Subcutaneous calcium heparin versus intravenous sodium heparin in treatment of established acute deep vein thrombosis of the legs: a multicentre prospective randomised trial.Anticoagulant properties of bovine plasma protein C following activation by thrombin.Levine MN, Hirsh J, Gent M, Turpie AGG, Weitz J, Ginsberg J, Geerts W, Leclerc J, Neemeh J, Powers P, Piovella F.These patients can be treated with subcutaneous heparin long term, but this is inconvenient and carries a risk of osteoporosis.
However, this view may not be correct during the induction phase of warfarin therapy.Deep vein thrombosis (throm-BO-sis), or DVT, is a blood clot that forms in a vein deep in the body.Connolly SJ, Laupacis A, Gent M, Roberts RS, Cairns JA, Joyner C.Implications of preoperative administration of aspirin in patients undergoing coronary artery bypass grafting: Department of Veterans Affairs Cooperative Study on Antiplatelet Therapy.These patients often have fleeting attacks of sharp chest pain that last for seconds or a feeling that they cannot take a deep breath.Because the side effects of interferon are usually manageable and transitory, and because injections may be decreased from three times weekly to once weekly, this cytokine should be considered for some patients.Long-term venous access through a central venous catheter is required for treatment of long-term disorders requiring chemotherapy, antibiotics, or hyperalimentation.
Prolonged activated partial thromboplastin time of unknown etiology: a prospective study of 100 consecutive cases referred for consultation.Boehringer Ingelheim has developed a non-vitamin K antagonist oral anticoagulant (NOAC) as a prevention treatment for DVT and PE.The diagnosis of VTE during pregnancy is difficult because leg pain and swelling are frequent and usually not due to DVT, 231 and performance of radiological procedures is a problem because of the fear of exposing the fetus to radiation.If bleeding is potentially life-threatening (eg, intracerebral, intraspinal, retroperitoneal, or severe gastrointestinal), heparin should be stopped and the anticoagulant effect reversed with protamine sulfate.Stroke Prevention in Atrial Fibrillation Study: final results.
The diagnosis of DVT or PE requires special tests that can only be performed by a doctor.This laboratory finding was confirmed by other investigators, who reported that between 20% and 60% of patients with recurrent thrombosis had APC resistance. 398 399 400 View this table: View inline.
If the INR is above the therapeutic range, treatment can be discontinued until bleeding has stopped and then reintroduced cautiously at a lower intensity.Thereafter, the incidence of postthrombotic syndrome rose very gradually to 28.0% after 5 years and 29.1% at 8 years.Powers PJ, Gent M, Jay RM, Julian DH, Turpie AGG, Levine M, Hirsh J.Warfarin embryopathy has not been reported with warfarin exposure outside this time period.Visualization of the proximal portion of calf veins can often be achieved by experienced operators, 95 but resolution can be suboptimal, and the sensitivity and specificity of venous ultrasonography is much lower for calf vein thrombosis than for proximal vein thrombosis.Thrombogenic properties of blood during early ischemic and nonischemic injury.
Probabilities of Pulmonary Embolism Based on a Combination of Clinical Impression and Lung Scan Findings.Resolution of acute symptoms can usually be obtained with either anticoagulant or lytic agents. 145 146 147 Anticoagulant therapy is not usually associated with anatomic resolution of the thrombus and clinical improvement because collaterals develop and bypass the obstruction.Hull RD, Carter CJ, Jay RM, Ockelford PA, Hirsh J, Turpie AGG, Zielinsky A, Gent M, Powers PJ.Heparin-associated thrombocytopenia: a prospective comparison of bovine lung heparin, manufactured by a new process, and porcine intestinal heparin.The weight-based heparin dosing nomogram compared with a standard care nomogram: a randomized controlled trial.Detection of deep-vein thrombosis by real-time B-mode ultrasonography.Protamine sulfate can produce a hypotensive response if given rapidly, so the dose should be injected slowly over a 20-minute period. 277 278 279 Some patients may also develop a hypersensitivity reaction to protamine sulfate.In patients with polycythemia vera, the hematocrit and platelet count should be controlled with appropriate therapy.
An INR of 3.0 to 4.0 has been recommended for patients with antiphospholipid antibodies, 171 172 173 although there is some disagreement on this issue. 174.Kelton JG, Sheridan D, Santos A, Smith J, Steeves K, Smith C, Brown C, Murphy WG.Some of these features also occur in patients with acute myocardial infarction, a fulminating pneumonia, dissecting aortic aneurysm, pericardial tamponade, a massive hidden bleed, or septic shock.The most accurate ultrasonic criterion for diagnosing venous thrombosis is noncompressibility of the venous lumen under gentle probe pressure. 77 99 Vein compressibility is best evaluated in the transverse plane.Hydroxyurea for patients with essential thrombocythemia and a high risk of thrombosis.Local infusion of urokinase for the lysis of thrombosis associated with permanent central venous catheters in cancer patients.
At present, however, there is insufficient evidence to support lifelong treatment for all patients with idiopathic thrombosis.PUTTING PATIENTS FIRST National Health Council Standards of Excellence Certification Program.
Patients with venous thromboembolic disease (VTE) are seen by a variety of medical specialists, including general physicians, surgeons, obstetricians, hematologists, radiologists, and chest physicians.In the absence of prophylaxis, the frequency of postoperative fatal PE ranges from 0.1% to 0.8% in patients undergoing elective general surgery, 0.3% to 1.7% in patients undergoing elective hip surgery, and 4% to 7% in patients undergoing emergency hip surgery. 60 Safe and effective forms of prophylaxis are available for patients at high risk, and primary prophylaxis is cost-effective. 61.In addition, nearly one-third of people who have a DVT will have long-term complications caused by the damage the clot does to the valves in the vein called post-thrombotic syndrome (PTS).
Fatal pulmonary embolism following removal of a central venous catheter.Mobin-Uddin K, Callard GM, Bolooki H, Rubinson R, Michie D, Jude JR.When administered to the nursing mother, warfarin is safe for the breastfed infant. 239 240.Two types of patient groups have the potential to benefit from thrombolytic therapy: those with major PE and selected patients with major venous thrombosis.Subclavian-axillary vein thrombosis: successful treatment with streptokinase.Case records of the Massachusetts General Hospital—weekly clinicopathological exercises: case 11-1990, a 38-year-old woman with fever, skin lesions, thrombocytopenia, and venous thromboses.If adjusted-dose heparin is being administered at term, some pregnant patients can have a prolonged aPTT for as long as 20 hours after their last dose of subcutaneous heparin. 237 To overcome the potential risk of a long aPTT at delivery, elective induction can be planned and heparin therapy discontinued 24 hours before induction.Deep vein thrombosis (DVT) or blood clot in the leg symptoms include swelling, warmth, redness, and pain in the leg with the blood clot.
Management of clinically suspected deep vein thrombosis with venous ultrasonography at presentation and on day 7.Coumarin is usually not effective. 448 449 Heparin often controls the thromboembolic manifestations and can be given long term on an outpatient basis in full therapeutic doses. 448.Protamine-induced fatal anaphylaxis: prevalence of antiprotamine immunoglobulin E antibody.Colour Doppler ultrasound in deep venous thrombosis: a comparison with venography.
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