Diagnosis Of Thromboembolic Disease Research Articles

Pathological Clotting and Deep Vein Thrombosis in Patients with HIV.

The number of people infected with human immunodeficiency virus (HIV) is rapidly increasing and the majority of those infected are living in sub-Saharan Africa. Some hallmarks of HIV are inflammation and upregulation of inflammatory markers. A pathological coagulation system may accompany these inflammatory changes and potentially result in venous thromboembolism such as a deep vein thrombosis (DVT). In this review, the authors describe the inflammatory profile in HIV, the treatment regimens currently in place in South Africa, and in particular how HIV affects the hematological system, with specific focus on platelets, red blood cells (RBCs; erythrocytes), and fibrin(ogen). They also discuss the presence of DVT in HIV, focus on screening tests, and suggest a more proactive approach to track the inflammatory profile of HIV patients, by specifically using parameters that might point to pathological coagulation; these should involve platelet, RBC, and fibrin(ogen) analysis. They conclude by suggesting that including coagulation function tests to study the effect of treatment interventions would improve outcomes in these individuals, as it could help in the diagnosis of thromboembolic disease. Furthermore, this approach could streamline treatment strategies due to improved monitoring. A better understanding of hypercoagulability of HIV-infected patients is therefore urgently needed. In conclusion, the authors suggest a panel of pathology tests that should be considered as standard procedures when HIV is present.

Khorama score as a predictive tool for thromboembolic events in high risk patients

There is an established relation between cancer and the development of thromboembolic venous disease. Khorana et al developed a predictive score using clinical characteristics and laboratory values to stratify patients according to their risk. To characterize using Khorana score, patients with active cancer and a diagnosis of thromboembolic disease during hospitalization in an oncology hospital. Review of records of the pharmacy of the hospital, selecting patients who received heparin in therapeutic doses during their hospitalization. Using laboratory values available in the medical records, the Khorama score was calculated. Twenty seven patients with thromboembolic events, aged 60 ± 2 years (56% males) were selected for the study. Eighty percent of them were catalogued in the intermediate and high risk group according to Khorana score. Khorana score is a simple scale that might be useful to establish early prophylactic measures in patients with high risk for thromboembolic events, especially those with cancer.

324 Thrombo-embolic disease in CF patients: Difficult to diagnose, difficult to treat

The diagnosis of thrombo-embolic disease in CF patients is often difficult because of overlapping symptoms/signs with CF lung disease. We, here, report on the 3 cases to raise awareness about this complication. Patient 1 is waitlisted for lung transplantation (LTx). He receives regular intravenous (iv) antibiotic courses via peripherally inserted central catheters (PICCs). Recently, 24 hrs after removal of a PICC he presented with acute respiratory distress and left-sided thoracic pain. Angio CT demonstrated pulmonary embolism (PE) in the left lower lobe. Echocardiography showed new pulmonary hypertension (PH) and right heart overload. Patient 2 is also waitlisted for LTx. She receives regular iv courses via a port-a-cath (PAC). During an iv course she deteriorated and developed new significant hemoptysis. Angio CT showed bilateral PE. Echocardiography revealed an echogenic structure at the tip of the PAC, which was believed to be a thrombus. Patient 3, a 17-yr-old girl with severe CF lung disease, developed fever, dyspnea and thoracic pain after a transatlantic flight. Chest X-ray showed a pneumothorax. Additionally, angio CT revealed bilateral pulmonary emboli. In none of the patients deep venous thrombosis was found. Patients 1 and 3 received subcutaneous heparin; in Patient 2 the PAC was replaced, heparin was not given because of persisting hemoptysis. The possible diagnosis of PE should be kept in mind in CF patients presenting with new respiratory symptoms and signs, especially in sicker patients and those equipped with removable/implanted central venous catheters. Treatment is not always straightforward because of the possibility of significant hemoptysis.

Evaluation of a new method and instrument for detection platelet aggregation function and its clinical application

This study was purpose to evaluate a new method and instrument for detecting platelet aggregation function, establish the reference intervals for PL-11 platelet analyzer, and evaluate its clinical application. The evaluation was based on the guidelines of Clinical and Laboratory Standards Institute (CLSI or NCCLS) and Clinical Laboratory Improvement Amendment 88. Intravenous blood samples anticoagulated with sodium citrate were detected by PL-11 platelet analyzer. The reference intervals were defined after statistic analysis. The clinical diagnostic significance of the PL-11 platelet analyzer was evaluated by testing the change rate of platelet maximum aggregation rate (MAR) of acute cerebral infarction (ACI) patients in the department of Neurology who took clopidogrel 7 d before and after. The result showed that all the parameters meet the standard of CLIA'88. The platelet MAR of 247 healthy volunteers which was induced by PLR-06, PLR-07, PLR-09 and PLR-10, was detected by the PL-11 platelet analyzer, respectively. The MAR is 58.8 ± 10.1 (%), 61.2 ± 11.8 (%), 51 ± 10.2 (%), 53.1 ± 9.2 (%), respectively. The MAR of ACI patients is significantly lower than that after taking clopidogrel. It is concluded that the PL-11 platelet analyzer is an ideal platelet function detector for early warning and diagnosis of thromboembolic disease, which is worthy to be extended and applied.

Utilidad de los marcadores tumorales como cribado de neoplasia oculta en enfermedad tromboembólica

ObjectiveTo evaluate the use of the tumour markers (TM) as part the advanced screening of occult neoplasia, in patients with thromboembolic disease (TED). Material and methodsA retrospective study was conducted between January 2007 and December 2008 on patients diagnosed with TED in our centre. The sample included 63.4% males, and 36.6% females, with a mean age of 62.8 years. The following TM were evaluated in a blood sample taken within one month after the diagnosis of TED: cancer antigen 19.9 (Ca 19.9), cancer antigen 125 (Ca 125), cancer antigen 15.3 (Ca 15.3), embryonic carcinoma antigen (CEA), alpha fetoprotein (AFP), and prostate specific antigen (PSA). The inclusion criteria were, DVT of lower and upper limbs, TEP diagnosed by imaging technique, acute clinic signs. Exclusion criteria: previous known neoplasia, non-idiopathic DVT, impossibility of follow-up. ResultsThe statistical analysis was performed on the basis of 122 patients out of 199 initially included, with an average follow-up of 38 months. At the end of the study no significant differences were found as regards the subsequent finding of a neoplasia in patients with positive TM values compared with those with negative values (Ca 125: P=.161; Ca 15.3: P=.930; CEA: P=.703; PSA: P=.382; AFP: 100% patients with negative values). Exempting the Ca 19.9 (P<.000). ConclusionsAs a conclusion of our study, TM as extensive screening of early stages of cancer after TED, is not useful for detecting an occult neoplasia during follow-up.

Molecular Imaging of Thrombosis

The diagnosis of thromboembolic diseases throughout the vascular system has been conducted with varying degrees of success by x-ray, ultrasound, CT, and MRI. Recently, a variety of potential molecular targets have been identified for early thrombus detection. This article describes these potential targets and the application of several imaging modalities currently being investigated to more accurately diagnose thrombosis and embolism.

64-MDCT Pulmonary Angiography and CT Venography in the Diagnosis of Thromboembolic Disease

64-MDCT Pulmonary Angiography and CT Venography in the Diagnosis of Thromboembolic Disease

A male adolescent with left iliac thrombophlebitis and heterozygosity for factor V Leiden mutation

The epidemiology of deep vein thrombosis in adolescents has 2 potential associations. First, there is a demonstrated association with a congenital anomaly of the inferior vena cava (Dean SM, Tytle TL. Vas Med. 2006;11:165-169; Schnieider JG, Eynatten MV, Dugi KA, et al. J Intern Med. 2002;252:276-280). Secondly, resistance to activated protein C as a result of factor V Leiden is associated with thromboembolic disease at an early age (Price DT, Ridker PM. Ann Intern Med. 1997;127:895-903). Imaging modalities, central venous catheters, and improved life expectancy for critically and chronically ill children have resulted in an increased diagnosis of thromboembolic disease in the pediatric population (Journeycake MM, Manco-Johnson MJ. Hematol Oncol Clin N Am. 2004;18;1315-1338), and evaluation for thrombophilia should be performed for any child with thromboembolic disease.

64-MDCT Pulmonary Angiography and CT Venography in the Diagnosis of Thromboembolic Disease

The purpose of our study was to investigate whether CT venography (CTV) performed after CT pulmonary angiography (CTPA) using 64-MDCT provides additional findings in the diagnosis of thromboembolic disease. Three hundred six consecutive patients in whom pulmonary embolism (PE) was clinically suspected were included in the study. The study group was classified according to the diagnostic quality of the CTPA examinations, the presence or absence of PE and deep venous thrombosis (DVT), and the most proximal localization that the embolus could lodge in the pulmonary artery. The diagnostic quality of CTPA was insufficient in 5.9%, acceptable in 8.2%, and excellent in 85.9% of the patients. The diagnostic quality of CTV was insufficient in 11.4%, acceptable in 47.4%, and excellent in 41.2%. The percentages of nondiagnostic examinations for CTPA and CTV were 5.2% and 10.8%, respectively. Acute PE and acute DVT were observed in 25.2% and 18.0%, respectively. The percentage of subsegmental emboli among patients with acute PE was 15.6%. The percentage of patients with thromboembolic disease was 29.1%. Of patients who were diagnosed as having thromboembolic disease, 13.5% (12 of 89 patients) had DVT only. Of all patients, 3.9% (12 of 306) had only isolated DVT. The number of patients with subsegmental PE who had DVT was two (0.7% all patients). As in MDCT scanning with a smaller number of slices, the combination of CTV with CTPA in 64-MDCT results in a small but definitive increase in the percentage of patients with a diagnosis of thromboembolic disease.

CT venography vs ultrasound in the diagnosis of thromboembolic disease in patients with clinical suspicion of pulmonary embolism

To assess the reliability of indirect computed tomography venography (CTV) in the detection of deep venous thrombosis (DVT) in patients with clinical suspicion of pulmonary embolism (PE). 235 consecutive patients with suspicion of PE underwent an imaging protocol composed of a CT pulmonary angiography (CTPA), a CTV and an ultrasound study of the deep venous system, which was considered the "gold standard." Sensitivity, specificity, and predictive values were calculated for CTV. ith CTV, 30 (12.8%) cases of DVT were detected, 9 (3.8%) of them without pulmonary embolism in CTPA, increasing the diagnosis of thromboembolic disease in 3.8%. However, six of these nine diagnoses were false positives, and CTV missed six cases of DVT. CTV rendered a sensitivity of 58.8%, specificity of 95.0%, a positive predictive value of 66.7%, and a negative predictive value of 93.2%. In patients with clinical suspicion of pulmonary embolism, ultrasound is preferred to CTV for the detection of DVT.

D-dimers in the diagnosis of thromboembolic disease and DIC

D-dimers in the diagnosis of thromboembolic disease and DIC

Critical care of spinal cord injury.

Review article. To review the pathophysiology and management of the pulmonary and hemodynamic derangements that occur after acute spinal cord injury. Acute spinal cord injury is often associated with alterations in pulmonary and cardiovascular function that require treatment in the intensive care unit. Review of published reports. Careful attention to the support of the pulmonary and cardiovascular systems can reduce the morbidity associated with acute spinal cord injury. Pulmonary function decreases markedly in the immediate postinjury period but improves in the subsequent weeks, allowing most patients with injury levels at C4 and below to be weaned from ventilatory support. Bradycardia and hypotension often accompany acute spinal cord injury, and management strategies are reviewed. The prophylaxis and diagnosis of thromboembolic disease are reviewed.

Evaluation of a disease management plan for prevention and diagnosis of thromboembolic disease in major trauma patients

Purpose Evaluate the effectiveness of our program of thromboembolic disease (TED) prophylaxis. Methods Multisystem trauma patients with closed head injury, spinal cord injury, and/or long bone/pelvic fractures severe enough to require inpatient rehabilitation are at high risk for TED: deep venous thrombosis (DVT) and pulmonary embolism (PE). A retrospective analysis of 262 such trauma patients, from September 1995 through July 1997, was performed to evaluate the effectiveness of our program of TED prophylaxis. Mechanical compression devices (CDs) and/or anticoagulation treatment were the primary methods of prophylaxis. If clinical suspicion of TED was present, duplex ultrasound (DU) was used. Otherwise, patients were screened once by DU before transfer to a rehabilitation facility. Results There was 99% compliance with prophylaxis use. One hundred one patients died of injuries less than 48 hours after admission. Forty-four patients died in the hospital more than 48 hours after admission; 4 (9%) had TED manifest as DVTs (3 patients; 66% at the level of the popliteal or above) and PE (1 patient; 2%). One hundred seventeen patients survived and were transferred to rehabilitation facilities. Fourteen of these (12%) had TED manifest as DVTs (13 patients; 71% at the level of the popliteal or above) before transfer and PE (1 patient; 1%). Three patients developed DVTs without PEs during 2-month follow-up in rehabilitation. Of the 14 patients who developed TED, 7 had prophylaxis with CDs alone and 5 had CDs plus heparin, aspirin, or caval filter (CD+), an incidence of 11%. Increased injury severity score and increased length of stay were associated with development of TED (p < 0.05). Forty-two percent of patients with TED were suspected on the basis of clinical examination and confirmed by DU; 9 of 105 (8.5%) were found exclusively by the single DU screening of clinically negative lower extremities. Conclusions The compliance rate for TED prophylaxis in these severely injured trauma patients was high. An 11% incidence of TED was found in this population; 4 of 160 patients (2.5%) died with or from TED. Compression devices alone or CD+ offered equal prophylaxis. Single DU screening of clinically negative lower extremities demonstrated an 8.6% incidence of TED; clinical suspicion of TED as an indication for DU screening increased positive findings to 42%.

Diagnosis of thromboembolic disease during infancy and childhood.

Thromboembolic disorders are frequent complications in pediatric patients and the incidence seems to rise. Adult guidelines for thromboembolism do not hold for children because there are many age-related features. Congenital prethrombotic disorders play a major role in the pediatric population and activated protein C (APC) resistance is also the most frequently encountered problem. Acquired risk factors in children are central venous line thrombosis with serious complications, cardiac diseases such as cardiomyopathies, prosthetic heart valves and aneurysms, renal vein thrombosis, and nephrotic syndrome. Renal vein thrombosis primarily affects newborns. Children with the antiphospholipid antibody syndrome also have thromboses although less frequent than adults, but systemic lupus erythematosus is associated with a high incidence. Acute lymphoblastic leukemia is frequently associated with thrombosis in children, especially when complicated by APC resistance. The greatest risk of thrombosis in children is during the neonatal period, and again congenital prethrombotic states and catheter placement play a major role. The clinical manifestations in children reflect the site of the thrombosis and extensive laboratory evaluations and advanced diagnostic procedures must be employed to diagnose the thrombotic events.

D-dimer in the early diagnosis of thromboembolic disease in acute spinal injuries.

The role of monitoring plasma levels of D-dimer (XDP) as a diagnostic aid for thromboembolic disease was investigated in 267 patients admitted for acute care to the Prince Henry Hospital Spinal Unit. Elevated plasma XDP levels were found in 103 patients (39%) and a diagnosis of thromboembolic disease was made in 33. Thromboembolic disease was not found in patients whose XDP levels remained normal.

Diagnosis of thromboembolic disease

Diagnosis of thromboembolic disease

Heparin requirements in pulmonary embolism and venous thrombosis: a prospective study.

To investigate the relationship between the clinical diagnosis of thromboembolic disease and heparin requirements for anticoagulation, we prospectively studied 31 patients suspected to have either deep vein thrombosis or pulmonary embolism. Six had the diagnosis of pulmonary embolism confirmed by a combination of ventilation and perfusion scans with pulmonary angiography, eight had venograms showing deep vein thrombosis, seven had diseases which mimicked pulmonary embolism, and ten had normal venograms. These four diagnostic groups were not significantly different with respect to heparin requirements during the first 24 hours of therapy (mean +/- S.D. = 426 +/- 105, 507 +/- 105, 434 +/-79, and 457 +/- 46 units/kg per 24 hours, respectively). Patients with pulmonary embolism and deep vein thrombosis did not differ significantly with respect to heparin requirements (UNITS/kg per 24 hours) on the second (386 +/- 108 vs. 439 +/- 127), third (415 +/- 136 vs. 464 +/- 130), and fourth (374 +/- 104 vs. 418 +/- 127) days of therapy. Our data suggest that the clinical diagnosis does not affect the dose of heparin necessary to anticoagulate patients with pulmonary embolism and deep vein thrombosis.

Current Research on the Diagnosis of Thrombo-Embolic Disease

Current Research on the Diagnosis of Thrombo-Embolic Disease

Investigation of Relation between Use of Oral Contraceptives and Thromboembolic Disease. A Further Report

The results of a previous study of the use of oral contraceptives by married women discharged from hospital with a diagnosis of thromboembolic disease in the years 1964-6 were reported by us last year. The present paper adds results relating to patients discharged during 1967 and a few data, that could not be sought previously, for patients discharged with cerebral or coronary thrombosis from three of the hospitals in the earlier period.Of 84 patients with deep-vein thrombosis or pulmonary embolism 42 (50%) had used oral contraceptives during the month preceding the onset of their illness, while only 23 of the 168 controls (14%) had done so. No differences in risk were found either for the types of preparation or for the duration of use. After allowance for age and height, the patients with venous thromboembolism were about 10 lb. (4,535 g.) heavier than the control patients, irrespective of whether they were using oral contraceptives or not. No appreciable difference was found between the smoking habits of patients with and without venous thromboembolism treated during 1967, nor between women who were using oral contraceptives and those who were not. The trend in hospital admissions for venous thromboembolism with time corresponded to the trend in the use of oral contraceptives, and there was no evidence to suggest that the number of admissions was affected by publicity about the risk of using the preparations. Of 19 patients with cerebral thrombosis 11 (58%) had been using oral contraceptives, compared with an expected figure of 3.5 from the experience of the control subjects. All the published data (clinical, angiographic, and post-mortem) show that the thrombosis affects the cerebral arteries rather than the cerebral veins. Of 17 patients with coronary thrombosis 2 (12%) had been using oral contraceptives, compared with an expected figure of 2.1. The patients with coronary thrombosis smoked more than the control patients and were, on average, 8.3 lb. (3,765 g.) heavier than control women of the same age and height.The new evidence strengthens the belief that oral contraceptives are a cause of venous thromboembolism and cerebral thrombosis but does not indicate that they are a cause of coronary thrombosis.

Thromboembolic disorders and oral contraceptives.

To the Editor:— An important point on possible relationships between thromboembolic disorders and oral contraceptive agents which was not sufficiently emphasized by your recent correspondents 1-4 is that the diagnosis of thromboembolic disease is often difficult. In the study of Freiman et al, 5 old or recent thromboemboli were found in 64% (39) of the cases in a series of 61 consecutive adult autopsies. This work shows clearly that only a very small fraction of patients with pulmonary emboli present with clinical manifestations, and while the majority of embolizations are probably of no clinical significance, many of the more severe episodes are overlooked. More recently Morrell and Dunhill 6 reported finding pulmonary emboli in 52% of 263 autopsy cases after methodical examination of one lung from each patient; the other lung was examined in the routine autopsy manner and pulmonary emboli were found in only 12%. In other words, the