RATE OF NORMALIZATION OF ABNORMAL IMPEDANCE PLETHYSMOGRAPHY IN PATIENTS WITH PROVEN DEEP VEIN THROMBOSIS: SIGNIFICANCE IN THE MANAGEMENT OF RECURRENT SYMPTOMS

1987 ◽  
Author(s):  
M V Huisman ◽  
H R Buller ◽  
J W ten Cate
Keyword(s):  
Deep Vein Thrombosis ◽  
Prospective Trial ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Impedance Plethysmography ◽  
Vein Thrombosis ◽  
Clinical Signs And Symptoms ◽  
One Year ◽  
The One ◽  
Deep Vein

The diagnosis of deep vein thrombosis (DVT) by clinical signs and symptoms is unreliable, but contrast venography is expensive and invasive. Therefore, the use of non-invasive methods to detect DVT have become en vogue, of which impedance plethysmography (IPG), either in combination with 125x fibrinogen leg scanning or performed serially as a single test, have been demonstrated to be a safe and effective alternative. Since the principle of IPG is based on the measurement of venous outflow obstruction due to intravascular thrombus and since the aim of anticoagulant treatment is to facilitate recanalisation one might expect a gradual normalisation of IPG in the majority of patients. This information is important for patients presenting with recurrent signs and symptoms. If the IPG has normalized prior to presentation it is possible to separate complaints due to recurrent DVT from post phlebitic syndrome. In this prospective trial we studied 161 consecutive outpatients with abnormal IPG and venography proven DVT three monthly during one year to determine the rate of normalization and to estimate the utility of IPG testing in patients with recurrent symptomatic DVT. The IPG test had normalized in 101 of 151 patients (67%) by three months, in 126 of 148 (85%) after six months, in 133 of 145 (92%) while after one year 139 of 146 (95%) had their IPG normalized. During the one year follow-up 35 of the 161 study patients (23%) returned with recurrent symptoms. Of these 31 had normal IPG tests prior to the visit. In 18 patients IPG remained normal at repeat testing. In 13 patients IPG became again abnormal (venography showed acute on chronic DVT in 10 patients while 3 patients showed no acute DVT). It is concluded that a 95% normalization of IPG occurs and that IPG is useful in the management of recurrent symptoms.

Features of Thrombi and Diagnostic Accuracy of Impedance Plethysmography in Symptomatic and Asymptomatic Deep Vein Thrombosis

1993 ◽  
Vol 70 (02) ◽  
pp. 266-269 ◽  
Author(s):  
Giancarlo Agnelli ◽  
Benilde Cosmi ◽  
Stefano Radicchia ◽  
Franca Veschi ◽  
Enrico Boschetti ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Diagnostic Accuracy ◽  
High Sensitivity ◽  
Impedance Plethysmography ◽  
Surveillance Programme ◽  
Vein Thrombosis ◽  
Asymptomatic Patients ◽  
High Prevalence ◽  
The Mean ◽  
Deep Vein

SummaryImpedance plethysmography (IPG) has high sensitivity and specificity in patients with symptomatic deep vein thrombosis (DVT) while it fails to detect asymptomatic DVT. The aim of this study was to determine whether the features of thrombi such as location, size and occlusiveness could explain the different accuracy of IPG in symptomatic and asymptomatic DVT patients. One-hundred and seventeen consecutive outpatients with a clinical suspicion of DVT and 246 consecutive patients undergoing hip surgery were admitted to the study. In symptomatic patients IPG was performed on the day of referral, followed by venography, while in asymptomatic patients IPG was performed as a surveillance programme, followed by bilateral venography.A venography proved DVT was observed in 37% of the symptomatic patients and 34% of the asymptomatic limbs. A significantly higher proportion of proximal DVTs was found in symptomatic patients than in asymptomatic patients (78% vs 46%; p = 0.001). The mean Marder score, taken as an index of thrombus size, was significantly higher in symptomatic patients than in asymptomatic patients (19.0 vs 9.6; p = 0.0001). A significantly higher proportion of occlusive DVTs was observed in symptomatic than in asymptomatic patients (69% vs 36%; p = 0.001).We conclude that the unsatisfactory diagnostic accuracy of IPG in asymptomatic DVT is due to the high prevalence of distal, small and non occlusive thrombi. Such thrombi are unlikely to cause a critical obstruction of the venous outflow and therefore to produce a positive IPG.

Intensive Initial Oral Anticoagulation and Shorter Heparin Treatment in Deep Vein Thrombosis

1984 ◽  
Vol 52 (03) ◽  
pp. 276-280 ◽  
Author(s):  
Sam Schulman ◽  
Dieter Lockner ◽  
Kurt Bergström ◽  
Margareta Blombäck
Keyword(s):  
Deep Vein Thrombosis ◽  
Oral Anticoagulation ◽  
Dose Group ◽  
Low Dose ◽  
Clinical Signs ◽  
Coagulation Factor ◽  
High Dose ◽  
Vein Thrombosis ◽  
Heparin Treatment ◽  
Deep Vein

SummaryIn order to investigate whether a more intensive initial oral anticoagulation still would be safe and effective, we performed a prospective randomized study in patients with deep vein thrombosis. They received either the conventional regimen of oral anticoagulation (“low-dose”) and heparin or a more intense oral anticoagulation (“high-dose”) with a shorter period of heparin treatment.In the first part of the study 129 patients were randomized. The “low-dose” group reached a stable therapeutic prothrombin complex (PT)-level after 4.3 and the “high-dose” group after 3.3 days. Heparin was discontinued after 6.0 and 5.0 days respectively. There was no difference in significant hemorrhage between the groups, and no clinical signs of progression of the thrombosis.In the second part of the study another 40 patients were randomized, followed with coagulation factor II, VII, IX and X and with repeated venograms. A stable therapeutic PT-level was achieved after 4.4 (“low-dose”) and 3.7 (“high-dose”) days, and heparin was discontinued after 5.4 and 4.4 days respectively. There were no clinical hemorrhages, the activity of the coagulation factors had dropped to the same level in both groups at the time when heparin was discontinued and no thromboembolic complications occurred.Our oral anticoagulation regimen with heparin treatment for an average of 4.4-5 days seems safe and reduces in-patient costs.

scholarly journals Correlation of clinical features with the risk of lower limb deep vein thrombosis assessed by duplex ultrasound

2013 ◽  
Vol 12 (2) ◽  
pp. 118-122
Author(s):  
Liz Andrea Villela Baroncini ◽  
Graciliano Jose Franca ◽  
Aguinaldo de Oliveira ◽  
Enrique AntonioVidal ◽  
Carlos Eduardo Del Valle ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Duplex Ultrasound ◽  
Iliac Vein ◽  
Vein Thrombosis ◽  
Below The Knee ◽  
Clinical Conditions ◽  
Deep Vein

BACKGROUND: Symptoms and clinical signs suggestive of deep vein thrombosis (DVT) are common but may have numerous possible causes. OBJECTIVES: 1) To identify the most frequent clinical symptoms and correlate them with duplex ultrasound scan (DS) findings; 2) to identify high-risk clinical conditions for DVT; and 3) to evaluate time since the onset of symptoms and DS examination. METHODS: A total of 528 patients with a clinical suspicion of DVT were evaluated by DS performed by experienced vascular ultrasonographists. RESULTS: DVT was present in 192 (36.4%) of the patients. The external iliac vein was involved in 53 patients (10.04%), the femoral veins in 110 (20.83%), the popliteal vein in 124 (23.48%), and veins below the knee were involved in 157 (29.73%) of the cases. Limb swelling was present in 359 cases (68%), and 303 (57.4%) complained of pain. Sixty nine patients received a DS due to suspected or proven pulmonary embolism (PE); 79 patients were in postoperative period. In the multivariate analysis, independent risk factors for DVT included age>65 years (OR=1.49; 95% confidence interval [95%CI] 1.01-2.18; p=0.042), edema (OR=2.83; 95%CI 1.72-4.65; p<0.001), pain (OR=1.99; 95%CI 1.3-3.05; p=0.002), cancer (OR=2.32; 95%CI 1.45-3.72; p<0.001), and PE (OR=2.62; 95%CI 1.29-5.32; p=0.008).Time since the onset of symptoms did not differ between the groups. CONCLUSIONS: In the present study, 36.4% of the patients referred to DS had DVT. Age > 65 years, presence of limb swelling, pain, cancer, and suspected or proven PE should be considered as major risk factors for DVT.

scholarly journals Improving Nutritional Status of Malnourished Bedridden Patient Diagnosed with Deep Vein Thrombosis and Pulmonary Embolism: A Case Study Approach

2018 ◽  
Vol 1 (1) ◽  
pp. 01-04
Author(s):  
Adikari AMNT
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Nutritional Status ◽  
Nutritional Management ◽  
Body Protein ◽  
Study Approach ◽  
Vein Thrombosis ◽  
The One ◽  
Deep Vein ◽  
Bedridden Patient

Malnutrition is common among hospitalized bed ridden patients. Nutritional management of hospitalized patients is a necessity in order to improve their nutritional status and disease conditions. The objectives of nutritional management of malnourished bedridden patient diagnosed with deep vein thrombosis and pulmonary embolism were to improve nutritional status of the patient through gradual provision of calorie and protein intake, to improve body protein status and control muscle wasting. Nutritional status was assessed by anthropometric, biochemical, clinical and dietary information. SGA was used to assess the malnutrition status of the patient. Since the patient was severely malnourished, she was fed with NG feeds followed by PEG feeds by gradually increasing calorie and protein up to the target level mainly through nutritional supplements for the one and half months of hospital stay. Patient’s serum protein, albumin levels and muscle mass were improved. According to the SGA, the patient was at normal/ well-nourished condition after nutrition management. Dietary management incorporating nutrition supplements indicated improvement of nutritional status of severely malnourished bedridden patient.

scholarly journals Clinico-epidemiological features of Japanese encephalitis patients hospitalized in a tertiary care center

2018 ◽  
Vol 5 (10) ◽  
pp. 4548
Author(s):  
Abu Hasan Sarkar ◽  
Bishnu Ram Das
Keyword(s):  
Japanese Encephalitis ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Complete Recovery ◽  
High Morbidity ◽  
Medical College ◽  
Clinical Signs And Symptoms ◽  
One Year

Background: Japanese encephalitis (JE) is of particular interest as it has a high morbidity and mortality. Neurological sequale is the most dreaded damage caused by JE. It is a preventable disease with specific interventions. The objective of the study was to study the demography, clinical profile and outcome of patients with Japanese Encephalitis admitted to the wards of Internal Medicine and Pediatrics at Jorhat Medical College Hospital.Methods: Hospital based observational study for one year in Jorhat Medical College, Jorhat, Assam.Results: The mean age for JE was 32.25±27 years for male, 27.47±22 years for female and 29.94±24 years overall. Assessment of clinical signs and symptoms showed that fever and change in mental status were present in 100% of JE cases followed by neck rigidity in 79.3% and headache in 68.9%. 44.8% of JE cases had history of seizure, 37.9% had vomiting, 34.5% had irritability, 13.8% were unconscious. The peak of JE incidence occurred in the month of July (77.6%). Complete recovery was seen in 39.2%, followed by death in 32.6% and recovery with neurological sequalae in 28.2% at the time of discharge.Conclusions: Vigorous awareness activities should be carried out to sensitize people on prevention of JE. 

Limitations of impedance plethysmography (IPG) in the diagnosis of clinically suspected deep-vein thrombosis (DVT)

1992 ◽  
Vol 65 ◽  
pp. S47
Author(s):  
D.R. Anderson ◽  
A.W.A. Lensing ◽  
P.S. Wells ◽  
M.N. Levine ◽  
J.I. Weitz ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Impedance Plethysmography ◽  
Vein Thrombosis ◽  
Deep Vein

Diagnosis Of Deep Vein Thrombosis - “The Case for NonInvasive Testing”

1981 ◽  
Author(s):  
R Hull ◽  
J Hirsh
Keyword(s):  
Deep Vein Thrombosis ◽  
High Sensitivity ◽  
Cost Effective ◽  
Impedance Plethysmography ◽  
Noninvasive Testing ◽  
Vein Thrombosis ◽  
Non Invasive ◽  
Long Term Follow Up ◽  
Deep Vein ◽  
High Degree

Ascending venography, although the diagnostic standard for deep vein thrombosis (DVT), has important clinical pitfalls and shortcomings. It is invasive and thus not readily repeated: its use is associated with significant discomfort in many patients and in 3-4% of patients post-veno- graphic phlebitis is induced. A high degree of technical and interpretive skill is required and in up to 20% of patients routine ascending venography fails to visualize the external and common iliac veins. In many hospitals, outpatient access is not readily available necessitating admission to hospital for elective venography. Non-invasive testing with impedance plethysmography (IPG) is gaining increasing acceptance and use because it is objective, versatile and free of morbidity. IPG is sensitive and specific for symptomatic proximal DVT, but has the potential limitation that it is insensitive to calf DVT. Because of this, two different non-invasive approaches are currently advocated: a) serial IPG’s to detect calf vein thrombi which extend proximally (advocates of this approach suggest that calf DVT rarely lead to symptomatic pulmonary emboli unless proximal extension occurs) and b) addition of leg scanning to detect calf DVT. The effectiveness of serial IPG’s is uncertain and to resolve this issue we are currently performing a randomized trial. Multiple large studies however demonstrate that because of both high sensitivity and specificity, the combined approach of IPG and leg scanning provides a replacement for venography in the majority of symptomatic patients. Furthermore, the safety of witholding anticoagulant therapy in patients negative by combined IPG and leg scanning has been confirmed by long-term follow-up. Combined IPG and leg scanning is more cost-effective than elective venography because these non-invasive tests are readily performed in the emergency room or clinic, thus preventing unnecessary admission to hospital of patients with clinically suspected DVT who are negative by testing.

The Diagnosis of Established Deep Vein Thrombosis

1979 ◽  
Author(s):  
R. Hull ◽  
J. Hirsh
Keyword(s):  
Deep Vein Thrombosis ◽  
Doppler Ultrasonography ◽  
Clinical Symptoms ◽  
Reference Method ◽  
Impedance Plethysmography ◽  
Vein Thrombosis ◽  
Non Invasive ◽  
Patient Morbidity ◽  
Low Sensitivity ◽  
Deep Vein

It is now generally accepted that the clinical diagnosis of deep venous thrombosis (DVT) is inaccurate both because of low sensitivity and specificity. Because more than 50% of symptomatic patients fail to show thrombi on venography, anticoagulant therapy on the basis of clinical symptoms of DVT is not acceptable. Venography has been the standard reference method for the diagnosis of DVT but is invasive and consequently associated with patient morbidity. Impedance plethysmography (IPG) and Doppler ultrasonography (Doppler) are both non-invasive and, in patients with clinically suspected DVT, are sensitive and specific tests for proximal DVT. Both tests are relatively insensitive to calf DVT. IPG has the advantage of being an objective technique whereas Doppler is subjective and its accuracy may suffer in inexperienced hands. 125I fibrinogen leg scanning (leg scanning) is an inappropriate test when used alone in patients with clinically suspected DVT as it is insensitive in the upper thigh, may be negative in 30% of patients with established DVT and may take up to 72 hours to become positive. The combination, however, of IPG and leg scanning provides an accurate approach for the detection of both proximal and calf DVT in patients with established DVT. This approach is not associated with patient morbidity and offers the clinician an alternative to venography.

Sign in / Sign up

Export Citation Format

Share Document