Fibrinogen Proteolysis and Deep Venous Thrombosis (DVT)

1979 ◽  
Author(s):  
H.L. Nossel
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Fibrinopeptide A ◽  
Terminal Portion ◽  
Two Stage ◽  
Normal Individuals

Thrombin cleaves fibrinogen in a two-stage reaction first producing fibrin I (fl) and fibrinopeptide A (FPA) and then fibrin II (fill and fibrinopeptide B (FPU). FI forms thinner strands than fil, a property which may be important in the pathogenesis of thrombosis. In the initial stages of plasmin proteolysis of fibrinogen the C-terminal portion of the Aα chain and the N-terminal portion of the EB chain are removed, leaving a molecule called fragment X (X). Release of the N-termlnal peptide Bβ1-42 serves as an index of X formation, llcnco plasma FPA levels serve as an index of X formation by thrombin action and Bβ1-42 levels as an index of X formation by plasmin action. In normal individuals Bβ1-42 levels were approvimately three times higher than FPA levels. In patients with symptoms of DVT, which was confirmed by venogram, PPA levels were almost invariably elevated. Bβ1-42 levels were not significantly elevated in these patients in the absence of complicating pulmonary embolism. Initial studies on patients at high risk for DVT studied prospectively have shown signigicant elevation of the plasma FPA level and little change in the Bβ1-42 level for several days preceding the onset of DVT as indicated by 125I-fibTinogen scan and confirmed by venogram. Bβ1-42 levels became elevated several days later inassociation either with pulmonary embolism or with resolution of the thrombosis. These data suggest_ that the development of DVT is associated with and preceded by imbalance between thrombin action as indicated by plasma FPA levels and plasmin action as indicated by Bβ1-42 levels.

scholarly journals Upper extremity deep venous thrombosis: risk factors, diagnosis, treatment

2016 ◽  
Vol 11 (1) ◽  
pp. 28-32
Author(s):  
Camelia C. DIACONU ◽  
◽  
Mădălina ILIE ◽  
Mihaela Adela IANCU ◽  
◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
High Risk ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Upper Extremity ◽  
Brachiocephalic Vein ◽  
Risk Of Death ◽  
Thrombosis Risk ◽  
Effort Thrombosis

Upper extremity deep venous thrombosis is a condition with increasing prevalence, with high risk of morbidity and mortality, due to embolic complications. In the majority of the cases, thrombosis involves more than one venous segment, most frequently being affected the subclavian vein, followed by internal jugular vein, brachiocephalic vein and basilic vein. Upper extremity deep venous thrombosis in patients without risk factors for thrombosis is called primary deep venous thrombosis and includes idiopathic thrombosis and effort thrombosis. Deep venous thrombosis of upper extremity is called secondary when there are known risk factors and it is encountered mainly in older patients, with many comorbidities. The positive diagnosis is established only after paraclinical and imaging investigations, ultrasonography being the most useful diagnostic method. The most important complication, with high risk of death, is pulmonary embolism. Treatment consists in anticoagulant therapy, for preventing thrombosis extension and pulmonary embolism.

scholarly journals Prevention of fatal pulmonary embolism in a patient with stomach cancer

2013 ◽  
Vol 94 (6) ◽  
pp. 903-905
Author(s):  
I A Kamalov ◽  
I R Aglullin ◽  
M G Tukhbatullin ◽  
I R Safin ◽  
A Yu Rodionova
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Inferior Vena Cava ◽  
Lower Extremity ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Inferior Vena Cava Filter ◽  
Inferior Vena ◽  
Vena Cava ◽  
Set Up

A clinical case of a 71-year old patient with stomach cancer and concomitant lower extremity deep venous thrombosis diagnosed before the surgical treatment is presented. The patient was administered anticoagulants, and despite the treatment, a diagnosis of deep venous thrombosis with high risk for thromboembolism was set up. Considering high risk for pulmonary embolism, an inferior vena cava filter was implanted in infrarenal part of inferior vena cava at the first stage. On the second day after the cancer surgery (subtotal stomach resection with lymphadenectomy), clot detachment and its dislocation from the left common femoral vein to the area where the cava filter was implanted with further fixation were diagnosed. Accurate diagnosis of lower extremity deep venous thrombosis with high risk for thromboembolism set up by ultrasonography and timely inferior vena cava filter implantation saved the patient with cancer from developing pulmonary embolism.

PREVENTION OF DEEP VENOUS THROMBOSIS: CONCLUSIONS OF A CONSENSUS DEVELOPMENT CONFERENCE

1987 ◽  
Author(s):  
H R Roberts
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Low Dose ◽  
Dose Heparin ◽  
Prophylactic Measures ◽  
Risk Patients ◽  
Patient Groups ◽  
Low Dose Heparin

Deep venous thrombosis (DVT) and pulmonary embolism (PE) are major health problems that lead to significant morbidity and mortality. In the United States, it is estimated that these two problems result in over 300,000 hospitalizations annually and available data indicate that 50,000 to 100,000 patients per year die of pulmonary embolism.The advent of several diagnostic tests has permitted the identification of groups of patients at high risk for development of deep venous thrombosis and subsequent pulmonary embolism. Identification of these patient groups has led to therapeutic measures designed to prevent both deep venous thrombosis and subsequent embolic episodes. However, the efficacy of these preventive measures have not been widely adopted and reservations have been expressed regarding use of low dose anticoagulant drugs for prevention of DVT and PE, especially in surgical patients. Because of the apparent reluctance to adopt putative preventive measures for DVT and PE, the National Heart, Lung and Blood Institute convened a Consensus Development Conference on the issue of prevention in 1986. Experts from North America, Europe, and South Africa presented data, both pro and con, on prevention of DVT and PE, using one or more therapeutic regimens. An impartial Panel was then asked to arrive at a consensus statement on the following questions: 1) the level of risk of DVT and PE in different patient groups; 2) the efficacy and safety of prophylactic measures in these groups; 3) the recommended prophylactic regimens for different patient groups, and 4) remaining questions related to prevention of DVT and PE. Recommendations for prevention were based on the assumption that reduction in DVT would also result in reduction of pulmonary embolism. Furthermore, the consensus was based, at least in part, upon data combined from multiple clinical trials. Thus, combined data on 12,000 individuals in randomized clinical trials indicated that in appropriate patient groups, treated with low dose heparin, there was a 68 percent reduction in DVT, as measured by the 125I-fibrinogen uptake test and venography, and that there was a reduction of 49% in pulmonary embolism and a significant decrease in overall mortality resulting from pulmonary embolism.Prophylactic measures for the following different patient groups were assessed: 1) general surgery; 2) orthopedic surgery; 3) urology; 4) gynecology-obstetrics; 4) neurosurgery and neurology; 5) trauma; and 6) medical conditions.Basically, the following prophylactic regimens were considered: 1) low dose heparin; 2) low dose dihydroergotamine heparin; 3) dextran; 4) low dose warfarin; and 5) external pneumatic compression. In general terms, low dose heparin appears to be one of the more effective prophylactic regimens in certain groups of high risk patients. This regimen is not useful in orthopedic or certain neurosurgical procedures where heparin has been shown to be of little value or hazardous. In these cases, dextran, warfarin, or external pnuematic compression may be more beneficial. In some groups of high risk patients, combination of mechanical measures with anticoagulant agents appear to be of value in prevention of DVT and PE.The recommendations of the Consensus Panel for Prevention of DVT and PE for each patient group will be assessed.

Deep Venous Thrombosis and Pulmonary Embolism in Trauma Patients: An Overstatement of the Problem?

2005 ◽  
Vol 71 (5) ◽  
pp. 387-391 ◽  
Author(s):  
Stanislaw P. Stawicki ◽  
Michael D. Grossman ◽  
James Cipolla ◽  
William S. Hoff ◽  
Brian A. Hoey ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Injury Severity ◽  
Clinical Importance ◽  
Trauma Patients ◽  
Lower Extremity Fracture ◽  
Cord Injury ◽  
Level I

Deep venous thrombosis (DVT) and pulmonary embolism (PE) affect high-risk trauma patients (HRTP). Accurate incidence and clinical importance of DVT and PE in HRPT may be overstated. We performed a ten-year retrospective analysis of HRTP of the Pennsylvania Trauma Outcome Study. High-risk factors (HRF) included pelvic fracture (PFx), lower extremity fracture (LEFx), severe head injury (CHI) (AIS – head ≥3), and spinal cord injury. HRF alone or in combination, age, Injury Severity Score (ISS), and Glasgow Coma Score (GCS) were examined for association with DVT/PE. A total of 73,419 HRTP were included: 1377 (1.9%) had DVT, 365 (0.5%) had PE. The incidence of DVT in level I trauma centers was 2.2 per cent and was 1.5 per cent in level II centers. The lowest incidence of DVT was 1.3 per cent for isolated LEFx; highest was 5.4% for combined PFx, LEFx, and CHI. Variables associated with DVT included age, ISS, and GCS (all P < 0.001). In logistic regression analysis, only ISS was consistently predictive for DVT and PE. Though increased during the past decade, the overall incidence of DVT in HRTP remains below 3 per cent. Only the combination of multiple injuries or an ISS >30 result in DVT incidence of ≥5 per cent. We believe that current guidelines for screening for DVT may need to be reevaluated.

Venous Thrombosis in Patients with Solid Tumors: Determination of Frequency and Characteristics

2002 ◽  
Vol 87 (04) ◽  
pp. 575-579 ◽  
Author(s):  
Jim Wan ◽  
Nam Nguyen ◽  
Sabah Sallah
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Solid Tumors ◽  
Current Knowledge ◽  
Patients With Cancer ◽  
Venous Thromboembolic ◽  
Patients At Risk ◽  
The Impact

SummaryDeep venous thrombosis (DVT) and pulmonary embolism (PE) are well recognized complications of cancer. However, our current knowledge of this association is derived from studies conducted more than a decade ago. In light of the changes in medical practice and the improvement in cancer care in recent years, a re-evaluation of the relationship between malignancy and venous thrombosis is in order. Of a total of 1041 patients with solid tumors admitted to 3 major medical centers, there were 81 (7.8%) diagnosed with DVT/PE. Patients were more likely to develop DVT/PE during chemotherapy (p = .0001). Advanced malignancies (p = .001), renal carcinoma (p = .005), pancreatic (p = .001), gastric (p = .014) and brain tumors (p = .001) were independent variables strongly associated with the occurrence of venous thrombosis. The occurrence of thrombotic events in the population tested in this study did not adversely affect survival (p = .082).The study identifies subset of patients with cancer at high risk for venous thrombosis. Early prophylaxis with anticoagulants in these patients may be warranted. Most importantly, further clinical trials are desperately awaited to detect possible new trends in the frequency and types of thrombotic events and to better define prevention strategies in cancer patients at risk for thrombosis.The association between venous thromboembolic disease (VTD) and malignant neoplastic disorders is well known and has been the subject of several reports for more than a century (1–8). There is a general agreement among investigators that thrombotic complications in patients with cancer occur at a rather high frequency, and that other circumstantial factors such as surgery or chemotherapy potentiates this risk (9,10). However, several important considerations pertaining to cancer and thrombosis continue to be shrouded in controversy. For example, there are inexplicable differences in the proportion of patients with cancer diagnosed with deep venous thrombosis (DVT) or pulmonary embolism (PE) reported in the literature (2, 4, 5, 11). In the absence of large well-controlled studies, one may only postulate on the reasons that contributed to these differences. The inclusion of different types of VTD such as superficial, venous, arterial or vascular access device-induced thrombosis may have led to overestimation of the incidence of these events in patients with underlying malignancy. Another possible explanation for this discrepancy relates to the use of a variety of diagnostic and methodological criteria ranging from observation and clinical suspicion to more invasive procedures resulting in considerable differences in the rate of reported clotting events (12). Along the same line of discussion, one may argue whether VTD is a random event or constitutes a complication that occurs more commonly in patients with distinct characteristics and certain tumor types. To further investigate the association between malignancy and thrombosis, we evaluated 1041 patients with solid tumors for the risk of DVT/PE. The main objectives of the study were to determine the frequency of DVT/PE based on validated diagnostic criteria and to identify patients with cancer at high risk for developing these thrombotic episodes. Also, we evaluated the impact of VTD on the survival of these patients.

Incidence of Venous Thromboembolism: A Community-based Study in Western France

2000 ◽  
Vol 83 (05) ◽  
pp. 657-660 ◽  
Author(s):  
Emmanuel Oger ◽  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Confidence Interval ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Medical Patients ◽  
Community Based ◽  
Effective Prophylaxis ◽  
One Year

SummaryThe incidence of venous thromboembolism has been studied during one year in a defined population of 342,000 inhabitants. The overall incidence (95% confidence interval) of venous thromboembolism was found to be 1.83 per thousand per year (1.69 to 1.98). The incidences of deep venous thrombosis and pulmonary embolism were 1.24 per thousand per year (1.12 to 1.36) and 0.60 per thousand per year (0.52 to 0.69), respectively. The incidence of venous thromboembolism rose markedly with increasing age for both sexes; over the age of 75, the annual incidence reached 1 per 100. Sixty three percent of the patients were at home when venous thromboembolism occurred. Of these, sixteen percent had been previously hospitalised within three months. These results raise concerns on identification of medical patients at high risk and effective prophylaxis.

scholarly journals Complement C3 and High Risk of Venous Thromboembolism: 80517 Individuals from the Copenhagen General Population Study

2016 ◽  
Vol 62 (3) ◽  
pp. 525-534 ◽  
Author(s):  
Ina Nørgaard ◽  
Sune F Nielsen ◽  
Børge G Nordestgaard
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
High Risk ◽  
General Population ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Population Study ◽  
Mean Value ◽  
Complement C3 ◽  
General Population Study

Abstract BACKGROUND Complement activation may contribute to venous thromboembolism, including deep venous thrombosis and pulmonary embolism. We tested the hypothesis that high complement C3 concentrations are associated with high risk of venous thromboembolism in the general population. METHODS We included 80 517 individuals without venous thromboembolism from the Copenhagen General Population Study recruited in 2003–2012. Plasma complement C3 concentrations were measured at baseline, and venous thromboembolism (n = 1176) was ascertained through April 2013 in nationwide registries. No individuals were lost to follow-up. RESULTS Complement C3 concentrations were approximately normally distributed, with a mean value of 1.13 g/L (interquartile range 0.98–1.26; SD 0.21). The cumulative incidence of venous thromboembolism was higher with progressively higher tertiles of complement C3 (log-rank trend: P = 3 × 10−8): at age 80, 7%, 9%, and 11% of individuals in the first, second, and third tertiles, respectively, had developed venous thromboembolism. Multivariable-adjusted hazard ratios for venous thromboembolism compared with individuals in the first tertile were 1.36 (95% CI, 1.16–1.59) for those in the second tertile and 1.58 (1.33–1.88) for those in the third tertile. Corresponding values were 1.36 (1.16–1.60) and 1.57 (1.33–1.87) after additional adjustment for C-reactive protein and 1.27 (1.09–1.49) and 1.31(1.10–1.57) after additional adjustment for body mass index. These results were similar for deep venous thrombosis and pulmonary embolism separately. The multivariable-adjusted hazard ratio for venous thromboembolism for a 1-g/L increase in complement C3 was 2.43 (1.74–3.40). CONCLUSIONS High concentrations of complement C3 were associated with high risk of venous thromboembolism in the general population.

Diagnostic Value of Fibrinopeptide A and Beta-Thromboglobulin in Acute Deep Venous Thrombosis and Pulmonary Embolism

2009 ◽  
Vol 211 (5) ◽  
pp. 323-330 ◽  
Author(s):  
Harry Hulsteijn ◽  
Ernest Briët ◽  
Carl Koch ◽  
Jo Hermans ◽  
Rogier Bertina
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Diagnostic Value ◽  
Fibrinopeptide A
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