DEEP VEIN THROMBOSIS PROPHYLAXIS IN SURGICALLY TREATED FRACTURED HIP PATIENTS

Mapping Intimacies ◽

10.1055/s-0038-1643692 ◽

1987 ◽

Author(s):

P J Powers ◽

M Gent ◽

R Jay ◽

J Hirsh ◽

M Levine ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Placebo Group ◽

Venous Thrombosis ◽

Major Complication ◽

Lower Limbs ◽

Thrombosis Prophylaxis ◽

Double Blind ◽

Vein Thrombosis ◽

Warfarin Group ◽

Deep Vein

Deep vein thrombosis is a major complication in'patients treated surgically for fractured hip. Methods employed toreduce the risk of thrombosis include dextran, ASA, warfarin, low or adjusted dose heparin and calf compression, but none has widespread acceptance.A randomized trial wascarried out to assess the effectiveness of sodium warfarinand acetyl salicylic acid(aspirin) compared to placebo inthe prevention of venous thrombosis in fractured hip patients. One hundred and ninty four patients were randomizedto receive warfarin (65 patients), ASA (66 patients) or placebo (63 patients).Prophylaxis commenced post operatively and continued for 21 days or until discharge, if earlier.Warfarin patients received 10 mg sodium warfarin orally as soon as possible after surgery. Warfarin was then given daily according to the prothrombin time (PT), to obtain a PT of 16 seconds on the 5th post operative day. The PT was maintain at 16 to 18 seconds until the end of treatment.ASA and placebo patients received enteric coated tablets, 650 mg twice daily, in a double blind fashion beginning as soon as possible post operatively and continuingto the end of treatment. Surveillance testing and I-fibrinogen leg scanning and impedance plethysmography was performed and venography was done if either test suggested thrombus at the popliteal vein or above. Otherwise venography was performed at day 21 or prior to discharge, if earlier. Venous thrombosis occurred in 13 patients (20%) in the warfarin group, 27 patients (^0.9%) in the ASA group, and 29 patients (46%) in the placebo group (P=0.005). Proximal vein thrombosis or pulmonary embolism occurred in 6patients (9.2%) in the warfarin group,7 patients (10.6%) in the ASA and 19 patients (30.2%) in the placebo group (P=0.002). Two major hemorrhages occurred in the warfarin group, none in the ASA group, and 2 in the placebo group.The results of this study show sodium warfarin to be safeand effective in reducing thromboembolic complications infractured hip patients and ASA to be effective in reducing thrombosis involving the proximal deep veins of the lower limbs in these patients.

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A DOUBLE BLIND RANDOMIZED TRIAL OF ORG 10172 LOW MOLECULAR WEIGHT HEPARINOID IN THE PREVENTION OF DEEP VEIN THROMBOSIS IN PATIENTS WITH THROMBOTIC STROKE

10.1055/s-0038-1643239 ◽

1987 ◽

Author(s):

A G G Turple ◽

M N Levin ◽

J Hirish ◽

C J Carter ◽

R M Jay ◽

...

Keyword(s):

Molecular Weight ◽

Deep Vein Thrombosis ◽

Placebo Group ◽

Venous Thrombosis ◽

Randomized Trial ◽

Thrombosis Prophylaxis ◽

Low Molecular Weight ◽

Double Blind ◽

Vein Thrombosis ◽

Deep Vein

The optimal method of venous thrombosis prophylaxis in patients with stroke is uncertain. ORG 10172 is a low molecular weight heparinoid consisting principally of heparan and dermatan sulphates. In animal studies, ORG 10172 is as effective as unfractionated heparin in preventing venous thrombosis but produces less bleeding. There have been a limited number of descriptive studies on its use in humans, but to date randomized efficacy trials of ORG 10172 in the prevention of venous thrombosis have not been reported. A double blind randomized trial was carried out to compare ORG 10172 with placebo in the prevention of deep vein thrombosis in patients with thrombotic stroke. Seventy-five patients were randomized to receive ORG 10172 (50 patients) in a loading dose of 1,000 anti-Xa units intravenously followed by 750 anti-Xa units subcutaneously 12 hourly or placebo (25 patients). Prophylaxis was commenced within 7 days of stroke onset, continued for 14 days or until discharge from hospital, if earlier. Venous thrombosis surveillance was carried out with 125-1 fibrinogen leg scanning and impedance plethysmography. Venous thrombosis was confirmed by venography which occurred in 2 of 50 (4%) in the ORG 10172 group and 7 of 25 (28%) in the placebo group (p=0.005). The corresponding rates for proximal vein thrombosis were 0% and 16%, respectively (p=0.01). There was one major haemorrhage in the treated group and one minor haemorrhage in the placebo group. The anti-factor Xa levels (units/ml; mean ± SE) gradually rose from 0.18 ± 0.001 and 0.06 ± 0.01 six and 12 hours after injection on the first day to 0.24 ± 0.02 and 0.12 ± 0.01 after 11 days treatment. The results of this study indicate that ORG 10172 heparinoid is effective prophylaxis against deep vein thrombosis in patients with acute thrombotic stroke.

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High Rate of Deep-Vein Thrombosis in Asia after Major Orthopedic Surgery: The AIDA Study Final Results.

Blood ◽

10.1182/blood.v104.11.2580.2580 ◽

2004 ◽

Vol 104 (11) ◽

pp. 2580-2580

Author(s):

Franco Piovella ◽

Ching-Jen Wang ◽

Housan Lu ◽

Lee Kenneth ◽

Lai Heng Lee ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Orthopedic Surgery ◽

Lower Limbs ◽

High Rate ◽

Orthopedic Procedures ◽

Thrombosis Prophylaxis ◽

Vein Thrombosis ◽

Asian Patients ◽

Major Orthopedic Surgery ◽

Deep Vein

Abstract Background: The incidence of post-surgical venous thromboembolism is thought to be low in Asian populations and routine thromboprophylaxis is not implemented. Objective: In this large multinational, multiethnic study, we evaluated the incidence of deep-vein thrombosis (DVT) patients undergoing major orthopedic surgery of the lower limbs. Methods: We performed a prospective epidemiological study in 19 centers across Asia (China, Indonesia, South Korea, Malaysia, Philippines, Taiwan and Thailand) in patients undergoing elective total hip replacement (THR), total knee replacement (TKR) or hip fracture surgery (HFS) not receiving pharmacological thromboprophylaxis. The primary endpoint was the rate of DVT of the lower limbs objectively documented by mandatory bilateral ascending venography performed 6 to 10 days after surgery and evaluated by a blinded central adjudication committee. Results: Overall, 407 Asian patients (20–99 years) undergoing THR (n=175), TKR (n=136) or HFS (n= 96) were recruited in 19 centres. 72.5% of the enrolled patients had adequate venograms. Total DVT was diagnosed in 121 of 295 evaluable patients (41.0%, [95% confidence interval: 35.4–46.7]). Proximal DVT was found in 30 patients (10.2% [7.0–14.2]). Total DVT and proximal DVT rates were the highest in TKR patients (58.1% and 17.1%, respectively), followed by HFS patients (42.0% and 7.2%, respectively), then THR patients (25.6% and 5.8%, respectively). DVT was more frequent in female patients aged at least 65 years. By-country analysis showed that the highest DVT rate was observed in Indonesia (78.6%) and the lowest in China (24.3%). By ethnic group, the lowest DVT rate was observed in Koreans (29.8%), while similar results were found in Chinese (45.0%) and in other non-Korean non-Chinese (46.3%) ethnic groups. Pulmonary embolism was clinically suspected in 10 of 407 patients (2.5%) and objectively confirmed in two patients (0.5%). Conclusions: Venographically detected thrombosis is well recognized as an appropriate surrogate for symptomatic outcomes and is the basis for the recommendation for routine prophylaxis in Western patients. The high rate of venographic thrombosis in Asian patients is similar to that observed in patients in Western countries. Thrombosis prophylaxis should therefore be considered in Asian patients undergoing major orthopedic procedures.

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A Double-Blind Trial of Intramuscular Stanozolol in the Prevention of Postoperative Deep Vein Thrombosis Following Elective Abdominal Surgery

Thrombosis and Haemostasis ◽

10.1055/s-0038-1661023 ◽

1984 ◽

Vol 51 (01) ◽

pp. 071-074 ◽

Cited By ~ 20

Author(s):

S L Blarney ◽

B M McArdle ◽

P Burns ◽

D C Carter ◽

G D O Lowe ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Placebo Group ◽

Controlled Trial ◽

Double Blind Trial ◽

Double Blind ◽

Vein Thrombosis ◽

Postoperative Deep Vein Thrombosis ◽

Deep Vein ◽

To Receive

SummaryFibrinolytic shutdown may be important in the development of postoperative deep vein thrombosis (DVT). We have previously shown that stanozolol 50 mg, given intramuscularly 24 hr before surgery, prevents the decrease in plasminogen activator activity (PA) seen on the first postoperative day in patients at high risk of DVT. To investigate the role of fibrinolytic shutdown in causation of DVT, sixty patients were randomised in a double-blind controlled trial to receive stanozolol or placebo intramuscularly, and DVT was detected by leg scanning and confirmed by venography. Scan positive DVT occurred in IT of 31 placebo patients (35%) and 12 of 29 who received stanozolol (41%). A significant decrease in PA was confirmed in the placebo group, while stanozolol caused a significant increase in PA on the first postoperative day. Patients in either group who did not develop DVT showed minimal changes in PA. We conclude that prevention of fibrinolytic shutdown by this regimen of stanozolol does not prevent postoperative DVT, and that further studies are required to clarify the relationships of postoperative fibrinolysis and DVT.

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Unusual deep vein thrombosis sites: magnetic resonance venography in patients with negative compression ultrasound and symptomatic pulmonary embolism

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2012.012054 ◽

2012 ◽

Vol 29 (1) ◽

pp. 25-29 ◽

Cited By ~ 2

Author(s):

T Gary ◽

K Steidl ◽

K Belaj ◽

F Hafner ◽

H Froehlich ◽

...

Keyword(s):

Pulmonary Embolism ◽

Risk Factor ◽

Deep Vein Thrombosis ◽

Magnetic Resonance ◽

Venous Thrombosis ◽

Lower Limbs ◽

Mr Venography ◽

Vein Thrombosis ◽

Compression Ultrasound ◽

Deep Vein

Objectives To evaluate the clinical characteristics of patients with pulmonary embolism (PE), negative compression ultrasound (CUS) of the lower limbs and detection of unusual deep vein thrombosis (DVT) sites by means of magnetic resonance (MR) venography. Methods A retrospective data analysis of PE patients hospitalized at our institution from April 2009 to 2011. Results From April 2009 to 2011, a total of 762 PE patients were treated at our institution. In 169 of these patients CUS for DVT was negative. In these patients MR venography was performed for further evaluation. We found venous thrombosis at unusual sites in 12 of these patients. Due to free floating thrombus masses and fear of life-threatening PE progression we inserted an inferior vena cava filter in three of these 12 patients. The leading venous thromboembolism risk factor in our patients was immobilization (5 patients, 41.7%). Conclusions We conclude that especially in patients with PE and negative CUS of the lower limbs a thrombosis of the pelvic veins should be considered in case of symptoms for venous thrombosis in this area. Further diagnostic work-up with MR venography should be scheduled in these patients especially in patients with risk factor immobilization as therapeutic consequences might occur.

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Failure of Aspirin and Dipyridamole to Influence the Incidence of Leg Scan Detected Venous Thrombosis after Elective Hip Surgery

10.1055/s-0039-1689350 ◽

1975 ◽

Author(s):

J. A. McBride ◽

A.G.G. Turpie ◽

V. Kraus ◽

C. Hiltz

Keyword(s):

Deep Vein Thrombosis ◽

Venous Thrombosis ◽

Randomized Trial ◽

Drug Combination ◽

Treated Group ◽

Hip Surgery ◽

Control Group ◽

Double Blind ◽

Vein Thrombosis ◽

Deep Vein

Drugs known to affect platelet function have been shown to be effective in the prevention of venous thrombosis after surgery. A double-blind randomized trial of aspirin plus dipyridamole was carried out to investigate the prophylactic value of the drug combination in the prevention of venous thrombosis detected by 125 Iodine-labelled fibrinogen leg-scanning after elective hip surgery. Aspirin 900 mg plus dipyridamole 100 mg were given once pre-operatively and twice daily for 10 days postoperatively, or until the patient was fully ambulant. 43 patients were entered into the trial, 22 in the control group and 21 in the treated group. Both groups were similar with respect to age, sex and factors known to predispose towards venous thrombosis. 8 patients (36.7%) in the control group and 8 patients (38.1% ) in the treated group developed leg scan-detected deep vein thrombosis. The thrombi were detected between the 1st and 17th post-operative day and were found as frequently in the operated limbs as in the non-operated limbs in both groups. It is concluded that prophylaxis with aspirin 900 mg and dipyridamole 100 mg twice daily does not influence the incidence of leg scan-detected deep vein thrombosis after elective hip surgery.

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Acute Deep Vein Thrombosis Treated with Porcine Plasmin

Thrombosis and Haemostasis ◽

10.1055/s-0038-1647715 ◽

1974 ◽

Vol 32 (02/03) ◽

pp. 468-482 ◽

Cited By ~ 2

Author(s):

O Storm ◽

P Ollendorff ◽

E Drewsen ◽

P Tang

Keyword(s):

Deep Vein Thrombosis ◽

Lower Limb ◽

Initial Dose ◽

Treated Group ◽

Allergic Reactions ◽

Double Blind ◽

Vein Thrombosis ◽

Thrombolytic Effect ◽

Acute Deep Vein Thrombosis ◽

Deep Vein

SummaryThe thrombolytic effect of pig plasmin was tested in a double blind trial on patients with deep venous thrombosis in the lower limb. Only patients with not more than three days old thrombi were selected for this study. The diagnosis of deep vein thrombosis was made clinically and confirmed by phlebography. Lysofibrin Novo (porcine plasmin) or placebo (porcine plasminogen) was administered intravenously to the patients. The enzyme and the placebo were delivered as lyophilized powder in labelled bottles - the contents of the bottles were unknown to the doctor in charge of the clinical administration of the trial. An initial dose of plasmin/plasminogen of 30 unit per kg body weight given slowly intravenously (1-1% hours infusion) was followed by a maintenance dosis of 15 per cent the initial dose per hour for the following 5-7 hours. In most cases a similar maintenance dosis was given the next day. In all patients heparin was administered after ending the plasmin/plasminogen infusion. The results of the treatment was evaluated clinically as well as by control phlebo- grams the following days.A statistically significant improvement was found in the plasmin treated group compared with the placebo (plasminogen) treated group. Thrombolysis was obtained clinically and phlebographically in 65 per cent of the plasmin treated group, but only in 15 per cent of the control patients were improvements found.This study has thus demonstrated that plasmin treatment according to a standard scheme was able to induce thrombolysis. There were only a few and insignificant side effects. Allergic reactions have not been seen and only very simple tests are required.

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D-Dimer Test and Diagnosis of Deep Vein Thrombosis: A Comparative Study of 7 Assays

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650615 ◽

1996 ◽

Vol 76 (04) ◽

pp. 518-522 ◽

Cited By ~ 44

Author(s):

A Elias ◽

I Aptel ◽

B Huc ◽

J J Chale ◽

F Nguyen ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Negative Predictive Value ◽

Predictive Value ◽

Latex Agglutination ◽

Lower Limbs ◽

First Episode ◽

Lower Sensitivity ◽

Vein Thrombosis ◽

Deep Vein ◽

D Dimer

SummaryThe current D-Dimer ELISA methods provide high sensitivity and negative predictive value for the diagnosis of deep vein thrombosis but these methods are not suitable for emergency or for individual determination. We have evaluated the performance of 3 newly available fast D-Dimer assays (Vidas D-Di, BioMerieux; Instant IA D-Di, Stago; Nycocard D-Dimer, Nycomed) in comparison with 3 classic ELISA methods (Stago, Organon, Behring) and a Latex agglutination technique (Stago). One-hundred-and-seventy-one patients suspected of presenting a first episode of deep vein thrombosis were investigated. A deep vein thrombosis was detected in 75 patients (43.8%) by ultrasonic duplex scanning of the lower limbs; in 11 of them the thrombi were distal and very limited in size (<2 cm). We compared the performance of the tests by calculating their sensitivity, specificity, positive and negative predictive value for different cut-off levels and by calculating the area under ROC curves. The concordance of the different methods was evaluated by calculating the kappa coefficient. The performances of the 3 classic ELISA and of the Vidas D-Di were comparable and kappa coefficients indicated a good concordance between the results provided by these assays. Their sensitivity slightly declined for detection of the very small thrombi. Instant IA D-Di had a non-significantly lower sensitivity and negative predictive value than the 4 previous assays; however its performance was excellent for out-patients. As expected, the Latex assay had too low a sensitivity and negative predictive value to be recommended. In our hands, Nycocard D-Dimer also exhibited low sensitivity and negative predictive value, which were significantly improved when the plasma samples were tested by the manufacturer. Thus significant progress has been made, allowing clinical studies to be planned to compare the safety and cost-effectiveness of D-Dimer strategy to those of the conventional methods for the diagnosis of venous thrombosis.

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Diagnosis of Deep Vein Thrombosis by Combination of Doppler Ultrasound Flow Examination and Strain Gauge Plethysmography

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657149 ◽

1982 ◽

Vol 47 (02) ◽

pp. 141-144 ◽

Cited By ~ 7

Author(s):

H Bounameaux ◽

B Krähenbühl ◽

S Vukanovic

Keyword(s):

Deep Vein Thrombosis ◽

Negative Predictive Value ◽

Doppler Ultrasound ◽

Strain Gauge ◽

Predictive Value ◽

Lower Limbs ◽

Vein Thrombosis ◽

Non Invasive ◽

Strain Gauge Plethysmography ◽

Deep Vein

SummaryDoppler ultrasound flow examination, strain gauge plethysmography and contrast venography were performed in 160 lower limbs of 80 in-patients. Deep vein thrombosis (DVT) was suspected in 87 limbs. Using measurement of venous stop-flow pressure, the Doppler method had an overall sensitivity of 83%. By combined use of Doppler and Plethysmography, sensitivity was increased to 96%. Specificity was 62% and 51%, respectively. With a positive and a negative predictive value of 80% and 73%, respectively, the combination of both non-invasive methods cannot reliably replace venography in the diagnosis of DTV, although all (40/40) thromboses proximal to or involving the popliteal segment were detected by either Doppler and Plethysmography or both.After exclusion of 14 patients (18%) suffering from conditions known to alter the results of these non-invasive methods, the positive predictive value of abnormal findings in both Doppler and Plethysmography was increased to 94% for suspected limbs, whilst negative predictive value of both negative Doppler and Plethysmography was 90%, allowing the avoidance of venography in these patients.

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