Vein Thrombosis Of Lower Extremity Research Articles

Clinical study for preoperative traction on impact of osteonecrosis of femoral head in patients with femoral neck fractures

To explore the impact of preoperative traction on the osteonecrosis of the femoral head (ONFH) in patients with femoral neck fractures. Between February 2013 and May 2016, 120 patients with femoral neck fractures, who were treated with screw fixation, were collected. Sixty patients with fractures of Garden type Ⅰ and Ⅱ were non-displaced fracture group; 60 cases with fractures of Garden type Ⅲ and Ⅳ were displaced fracture group. The patients in 2 groups were randomly divided into traction and non-traction subgroups ( n=30). There was no significant difference in gender, age, injury mechanism, damage side, the time from injury to operation, and fracture classification between 2 subgroups ( P>0.05). Intracapsular pressure was recorded before operation. The quality of fracture reduction and the satisfaction ratio of screw implant were evaluated during operation. Visual analogue scale (VAS), Harris score, joint mobility, and the incidence of ONFH would be evaluated at 6 months, 1 year, and 2 years after operation. All incisions of 2 groups healed by first intention after operation. There was no infection or deep vein thrombosis of lower extremity. All patients were followed up 2 years. In displaced and non-displaced fracture groups, the intracapsular pressure of traction subgroups were higher than that of non-traction group ( P<0.05); the differences of the quality of fracture reduction and the satisfaction ratio of screw implant were not significant ( P>0.05) between 2 subgroups. At 6 months, 1 year, and 2 years after operation, VAS scores were higher in traction subgroup than in non-traction subgroup ( P<0.05); and the joint mobility and Harris scores were lower in traction subgroup than in non-traction subgroup ( P<0.05). X-ray films showed all fractures healed. Except for the non-displaced group at 6 months, the incidences of ONFH were higher in traction subgroup than in non-traction subgroup at other time points ( P< 0.05). Preoperative traction may increase the risk of ONFH, which can increase the intracapsular pressure and affect the blood supply of femoral head.

Treatment of cancer-associated thrombosis after craniotomy.

e13510 Background: The high rates of mortality from venous thromboembolism (VTE) in neurooncological patients determine the relevance of the topic. The risk of VTE in patients with glioma reaches 36% during the treatment period, 16.1% during the first 6 months and increases by 3 times after tumor biopsy. The aim of this study was to evaluate the efficacy and safety of VTE treatment with fondaparinux after surgical interventions for brain tumors. Methods: The study included 32 cancer patients aged from 27 to 76 years (mean 56.5 years) in the acute period of VTE, the first month after craniotomy. Creatinine clearance below 30 ml/min, active bleeding, thrombocytopenia below 50x109/l were exclusion criteria. Glioma was diagnosed in 15 patients (46.9%), metastasis - 9 (28.1%), and meningioma - 8 patients (25%). Radical interventions were performed in 12 (37.5%) cases, palliative - 20 (62.5%). In 81.2% of cases (26 patients) deep vein thrombosis of lower extremities (DVT) was detected, 3 patients (9.4%) had combination with pulmonary embolism. VTE developed in the postoperative period with radiotherapy in 9 cases (32%), dexamethasone - 13 (40.6%). Surgical treatment of DVT was performed in 8 patients (thrombectomy, plication of the femoral vein). Segmental deep vein thrombosis of the lower leg was detected in 14 (43.8%) cases. Results: The efficiency of anticoagulant therapy was assessed by a decrease of thrombinemia markers (fibrinogen, SFMC and D-dimer). After a week of anticoagulant therapy, a significant reduction in the level of D-dimer was observed. However, the decline in fibrinogen and SFMC was statistically insignificant. VTE therapy was performed with fondaparinux in a therapeutic dose from 10 days to 1 month, followed by a transition to oral anticoagulants. There was no hospital mortality. Hematuria developed in one case (3.1%), and was managed conservatively. There were no hemorrhagic complications in the operative intervention zone. Two patients (6.25%) had a recurrence of VTE during the period of radiation therapy. Conclusions: An integrated approach to the treatment of VTE in patients undergoing craniotomy provides a low incidence of recurrent VTE and major bleeding.

Short term effect of total hip arthroplasty through direct anterior approach for the treatment of ankylosing spondylitis with hip flexion deformity

To investigate the short term clinical efficacy of direct anterior approach(DAA) total hip arthroplasty for the treatment of ankylosing spondylitis with hip flexion deformity. From September 2014 to June 2017, 15 cases of ankylosing spondylitis with flexion deformity of the hip were treated with total hip arthroplasty through DAA approach including 12 males(17 hips) and 3 females(4 hips) with an average age of 34.4 years old ranging from 21 to 57 years old. Harris score system was used before and after operation to evaluate hip function, total hip activity and visual analogue scale (VAS) were used to evaluate the clinical efficacy. All 15 patients were followed up for an average of 26.2 months. In the operation, 1 case of great trochanter avulsion was given wire binding, and 1 case of linear split of the femur were given by wire binding. There were no hematoma, nerve injury and deep vein thrombosis of lower extremity. No prosthesis loosening and sinking were observed in the follow-up of X-ray film after operation. There was no heterotopic ossification after operation. After operation, 18 hips pain were relieved completely, and 3 hips pain were found when walking, which all satisfied with the daily life self-care requirements. Harris hip score, total hip motion and VAS score at 1 week after operation were significantly different from those before operation(P<0.05). There was no significant difference in the scores of HHS, total hip motion and VAS at 1, 6 months after operation(P>0.05). At the final follow-up, the Harris score was 91.2±5.3, the total hip mobility was (217.1±29.7)°, and the postoperative VAS pain score was 1.2±0.5, which was significantly different from the preoperative score(P<0.05). DAA approach THA has good effect in treating AS hip nonfunctional ankylosis with less trauma, less pain and quick recovery. It has a good short term effect, which can effectively improve the quality of life of patients.

Lower extremity vein thrombosis in obstetric practice

Lower extremity vein thrombosis in obstetric practice

CN48 - Peripherally inserted central venous catheters did not increase the risk of deep venous thrombosis in advanced colorectal cancer and lung cancer patients with bevacizumab

Background: Deep Venous thrombosis (DVT) is one of the serious adverse events associated of bevacizumab, which is also one of the most notable complications associated with peripherally inserted central catheters (PICCs). However, there was no report about their correlation directly. The purpose of this study was to explore whether the use of PICCs increases the risk of DVT in advanced colorectal cancer and lung cancer patients with bevacizumab. Methods: From June 2011 to April 2017, patients with documented advanced colorectal cancer and lung cancer who received bevacizumab were selected from West China hospital log-out registries. The patients inserted with central venous catheters (CVCs) or ever had thrombosis were excluded. According to whether use PICCs or not, patients were divided into two groups. The incidence of DVT during the use of bevacizumab between two groups was compared. Many risk factors were also analyzed. Results: A total of 217 patients received bevacizumab were included in this analysis. 186 patients were colorectal cancer, 31 were lung cancer. Among them, 137 patients were inserted with PICCs and 80 patients were not. 5.1% (11/217) patients had DVT during the use of bevacizumab. 4 cases had upper extremity vein thrombosis, 1 had subclavian vein hrombosis and others were lower extremity vein thrombosis. Single factor analysis revealed that patients inserted with PICCs were more likely to have DVT than others (6.6% vs. 2.5%, P = 0.318), but it had no statistical difference. The incidence of DVT was higher in patients with diabetes mellitus (DM) than non-(DM) (21.1% vs. 3.5%, P < 0.05). Logistic analysis revealed that the use of PICCs had no statistical significance for the occurrence of the DVT. However, diabetes was a risk factor for DVT in advanced colorectal cancer and lung cancer patients with bevacizumab. Conclusions: Peripherally inserted central venous catheters did not increase the risk of DVT in advanced colorectal cancer and lung cancer patients with bevacizumab. The patients with diabetes mellitus may be prone to develop DVT, whom we should manage more carefully during the use of bevacizumab. Legal entity responsible for the study: Meng Qiu. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Скрининговый тест выявления тромбоза глубоких вен и тромбоэмболии легочной артерии

Введение. Учитывая распространенность тромбозов, а каждый год в большинстве стран тромбоз глубоких вен (ТВГ) или тромбоэмболия легочной артерии (ТЭЛА) развивается у 80–120 человек на 100 тысяч населения, актуальным является использование скрининговых параметров гемостаза и оценка предрасположенности к тромбозам. Важным лабораторным маркером тромбоза и тромбоэмболии является Д-димер. Представляет интерес сравнение тестов различной чувствительности, имеющих признанное клиническое применение, для принятия решения о возможности их использования в ходе амбулаторного скрининга пациентов. Материалы и методы. Исследованы цитратные пробы крови 101 пациента (средний возраст — 41 ± 9,1 лет), среди которых были сформированы 3 группы: 69 человек, проходивших диспансерное обследование; 8 пациентов отделения интенсивной терапии; 24 пациента с подтвержденным сердечно-сосудистым заболеванием. Исследование содержания Д-димера в пробах цитратной плазмы выполняли одномоментно 2 методами: иммунотурбодиметрическим (ИТД) и иммунохемилюминесцентным (ИХЛ). Результаты. Получены результаты сравнения 2 методов исследования Д-димера. Коэффициент корреляции в разных группах пациентов составил 0,74–0,99 в зависимости от патологии, что свидетельствует о высокой степени соответствия результатов измерения Д-димера и возможности применения как метода ИТД, так и метода ИХЛ в скрининге пациентов с целью исключения ТВГ и ТЭЛА. Заключение. Проведенные исследования позволяют рассматривать метод ИХЛ для исследования содержания Д-димера на анализаторе Immulite 2000 XPi как скрининговый для амбулаторного догоспитального обследования пациентов. Introduction. Every year in most countries deep vein thrombosis (DVT) or pulmonary embolism (PE) develops in 80–120 people per 100 thousand population so screening of hemostatic parameters and assessment of predisposition to thrombosis is very actual problem. D-dimer is the important laboratory marker of thrombosis and thromboembolism. It is of interest to compare common clinical tests with diff erent sensitivities to determine whether they can be used during outpatient screening. Materials and methods. We examined citrate blood samples of 101 patients (mean age — 41 ± 9.1 years) who were divided into 3 groups: 69 persons passed the outpatient examination; 8 patients were in intensive care unit; 24 patients had confirmed cardiovascular disease. Measurement of D-dimer content in citrate plasma samples was carried out simultaneously by 2 methods: immunoturbodimetry (ITD) and immunochemiluminescence (IСL). Results. We obtained the results of D-dimer levels that were measured by 2 methods and calculated their relationships. The correlation coeffi cient in diff erent patient groups was 0.74–0.99 depending on their pathology. This fact shows a high degree of compliance of D-dimer results and the possibility of using both methods (ITD and IСL) in screening patients for excluding DVT and PE. Conclusion. Our researches allow to consider the IСL method for studying D-dimer content by Immulite 2000 XPi analyzer as a screening method for outpatient pre-hospital examination.

Risk factors for deep vein thrombosis of lower extremities in Sudanese women.

AimIn this study, we aimed to analyze the genetic and acquired risk factors for deep vein thrombosis (DVT) of the lower extremities among Sudanese women.MethodsA total of 136 women were enrolled in the study, including 75 DVT patients and 61 healthy controls. Demographic and clinical data were collected using a specific questionnaire. Citrated blood samples of patients and controls were used for coagulation assays, and DNAs isolated from EDTA-blood samples were used for the detection of Factor V Leiden and prothrombin G20210A mutations using multiplex polymerase chain reaction-restriction fragment length polymorphism analysis.ResultsBoth gene mutations were found to be absent from all 136 subjects, and therefore did not account for the incidence of DVT in Sudanese women. Of the 75 DVTs, 70 (93.3%) were localized in the left leg and 5 (6.7%) in the right leg. Additionally, 84% of the DVTs were proximal and 16% were distal. Among the 75 patients, 22 (29.33%) were postpartum, 7 (9.33%) were pregnant, and 46 (61.33%) were nonpregnant. Levels of prothrombin fragment 1+2, prothrombin time, activated partial thromboplastin time, and D-dimer were significantly higher in DVT patients than in healthy controls (P<0.0001).ConclusionRisk factors that most significantly affected patients in the 18–45 years age group were pregnancy and oral contraceptive usage, whereas those that most significantly affected patients in the 66–90 years age group were immobility, heart disease, and history of DVT.

Effects of comprehensive protective nursing measures in prevention of deep vein thrombosis in lower extremity after breast cancer surgery

目的 观察综合防护措施预防乳腺癌手术后下肢深静脉血栓的临床效果。 方法 回顾性选取2015年1月至2016年9月接受乳腺癌手术患者90例作为对照组，选择2016年10月至2017年10月医院进行JCI认证准备及通过认证后这段时间接受乳腺癌手术患者90例作为观察组，对照组给予常规护理，观察组采取为创建JCI制定的更全面的综合护理模式，对比两组护理效果。 结果 观察组发生下肢深静脉血栓1例，下肢酸痛1例，皮温升高1例，下肢水肿0例；对照组发生下肢深静脉血栓7例，下肢酸痛8例，皮温升高7例，下肢水肿6例，组间差异有统计学意义(χ2＝4.709、5.731、5.328、6.397，均P<0.05)。察组手术后髌下10 cm肢体周径(33.02±1.97)cm，髌下10 cm肢体体表温度(33.54±0.48)℃；对照组手术后髌下10 cm肢体周径(35.87±2.58)cm，髌下10 cm肢体体表温度(35.94±1.05)℃，组间对比差异有统计学意义(t＝8.329、19.721，均P<0.05)。观察组手术后焦虑自评量表评分(43.12±2.05)分，抑郁自评量表评分(45.27±2.26)分；对照组手术后焦虑自评量表评分(49.03±3.23)分，抑郁自评量表评分(51.15±4.03)分，组间对比差异有统计学意义(t＝14.655、12.073，均P<0.05)。 结论 综合防护措施在乳腺癌手术中可以预防下肢深静脉血栓发生，减轻患者负性心理压力，有助于患者术后康复，值得在临床推广应用。

Predictive value of platelet aggregation rate in postpartum deep venous thrombosis and its possible mechanism.

The present study investigated the predictive value of the platelet aggregation rate in postpartum deep venous thrombosis and its possible mechanism. From January 2014 to January 2016, 23 patients with postpartum deep vein thrombosis of lower extremity treated in the Department of Obstetrics of Beijing Chaoyang Hospital were as assigned as the observation group. At the same time, 25 cases with normal recovery were assigned as the control group. Blood samples were collected from all the subjects. The platelet aggregation rate was measured using a platelet aggregation apparatus. Plasma platelet activating factor (PAF) levels were measured by ELISA. The positive rate of platelet P-selectin (CD62p) and lysosomal membrane glycoprotein (CD63) was measured by flow cytometry. PI3K expression and AKt phosphorylation levels were measured by western blot analysis. The ROC curve was used to evaluate the value of the platelet aggregation rate in predicting postpartum deep vein thrombosis of lower extremity. The correlation between the platelet aggregation rate and PAF and PI3K/AKt expression was also analyzed. The cesarean section rate, platelet 5-min maximum aggregation rate, PAF level and the positive rate of CD62p and CD63 were significantly higher in the control than those in the observation group (P<0.05). Furthermore, the platelet aggregation rate was positively correlated with the expression of PAF, CD62p and CD63 (r=0.389, 0.451, and 0.452; all P<0.05). The platelet 5-min maximum aggregation rate for predicting postpartum deep vein thrombosis of lower extremity was reflected by the area under the ROC curve (AUC=0.797, P=0.000). The PI3Kp110β/β-actin and p-AKt/AKt ratio was significantly higher in the observation compared with the control group (P<0.05). In addition, the platelet aggregation rate was positively correlated with the expression of PI3K and phosphorylation level of AKt (r=0.441, 0.430; all P<0.05). The results suggested that platelet aggregation activity is elevated in postpartum deep vein thrombosis patients. It has a certain predictive value for the occurrence of postpartum deep vein thrombosis of lower extremity. Thuss, the PI3K/AKt signaling pathway may be one of the mechanisms of platelet aggregation.

Value of color Doppler ultrasonography combined with coagulation test in the diagnosis of postpartum thrombosis and the prediction of thrombosis in pregnant women

Objective To evaluate the value of color Doppler ultrasonography combined with coagulation test in the diagnosis of postpartum thrombosis and the prediction of thrombosis in pregnant women. Methods Color Doppler ultrasonography and blood coagulation examination were performed at 1 weeks before and 1 weeks after delivery respectively.Two or more abnormalities in both examinations were defined as positive thrombus combined diagnosis, two ultrasound tests that showedsnowstormsign were cdefined aspositive ultrasonic diagnosis.Thrombus formation in 30d after delivery was followed up.Three-dimensional χ2 test was used to compare the sensitivity and specificity of the combined diagnosis group and the ultrasonic diagnosis group. Results 238 cases were included in the study, including 76 positive cases and 162 negative cases in combined diagnosis group, 103 positive cases and 135 negative cases in ultrasonic diagnosis group.At the end of the follow-up period, there were 28 cases (36.84%) of the deep venous thrombosis of the lower extremities occurred in the combined diagnosis positive group and 21 cases (20.39%) in ultrasound diagnosis positive group.Kaplan-Meier method was used to analyze the lower extremity deep vein thrombosis of the positive subjects in the two diagnostic methods.Log Rank showed that the difference between the two groups was statistically significant (χ2=5.952, P=0.015). The sensitivity and specificity of the combined diagnosis positive group were higher than those of ultrasound diagnosis positive group, the difference was statistically significant(90.32% vs.67.74%; 76.81% vs.60.39%) (χ2=4.00, χ2=22.69, P<0.05). Conclusion Color Doppler ultrasonography combined with blood coagulation function can be used to diagnose prethrombotic state in pregnant women, and have high sensitivity and specificity for predicting deep vein thrombosis of lower extremities in pregnant women. Key words: Lower extremity deep vein thrombosis; Prethrombotic state; Color Doppler ultrasonography; Maternal value

Meta plate and cannulated screw fixation for treatment of type Letenneur III lateral Hoffa fracture through posterolateral approach

To explore clinical effect of meta plate with cannulated screw fixation in treating Letenneur III lateral Hoffa fracture through posterolateral approach. From June 2012 to June 2016, 12 patients with Letenneur III lateral Hoffa fracture were treated with meta plate and cannulated screw fixation through posterolateral approach, including 8 males and 4 females;aged from 22 to 66 years with an average of 42 years old;and 5 cases on left side, 7 cases on right side. Preoperative and postoperative X-ray and CT were taken before and after operation to assess location of fracture and fracture healing. Letenneur scoring standard was used to evaluate clinical effects. All patients were treated with meta plate combined with cannulated screws. All incisions healed at stage I. The fractures were healed from 11 to 32 weeks with an average of 17.2 weeks. No internal fixation loosening, displacement and necrosis of femoral condyle and deep vein thrombosis of lower extremity occurred. All patients were followed up from 8 to 24 months with an average of 12.8 months. At the latest follow-up, 7 cases got excellent results, 4 good and 1 moderate according to Letenneur scoring standard. Posterlateral approach is easy to expose, meta plate fixation with cannulated screws has advantages of strong internal fixation, high fracture healing rate, early knee joint function exercise and good recovery of joint function.

Pathogenesis and prevention of venous and arterial thromboembolic events in patients after deep vein thrombosis of lower extremities

To define the role of thrombophilic and other procoagulant conditions in pathogenesis of deep vein thrombosis and the effectiveness of pathogenetic secondary prevention of venous and arterial thromboembolic events. The study included 107 patients for the period 2007-2016 who were divided into 3 groups. The main group (n=40) - lifelong individual antithrombotic therapy with warfarin predominantly; the second (control) group (n=39) - warfarin administration for 3-6 months; the third (additional) group (n=28) - specific life-long therapy depending on procoagulant status which was assessed according to original scale. The main anticoagulants were rivoroxaban or dabigatran etexilate. Recurrent venous thromboembolic complications (RVTE) were observed in one (2.5%) patient of the first group and in 8 (20.5%) cases of the second group. In the third group RVTE were absent (significant differences, p<0.03 and 0.001, respectively). Arterial thromboembolic diseases were noted in 1 (2.5%) patient of the first group, in 4 (10.25%) cases of the second group and in none of the third group (significantly only for group II vs. group III, p<0.01). Individual antithrombotic therapy reduces the incidence of recurrent venous and arterial thromboembolic events in patients with idiopathic deep vein thrombosis.

Evaluation of anticoagulant therapy after cerebral hemorrhage combined with deep vein thrombosis of lower extremity

Objective To evaluate the efficacy and safety of anticoagulant therapy with low-molecular-weight heparin after cerebral hemorrhage combined with deep vein thrombosis of lower extremity. Methods One hundred and fifty-three cases of deep vein thrombosis of lower extremity after intracerebral hemorrhage were collected of Beijing Tiantan Hospital, Capital Medical University from June 2014 to June 2016. According to whether accepted anticoagulant therapy with low-molecular-weight heparin, the patients were divided into treatment group (n=79) and control group(n=74). Compared the head CT images and the ultrasound of lower extremity venous in the day when admissed to hospital and in the 7th day after treatment. The measurement data was adopted by t test, Chi-square test was adopted in the count data. Results Before the low-molecular-weight heparin therapy, the average bleeding volume in intracerebral was(1.38±0.45) ml for the anticoagulant therapy group. After 7 days of low-molecular-weight heparin therapy, the average bleeding volume in intracerebral was(1.01±0.54) ml, there was no increasing cerebral hemorrhage, with a statistically significant difference(P=0.000). The bleeding volume in intracerebral was(1.47±0.47) ml of control group cases, and after 7 days it became (1.17±0.52) ml, with a statistically significant difference (P=0.000), all these showed that cerebral hemorrhage had significantly absorbed. There was no statistically significant difference between the treatment group and the control group (P=0.123). It explained that anticoagulation was not increased intracranial hemorrhage with low-molecular-weight heparin. ultrasound showed that the lower extremity venous thrombosis was stable or decreased before and after anticoagulant therapy, and the difference was statistically significant (P=0.000), indicating that the anticoagulant therapy was effective. Conclusions It is safe and effective in low-molecular-weight heparin anticoagulant therapy for deep vein thrombosis of lower extremity after intracerebral hemorrhage. But patients need strict screening, and follow the individualized treatment. Key words: Cerebral hemorrhage; Venous thrombosis; Heparin, low-molecular-weight; Anticoagulants

Профилактика тромбоэмболических осложнений у пациентов с геморрагическим инсультом

Введение. Одним из основных клинических факторов риска венозных тромбоэмболических осложнений (ВТЭО), не связанных с травмой и операцией, является инсульт и/или парез нижних конечностей. Однако для пациентов с геморрагическим инсультом до сих пор нет общепринятой эффективной и безопасной схемы профилактики ВТЭО. Цель исследования: оценка эффективности и безопасности профилактики тромбоза глубоких вен нижних конечностей и тромбоэмболии легочной артерии с помощью препарата Флюксум®. Материалы и методы. Обследовано 60 пациентов с геморрагическим инсультом: группа 1 (n = 30) – пациенты получали препарат парнапарин в дозе 0,3 мл подкожно 1 раз в сутки ежедневно, начиная со вторых суток от момента начала заболевания; группа 2 (n = 30) – пациенты получали другие низкомолекулярные гепарины в профилактических дозах также со вторых суток от момента начала геморрагического инсульта (эноксапарин в дозе 0,4 мл 1 раз в сутки, надропарин в дозе 0,3 мл 1 раз в сутки). Результаты. Показано, что у пациентов с геморрагическим инсультом использование нового низкомолекулярного гепарина – парнапарина (Флюксум®, Альфа Вассерманн, Италия) в дозе 0,3 мл подкожно 1 раз в сутки столь же эффективно для профилактики тромбоза глубоких вен, как и терапия другими низкомолекулярными гепаринами, при этом риск развития геморрагических осложнений не увеличивается. Заключение. Применение препарата Флюксум® может быть приемлемой альтернативой использованию других низкомолекулярных гепаринов для профилактики венозных тромбоэмболических осложнений у пациентов с геморрагическим инсультом. Introduction. Stroke and/or paresis of lower extremities are one of the main risks of vvenous thromboembolic complications (VTEC) not associated with trauma and surgery. At the same time, there is still no generally accepted effective and safe scheme of VTEC prophylaxis for patients with hemorrhagic stroke. The aim of study was to evaluate the efficacy and safety of prophylaxis of deep vein thrombosis of lower extremities and pulmonary embolism with drug Fluxum®. Materials and methods. We examined 60 patients with hemorrhagic stroke: group 1 (n = 30) – patients received Parnaparin at dose 0,3 ml subcutaneously once a day, starting from the second day after the disease onset; group 2 (n = 30) – patients received other low molecular weight heparins in prophylactic doses also from the second day after the onset of hemorrhagic stroke (Enoxaparin at dose 0,4 ml once a day, Nadroparin at dose 0,3 ml once a day). Results. It was shown that in patients with hemorrhagic stroke the usage of a new low molecular weight heparin – Parnaparin (Fluxum®, Alfa Wassermann, Italy) at dose of 0,3 ml subcutaneously once a day was equally effective for prophylaxis of deep vein thrombosis as therapy with other low-molecular heparins, and risk of hemorrhagic complications not increased. Conclusion. Fluxum® usage may be an acceptable alternative of other low molecular weight heparins usage for prevention of deep vein thrombosis in patients with hemorrhagic stroke.

Comparison of Wells Score, D–Dimer and Combination of Wells Score and D–Dimer with Venous Duplex Ultrasonography in Diagnosis of Acute Deep Vein Thrombosis in Lower Extremity

Introduction . Diagnosis of acute deep vein thrombosis (DVT) of lower extremity using available diagnostic tools such as venous duplex ultrasonography (VDUS) encountered problems including cost, time consuming and the operator. A simple and practical tool is required. Thus, we run a study aimed to evaluate the efficacy of Wells score, D–Dimer, or combination of both, compared to VDUS in early detection of acute DVT of lower extremity. Method . A diagnostic study was run using cross–sectional design in Department of Surgery enrolling all adult subjects of which suspected to acute DVT of lower extremity managed in period of January 2014 – December 2015 who met the criteria. The diagnosis was confirmed by VDUS. Those data of medical record were analyzed statistically with diagnostic study to find out the sensitivity and specificity. Results . The study enrolled of 85 subjects. The prevalence of acute DVT of lower extremity was 65.88%. Sensitivity and the highest negative predictive value of 100.00% were found in score combination of II and IV. While as the highest specificity of 89.66% and the highest positive predictive value of 92.68% were found in score combination of III. The score with balanced diagnostic value (sensitivity of 87.50% and specificity of 72.41%) was found in Wells score 3 level I. Conclusion. Wells score and VDUS showed comparable efficacy in detection of acute DVT of lower extremity. Thus, a score could be used as a diagnostic tool. Keywords : acute DVT of lower extremity, Wells score, D–Dimer, venous duplex ultrasonography

Applicability of wells' criteria for diagnosis of deep vein thrombosis in lower extremities at Dhulikhel hospital, Kathmandu university hospital

Introduction: Deep vein thrombosis (DVT) is the presence of thrombus in deep venous system, commonly encountered in lower extremities. P. S. Wells was one of the pioneers to diagnose DVT without relying on imaging methods and using the clinical criteria for patient management. Methods: All the patients with clinical suspicion of DVT in lower extremities (new onset edema, pain) visiting the Outpatient Department or Emergency Department of Dhulikhel Hospital between September 2012 and August 2016 were included in the study. The patients were asked/examined for knowing all the points in Wells' criteria. Confirmation of the diagnosis was done by color Doppler ultrasonography on the same day by a radiologist. The patients were categorized into three groups as ≥3 as high probability, 1–2 as moderate probability, and

Study on the dynamic changes of D-dimer during pregnancy and early puerperium

Objective: To explore the dynamic changes of D-dimers during pregnancy and early puerperium(within 3 days postpartum). Methods: A retrospective study was performed among 8 367 healthy women who had term singleton delivery in Women's Hospital, School of Medicine, Zhejiang University from January 2007 to December 2014. D-dimers concentrations during pregnancy and early puerprium of all the cases were collected. Data of 21 065 D-dimers tests were assigned to 5 groups according to the time of sampling, including early pregnancy(≤12 gestation weeks), middle pregnancy(12-28 gestation weeks), late pregnancy(>28 gestation weeks), 1 postpartum(within 48 hours postpartum)and 2 postpartum(48- 72 hours postpartum). The D-dimers concentrations in different groups were compared. The effect of delivery mode on D-dimers of early pureperium was analyzed. The correlation between D-dimers and the thromboembolic disease was also explored. In this study, Student's t-test and Wilcoxon rank sum test were used for statistical analysis. D-dimers concentration ≤0.5 mg/L was used as the normal range. Results: (1)D-dimers concentrations during pregnancy were higher than the non-pregnant women(P<0.01), but there was no statistical difference between early pregnancy and late pregnancy(P=0.820). D-dimers concentration in the 1 postpartum group was higher than that of early pregnancy group or late pregnancy group(P<0.01). But in the 2 postpartum group, it was lower than early pregnancy, late pregnancy and 1 postpartum groups.(2)D-dimers in cesarean section cases was significantly higher than in vaginal delivery cases in each period of pregnancy and early pueprium.(3)The 95%CI of D-dimers in early pregnancy, late pregnancy, 48 hours after vaginal delivery, 48- 72 hours after vaginal delivery, ≤48 hours after cesarean section, 48- 72 hours after cesarean section were 0.58-8.28, 0.47-11.52, 1.04-9.59, 0.87-5.22, 1.07-11.58 and 1.00-6.23 mg/L, respectively.(4)In 6 cases with thromboembolic disease, D-dimers was 6.89- 19.89 mg/L, with the mean value of 13.66 mg/L. It was significantly higher than normal range. In 3 cases, all after cesarean section, with lower extremity vein thrombosis within 48 hours postpartum, the D-dimers concentrations, 9.77, 8.65 and 6.89 mg/L respectively, were in the 95% CI of the study population after cesarean section. Conclusions: D-dimers concentration of 0.5 mg/L is not suitable for venous thromboembolism screening during pregnancy. D-dimers concentration in pregnancy and early puerprium is higher than non-pregnancy. It increases in the very early period postpartum and decreases with time. D-dimers should not be a routine screening test to exclude thromboembolic disease in pregnant women without high risk factors and clinical manifestation of thromboembolic disease.

Abstract PR132

Background & Objectives: It’s known that deep vein thrombosis of lower extremities and pulmonary embolism occupies an important place in the structure of postoperative morbidity and mortality. Materials & Methods: After Ethics approval and informed consent (Research Ethical Board number 3747-Л of Odessa National Medical University on 15 of April 2015), was studied the functional state of hemostasis in a group of 60 healthy volunteers, who were not receiving drugs affecting coagulation. Monitoring of hemostasis was by low-frequency piezoelectric thromboelastography (LPTEG) (fig. 1), platelet aggregation test (PAT), standard coagulation tests (SCT) and thromboelastogram (TEG). Results: It was found that the indexes of LPTEG as the intensity of the contact phase of coagulation (ICC), the time the contact phase of coagulation (t1), and initial rate of aggregation of blood (A0) were correlated with PAT indexes as the spontaneous platelet aggregation and epinephrine-induced platelet aggregation (0.59 – 0.76); the intensity of coagulation drive (ICD) correlate with activated partial thromboplastin time of SCT (0.56) and reaction time to initial fibrin formation of TEG (0.64), maximum density of the clot (MDC) with fibrinogen level of SCT (0.67) and maximal amplitude of TEG (0.86) a constant thrombin activity (CTA) with thrombin time of SCT (0.78) and clotting time of TEG (0.93), and the intensity of the retraction and clot lysis (IRCL) with the total fibrinolytic activity of SCT (0.83) and clot lysis of TEG (0.74). Conclusion: LPTEG allows make the total assessment of all parts hemostasis: from initial viscosity and platelet aggregation to coagulation and lysis of clot, as well as their interaction. We can use the indexes ICC, A0, t1 for control aggregation, ICD, MDC, CTA for control coagulation and IRCL for control fibrinolysis. His figures are objective and informative, as evidenced by close correlation with the performance of traditional coagulation methods. Disclosure of Interest: None declared

Deep Venous Thrombosis Caused by Paroxysmal Nocturnal Hemoglobinuria in a Young Man

Background: Paroxysmal nocturnal hemoglobinuria is a rare acquired autoimmune disease relation to defect of hematopoietic stem, and is often associated with high rate of life-threatening venous thrombosis. Method: Lower extremity vein thrombosis is rarer than cerebral and hepatic veins in terms of thrombosis localization. Patients are exposed to intravascular hemolysis, smooth muscle dystonia, renal failure, arterial and pulmonary hypertension, recurrent infectious diseases and an increased risk of especially terrible thrombotic complications. The diagnosis is made by flow cytometry. Deficiency of the glycophosphatidylinositol - anchored complement regulatory proteins CD55 and CD59 accounts for the intravascular hemolysis that is the primary clinical manifestation of the disease. Besides, paroxysmal nocturnal hemoglobinuria is frequently associated with aplastic anemia or low-risk myelodysplasia and may be asymptomatic. Result: A patient, who developed thrombosis of the bilateral common iliac veins with the diagnosis of paroxysmal nocturnal hemoglobinuria, is described.

Behçet's disease: How to diagnose and treat vascular involvement.

Behçet's disease is a multisystem disorder with unknown etiology and a unique geographic distribution. The disease is characterized by recurrent skin-mucosa lesions and sight-threatening panuveitis. Vascular involvement, which is more common and more severe among males, has also equally characteristic features such as affecting mostly veins, having a significant tendency for thrombosis, and running a relapsing course. Lower extremity vein thrombosis (LEVT) is the most frequent manifestation, followed by vena cava inferior thrombosis. Pulmonary artery involvement (PAI), the most common form of arterial involvement, manifests as aneurysms and "in situ" thrombosis. PAI and Budd-Chiari syndrome are the leading causes of increased mortality. In vascular cluster, typically, several types of venous or arterial vascular involvement may accumulate in the same individual. LEVT or cerebral venous sinus thrombosis is often present in these subgroups as the first event. Immunosuppressive treatment is essential in preventing the attacks and increasing survival.