Management Of Thromboembolism Research Articles

Monitoring Heparin Therapy To Manage Thrombotic Disease

The acute and long-term management of deep vein thrombosis and thromboembolism are evolving rapidly. The use of unfractionated heparin and low-molecular-weight heparin in such therapy is the focus of this article. Included are current indications, recommended laboratory monitoring approaches, and the shortcomings of basing such recommendations on studies that do not control variables that affect prolongation of the activated partial thromboplastin time. This article is the third in a four-part continuing education series on hematology. Other articles focus on the antiphospholipid syndromes, oral anticoagulants in thromboembolic disease, and thrombolytic therapy. The exam will appear in the May issue.

Recent developments in the diagnosis, treatment, and prevention of pulmonary embolism.

The diagnosis of pulmonary embolism remains enigmatic. Points to look for are: (1) Ninety percent or more of patients with pulmonary embolism have known predisposing factors. (2) Eighty percent or more complain of dyspnea and exhibit hyperpnea (eg, respiratory rate > 20 breaths per minute). (3) Chest roentgenogram abnormalities occur in more than 80% of patients. (4) Seventy percent to 90% of patients complain of chest pain. (5) Either the pCO2 is low or the alveolar-arterial oxygen gradient is high in more than 95% of cases. (6) Twenty percent of patients have normal pO2. (7) Anxiety is present more often than not, and, if present, is no reason to dismiss the cause as "hyperventilation syndrome." Pulmonary arteriography is the "gold standard" for diagnosis, although the combination of ventilation/perfusion scan and noninvasive leg vein studies may decrease its use. An experimental test, the immunosorbent plasma D-dimer assay, seems a promising future screening tool if its reportedly high sensitivity is confirmed. Transthoracic or esophageal echocardiology, if immediately available, may have a place in assessing patients who present with cardiovascular collapse. Early and adequate heparinization coupled with the use of intravenous heparin protocols should lower future mortality rates. Food and Drug Administration approval of low-molecular-weight heparin and heparinoids may revolutionize the management of routine thromboembolism, as these substances are easier to use and less hazardous. A recent British study showed no advantage to anticoagulation beyond 4 weeks for patients with perioperative thrombophlebitis and no other risk factors. In selected cases, thrombolytic therapy, vena caval filters, and invasive embolectomy have been shown to decrease both short- and long-term mortality.

Antithrombotic Therapy in Patients With Mechanical and Biological Prosthetic Heart Valves

Antithrombotic Therapy in Patients With Mechanical and Biological Prosthetic Heart Valves

Current trends in the management of postsurgical thromboembolism: the role of low molecular weight heparin.

Current trends in the management of postsurgical thromboembolism: the role of low molecular weight heparin.

Thromboembolism and its management in pregnancy

To formulate recommendations for the management of thromboembolism during pregnancy. The English language published literature derived from Medline and covering the following aspects of thromboembolism in pregnancy was reviewed: epidemiology; pathogenesis; clinical features; investigations; the pharmacology of various anticoagulants; management and prophylaxis of deep vein thrombosis and pulmonary embolism; medicolegal aspects. Publications published between 1960 and 1990 were cited. These studies were selected because data appeared reliable and with appropriate conclusions. Many questions are still not completely resolved, but the information gathered should provide firm guidelines to practitioners in the areas of diagnosis, the choice of anticoagulant drugs, methods of administration of the drugs, and measurement of therapeutic endpoints.

Diagnosis and Management of Pulmonary Thromboembolism

Diagnosis and Management of Pulmonary Thromboembolism

Thromboembolism and antithrombotic therapy in peripheral arterial disease

Atherosclerosis complicated by thromboembolism is the main cause of obstructive arterial disease in the legs. Two studies from West Germany suggest that antiplatelet drugs may slow the progress of atherosclerosis in leg arteries and prevent occlusive thrombosis under some circumstances. The same agents may also reduce the risk of rethrombosis after successful vascular repair in the femoropopliteal region; in one trial, aspirin decreased the incidence of reocclusion after thromboendarterectomy and, in another, the combination of aspirin and dipyridamole was effective after bypass with synthetic material. Antithrombotic drugs are used in most centers after percutaneous transluminal angioplasty, but there is no definite evidence for their need. Thus, it appears that in contrast to cardiac and cerebrovascular disease, few efforts have been made to determine the true value of antithrombotic therapy in peripheral arterial disease. The management of acute thromboembolism in the legs requires a multidisciplinary approach. Depending on the type (embolic or thrombotic), length and localization of the arterial occlusion, surgical (embolectomy, thromboendarterectomy, peripheral bypass surgery) or nonsurgical (systemic fibrinolysis or local thrombolytic therapy with or without balloon angioplasty) treatment is preferred. The importance of nonsurgical therapeutic approaches may become even greater in elderly patients with a poor operative risk. This review discusses the available therapeutic modalities in acute and chronic peripheral thromboembolic arterial disease.

Antithrombotic and Fibrinolytic Therapy

Antithrombotic therapy with heparin is effective in reducing the incidence of thromboembolic disease when given prophylactically to high-risk patients. Heparin followed by oral antithrombotic therapy is accepted practice for the management of established thromboembolism. Fibrinolytic therapy has been demonstrated to be effective in recanalization of vessels occluded by thrombus, but is contraindicated if the effect of peripheral embolization from the occlusion is likely to result in severe morbidity. The use of heparin and oral antithrombotic drugs is associated with an increased frequency of bleeding, and requires careful clinical and laboratory control, for which the best methods have not yet been determined. Low-molecular-weight preparations of heparin have been shown to have effectiveness when administered once or twice a day, but not to have less risk for hemorrhage than regular heparin. Fibrinolytic therapy is entering a new phase with the conclusion of clinical trials of the newer agents that are associated with a reduced risk of systemic anticoagulation.

Management of Thromboembolism: Anticoagulants, Thrombolytics, or Surgical Intervention?

It is estimated that acute pulmonary embolism is the sole cause of death in 100,000 patients and a major contributing factor in another 100,000 patients annually, making it the third leading cause of death in the United States. 1 Dalen JE Alpert JS Natural history of pulmonary embolism. Prog Cardiovas Dis. 1975; 17: 259-270 Abstract Full Text PDF PubMed Scopus (956) Google Scholar Since the study of Barritt and Jordan 2 Barritt DW Jordan SC Anticoagulant drugs in the treatment of pulmonary embolism: a controlled trial. Lancet. 1960; 1: 1309-1312 Abstract PubMed Scopus (1095) Google Scholar in 1960 demonstrated that therapy significantly improves survival in this disorder, it is generally acknowledged that all patients with documented thromboembolic disease should be treated. However, the optimal form of therapy for an individual patient is still controversial.

Management of Thromboembolism in Pregnancy

Management of Thromboembolism in Pregnancy

Experience with the management of thromboembolism in patients with spinal cord injury: Part I. Incidence, diagnosis and role of some risk factors.

Fifty acute SCI patients are reviewed retrospectively for incidence of deep vein thrombosis and pulmonary embolism and the problems encountered in the diagnosis. The possible role of some risk factors in triggering thromboembolism and the consequent implications in anticoagulant therapy are discussed.

Diagnosis, Prevention and Management of Thromboembolism

Diagnosis, Prevention and Management of Thromboembolism

Diagnosis, Prevention and Management of Thromboembolism

Diagnosis, Prevention and Management of Thromboembolism

Diagnosis, Prevention and Management of Thromboembolism

Diagnosis, Prevention and Management of Thromboembolism

Diagnosis, Prevention and Management of Thromboembolism

Diagnosis, Prevention and Management of Thromboembolism

Diagnosis, Prevention and Management of Thromboembolism

Diagnosis, Prevention and Management of Thromboembolism

Diagnosis, Prevention and Management of Thromboembolism

Diagnosis, Prevention and Management of Thromboembolism

Venous thrombosis: The problem and its management

1. 1. Venous thrombosis is an ever increasing and progressive pathologic process of intravascular clotting which can best be managed by anticoagulant therapy. 2. 2. Heparin is the anticoagulant of choice for reasons outlined. 3. 3. Vein ligations are neither physiologic nor more efficacious than anticoagulant therapy in the management of thromboembolism, and in necessitating another surgical procedure they often aggravate the pathologic condition. 4. 4. In the absence of an unforseeable panacea for the detection and treatment of the “thrombophiles” there will always be an irreducible minimum of thromboembolic deaths.

An early clinical sign of venous thrombosis.

Venous thrombosis, with its insidious onset and disabling, if not tragic, complications, is receiving more attention than ever by surgeons, internists, and obstetricians. As medical science conquers more and more of the traditional foes of mankind, it becomes only natural that intravascular clotting command and receive more attention. Furthermore, with the ever-increasing elective invasion of heretofore unexplored surgical fields, the problem of postoperative venous thrombosis becomes even greater. Whether or not venous thrombosis is actually on the increase, the medical profession has become more conscious of the problem, so that routine postoperative examination of the lower extremities is a daily function of all surgical residents and surgeons, and should be for obstetricians and internists as well, especially in the elderly bedridden patients. Much of the difficulty in the management of thromboembolism is due to the fact that diagnosis is frequently not established until serious embolic manifestations have arisen. Recently Dr.

Management of Thrombo-Embolism After Aortic Valve Replacement with the Bjork-Shiley Tilting Disc Valve Medicamental Prevention with Dicumarol in Comparison with Dipyridamole - Acetylsalicylic Acid. Surgical Treatment of Prosthetic Thrombosis

Dicumarol anticoagulation proved very effective in the prevention of thromboembolic complications after aortic valve replacement with the Bjork-Shiley tilting disc valve. We have, however, encountered six late deaths because of massive cerebral haemorrhage, which represent 3 % of the patients who were maintained on dicumarol medication at that time. This unacceptable mortality prompted us to introduce two programmes, one without anticoagulation and another one with dipyridamole-acetylsalicylic acid. Furthermore, dicumarol was terminated in patients with haemorrhagic episodes, instable anticoagulation, pregnancy, and in those requiring surgery. The results were disappointing, however, and the majority of the patients involved were therefore put on dicumarol medication.Eleven of the 64 consecutive patients taking dipyridamole - acetylsalicylic acid had thrombo-embolic episodes during a mean follow-up period of 9 months. Without anticoagulation, 3/27 patients were affected during 6 months and 5/32 during 12 ...