Bed Rest in Deep Vein Thrombosis and the Incidence of Scintigraphic Pulmonary Embolism

1999 ◽  
Vol 82 (S 01) ◽  
pp. 127-129 ◽  
Author(s):  
Thomas Schwarz ◽  
Joachim Kropp ◽  
Yvette Prescher ◽  
Bettina Beuthien-Baumann ◽  
Werner G. Daniel ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Treatment Group ◽  
Bed Rest ◽  
Compression Therapy ◽  
Control Group ◽  
P Value ◽  
Theoretical Assumption ◽  
Vein Thrombosis ◽  
Deep Vein

SummaryIn several countries of central Europe, patients with acute proximal deep vein thrombosis (DVT) are treated not only by anticoagulation and compression therapy but additionally by strict bed rest for 6-8 days. Until now the theoretical assumption that bed rest substantially reduces the incidence of pulmonary embolism has not been subjected to empirical verification. Patients with acute proximal DVT proven by ultrasonography were randomly assigned to strict bed rest for 8 days (treatment group) or to stay mobilised (control group). In both groups, basic treatment consisted in anticoagulation by subcutaneous low molecular weight heparin/vitamin-K-antagonist and compression therapy. The incidence of pulmonary embolism was assessed by serial ventilation/perfusion SPECT on day 1 and days 8-10. Of the 309 patients with proximal DVT considered for inclusion, 180 were excluded according to the study protocol, and 3 did not give informed consent. One hundred and twenty-six patients were randomly assigned to observe bed rest (n = 62) or to keep mobilised (n = 64). Four patients refused follow-up lung scan.A new lung perfusion defect was detected in 10/59 patients in the treatment group compared to 14/63 patients in the control group (one-sided p-value = 0.25; power 0.8). Bed rest as an additional measure in the treatment of DVT is not able to substantially reduce the incidence of scintigraphically detectable pulmonary embolism. The discomfort and costs associated with the prescription of bed rest in DVT are obviously inappropriate.

scholarly journals The Risk of Subsequent Deep Vein Thrombosis and Pulmonary Embolism in Patients with Nontyphoidal Salmonellosis: A Nationwide Cohort Study

2020 ◽  
Vol 17 (10) ◽  
pp. 3567
Author(s):  
Renin Chang ◽  
Den-Ko Wu ◽  
James Cheng-Chung Wei ◽  
Hei-Tung Yip ◽  
Yao-Min Hung ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Proportional Hazards ◽  
Absolute Risk ◽  
Cox Proportional Hazards ◽  
Control Group ◽  
P Value ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Deep Vein

The purpose of this study was to evaluate the deep vein thrombosis (DVT) and pulmonary embolism (PE) risk among patients with a diagnosis of nontyphoidal salmonellosis (NTS) in an Asian population. The risk was analyzed in a cohort of 17,855 patients newly diagnosed with NTS and 71,420 individuals without NTS using a hospitalization claim dataset. Both groups were matched by age, sex, and index date as an original analysis. A Cox proportional-hazards regression model was applied to estimate the risk of DVT and PE, accounting for any competing event (death). With a follow-up of 4.94 (±3.93) years in the NTS group and 6.30 (±3.67) years in the non-NTS group, the adjusted subhazard ratios (SHRs) of DVT and PE were 1.83 (95% CI 1.44–2.31) and 1.84 (95% CI 1.30–2.60). The NTS group had an increased risk of DVT and PE compared with the control group in all of the age subgroups. Stratified analyses showed that patients aged 18–39 years in the NTS group had significantly higher DVT and PE risks compared with patients of the same age in the non-NTS group (aHR, 5.95; 95% CI, 2.22–15.91 for DVT; aHR 6.72; 95% CI, 2.23–20.30 for PE). The P-value for interaction between age and exposure of NTS is <0.001 for DVT and 0.004 for PE in our sub-group analyses. The findings were cross-validated by a re-analysis with propensity score matching (PSM), and that revealed consistent results. Despite of low absolute risk, clinicians should be aware that patients with an NTS hospitalization history is at increased risk for VTE especially when assessing patients coincident with other VTE risk factors.

scholarly journals Incidence, risk factors and clinical course of pyogenic spondylodiscitis patients with pulmonary embolism

2021 ◽  
Author(s):  
Daniel Dubinski ◽  
Sae-Yeon Won ◽  
Fee Keil ◽  
Bedjan Behmanesh ◽  
Max Dosch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Bed Rest ◽  
Blood Type ◽  
Vein Thrombosis ◽  
Pyogenic Spondylodiscitis ◽  
Increased Risk ◽  
Retrospective Clinical Study ◽  
Deep Vein

Abstract Purpose In patients with pyogenic spondylodiscitis, surgery is considered the treatment of choice to conduct proper debridement, stabilise the spine and avoid extended bed rest, which in turn is a risk factor for complications such as deep vein thrombosis and pulmonary embolism. Methods We conducted a retrospective clinical study with analysis of a group of 99 patients who had undergone treatment for pyogenic discitis at our institution between June 2012 and August 2017. Included parameters were age, sex, disease pattern, the presence of deep vein thrombosis, resuscitation, in-hospital mortality, present anticoagulation, preexisting comorbidities, tobacco abuse, body mass index, microbiological germ detection and laboratory results. Results Among the analysed cohort, 12% of the treated patients for pyogenic spondylodiscitis suffered from a radiologically confirmed pulmonary embolism. Coronary heart disease (p < 0.01), female sex (p < 0.01), anticoagulation at admission (p < 0.01) and non-O blood type (p < 0.001) were associated with development of pulmonary embolism. Pulmonary embolism was significantly associated with resuscitation (p < 0.005) and deep vein thrombosis (p < 0.001). Neurosurgery was not associated with increased risk for pulmonary embolism compared to conservative-treated patients (p > 0.05). Conclusion Surgery for pyogenic spondylodiscitis was not associated with an elevated risk of pulmonary embolism in our analysis. However, we describe several risk factors for pulmonary embolism in this vulnerable cohort. Prospective studies are necessary to improve prevention and postoperative management in patients with pyogenic spondylodiscitis.

Abstract TMP74: Stroke And Pulmonary Embolism, Clinical Features, Risk Factors And Outcome

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
jitphapa pongmoragot ◽  
Alejandro Rabinstein ◽  
Yongchai Nilanont ◽  
Daniel Selchen ◽  
Rick Swartz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Length Of Stay ◽  
Predisposing Factors ◽  
P Value ◽  
Stroke Patients ◽  
Vein Thrombosis ◽  
History Of ◽  
Deep Vein

Introduction: Pulmonary embolism (PE) is an uncommon medical complication after stroke. Predisposing factors include deep vein thrombosis (DVT) in patients with hemiplegia or an underlying hypercoagulable state. However, little information is known regarding PE in stroke patients. Objective: We evaluated clinical characteristics, predisposing factors, and outcomes in stroke patients who developed PE. Methods: We included patients with an acute ischemic stroke (AIS) admitted to the participating institutions in the Registry of the Canadian Stroke Network between 2003 to 2008. Pulmonary embolism was diagnosed by nuclear imaging within 30 days of the stroke case index. Demographic data and clinical variables were collected. Logistic regression and survival analyses were completed to determine the association of risk factors with the outcomes of interest. Outcome Measures: primary outcome was death or disability at discharge defined as the modified Rankin scale >3. Secondary outcomes include admission to the Intensive Care Unit, disposition, and length of hospital stay, death at 3 months and at 1 year. Results: Among 11,287 patients with AIS, PE was found in 89 (0.78%) of patients. The development of PE was associated with higher risk of death in 30 days (25.8%vs 13.6%;p <0.001) and 1 year, (47.2% vs 24.6%;p <0.001). Disability was also more common in stroke patients with PE (85.4% vs 63.6% without PE; p <0.001). Mean length of stay was longer in stroke patients with PE (36 vs 16 days; p<0.001). Past medical history of cancer or deep vein thrombosis, history of cardiac arrest or deep vein thrombosis during admission were associated with PE. After adjustment, PE was associated with lower survival at 30 days (p value = 0.0012) and 1 year (p value < 0.0001) (Figures 1 & 2 represent survival function). Conclusions: In this large study, PE occurs in approximately 1% of AIS patients. PE was associated with higher disability, longer length of stay and lower short and long-term survival.

The risk of postoperative hemorrhage and efficacy of heparin for preventing deep vein thrombosis and pulmonary embolism in adult patients undergoing neurosurgery: a systematic review and meta-analysis

2017 ◽  
Vol 65 (8) ◽  
pp. 1136-1146 ◽  
Author(s):  
Xuan Wang ◽  
Ying-Chun Zhou ◽  
Wen-De Zhu ◽  
Yun Sun ◽  
Peng Fu ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Meta Analysis ◽  
Postoperative Bleeding ◽  
Postoperative Hemorrhage ◽  
Adult Patients ◽  
Control Group ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Heparin Prophylaxis

The aim of this meta-analysis was to examine the risk of postoperative bleeding and efficacy of heparin for preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) in adult patients undergoing neurosurgery. MEDLINE, Cochrane, and EMBASE databases were searched until October 31, 2016, for randomized controlled trials (RCTs) and non-randomized comparative studies that assessed the rates of postoperative hemorrhage, DVT, PE, and mortality in adult patients undergoing neurosurgery. Nine eligible studies (five RCTs, four retrospective studies) including 874 patients treated with either unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) and 1033 patients in control group (placebo with or without compression device) were analyzed. The overall analysis revealed that there was an increase in the risk of postoperative hemorrhage in patients who received heparin (pooled OR 1.66, 95% CI 1.01 to 2.72, p=0.046) compared with no treatment group. The risk of postoperative hemorrhage was more significant if only RCTs were included in analysis. Heparin prophylaxis was associated with a decrease in the risk of DVT (pooled OR 0.48, 95% CI 0.36 to 0.65, p<0.001) and PE (pooled OR 0.25, 95% CI 0.09 to 0.73, p=0.011) but it did not affect the rate of mortality. In conclusion, heparin increased the rate of postoperative bleeding, decreased the risk of DVT, PE and venous thromboembolic event (VTE) but it did not affect the mortality of patients undergoing neurosurgery. For the heparin prophylaxis, the trade-off between the risk of postoperative bleeding and benefit of prophylaxis against VTEs requires further investigation.

scholarly journals The frequencies of FV Leiden and FII G20210A mutations in patients with different clinical manifestations of venous thromboembolism: Experience from large Serbian cohort

Genetika ◽  
2016 ◽  
Vol 48 (2) ◽  
pp. 609-616
Author(s):  
Branko Tomic ◽  
Maja Gvozdenov ◽  
Iva Pruner ◽  
Mirjana Kovac ◽  
Nebojsa Antonijevic ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Clinical Manifestations ◽  
Rflp Analysis ◽  
Control Group ◽  
Vein Thrombosis ◽  
G20210a Mutation ◽  
Fv Leiden ◽  
Deep Vein

Venous thromboembolism is a multifactorial disorder with two manifestations: deep-vein thrombosis and pulmonary embolism. Pulmonary embolism is usually considered as the complication of deep-vein thrombosis, but there are reported cases of isolated pulmonary embolism. FV Leiden and FII G20210A mutations are most common genetic risk factors for the venous thromboembolism. Several studies reported "FV Leiden paradox": lower prevalence of FV Leiden mutation among patients with isolated pulmonary embolism than among those with deep-vein thrombosis. The aim of this study was to determine FV Leiden and FII G20210A mutations frequency in thrombophilic patients in Serbian population. We tested prevalence of these mutations carriers in 1427 individuals divided in three groups of patients (with deep-vein thrombosis, deep-vein thrombosis/ pulmonary embolism and isolated pulmonary embolism) and control group. All subjects were tested for these mutations using PCR-RFLP analysis. Detected frequency of FV Leiden heterozygous carriers in patients with isolated pulmonary embolism was 6.9% (for FII G20210A 11.6%), while in other two groups of patients with deep-vein thrombosis and deep vein thrombosis/pulmonary embolism, frequency was 18.6% (for FII G20210A mutation were 11.6% and 8.3%, respectively). Our results showed that FV Leiden mutation is less frequent in patients with isolated pulmonary embolism than in patients with deep-vein thrombosis or deep-vein thrombosis accompanied with pulmonary embolism, confirming "FV Leiden paradox". On the other hand, detected frequency of FII G20210A mutation carriers was similar in all three groups of patients.

Biological Findings During Sequential Thrombolytic Treatments With Defibrase, Lysyl-Plasxinogen and Urokinase

1979 ◽  
Author(s):  
P. Griguer ◽  
PH. Dusson ◽  
Mireille Brochier
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Treatment Group ◽  
Fibrinolytic Activity ◽  
Thrombolytic Treatment ◽  
Large Drop ◽  
Vein Thrombosis ◽  
Group I ◽  
Deep Vein ◽  
Rapid Drop

Biological changes induced by a snake venom (Defibrase - DEF) infused prior to a thrombolytic treatment are studied in a series of 35 pulmonary embolism (P. E) and/or deep vein thrombosis (D. V. T). Group I (n : 13) includes old PE and or D.V.T (14 ± 6 days old) in which DEF infusion is performed prior to thrombolytic treatment ; Group II (n : 22) includes recent P. E and/or D.V.T. A first treatment with Lysyl-Plasminogen (Lys-Plg) and Urokinase (UK) with poor or insufficient results is followed by DEF infusions just before a second thrombolytic treatment. The results of these treatments controlled angiographically (before and 24 hours after the end of the last UK infusion) have shown that a better revascularisation could be obtained even in old PE, when Defibrase is given prior to thrombolytic treatment. During the DSF infusions, we observed a decrease of fibrinogen m less than 36 hours (to a mean level of 0,20 to 0,30 g/l). The % of circulating plasminogen consumption is 48.22 % ± 22, and a rapid drop of the fast reacting antiplasmin level (F.R. antipl) occurs (from 77,5 % ± 30 to 12,9 % ± 7,6) During the thrombolytic treatment following DEF, we observed an enhancement of fibrinolytic activity. From these data we may conclude that DEF is able to determine plasminantiplasmin complexes and a large drop of the fast antiplasmin level, in the blood

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