Phlebitis, Pulmonary Emboli and Presidential Politics: Richard M. Nixon's Complicated Deep Vein Thrombosis

2013 ◽  
Vol 79 (2) ◽  
pp. 128-134 ◽  
Author(s):  
Luigi Pascarella ◽  
Theodore N. Pappas
Keyword(s):  
Health Care ◽  
Deep Vein Thrombosis ◽  
The United States ◽  
The Political ◽  
Pulmonary Emboli ◽  
Legal Proceedings ◽  
Vein Thrombosis ◽  
Richard Nixon ◽  
Recurrent Deep Vein Thrombosis ◽  
Deep Vein

In September of 1974, Richard Nixon resigned the Presidency of the United States during an impeachment investigation concerning the Watergate Affair. One month after his resignation, the former President had an exacerbation of his chronic deep vein thrombosis. He also received a Presidential pardon from Gerald Ford on the same day that his recurrent deep vein thrombosis was diagnosed. The political, legal, and medical events that unfolded in the fall of 1974 are the substance of this report. Presidents often receive medical care that stretches the ordinary as a result of their position and the importance of their actions. The events surrounding Richard Nixon's care for deep vein thrombosis and its complications were not unusual for Presidential health care but were closely intertwined with the legal proceedings during the prosecution of the Watergate defendants.

scholarly journals Venous thromboembolism and COVID-19: a case report and review of the literature

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Harshil Bhatt ◽  
Sandeep Singh
Keyword(s):  
Health Care ◽  
Deep Vein Thrombosis ◽  
Case Report ◽  
Venous Thromboembolism ◽  
Health Care Providers ◽  
Polymerase Chain Reaction Test ◽  
Pulmonary Emboli ◽  
Care Providers ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Background Currently, there is minimal data available highlighting the prevalence of venous thromboembolism in patients infected with coronavirus disease 2019 (COVID-19). This case report with a literature review emphasizes a unique presentation of COVID-19 that is highly important for health care providers to consider when treating their patients. Case report A 65-year-old Caucasian male patient presented to the emergency department with a 2-day history of dyspnea on exertion after his wife’s recent diagnosis of COVID-19. He additionally had experienced a couple of episodes of self-resolving diarrhea a few days before presentation. Based on the patient’s clinical presentation and the laboratory workup identifying an elevated D-dimer, a computed tomography angiogram of the chest was obtained, which was significant for moderately large, bilateral pulmonary emboli with a saddle embolus, and an associated small, left lower lobe, pulmonary infarct. Ultrasound of the lower extremity showed non-occlusive deep vein thrombosis at the distal left femoral vein to the left popliteal vein. The patient was additionally diagnosed with COVID-19 when the results of the COVID-19 polymerase chain reaction test returned as positive. The patient was admitted to the COVID unit, and he was started on an intravenously administered, unfractionated heparin drip for management of his bilateral pulmonary emboli and deep vein thrombosis. The patient’s clinical condition improved significantly with anticoagulation, and he was observed in the hospital for 3 days, after which he was discharged home on the enoxaparin bridge with warfarin. Post-discharge telephone calls at day 10 and week 4 revealed that the patient was appropriately responding to anticoagulation treatment and had no recurrence of his symptoms related to venous thromboembolism and COVID-19. Conclusion As COVID-19 continues to lead to significant mortality, more data is emerging that is exposing its perplexing pathogenicity. Meanwhile, the presentation of venous thromboembolism in patients with COVID-19 remains an unusual finding. It is imperative for health care providers to be mindful of this unique association to make necessary diagnostic evaluations and provide appropriate treatment for the patients.

Advances in Thrombolytic Therapy

1982 ◽  
Vol 16 (2) ◽  
pp. 115-121 ◽  
Author(s):  
Diane M. Rutkowski ◽  
Wayne S. Burkle
Keyword(s):  
United States ◽  
Clinical Trials ◽  
Deep Vein Thrombosis ◽  
Arterial Thrombosis ◽  
The United States ◽  
Pulmonary Emboli ◽  
Vein Thrombosis ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Deep Vein

Streptokinase and urokinase are the two thrombolytic agents currently available in the United States. These drugs promote dissolution of thrombi by stimulating the conversion of plasminogen to plasmin, resulting in an overall “lytic state” in the blood. Recent clinical trials in patients with pulmonary emboli, deep vein thrombosis, arterial thrombosis, and arteriovenous cannula occlusions demonstrated significantly greater lysis with thrombolytics than with heparin alone. However, because of the increased risk of bleeding, the use of these agents is reserved for patients in whom the therapeutic advantages outweigh the disadvantages. Contraindications are numerous and include any preexisting condition that may render the patient more susceptible to bleeding.

Role of Platelets in Recurrent Deep Vein Thrombosis

1975 ◽  
Author(s):  
K. K. Wu ◽  
R. W. Barnes ◽  
J. C. Hoak
Keyword(s):  
Deep Vein Thrombosis ◽  
Oral Anticoagulant Therapy ◽  
Additional Patient ◽  
Ratio Method ◽  
Vein Thrombosis ◽  
Platelet Survival ◽  
Platelet Aggregate ◽  
Recurrent Deep Vein Thrombosis ◽  
Platelet Aggregates ◽  
Deep Vein

To evaluate the role that platelets play in the pathogenesis of recurrent deep vein thrombosis (DVT), a platelet count ratio method was used for the detection of platelet aggregates and an aggregometric technique was used to measure spontaneous aggregation (SPA) in 27 patients with idiopathic recurrent DVT. Seventeen patients were found to have decreased platelet aggregate ratios (mean 0.63±SEM 0.02) which were significantly lower than those of normals (0.90 ±0.02, p < 0.01). Twelve of the 17 patients had SPA. The mean platelet survival half-time of 5 patients with increased platelet aggregates was 2.9 days±0.49, significantly decreased from that of normals (4.2 ±0.10, p < 0.05). Platelet survival values were normal in patients with normal platelet aggregate ratios. Five patients who failed to improve on oral anticoagulant therapy responded to aspirin and dipyridamole with normalization of platelet aggregates and disappearance of SPA. An additional patient responded to sulfinpyrazone. When the drug was discontinued, pulmonary embolus recurred. These findings suggest that recurrent DVT may involve heterogeneous groups of patients and platelets may play an important pathogenetic role in some of them. The approach to the problem with this panel of 3 tests appears useful in the selection of patients for treatment with antiplatelet agents.

Venous Thromboembolism

2017 ◽  
Author(s):  
Guillermo A. Escobar ◽  
Peter K. Henke ◽  
Thomas W. Wakefield
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Lower Extremity ◽  
The United States ◽  
Laboratory Evaluation ◽  
Individual Risk ◽  
Vein Thrombosis ◽  
Clinical Scenarios ◽  
Deep Vein

Deep vein thrombosis (DVT) and pulmonary embolism (PE) comprise venous thromboembolism (VTE). Together, they comprise a serious health problem as there are over 275,000 new VTE cases per year in the United States, resulting in a prevalence of one to two per 1,000 individuals, with some studies suggesting that the incidence may even be double that. This review covers assessment of a VTE event, initial evaluation of a patient suspected of having VTE, medical history, clinical presentation of VTE, physical examination, laboratory evaluation, imaging, prophylaxis against perioperative VTE, indications for immediate intervention (threat to life or limb), indications for urgent intervention, and management of nonemergent VTE. Figures show a modified Caprini score questionnaire used at the University of Michigan to determine individual risk of VTE and the indicated prophylaxis regimen; Wells criteria for DVT and PE; phlegmasia cerulea dolens secondary to acute left iliofemoral DVT after thigh trauma; compression duplex ultrasonography of lower extremity veins; computed tomographic angiogram of the chest demonstrating a thrombus in the pulmonary artery, with extension into the right main pulmonary; management of PE according to Wells criteria findings; management of PE with right heart strain in cases of massive or submassive PE; treatment of DVT according to clinical scenario; a lower extremity venogram of a patient with May-Thurner syndrome and its subsequent endovascular treatment; and various examples of retrievable vena cava filters (not drawn to scale). Tables list initial clinical assessment for VTE, clinical scenarios possibly benefiting from prolonged anticoagulation after VTE, indications for laboratory investigation of secondary thrombophilia, venous thromboembolic risk accorded to hypercoagulable states, and Pulmonary Embolism Rule-out Criteria Score to avoid the need for D-dimer in patients suspected of having PE.   This review contains 11 highly rendered figures, 5 tables, and 167 references. Key words: anticoagulation; deep vein thrombosis; postthrombotic syndrome; pulmonary embolism; recurrent venous thromboembolism; thrombophilia; venous thromboembolism; PE; VTE; DVT 

Diagnosis of deep-vein thrombosis: Adherence to guidelines and outcomes in real-world health care

2009 ◽  
Vol 102 (12) ◽  
pp. 1234-1240 ◽  
Author(s):  
Horst Gerlach ◽  
Viola Hach-Wunderle ◽  
Eberhard Rabe ◽  
Hanno Riess ◽  
Heike Carnarius ◽  
...  
Keyword(s):  
Health Care ◽  
Deep Vein Thrombosis ◽  
Ambulatory Care ◽  
Real World ◽  
Diagnostic Methods ◽  
World Health ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Work Up ◽  
Current Guidelines

SummaryCurrent guidelines recommend optimised algorithms for diagnosis of suspected deep-vein thrombosis (DVT). There is little data to determine to what extent real-world health care adheres to guidelines, and which outcome in terms of diagnostic efficiency and safety is achieved. This registry involved patients with clinically suspected DVT of the leg recruited in German ambulatory care between October and December 2005. Registry items were: diagnostic methods applied; diagnostic categories at day 1; and venous thromboembolic events up to 90 days in patients without firmly established DVT. A total of 4,976 patients were recruited in 326 centres. Venous ultrasonography was performed in 4,770 patients (96%), D-dimer assay in 1,773 patients (36%) and venography in 288 patients (6%). At day 1, DVT was confirmed in 1,388 patients (28%), and ruled out in 3,389 patients (68%), and work-up was inconclusive in 199 patients (4%).The rate of venous thromboembolism at 90 days was 0.34% (95% confidence interval [CI]: 0.09 to 0.88) in patients in whom the diagnosis of DVT had been ruled out, and 2.50% (95% CI: 0.69 to 6.28) in patients with inconclusive diagnostic workup. This nationwide evaluation in German ambulatory care revealed that the diagnostic work-up for suspected DVT did not adhere to current guidelines. However, the overall diagnostic safety was excellent, although there is potential for improvement in a well defined minority of patients.The TULIPA registry was funded by GlaxoSmithKline GmbH und Co KG, Munich.

scholarly journals Association between Cancer and Anatomical Site of Venous Thromboembolic Disease

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 6-6
Author(s):  
David A Froehling ◽  
Damon E. Houghton ◽  
Waldemar E. Wysokinski ◽  
Robert D. McBane ◽  
Danielle Vlazny ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Upper Extremity ◽  
Renal Vein ◽  
The Body ◽  
Published Data ◽  
Anatomical Site ◽  
Pulmonary Emboli ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Active Cancer

Background:There is limited published data on the association between malignancy and the location of venous thromboembolism (VTE) in the body. Aims:Assess the location of VTE in the body in patients with active cancer and compare these results in patients without malignancy. Methods:Consecutive patients enrolled in the Mayo Clinic VTE Registry between March 1, 2013 and November 30, 2019 for acute VTE were followed prospectively. Anatomical site of thrombosis and malignancy status were recorded. Patient outcomes were assessed in person, by mailed questionnaire, or by a scripted phone interview. Active cancer was defined as treatment for malignancy within the last six months or not yet in remission. Results:During the study period there were 2,798 patients with acute VTE (1256 with and 1542 without active cancer). Pulmonary emboli were more common in patients with active cancer compared to patients without cancer (49.5% vs. 39.7%, p&lt;0.001). Upper extremity deep vein thrombosis (11.4 % vs. 7.7%, p&lt;0.001), renal vein thrombi (1.4% vs. 0.2%, p&lt;0.001) and splanchnic vein thrombi (9.3% vs. 6.0%, p=0.001) were all more common in patients with active cancer compared to patients without cancer. Conclusion:Compared to those without malignancy, patients with active cancer were more likely to have pulmonary emboli, upper extremity deep vein thrombosis, renal vein thrombi, and splanchnic vein thrombi. Disclosures No relevant conflicts of interest to declare.

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