de fatores anticoagulantes, não importando a dose utilizada
Thrombotic and thromboembolic disorders apparently are less common in cats and dogs than in humans.Thrombosis was clinically recognized associated with some diseases, such as hyperadrenocorticism (HAC). Several drugs can change the hemostatic balance, such as the corticosteroid prednisone, widely used in veterinary medicine mainly by its immunosuppresive and anti-inflammatory effects. In addition, it is known that hypercortisolism can stimulate the thrombi formation by the increase of coagulation factors and reduced fibrinolysis.The aim of this study, therefore, was to demonstrate the effect of prednisone on haemostatic profile. For this purpose, two experimental groups were set up, the group I composed by 10 higid dogs, which received a dose of 1,0 mg/kg/BID for 15 days, and group II, composed by 10 higid dogs that received the dose of 2,0 mg/kg/BID for 15 days.There was a significant decrease on antithrombin levels in both groups, increase on platelet aggregation and decrease of von Willebrand factor activity on group II. No statistically significant changes were observed in relation to oral mucosal bleeding time (OMBT), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), platelet count, plasmatic fibrinogen values,factor VIII activityand fibrin degradation products (FDPs) in both groups. It can be concluded that the prednisone can increase the thromboembolic risk, especially by the decrease of anticoagulant factors, regardless of the dosage
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Romão, Felipe Gazza. "Análise do perfil hemostático e do risco tromboembólico em cães submetidos ao tratamento com prednisona /." Botucatu, 2012. http://hdl.handle.net/11449/89245.
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Orientador: regina Kiomi TakahiraBanca: Luiz Henrique de Araújo Machado
Banca: Ricardo Duarte Silva
Resumo: Os distúrbios trombóticos e tromboembólicos aparentemente são menos comuns em felinos e caninos do que em humanos. A trombose foi reconhecida clinicamente associada a algumas doenças, como o hiperadrenocorticismo (HAC). Vários fármacos podem alterar o equilíbrio hemostático; dentre elas a prednisona, corticosteroide amplamente utilizado na medicina veterinária principalmente por seus efeitos imunossupressivos e anti-inflamatórios. Além disso, sabe-se que o hipercortisolismo pode estimular a formação de trombos pelo aumento de fatores de coagulação e diminuição da fibrinólise. O objetivo do presente estudo, portanto, foi demonstrar o efeito da prednisona sobre o perfil hemostático. Para tanto, foram constituídos dois grupos experimentais, sendo o grupo I, composto de 10 cães hígidos que receberam a dose de 1,0 mg/kg/BID por 15 dias, e ogrupo II, composto de 10 cães hígidos que receberam a dose de 2,0 mg/kg/BID por 15 dias. Houve diminuição significativa dos níveis de antitrombina em ambos os grupos, aumento da agregação plaquetária e diminuição do fator de von Willebrand no grupo II. Não foram observadas alterações estatisticamente significativas em relação ao tempo de sangramento da mucosa oral (TSMO), tempo de protrombina (TP), tempo de tromboplastina parcial ativada (TTPA), tempo de trombina (TT), contagem plaquetária, e dos valores de fibrinogênio, fator VIII e produtos de degradação da fibrina (PDFs) em nenhum dos grupos. Pode-se concluir que a prednisona pode aumentar o risco tromboembólico especialmente por diminuição de fatores anticoagulantes, não importando a dose utilizada
Abstract: Thrombotic and thromboembolic disorders apparently are less common in cats and dogs than in humans.Thrombosis was clinically recognized associated with some diseases, such as hyperadrenocorticism (HAC). Several drugs can change the hemostatic balance, such as the corticosteroid prednisone, widely used in veterinary medicine mainly by its immunosuppresive and anti-inflammatory effects. In addition, it is known that hypercortisolism can stimulate the thrombi formation by the increase of coagulation factors and reduced fibrinolysis.The aim of this study, therefore, was to demonstrate the effect of prednisone on haemostatic profile. For this purpose, two experimental groups were set up, the group I composed by 10 higid dogs, which received a dose of 1,0 mg/kg/BID for 15 days, and group II, composed by 10 higid dogs that received the dose of 2,0 mg/kg/BID for 15 days.There was a significant decrease on antithrombin levels in both groups, increase on platelet aggregation and decrease of von Willebrand factor activity on group II. No statistically significant changes were observed in relation to oral mucosal bleeding time (OMBT), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), platelet count, plasmatic fibrinogen values,factor VIII activityand fibrin degradation products (FDPs) in both groups. It can be concluded that the prednisone can increase the thromboembolic risk, especially by the decrease of anticoagulant factors, regardless of the dosage
Mestre
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Kadri, Amer N., Misam Zawit, Raed Al-Adham, Ismail Hader, Leen Nusairat, Mohamed F. Almahmoud, Mourad Senussi, et al. "Prevalence of venous thromboembolism in admissions and readmissions with and without syncope: A nationwide cohort study." Oxford University Press, 2021. http://hdl.handle.net/10757/655949.
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Aims: The Pulmonary Embolism in Syncope Italian Trial reported 17.3% prevalence of pulmonary embolism (PE) in patients admitted with syncope. We investigated the prevalence of venous thromboembolism [VTE, including PE and deep vein thrombosis (DVT)] in syncope vs. non-syncope admissions and readmissions, and if syncope is an independent predictor of VTE. Methods and results: We conducted an observational study of index admissions of the 2013-14 Nationwide Readmission Database.National Institutes of Health
Revisión por pares
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Visagie, Amcois. "The effects of physiological concentrations of 17ß-Estradiol and Progesterone on fibrin network ultrastructure." Diss., University of Pretoria, 2016. http://hdl.handle.net/2263/61676.
Full textAbstract:
17β-Estradiol (E2) and progesterone (P4) have various important functions but the effect of
these endogenous hormone concentrations on fibrin network formation has not been
established. It is essential to understand natural hormone mechanisms since these
hormones are still present in circulation while hormonal contraceptives, which are
associated with increased risk of venous thromboembolism, are used. In this study the
formation of a fibrin network is analysed when different physiological concentrations of E2
and P4 is added to platelet poor plasma. Blood coagulation is critical for haemostasis but
when the formation of a stable clot is influenced in such a way that hypercoagulation takes
its course, it can have detrimental effects as it increases the risk of venous thrombosis.
During blood coagulation fibrinogen is converted into fibrin in the presence of thrombin.
The formation of a dense fibrin clot structure is quite an intense process and packaged in
very specific ways. Both E2 and P4 has the ability to shift the haemostatic balance to a
hypercoagulable state and therefore viscoelastic studies, morphological analysis as well as turbidimetry were used in this study to observe the possible changes in the fibrin network
formation. Viscoelastic studies included thromboelastography (TEG) which gave insight to
the properties of clot formation. Morphological studies included scanning electron
microscopy (SEM) and atomic force microscopy (AFM) which delivered an investigation in
fibrin network morphology, fibrin fiber diameter and surface roughness. Turbidimetry
included further analysis of plasma fibrin clot formation and clot lysis time (CLT). Results
showed that E2 and P4 showed hypercoagulable viscoelastic properties with decreased
fibrin diameter and surface roughness while increased occurrence of dense matted deposits
(DMDs) were evident. Turbidimetry showed decreased CLT for E2, but not P4. These results
suggest in the presence of endogenous estrogen and progesterone, which is associated with
hypercoagulability, the additional burden of synthetic hormones may result in a prothrombotic
and hypercoagulable state in females with an inflammatory predisposition. It
appears that both E2 and P4, which are known for their anti- and pro-inflammatory action,
may influence fibrin network formation on a molecular level. These results are of clinical
importance when considering hormones as either a pathological agent or therapeutic
intervention.Dissertation (MSc)--University of Pretoria, 2016.
Physiology
MSc
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Raman, Rachna. "Inferior vena cava filters in the management of cancer-associated venous thromboembolism: A systematic review." University of Cincinnati / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1307442047.
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Baggs, Jennifer, Grace Chang, and Jinwen Li. "Evaluation of Adherence to Treatment Standards and Clinical Outcomes Associated with Prophylaxis of Venous Thromboembolism in Hospitalized Patients at University Medical Center in Arizona." The University of Arizona, 2009. http://hdl.handle.net/10150/623985.
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Class of 2009 AbstractOBJECTIVES: To assess whether patients at University Medical Center (UMC) in Arizona who have indications for venous thromboembolism (VTE) prophylaxis receive treatment, determine whether appropriate pharmacologic VTE prophylaxis is implemented, and analyze the incidence of VTE associated with prescribed regimens. METHODS: Data were derived from a retrospective chart review on risk factors for VTE and prescription of pharmacological and non-pharmacological thromboprophylaxis. Two risk assessment models were used to evaluate adherence to treatment standards: the 2008 American College of Chest Physicians (ACCP) evidence-based consensus guidelines and the Caprini score. Clinical outcomes were evaluated with regard to proper thromboprophylaxis including assessment of appropriate time, type, intensity, and duration of treatment. RESULTS: A total of 366 patients met inclusion critera. Based on the Caprini score, 94% of patients were judged to be at risk for VTE. Of those at risk, 90% received thromboprophylaxis; however, only 35% of treated patients received proper thromboprophylaxis. Ten patients (2.7%) experienced a VTE during their hospital stay or within the following 6 months after discharge. There was not a significant difference in incidence of VTE with respect to treatment versus no treatment or proper versus improper prophylaxis (p=0.15 and 0.65, respectively); however, a favorable trend in incidence of VTE was observed for treated patients and patients treated with correct thromboprophylaxis based on risk assessment. CONCLUSIONS: Most patients at UMC who were indicated for VTE prophylaxis received treatment; however, the type, intensity, and duration of thromboprophylaxis were often inappropriate despite the existence of various guidelines.
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Nikolis, Andreas. "Assessment of risk factors in the development of thromboembolism in a trauma population." Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=29577.
Full textAbstract:
The aim of this study was to: (a) identify risk factors for the development of venothromboembolism in a trauma population, (b) evaluate whether risk factors vary with increasing Injury Severity Score (ISS), and (c) assess the predictive ability of the Risk Assessment Profile for Thromboembolism (RAPT) in this trauma population. There were 7532 admissions for trauma between 1993 and 1998 to the Montreal General Hospital trauma center. A nested case-control design was used. Cases were defined as all patients with radiological evidence of either a deep venous thrombosis or pulmonary embolus during their admission. Controls were patients satisfying the same inclusion criteria who did not suffer a symptomatic deep venous thrombosis or pulmonary embolism while in hospital, did not have evidence of deep venous thrombosis prior to the traumatic event, and found to be free of any symptomatic thromboembolic events on consequent follow up. Patients were divided into three categories, ISS 1--24 (mild-moderate injuries), ISS 25--59 (moderate-severe injuries), and ISS 60--75 (severe-fatal injuries). (Abstract shortened by UMI.)
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Huang, Shenwen. "The Effect of 120-kHz Ultrasound on Thrombolytic Efficacy in Porcine Thromboembolism Models." University of Cincinnati / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1511884862297255.
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Louzada, Martha. "Evaluating Risk of Recurrent Venous Thromboembolism During the Anticoagulation Period in Patients with Malignancy." Thesis, Université d'Ottawa / University of Ottawa, 2011. http://hdl.handle.net/10393/19827.
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Background - Current guidelines suggest that all cancer patients with venous thrombosis be treated with long-term low molecular weight heparin. Whether treatment strategies should vary according to clinical characteristics remains unknown. // Systematic review -
A systematic review was performed to determine current understanding of the association between malignancy characteristics in patients with cancer-associated VTE and the risk of VTE recurrence. Four retrospective and 6 prospective studies were included. They suggest that lung cancer, metastases, and adenocarcinomas confer an increased the risk of recurrence and breast cancer a low risk. // Survey - I performed survey to evaluate thrombosis experts’ opinion about the low risk of VTE recurrence they would consider acceptable for patients with cancer- associated thrombosis 103 specialists participated. 80% of respondents agreed that a risk of recurrent VTE during anticoagulation below 7% is low enough. 92% agreed that a CPR that categorizes risk of recurrence is relevant. // Retrospective Study - I performed a single retrospective cohort study to assess the feasibility of derivation of a CPR that stratifies VTE recurrence risk in patients with cancer–associated thrombosis. The study included 543 patients. A multivariate analysis selected female, lung cancer and prior history of VTE as high risk predictors and breast cancer and stage I disease as low risk. // Conclusion - Patients with cancer-associated thrombosis do have varying risks of recurrent VTE depending on clinical characteristics.
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Cullberg, Marie. "Direct Thrombin Inhibitors in Treatment and Prevention of Venous Thromboembolism: Dose – Concentration – Response Relationships." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Universitetsbiblioteket [distributör], 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-6872.
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Sabapathy, Christine A. "A population based cohort study: the epidemiology of pediatric venous thromboembolism in Quebec, Canada." Thesis, McGill University, 2014. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=121104.
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Background: Pediatric venous thromboembolism (VTE), although rare, is associated with significant morbidity and mortality. Published incidence and recurrence rates in children vary widely with incidence rates ranging from 0.07 to 0.49 VTE per 10 000 children/year and recurrence risks ranging from 5.5% to 18.5%. There is currently a paucity of studies evaluating temporal incidence trends, as well as risk factors for recurrence. Objectives: To describe the age-adjusted incidence rate of pediatric VTE and its trend over time, to determine VTE recurrence rate and overall all-cause mortality following VTE, and to determine predictors of VTE recurrence and all-cause mortality. Methods: A retrospective population-based cohort of all children (ages 1-17 inclusive) with a first time diagnosis of VTE in the province of Quebec between January 1st, 1994 and December 31st, 2004 was obtained from a comprehensive administrative hospital database (Med-Echo). Provincial census estimates were used to calculate age-standardized incidence rates (IR) of pediatric VTE. The incidence rate trend was then analyzed over the eleven-year study period using Poisson linear regression with time as both a continuous (yearly) and categorical (time periods) variable. Rate of VTE recurrence and all-cause mortality were determined. Univariate Cox-proportional hazards models and log rank testing were used to assess which risk factors would be incorporated into the final multivariate Cox-proportional hazards model evaluating risk of VTE recurrence and all-cause mortality. Results: In total, 487 incident cases of VTE in children 1-17 years of age were documented. Based on the estimated provincial census person-years during the study period, the age-standardized IR was 0.29 VTE per 10 000 person-years (95% confidence interval (CI) 0.26-0.31). Females had a statistically significant higher VTE incidence rate (per 10 000 person-years) than males, 0.37 and 0.21 per 10 000 person-years, respectively with an incidence rate ratio comparing females to males, adjusted for age group of 1.75 (95% CI 1.46-2.10). Trend analysis showed no statistically significant change in the age-standardized IRs over the 11-year period. The VTE recurrence rate was 2.77 (95% CI 2.2-3.4) per 1000 person-months (overall risk of 16%). Recurrence was associated with the presence of a chronic disease, defined as a diagnosis of inflammatory bowel disease, cystic fibrosis, lupus, sickle cell disease or nephrotic syndrome, (hazard ratio (HR) 2.3; 95% CI 1.2-4.3), presence of a central vascular line at time of initial VTE (HR 1.9; 95% CI 1.0-3.3) and portal vein thrombosis as the initial VTE presentation (HR 4.1; 95% CI 1.5-11.0). Overall all-cause mortality was 6.4%, hazard modeling of known risk factors for VTE was inconclusive for mortality. Conclusions: Pediatric VTE is more frequent than previously described, however its incidence appears to be stable over time. Females are more prone to VTE than males in this age group. Risk of recurrence in our cohort is at the higher end of previously reported values, and is higher in those with a pre-existing chronic illness, central vascular line or with an initial diagnosis of portal vein thrombosis. All-cause mortality was lower in our cohort than previous large studies of VTE in this age group. Our findings highlight the need for future studies to address sex differences in the incidence of pediatric VTE to help determine effective primary thromboprophylaxis strategies in children at high risk for VTE, as well as determine effective secondary prophylaxis strategies in children at high risk for VTE recurrence.Introduction: La thromboembolie veineuse (TEV) pédiatrique est un phénomène rare mais dont les séquelles peuvent être dramatiques. Selon la littérature, l'incidence est estimée entre 0.07 et 0.49 TEV par 10 000 enfants/année et la risque de récidive se situe entre 5.5 et 18.5%, toutefois, la qualité et le nombre d'études concernant le sujet demeure un facteur limitatif pour une meilleure compréhension de cette complication. Objectifs: Décrire le taux d'incidence de la TEV pédiatrique selon l'age ainsi que la tendance dans le facteur temps; de déterminer le taux de récidive ainsi que décrire les facteurs de risque de récidive et de mortalité. Méthodologie: En utilisant la base de données Med-Écho, une cohorte rétrospective des enfants âgés entre 1-17 ans (inclusif) avec un diagnostic d'un première TEV dans la province de Québec entre le 1 janvier 1994 et la 31 décembre 2004 a été établi. Une estime basée sur le résultat des recensements provinciaux a été utilisée pour standardiser et calculer les taux d'incidence. Le taux décrit annuellement et en trois catégories de temps, a été évalué en utilisant la méthode de Régression Linéaire Poisson pour établir si une tendance existe. Le taux de récidive et de mortalité ont été détermines et une analyse univariable du modèle de Cox et le « Log Rank » ont été utilises pour établir quels facteurs de risque seront incorporés dans le modèle finale de multivariable de Cox.Résultats: Au total, nous avons observé 487 épisodes de TE chez des enfants âgés entre 1 et 17 ans. Le taux d'incidence de TEV pédiatrique ajusté pour la distribution d'age de la population, calculé en utilisant des estimations basées sur les recensements provinciaux, est de 0.29 TEV par 10 000 personnes-années (intervalle de confiance à 95% (IC) 0.26-0.31). Le taux d'incidence ajusté pour variation en catégories d'age des femmes comparativement aux hommes est 1.75 fois plus élevé (IC à 95% 1.46-2.10) et est statistiquement significatif, avec des taux respectifs de 0.37 et 0.21 par 10 000 personnes-années. L'analyse de l'incidence de TEV pédiatrique entre 1994-2004 ne démontre aucune différence significative pendant cette période. Le taux de récidive est de 2.77 (IC à 95% 2.2-3.4) par 1000 personnes-mois (risque de 16%). La récidive est associée avec le diagnostic d'une maladie chronique, incluant la maladie inflammatoire intestinale, la fibrose kystique, l'anémie falciforme, le lupus, et le syndrome néphrotique (le hazard ratio (HR) 2.3; IC à 95% 1.2-4.3), la présence d'une ligne centrale (HR 1.9; IC à 95% 1.0-3.3) ainsi qu'une une thrombose du système portal comme premier épisode de TEV (HR 4.1; IC à 95% 1.5-11.0). La mortalité à tout cause est 6.4%, estimation de HR pour plusieurs facteurs de risque par modèle de Cox hazard était indécisif. Conclusion: Le TEV pédiatrique est plus fréquente que la littérature ne le suggère, et sa tendance ne semble pas avoir change entre 1994 et 2004. Les femmes semblent avoir une incidence accrue par rapport aux hommes dans ce groupe. Le taux de récidive dans notre cohorte se situe à la limite supérieure des résultats des études précédentes. Le taux de récidive est plus élevé chez les enfants atteints d'une maladie chronique, avec une ligne centrale ou un diagnostic initial de TEV du système portal. La mortalité de notre cohorte est inferieure à ce que la littérature suggère. Nos résultats soulignent la nécessite d'entreprendre de nouvelles études afin de déterminer l'usage de prophylaxie chez les enfants a haut risque de TEV et/ou de récidive.