Fortnightly review: Prophylaxis of venous thromboembolism

Verstraete, Marc

doi:10.1136/bmj.314.7074.123

Cited by 56 publications

(40 citation statements)

References 22 publications

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“…Clinical data were: symptoms and signs on physical examination, risk factors for thromboembolism accepted by the current literature [12], primary prophylaxis and hemorrhagic side effects of anticoagulant therapy, mean time to the diagnosis as established by performance of a lung scan, and mean time to the start of anticoagulant therapy upon suspicion of PE. We defined major bleeding as: all events causing a fall in the hemoglobin level of at least 2.0 g/dl or the need for a transfusion, all retroperitoneal or intracranial bleedings, and all events that forced permanent discontinuation of treatment.…”

Section: Methodsmentioning

confidence: 99%

“…Therapeutic measures for secondary prophylaxis in surviving patients Number of patients treated with warfarin Number of patients treated with LMWH Number of patients treated with SUH Number of patients treated with caval filters 30 9 7 2 SUH = Subcutaneous unfractioned heparin, 25,000 IU/day with monitoring of the activated partial thromboplastin time; LMWH = low molecular weight heparin, enoxaparin 100 IU/kg/day; IUH = intravenous unfractioned heparin, 5,000 IU bolus plus continuous infusion with monitoring the treatment to maintain the activated partial thromoplastin time at a level of 60-85 s, according to the protocol for dose adjustment of Verstraete [12]. a One case fatal.…”

Section: B3 30mentioning

confidence: 99%

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Pulmonary Embolism in the Elderly: Clinical, Instrumental and Laboratory Aspects

Masotti¹,

Ceccarelli²,

Cappelli³

et al. 2000

Gerontology

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Objective: To focus on diagnostic and therapeutic problems of pulmonary embolism in the elderly. Methods: Retrospective analysis of 5 years of clinical, instrumental, and laboratory data (collected at the time of hospital admission) for patients 65 years and older with pulmonary embolism proven by a high-probability scintigraphic lung scan or necropsy. Sixty-eight patients, 46 females and 22 males, 78.61 ± (SD) 7.71 years old, were enrolled in the study. Results: Dyspnea, chest pain, tachycardia, and tachypnea were the most common symptoms and signs; they were present alone or in combination in all patients. Bed rest over 4 days was found in 65% of the patients and deep vein thrombosis in the leg in 35%. Only 7 patients were on anticoagulant therapy which was likely to reduce the incidence of pulmonary embolism. The mortality was 29.5%. Major bleeding due to anticoagulant therapy was observed in 4.4% of the patients; 1 case was fatal. Sinus tachycardia, ST segment and T wave abnormalities in anterior leads, and incomplete bundle branch block were the most frequent electrocardiographic findings. Chest X-ray was normal in 19.5% of the patients and compatible with pulmonary embolism in 10%. A transthoracic two-dimensional echocardiogram was abnormal in 74% of the cases, with involvement of the right ventricle in the majority of them. Many patients had laboratory parameters within the normal range. The value of the latex agglutination D-dimer assay was less than the cutoff value of 500 µg/l in 16% of the patients. Hypoxemia and a high alveolar-arterial oxygen gradient were the most frequent aspects of the arterial blood gas analysis. Respiratory alkalosis was observed in only one third of the patients. Conclusions: Pulmonary embolism is often underdiagnosed in the elderly. Clinical, instrumental, and laboratory findings are nonspecific. Only acute suspicion can increase the number of diagnoses, reduce the time to diagnosis, and improve the prognosis.

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Section: Methodsmentioning

confidence: 99%

Section: B3 30mentioning

confidence: 99%

Pulmonary Embolism in the Elderly: Clinical, Instrumental and Laboratory Aspects

Masotti¹,

Ceccarelli²,

Cappelli³

et al. 2000

Gerontology

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“…The methodology used in this study has been described elsewhere [7]. It was applied it to a wide range of practice groups in the form of a membership audit with the aim of profiling higher level practice.…”

Section: Methodsmentioning

confidence: 99%

UKCPA Spring Meeting 2006

2008

Pharm World Sci

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IntroductionRestenosis is a major complication following angioplasty particularly post stent insertion. Insertion of a foreign body in the circulation may lead to platelets adhering to it and subsequent activation and aggregation [1]. Aggregation of platelets leads to thrombus formation and re-occlusion of the artery. Rates of restenosis have reduced over time due to a better understanding of restenosis pathophysiology and more aggressive antiplatelet therapy during and following angioplasty [1]. Polymer-based coronary stents eluting sirolimus or paclitaxel (drug eluting stents-DES) substantially reduce the need for repeat percutaneous intervention compared with bare metal stents, and are rapidly replacing traditional bare-metal stents. Although the safety profiles of DES do not seem to differ from bare metal stents in the shortto-medium term, concern has arisen about the potential for late stent thrombosis related to delayed endotheliasation of the stent struts.Reports within the literature have confirmed stent thrombosis angiographically, that have occurred late after elective implantation of DES, and resulted in myocardial infarction [2]. All cases arose soon after antiplatelet therapy was interrupted. Three of these late occlusions happened when antiplatelet therapy was discontinued for noncardiac surgery [2]. Currently aspirin and clopidogrel are the recommended antiplatelet combination. The American guidelines [3] suggest that in patients who have undergone angioplasty, clopidogrel 75 mg daily should be given for at least 3 months after sirolimus stent implantation, and 6 months after paclitaxel stent implantation, and ideally up to 12 months in patients who are not at high risk of bleeding. The case report highlights the importance and ignites the debate on the appropriate duration of clopidogrel in DES.This information also needs to be communicated across the interface (primary and secondary sectors) to ensure continuation of therapy. There have been a number of initiatives aimed at improving communication at interface, but evidence suggests that there is still vast room for improvement [4]. The reasons for this are often multi-factorial such as the tta (to take away) prescription copy sent to GP is not legible or information is never received by the GP. The main stumbling block is the lack of implementation strategies to ensure initiatives demonstrated become routine. Due to the importance of adequate duration of clopidogrel post DES, there is a need for patients to ensure ownership to prevent inappropriate abruption of therapy. This also supports the consumers association report [5] stating that patients would prefer to get information on their illness and treatment from pharmacists and medical practitioners, rather than just from manufacturers' leaflets. ObjectiveThe objective was to develop a card that will ensure the appropriate information was communicated to both the patient and across the interface to primary care, improve the adherence and appropriate continuation of clopidogrel. MethodTogethe...

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“…W dostępnym piśmiennictwie częstość występowania zakrzepicy żył głębokich w otolaryngologii waha się pomiędzy 0,25% a 0,75% [29,92,133,212]. Wśród polskich autorów o zakrzepowym zapaleniu żył głębokich kończyn dolnych piszą Semczuk i wsp.…”

Section: Według Wytycznych Committee On Perioperative Cardiovascular unclassified

Powikłania ogólne operacji nowotworów złośliwych głowy i szyi

Sierszeń¹

2011

Otolaryngologia Polska

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Fortnightly review: Prophylaxis of venous thromboembolism

Cited by 56 publications

References 22 publications

Pulmonary Embolism in the Elderly: Clinical, Instrumental and Laboratory Aspects

Pulmonary Embolism in the Elderly: Clinical, Instrumental and Laboratory Aspects

UKCPA Spring Meeting 2006

Powikłania ogólne operacji nowotworów złośliwych głowy i szyi

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