Heterotopic Ossification and Deep Venous Thrombosis: Concurrence (?), Bleeding Complications, and Caval Interruption

1992 ◽  
Vol 85 (12) ◽  
pp. 1244-1246 ◽  
Author(s):  
DAVID R. GUTKNECHT
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Heterotopic Ossification ◽  
Bleeding Complications

Heparin Assays and Bleeding Complications in Treatment of Deep Venous Thrombosis with Particular Reference to Retroperitoneal Bleeding

1985 ◽  
Vol 53 (02) ◽  
pp. 278-281 ◽  
Author(s):  
H Asbjørn Holm ◽  
Ulrich Abildgaard ◽  
Sigmund Kalvenes
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Major Bleeding ◽  
Bleeding Complications ◽  
Minor Bleeding ◽  
Thrombin Time ◽  
Heparin Infusion ◽  
Retroperitoneal Bleeding ◽  
Heparin Activity ◽  
The Difference

SummaryBleeding complications occurred in 30 (11%) out of 280 patients who received continuous heparin infusion for deep venous thrombosis (DVT). 22 (8%) had minor while 8 patients (3%) had major bleeding complications (1 intrathoracic [fatal], 2 gastrointestinal and 5 retroperitoneal). Heparin activity, in daily drawn blood samples, was determined by four assays (chromogenic substrate [CS] assay, activated partial thromboplastin time [APTT], thrombin time with citrated plasma [CiTT] and thrombin time with recalcified plasma [CaTT]). The differences in median heparin activity between patients with minor bleeding and patients with no bleeding did not reach significance for any of the tests. In patients with major bleeding, the differences were significant with the CS (p = .011) and the CaTT (p = .030) assays. Patients with retroperitoneal bleeding had significantly increased median activity judged by all four assays: CS (p = .002), CaTT (p = .003), APTT (p = .010), CiTT (p = .029). The difference was most pronounced after four days of heparin treatment, but there was a considerable overlap with patients without bleeding.

Subcutaneous Heparin in the Prevention of Venous Thrombosis After Elective Aortic Bifurcation Graft Surgery

1979 ◽  
Author(s):  
J.J.F. Belch ◽  
G.D.O. Lowe ◽  
J.G. Pollock ◽  
C.D. Forbes ◽  
C.R.M. Prentice
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Controlled Trial ◽  
Bleeding Complications ◽  
Aortic Bifurcation ◽  
Double Blind ◽  
Risk Of Bleeding ◽  
Subcutaneous Heparin ◽  
Calcium Heparin ◽  
Intravenous Sodium

In a randomised double-blind controlled trial 24 patients undergoing elective aortic bifurcation graft surgery received subcutaneous calcium heparin (2, 500 u preoperatively then 5,000 u 12 hourly or 7 days) and 25 control patients received saline injections. All patients received the routine dose of intravenous sodium heparin intraoperatively. The trial was terminated because of excess bleeding complications in patients on subcutaneous heparin (8 vs. 1, p<0.05). Deep venous thrombosis was diagnosed by 125I-fibrinogen scanning in 8 control patients and 3 patients on heparin (p>0.05). In this group of patients the risk of bleeding due to subcutaneous heparin appeared to outweigh the benefit of thrombotic prophylaxis.

Subcutaneous vs Intravenous Heparin in the Treatment of Deep Venous Thrombosis – A Randomized Clinical Trial

1990 ◽  
Vol 64 (02) ◽  
pp. 222-226 ◽  
Author(s):  
M Pini ◽  
C Pattacini ◽  
R Quintavalla ◽  
T Poli ◽  
A Megha ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Strain Gauge ◽  
Bleeding Complications ◽  
Comparable Efficacy ◽  
Venous Capacitance ◽  
Strain Gauge Plethysmography ◽  
Intravenous Heparin ◽  
Group 1

Summary271 patients with acute symptomatic deep venous thrombosis of lower limbs, confirmed by strain-gauge plethysmography and/ or venography, were randomly assigned to receive intermittent subcutaneous heparin calcium or heparin sodium by continuous intravenous infusion for 6–10 days. Heparin dosage was adjusted to maintain activated partial thromboplastin time values (Throm-bofax reagent) at 1.3–1.9 times the basal ones. Strain-gauge plethysmography was repeated at the end of heparin treatment, and evaluation of therapy was performed by comparing the indexes of venous hemodynamics and by assessing the incidence of pulmonary embolism and of bleeding complications.In the intravenous group, Maximal Venous Outflow (MVO) increased from 20.8 ± 12.8 to 28.4 ± 17.5 ml/min per 100 ml of tissue and Venous Capacitance (VC) from 1.39 ± 0.92 to 1.94 ± 1.0 ml/100 ml of tissue (mean ± SD). In the subcutaneous group, MVO increased from 21.0 ± 12.7 to 27.5 ± 18.1 and VC from 1.60 ± 0.86 to 2.06 ± 1.0. The median improvement of MVO and VC were 22% and 36% respectively in the IV group and 20% and 24% in the SC group. Clinical pulmonary embolism occurred in 2 patients in the intravenous group (1 fatal) and in 4 in the subcutaneous group (1 fatal). 9 major bleeding complications occurred in the intravenous group (1 fatal) and 5 in the subcutaneous group (1 fatal). The differences were not significant at the statistical analysis.The results suggest that subcutaneous intermittent heparin has a comparable efficacy to continuous intravenous heparin in the treatment of deep venous thrombosis.To the same conclusion points an overview of the seven randomized trials which compared these treatment modalities.

Subcutaneous Heparin For Prophylaxis For Recurrent ThromBoembolism

1981 ◽  
Author(s):  
J A Caprini ◽  
C J Thorpe ◽  
S J Torkelson ◽  
J P Vagher ◽  
A Z Delos Reyes ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Pulmonary Embolus ◽  
Oral Anticoagulant Therapy ◽  
Clinical Signs ◽  
Impedance Plethysmography ◽  
Heparin Therapy ◽  
Bleeding Complications ◽  
Subcutaneous Heparin ◽  
Intravenous Heparin

One hundred consecutive patients with thromboembolic disease were treated with subcutaneous heparin to prevent recurrence of deep venous thrombosis (70 patients), pulmonary embolus (21), or both deep venous thrombosis and pulmonary embolus (9). Thrombosis was documented by venography, doppler ultrasound, impedance plethysmography, V-P lung scanning, or pulmonary angiography. The hospitalized patients received intravenous heparin for an average of 12.3 days. Intravenous heparin was overlapped with the first dose of 5000 units of subcutaneous heparin which was then given every 12 hours. Fifteen patients had the subcutaneous dosage increased before discharge and 52 had changes in dosage at some point during therapy according to test results. Subcutaneous heparin therapy averaged 111 days per patient (range - 15 days to 16 months). No episodes of major bleeding occurred, although 5 patients had minor localized eccymosis or rash. Self-injection was well accepted and tolerated by the patients. Clinical examination, hematocrit platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, fibrin split products, and thrombelastography were performed every six weeks. Doppler and impedance plethysmography studies were repeated if clinical signs persisted or recurred. Two patients had recurrent nonfatal deep vein thrombosis 3 months after starting subcutaneous heparin therapy. Both of these patients originally had above knee thrombi.The results suggest that self-administered subcutaneous heparin injections titered to laboratory tests are effective in preventing recurrent thromboembolism without bleeding complications. This approach represents an effective alternative to oral anticoagulant therapy.

scholarly journals Feasibility of Anticoagulation Using Low Molecular‑Weight Heparin During Catheter-Directed Thrombolysis for Lower Extremity Deep Venous Thrombosis 

2020 ◽  
Author(s):  
Yonghui Li ◽  
Junwei Wang ◽  
Rongzhou He ◽  
Junmeng Zheng ◽  
Zhibo Chen ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Therapeutic Dose ◽  
Infusion Rate ◽  
Low Molecular Weight Heparin ◽  
Anticoagulation Therapy ◽  
Bleeding Complications ◽  
Low Molecular Weight ◽  
Catheter Directed Thrombolysis

Abstract Background: The optimal anticoagulant scheme during catheter-directed thrombolysis (CDT) for deep venous thrombosis (DVT) remains unknown. This study was performed to evaluate the feasibility of anticoagulation therapy using low molecular‑weight heparin (LMWH) during CDT for DVT.Methods: The clinical data of DVT patients who underwent CDT during the past six years was retrospectively collected and reviewed. Patients were divided into therapeutic-dose anticoagulation (TPDA) and sub therapeutic-dose anticoagulation (sub-TPDA) groups according to LMWH dosage.Results: A total of 61 patients involving 61 limbs were comprised. Acute and subacute DVT were identified in 39 (63.9%) and 22 (36.1%) patients, respectively. Thrombosis involving the iliac vein was identified in 34 (55.7%) patients. Inferior vena cava filter placement was performed in 38 (62.3%) patients. Intraoperatively, adjunctive balloons, stents, and thrombectomy were provided for nine (14.8%), four (6.6%), and one (1.6%) patients, respectively. Twenty (32.8%) patients accepted TPDA therapy, while 41 (67.2%) patients were administrated with sub-TPDA therapy. Median urokinase infusion rate was 2.5 (0.83 to 5) x 104 U/h. Median infusion duration time was 4 (2 to 14) days, and median urokinase dose infused was 2.4 (0.6 to 10.80) x 106 U. During CDT, five (8.2%) cases of minor bleeding were observed, and blood transfusion was not required. No major bleeding, symptomatic pulmonary embolisms, or death occurred. Complete (>90%) and partial thrombolysis (50~90%) were achieved in 56 (91.8%) patients. In comparison with sub-TPDA group, TPDA group exhibited no significant difference in baseline characteristics, clinical improvement, thrombolysis results, and complications. Conclusions: Anticoagulation therapy using low molecular‑weight heparin during CDT with low infusion rate for DVT is likely to be feasible and safe. Sub-therapeutic-dose anticoagulation and therapeutic-dose could be used for CDT with similar clinical outcome and bleeding complications.

scholarly journals Feasibility of Anticoagulation Using Low Molecular‑Weight Heparin During Catheter-Directed Thrombolysis for  Lower Extremity Deep Venous Thrombosis

2021 ◽  
Author(s):  
Yonghui Li ◽  
Junwei Wang ◽  
Rongzhou He ◽  
Junmeng Zheng ◽  
Zhibo Chen ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Therapeutic Dose ◽  
Infusion Rate ◽  
Low Molecular Weight Heparin ◽  
Anticoagulation Therapy ◽  
Bleeding Complications ◽  
Low Molecular Weight ◽  
Catheter Directed Thrombolysis

Abstract Background: The optimal anticoagulant scheme during catheter-directed thrombolysis (CDT) for deep venous thrombosis (DVT) remains unknown. This study was performed to evaluate the feasibility of anticoagulation therapy using low molecular‑weight heparin (LMWH) during CDT for DVT.Methods: The clinical data of DVT patients who underwent CDT during the past six years was retrospectively collected and reviewed. Patients were divided into therapeutic-dose anticoagulation (TPDA) and sub therapeutic-dose anticoagulation (sub-TPDA) groups according to LMWH dosage.Results: A total of 61 patients involving 61 limbs were comprised. Acute and subacute DVT were identified in 39 (63.9%) and 22 (36.1%) patients, respectively. Thrombosis involving the iliac vein was identified in 34 (55.7%) patients. Inferior vena cava filter placement was performed in 38 (62.3%) patients. Intraoperatively, adjunctive balloons, stents, and thrombectomy were provided for nine (14.8%), four (6.6%), and one (1.6%) patients, respectively. Twenty (32.8%) patients accepted TPDA therapy, while 41 (67.2%) patients were administrated with sub-TPDA therapy. Median urokinase infusion rate was 2.5 (0.83 to 5) x 104 U/h. Median infusion duration time was 4 (2 to 14) days, and median urokinase dose infused was 2.4 (0.6 to 10.80) x 106 U. During CDT, five (8.2%) cases of minor bleeding were observed, and blood transfusion was not required. No major bleeding, symptomatic pulmonary embolisms, or death occurred. Complete (>90%) and partial thrombolysis (50~90%) were achieved in 56 (91.8%) patients. In comparison with sub-TPDA group, TPDA group exhibited no significant differences in baseline characteristics, clinical improvement, thrombolysis results, and complications. Conclusions: Anticoagulation therapy using low molecular‑weight heparin during CDT with low infusion rate for DVT is likely to be feasible and safe. Sub-therapeutic-dose anticoagulation and therapeutic-dose could be used for CDT with similar clinical outcome and bleeding complications.

The Incidence of Deep Venous Thrombosis in Patients with an Acute Myocardial Infarction Treated with Acenocoumarol or Indobufen

1982 ◽  
Vol 48 (02) ◽  
pp. 222-225 ◽  
Author(s):  
S H A Peters ◽  
J J C Jonker ◽  
A C de Boer ◽  
G J H den Ottolander
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Prognostic Index ◽  
Impedance Plethysmography ◽  
Antiplatelet Drug ◽  
Bleeding Complications ◽  
Double Blind ◽  
Significant Difference

SummaryIn a randomized double blind clinical trial, we compared indobufen, an antiplatelet drug, with acenocoumarol for the prevention of deep venous thrombosis (D. V. T.) in patients with acute myocardial infarction. Therapy was started on admission and continued for 10 days. All patients were screened daily with impedance plethysmography (I.P.G.) and 125I-fibrinogen leg scanning. Diagnosis of D.V.T. was made when either one or both tests became positive. 74 patients were randomized to treatment with indobufen (200 mg b.i.d.) and 76 patients to acenocoumarol (controlled by thrombotest). The incidence of venous thrombosis in patients with indobufen was 11% and in those treated with acenocoumarol 9%. Major bleeding was observed in 2 patients treated with acenocoumarol. In the indobufen group, no bleeding complications or other serious side-effects were observed. The majority of patients developed thrombosis after the first week of admission. For patients with and without thrombosis, there was no significant difference between the two treatment groups concerning the age, the coronary prognostic index, the maximum C.P.K. value, mobility, incidence of congestive heart failure and the site or extent of the infarct. In this study no clinical or laboratory (fibrinogen, platelet count and anti-thrombin III) parameter, either alone or in combination, was of predictive value for the development of D.V.T. It can be concluded that indobufen appears to be as good as acenocoumarol for the prevention of D.V.T. in patients with acute myocardial infarction. Because it is safe and easy to administer, indobufen seems to be preferable. Prophylaxis is required for at least 10 days.

Bilateral catheter-directed thrombolysis in a patient with deep venous thrombosis caused by a hypoplastic inferior vena cava

2014 ◽  
Vol 30 (4) ◽  
pp. 293-295 ◽  
Author(s):  
S Sloot ◽  
J Van Nierop ◽  
JJ Kootstra ◽  
C Wittens ◽  
WM Fritschy
Keyword(s):  
Inferior Vena Cava ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Inferior Vena ◽  
Vena Cava ◽  
Adolescent Male ◽  
Bleeding Complications ◽  
Systemic Thrombolysis ◽  
Catheter Directed Thrombolysis

Introduction Deep venous thrombosis treatment using catheter-directed thrombolysis is advocated over systemic thrombolysis because it reduces bleeding complications. With the development of a catheter that combines ultrasound vibrations and the local delivering of thrombolytics, new and safer treatments appear that are suitable for more complex problems. Report An adolescent male presented with bilateral iliofemoral thrombosis based on a hypoplastic inferior vena cava that had existed for more than two weeks. He was succesfully treated by bilateral ultrasound-accelerated catheter-directed thrombolysis using EkoSonic® (Small Vessel) Endovascular System (EKOS) and stenting of the inferior vena cava. After eight months of follow-up, the inferior vena cava is still patent. Conclusion EKOS thrombolysis of longer existing bilateral deep venous thrombosis in the central venous system is a succesful treatment modality in congenital inferior vena cava anomalies.

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