Incidence Of Venous Thrombosis, Increased Platelet Release Reaction And Thromboxane Synthesis Following Tourniquet Ischaemia

1981 ◽  
Author(s):  
J Zahavi ◽  
A J Price ◽  
J Westwick ◽  
V V Kakkar
Keyword(s):  
Venous Thrombosis ◽  
Young Patients ◽  
Surgical Trauma ◽  
Pneumatic Tourniquet ◽  
Vein Thrombosis ◽  
High Incidence ◽  
Total Knee ◽  
High Level ◽  
Deep Vein

Deep vein thrombosis (DVT) was established by ascending phlebography in 121 meniscectomy (M) (mean age 34 years) and 27 total knee replacement (TKR) (mean age 62.9 years) patients, both procedures performed under ischaemia (by inflating a pneumatic tourniquet to 500 mm Hg). In 27 of the M, 10 TKR and another 10 patients undergoing herniorrhaphy (H) and served as controls plasma β-thromboglobu- lin (βTG) was measured by radioimmunoassay and in 22 M and 10 TKR patients plasma thromboxane B2 (TxB2) was also determined. The incidence of DVT was 29% in the M patients. It increased significantly with age reaching a level of 50% at 60 years. In the TKR group 49% developed DVT. There was also a positive correlation between the severity of of DVT and patient age in both groups. The mean plasma βTG and TxB2, rose sharply (p<0.001) 5 min after the release of the tourniquet and were positively correlated to each other. The high level returned to the pre-operative level after 48 hours. In the H patients βTG did not alter significantly pos toperativelyThe high incidence of DVT in the relatively young patients who underwent M (minor surgical trauma similar to that of H) reaching the incidence of TKR patients (major surgical trauma) at 60 years, suggests that tourniquet ischaemia may be an important factor in the development of venous thrombosis in these patients. The increased in-vivo platelet activation and thromboxane synthesis, indicated by the increased plasma βTG and TxB2 levels, which was not detected in the H patients, suggests that platelets may play an important role in the initiation of the DVT in tourniquet ischaemia patients.

scholarly journals Outpatient total knee arthroplasty: is it worth considering?

2020 ◽  
Vol 5 (3) ◽  
pp. 172-179
Author(s):  
E. Carlos Rodríguez-Merchán
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Discharge Planning ◽  
Young Patients ◽  
Cost Effective ◽  
Medical Outcomes ◽  
Vein Thrombosis ◽  
Cost Effective Treatment ◽  
Total Knee ◽  
Deep Vein

Some authors have reported that outpatient total knee arthroplasty (TKA) is a successful, safe and cost-effective treatment in the management of advanced osteoarthritis. The success obtained has been attributed to the coordination of the multidisciplinary team, standardized perioperative protocols, optimal hospital discharge planning and careful selection of patients. One study has demonstrated a higher risk of perioperative surgical and medical outcomes in outpatient TKA than inpatient TKA, including component failure, surgical site infection, knee stiffness and deep vein thrombosis. There remains a lack of universal criteria for patient selection. Outpatient TKA has thus far been performed in relatively young patients with few comorbidities. It is not yet clear whether outpatient TKA is worth considering, except in very exceptional cases (young patients without associated comorbidities). Outpatient TKA should not be generally recommended at the present time. Cite this article: EFORT Open Rev 2020;5:172-179. DOI: 10.1302/2058-5241.5.180101

SEMI-QUANTITATIVE RADIONUCLIDE PHLEBOGRAPHIC (RNP) ASSESSMENT OF DEEP VEIN THROMBOSIS (DVT) AND CHRONIC VENOUS INSUFFICIENCY (CVI)

1987 ◽  
Author(s):  
J Zahavi ◽  
S Zaltzman ◽  
E Firsteter ◽  
E Avrahami
Keyword(s):  
Venous Insufficiency ◽  
Cost Effective ◽  
Vein Thrombosis ◽  
Below The Knee ◽  
High Incidence ◽  
Complete Thrombosis ◽  
The Right ◽  
High Level ◽  
Deep Vein

A semi-quantitative RNP using 99Technetium macroaggregated albumin for the evaluation and follow-up of DVT and CVI has been developed. Values were assigned to the deep veins of the calf, knee, tigh and pelvis based upon the localization and the characteristics of the images obtained: stasis, hot spots and collateral circulation. A maximum score of 18 reflected complete thrombosis of all 4 segments. 208 patients (mean age 53.7 years, range 18-92), 161 of whom had a proven risk factor for DVT were studied. 99Technetium was injected into the dorsal foot vein of 407 limbs with appropriate tourniquets and early and late imaging of the limbs, pelvis and lungs was performed. In 48 patients, 83 limbs, X-ray contrast phlebography (CP) was also done. The mean RNP score was 4.1 units (range 0.4-18) and higher in the left than the right lower limb. It was mostly high in patients with proximal recurrent DVT or in DVT superimposed on CVI. The score was easy to follow and helpful in the assessment of the extent of DVT. It was particularly helpful in 3 instances. 1) Assessment of venous patency following anticoagulant therapy. 2) Estimation of recurrent DVT. 3) Differentiation of recent DVT from venous insufficiency. Overall RNP method had a sensitivity of 87.6%, a specificity of 54% and an accuracy of 64.8%. The sensitivity was similar in above & below-knee thrombi. Yet the specificity was higher in above-knee thrombi. The highest accuracy (87.3%) was observed in pelvic and groin thrombi. The distribution of thrombi on CP was 19% below the knee, 31% above it and 50% both above and below the knee. Pulmonary embolism (PE) was initially observed in 54 patients (26%) with no clinical evidence of DVT and therefore untreated. This high level is most probably related to the high incidence of proximal DVT in the patients. 181 patients were treated with heparin & coumadin and the RNP score was decreased to 3.6 units (range 0.4-8.8). PE occurred during treatment in 11 (6.1%) and recurrent DVT in 16 (8.8%) patients. CVI was observed in 23 patients before treatment and in another 24 patients (13.2%) after treatment. These results indicate that the RNP method is a simple, semi-quantitative and useful technique for the evaluation and follow-up of DVT and CVI. It is most helpful in the assessment of the extent of DVT. It is also a rapid, noninvasive and cost effective techniaue.

Comparison of Two Warfarin Regimens in the Prevention of Venous Thrombosis following Total Knee Replacement

1996 ◽  
Vol 75 (05) ◽  
pp. 706-711 ◽  
Author(s):  
Charles W Francis ◽  
Vincent D Pellegrini ◽  
Kristin M Leibert ◽  
Saara Totterman ◽  
Michael V Azodo ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Total Knee Replacement ◽  
Venous Thrombosis ◽  
Knee Replacement ◽  
International Normalized Ratio ◽  
Bleeding Complications ◽  
Vein Thrombosis ◽  
Transfusion Requirements ◽  
Total Knee ◽  
Deep Vein

SummaryA prospective, randomized trial was conducted to compare the effectiveness and safety of warfarin given in two regimens in prevention of venous thrombosis after total knee replacement. Adult patients scheduled for primary or revision total knee replacement were randomly assigned to receive either a “two-step” warfarin regimen beginning 10-14 days pre-operatively or, alternatively, to begin warfarin the night before surgery. Post-operatively, the dose was adjusted in both groups to achieve a target International Normalized Ratio (INR) of 2.2 and prophylaxis was continued until venography on post-operative days five through nine. Bleeding was assessed by surgical blood loss, transfusion requirements, changes in hematocrit, and clinically identified bleeding complications. The occurrence of deep vein thrombosis was nearly the same in the two treatment groups, 39% in patients randomized to the two-step regimen as compared to 38% in those beginning the night before surgery. The occurrence of proximal vein thrombosis was also similar, 5% versus 7% (p = NS). Patients in the two-step group received 1.33 ± 1.26 transfusions compared to 0.95 ± 1.22 in the night before group (p <0.05) and also had a lower nadir post-operative hematocrit of 26.7 ± 3.1 as compared to 28.5 ± 3.2 (p <0.0001). Major bleeding complications were associated with excessively prolonged INRs and occurred in five patients in the two-step group and two in the night before group. Patients in both groups who developed thrombosis had a significantly lower INR on post-operative days two and three compared to those without thrombosis. We conclude that a prophylactic warfarin regimen for prevention of deep vein thrombosis after total knee replacement beginning the night before surgery is more convenient and may be associated with less bleeding than a regimen beginning warfarin 10-14 days pre-operatively. Careful control of anticoagulant intensity is needed to achieve maximum effectiveness and avoidance of bleeding complications.

scholarly journals COVID-19 Presented with Deep Vein Thrombosis in a Patient with Paroxysmal Nocturnal Haemoglobinuria

2021 ◽  
Author(s):  
Zlatko Pravdic ◽  
Mirjana Mitrovic ◽  
Andrija Bogdanovic ◽  
Marijana Virijevic ◽  
Nikica Sabljic ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Venous Thrombosis ◽  
Arterial Thrombosis ◽  
Distress Syndrome ◽  
Bone Marrow Failure ◽  
Rare Event ◽  
Paroxysmal Nocturnal Haemoglobinuria ◽  
Vein Thrombosis ◽  
High Incidence ◽  
Deep Vein

AbstractParoxysmal nocturnal haemoglobinuria (PNH) is a rare, acquired clonal haematological disease characterized by complement-mediated haemolysis, bone marrow failure and venous thrombosis. Anticomplement therapy eculizumab improves survival and reduces complications. Severe acute respiratory distress syndrome corona virus 2 (SARS-CoV-2) disease 2019 (COVID-19) is associated with high incidence of both venous and arterial thrombosis in hospitalized patients with pneumonia. Deep venous thrombosis (DVT) as the presenting symptom of COVID-19 is a rare event. We describe a well-controlled PNH patient on eculizumab for more than 5 years who presented with DVT, while on warfarin, as the first sign of COVID-19. To our knowledge, this is the first described case of DVT in a PNH patient with COVID-19.

A Comparison of General Anesthesia and Regional Anesthesia as a Risk Factor for Deep Vein Thrombosis Following Hip Surgery: A Critical Review

1990 ◽  
Vol 64 (04) ◽  
pp. 497-500 ◽  
Author(s):  
Martin H Prins ◽  
Jack Hirsh
Keyword(s):  
Deep Vein Thrombosis ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Lower Incidence ◽  
Hip Surgery ◽  
Level Of Evidence ◽  
Vein Thrombosis ◽  
Postoperative Thrombosis ◽  
High Level ◽  
Deep Vein

SummaryWe evaluated the evidence in support of the suggestion that the risk of deep vein thrombosis after hip surgery is lower with regional than with general anesthesia. A literature search was performed to retrieve all articles which reported on the incidence of postoperative thrombosis in both fractured and elective hip surgery. Articles were included if the method of anesthesia used was reported and if they used mandatory venography. Based upon the quality of study design the level of evidence provided by a study was graded.In patients who did not receive prophylaxis there were high level studies in elective and fractured hip surgery. All studies showed a statistically significantly lower incidence of postoperative deep vein thrombosis with regional anesthesia (relative risk reductions of 46-55%). There were no direct comparative studies in patients who received prophylaxis. However, between study comparisons did not show even a trend towards to lower incidence of postoperative thrombosis with regional anesthesia.

Outcome of Anticoagulation in Isolated Distal Deep Vein Thrombosis Compared to Proximal Deep Venous Thrombosis

2021 ◽  
Author(s):  
Danielle T Vlazny ◽  
Ahmed K Pasha ◽  
Wiktoria Kuczmik ◽  
Waldemar E Wysokinski ◽  
Matthew Bartlett ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Vein Thrombosis ◽  
Distal Deep Vein Thrombosis ◽  
Deep Vein

In Vivo Porcine Aged Deep Vein Thrombosis Model for Testing Ultrasound-based Thrombolysis Techniques

2021 ◽  
Author(s):  
Greyson E. Stocker ◽  
Jiaqi Shi ◽  
Kimberly Ives ◽  
Adam D. Maxwell ◽  
Paul A. Dayton ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Thrombosis Model ◽  
Deep Vein

Low-dose subcutaneous heparin in prevention of deep-vein thrombosis

1972 ◽  
Vol 10 (23) ◽  
pp. 89-91
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Low Dose ◽  
Fatal Pulmonary Embolism ◽  
Vein Thrombosis ◽  
Subcutaneous Heparin ◽  
Prevention And Treatment ◽  
Deep Vein ◽  
Low Dosage

Earlier this year1 we discussed the prevention and treatment of venous thrombosis and concluded that heparin in low dosage seemed the most promising drug for preventing deep-vein thrombosis postoperatively, although the optimum regimen was not yet known. Sharnoff and his associates who began this work 10 years ago claim to have shown that this treatment largely prevents fatal pulmonary embolism.2

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