Diagnostic efficacy of impedance plethysmography for clinically suspected deep-vein thrombosis: a randomized trial.Alpha 2-macroglobulin and antithrombin-heparin cofactor: modulators of hemostatic and inflammatory reactions.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.Central nervous system abnormalities, both hemorrhage and malformations, have been reported after warfarin exposure at any time during pregnancy, but the incidence is very low. 233 236 Therefore, heparin is the anticoagulant of choice for treatment of VTE during pregnancy.The second option is to continue warfarin and perform regular pregnancy tests when conception is attempted.Hunter JA, DeLaria GA, Goldin MD, Serry C, Monson DO, DaValle MJ, Najafi H.Management of clinically suspected acute venous thrombosis in outpatients with serial impedance plethysmography in a community hospital setting.In a report of up to 18 years of experience involving 191 cases, Hunter and associates 198 reported no malfunction of the inflation mechanism and no migration from the site of inflation.Heparin-associated thrombocytopenia: a prospective evaluation of 211 patients.
Hull R, Delmore T, Carter C, Hirsh J, Genton E, Gent M, Turpie AGG, McLoughlin D.Oral anticoagulants can then be started postoperatively in combination with low-dose or full-dose heparin, the choice of heparin regimens depending on the anticipated risk of postoperative bleeding.Find information about deep vein thrombosis and pulmonary embolism including.Anderson DR, Lensing AWA, Wells PS, Levine MN, Weitz JI, Hirsh J.Dedicated to dealing with a challenging disease, previously thought to be incurable, but with the advent of new drugs, now amenable to management and a much improved.
Heparin can inhibit thrombin activity as well as further thrombin generation by modulating positive feedback loops.Thus, large defects are more likely to be caused by PE than small defects, and mismatched defects (abnormal perfusion and normal ventilation) are more likely to be caused by PE than are matched defects. 3 122 123 137 138 139 140 However, these distinctions are not absolute.However, if the INR is markedly prolonged, it is not usually necessary to look for a source of bleeding.Ginsberg JS, Kowalchuk G, Hirsh J, Brill-Edwards P, Burrows R, Coates G, Webber C.Despite receiving a lower dose of heparin, patients randomly assigned to monitoring by heparin level had a low rate of recurrence that was no different than the group randomly assigned to monitoring with aPTT.US Dept of Health, Education, and Welfare Publication NIH 76-866.
A rapid and sensitive test for diagnosing heparin-associated thrombocytopenia.Deep vein thrombosis and pulmonary embolism in two cohorts:.Two options are available when patients receiving long-term anticoagulant therapy decide to conceive.The thrombogenic effect of anticancer drug therapy in women with stage II breast cancer.However, in patients with first-episode typical DVT, without special features of a thrombophilic state, expensive or uncomfortable investigations for malignant disease should not be performed if simple investigations (complete blood count, chest radiograph, and fecal occult blood testing) are negative.Probabilities of Pulmonary Embolism Based on a Combination of Clinical Impression and Lung Scan Findings.
If the perfusion scan is normal, the diagnosis of PE is excluded.The delay in starting warfarin is used to ensure that patients receive an adequate dose of heparin for at least 5 days.
Subcutaneous calcium heparin versus intravenous sodium heparin in treatment of established acute deep vein thrombosis of the legs: a multicentre prospective randomised trial.The macroaggregates are trapped in the pulmonary capillary bed and their distribution, which reflects the distribution of lung blood flow, is recorded with an external photoscanner.Thrombosis in systemic lupus erythematosus: relation to the presence of circulating anticoagulants.Three approaches can be used to treat a thrombophilic patient during pregnancy: Full-dose heparin by subcutaneous injection every 12 hours for the duration of pregnancy.If bleeding occurs when the aPTT response is in the therapeutic range or just beyond the therapeutic range, or if the anticoagulant-associated bleeding is potentially life-threatening, treatment with anticoagulant therapy should be stopped, and an alternative form of treatment should be used to manage the thromboembolic event.Thrombolytic therapy is more effective than heparin in producing rapid lysis of thromboemboli.Pulmonary emboli can also be prevented by inserting a filter into the vena cava, but this approach is used only if anticoagulant therapy is contraindicated because of bleeding or if PE has recurred despite adequate treatment with anticoagulants (see below for definition of adequate anticoagulant 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.Administration of LMWHs in a fixed dose by subcutaneous injection has been compared with administration of dose-adjusted heparin by continuous infusion for treatment of venous thrombosis.If a patient develops local skin reactions at the site of injection, the source of heparin should be changed because local reactions may not occur with a different preparation of heparin, including LMWHs.Asherson RA, Khamashta MA, Ordi-Ros J, Derksen RH, Machin SJB, Barquinero J, Outt HH, Harris EN, Vilardell-Torres M, Hughes GR.The concept of a therapeutic range is based on experimental studies in animals 152 and subgroup analysis of the results of two prospective studies in humans. 41 153 The animal studies demonstrated that prevention of growth of experimental venous thrombi required doses of heparin that prolonged the aPTT to approximately twice that of control subjects.In addition, the patient should undergo chest radiography and electrocardiography.
A total of 355 consecutive patients with a first episode of DVT confirmed by venography were included in the study.
Heijboer H, Jongbloets LMM, Buller HR, Lensing AW, ten Cate JW.LMWHs have recently been approved for use as prophylactic agents in North America.Although a number of tests have been evaluated over the years, only three have been shown to be accurate for diagnosing venous thrombosis in symptomatic patients: venography, 81 82 83 IPG, 3 4 35 77 84 85 86 87 88 89 90 and venous ultrasonography. 77 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105.Ezekowitz MD, Bridgers SL, James KE, Carliner NH, Colling CL, Gornick CC, Krause-Steinrauf H, Kurtzke JF, Nazarian SM, Radford MJ, et al.Fatal pulmonary emboli in hospitalized patients: an autopsy study.
Further clinical investigation is needed before more definitive recommendations can be made.Osteopenia in pregnancy during long-term heparin treatment: a radiological study post partum.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.The frequency of type I heterozygous protein S and protein C deficiency in 141 unrelated young patients with venous thrombosis.Ventilation-perfusion studies in suspected pulmonary embolism.Finally, patients with ongoing risk factors (eg, immobilization in a plaster cast) should be treated until the period of risk is over.