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2023 SEP 9 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators publish new report on pulmonary embolism. According to news reporting from [...]

2018 MAY 26 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Data detailed on Cardiovascular Diseases and Conditions - Deep Vein Thrombosis have [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2008.05.045 Byline: Raza Alikhan (a), Alex C. Spyropoulos (b) Keywords: Chronic obstructive pulmonary disease; Deep vein thrombosis; Epidemiology; Heart failure; Infection; Pulmonary embolism; Thromboprophylaxis; Venous thromboembolism Abstract: Venous thromboembolic complications -- deep vein thrombosis and pulmonary embolism -- occur in a significant proportion of hospitalized medical patients. The incidence in acutely ill medical patients is 10%-40%, equivalent to that seen in general surgical patients. Prophylaxis is effective and well tolerated, yet remains under-prescribed in medical wards. Current recommendations for prophylaxis are generalized and do not specifically address many patient groups. Data on the prevalence in patients with chronic obstructive pulmonary disease, heart failure, and infectious diseases are limited. However, studies on large numbers of hospitalized patients with these admission diagnoses have provided important information on incidence, and the efficacy of thromboprophylaxis. This review summarizes current knowledge of the epidemiology of venous thromboembolism in patients with chronic obstructive pulmonary disease, heart failure, and infectious diseases, and highlights the benefits of, and needs for, appropriate prophylaxis in these groups. Increased awareness of the prevalence of thrombosis in the major subgroups of medical inpatients should improve the prescribing of prophylaxis and prevent potentially avoidable and costly complications. Author Affiliation: (a) Department of Haematology, John Radcliffe Hospital, Oxford, UK (b) Clinical Thrombosis Center, Lovelace Medical Center, Albuquerque, NM

2017 AUG 12 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Researchers detail new data in Lung Diseases and Conditions - Pulmonary Embolism. [...]

2017 JUL 1 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Fresh data on Cardiovascular Diseases and Conditions - Venous Thromboembolism are presented [...]

INTRODUCTION Deep venous thrombosis (DVT) and pulmonary embolus (PE) are major risk factors for patients undergoing surgical or other invasive procedures, and thromboprophylaxis should be considered for all these patients. [...]

* EVERY YEAR, THOUSANDS OF PATIENTS develop deep vein thrombosis (DVT) after undergoing surgery. Deep vein thromboses that result in pulmonary embolisms (PEs) are believed to be one of the most frequently occurring, preventable killers of hospitalized patients. * STRATEGIES FOR PREVENTING a patient from developing DVT include implementing chemical or mechanical prophylaxis or a combination of the two. * BY INSTITUTING a DVT-assessment program, implementing mechanical DVT prophylaxis, and educating nurses and patients, the incidence of DVTs in orthopedic patients can be reduced, leading to fewer deaths from PEs., Deep vein thrombosis (DVT) and pulmonary embolism (PE) affect between 200,000 and 600,000 Americans each year. Of those patients who develop a PE, 60,000 to 200,000 will die. (1) Pulmonary [...]

Background: The optimal duration of oral anticoagulant treatment after a first episode of pulmonary embolism remains uncertain. Objective: To evaluate the long-term clinical benefit of extending a 3-month course of oral anticoagulant therapy to 6 months (pulmonary embolism associated with temporary risk factors) or to 1 year (idiopathic pulmonary embolism) in patients with a first episode of pulmonary embolism. Design: Multicenter randomized study with independent, blinded assessment of the outcome events. Setting: 19 Italian hospitals. Patients: 326 patients who had had 3 months of oral anticoagulant therapy without experiencing recurrence or bleeding. Measurements: The primary study outcome was recurrence of symptomatic, objectively confirmed venous thromboembolism. Results: Among 165 patients assigned to extended anticoagulant therapy, 15 patients (9%) had a recurrence of venous thromboembolism (3.1% per patient-year; average follow-up, 34.9 months), as compared with 18 of 161 patients (11.2%) assigned to discontinue treatment (4.1% per patient-year; average follow-up, 32.7 months); the rate ratio was 0.81 (95% CI, 0.42 to 1.56). All but one of the recurrences occurred after anticoagulant treatment was discontinued. Nineteen recurrences (57.6%) were episodes of pulmonary embolism, two of which were fatal. Three major bleeding episodes were observed during extended anticoagulation (1.8%). Among patients with idiopathic venous thromboembolism, 11 of 90 patients assigned to extended anticoagulation and 11 of 91 patients assigned to discontinue treatment experienced a recurrence (relative risk, 0.99 [CI, 0.45 to 2.16]). Conclusion: Patients with pulmonary embolism have a substantial risk for recurrence after discontinuation of oral anticoagulation, regardless of treatment duration. Physicians should try to identify patients who are at high risk for recurrent venous thromboembolism and are therefore potential candidates for indefinite oral anticoagulant therapy.

This article examines the nurse's role in the care of patients with deep venous thrombosis. Treatment for deep venous thrombosis attempts to prevent pulmonary embolism, minimize related complications, and resolve the existing condition by utilizing treatments including rest, progressive ambulation, analgesics, and anticoagulant therapy.

Background: Our objective was to systematically review the incidence of deep vein thrombosis (DVT) and the efficacy of thromboprophylaxis in critically ill adults, including patients admitted to intensive care units and following trauma, neurosurgery, or spinal cord injury. Methods: Two authors independently searched MEDLINE, EMBASE, abstract databases, and the Cochrane database. Data were extracted independently in triplicate. Results: Ten percent to 30% of medical and surgical intensive care unit patients develop DVT within the first week of intensive care unit admission. The use of subcutaneous low-dose heparin reduced the rate by 50% compared with no prophylaxis. Approximately 60% of trauma patients developed DVT within the first 2 weeks of admission. Use of unfractionated heparin appears to decrease the incidence of DVT by only 20%, whereas low-molecular-weight heparin decreases the incidence by a further 30%. The estimated prevalence of DVT in neurosurgical patients not given prophylaxis is 22% to 35%. Mechanical prophylaxis is efficacious, with a pooled odds ratio in 5 randomized trials of 0.28. Use of low-molecular-weight heparin has been investigated as an adjunct to mechanical prophylaxis with a pooled odds ratio of 0.59 compared with graduated compression stockings alone. The incidence of DVT without prophylaxis in acute spinal cord injury patients is likely in excess of 50% to 80%. Studies of prophylaxis in these patients are too sparse to come to any definitive conclusion. Conclusions: Critically ill patients commonly develop DVT, with rates that vary from 22% to almost 80%, depending on patient characteristics. Methods of prophylaxis proven in one group do not necessarily generalize to other critically ill patient groups. More potent prophylactic regimens other than unfractionated or low-molecular-weight heparins alone may be needed with higher-risk groups.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1067/mob.2000.105941 Byline: Steven R. Goldstein Keywords: SERMs; selective estrogen receptor modulators; tamoxifen; raloxifene; breast cancer Abstract: Tamoxifen was approved for breast cancer prevention in October 1998. Thus, for the first time, we as gynecologists are being asked to prescribe this drug to healthy women. In the past each one of us has cared for women with breast cancer who have been treated with tamoxifen by oncologists or breast surgeons for the malignancy. Effects of tamoxifen on the uterus resulting in carcinomas, hyperplasia, and polyps are well known. Furthermore, tamoxifen has estrogenic properties in the venous system, increasing the incidence of deep vein thrombosis and pulmonary emboli. A new SERM (selective estrogen receptor modulator), raloxifene, has been approved for prevention and treatment of osteoporosis in postmenopausal women. It does not have stimulatory effects on the endometrium; however, it is estrogenic in the venous system. Preclinical data, as well as the breast cancer incidence reported in studies of the skeleton, seem to indicate that its effects in the breast are similar to those of tamoxifen. This article reviews tamoxifen and the new SERM, raloxifene, in an attempt to help gynecologists better understand each compound and what data are currently known, what we hope to learn from future studies, and what currently makes sense for clinical practice. (Am J Obstet Gynecol 2000;182:1121-6.) Author Affiliation: Department of Obstetrics and Gynecology, New York University School of Medicine New York, New York Article Note: (footnote) [star] Reprint requests: Steven R. Goldstein, MD, Department of Obstetrics and Gynecology, New York University School of Medicine, 530 First Ave, Suite 10N, New York, NY 10016.

Drugs and techniques to prevent the formation of blood clots in the legs are usually necessary for the prevention of pulmonary embolism and deep-vein thrombosis in patients undergoing total knee or hip replacement surgery. In patients with rheumatoid arthritis, the use of anticoagulants in conjunction with antiinflammatory drugs for pain may increase the risk of bleeding. Research to determine the risk and benefits of thromboprophylaxis in rheumatoid arthritis patients is needed.

Prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE) are important nursing considerations. Nurses should first be aware of risk factors for DVT and PE. They should make use of risk assessment tools, especially with surgical patients over 40 with other risk factors. With physician guidance, preoperative and postoperative prophylaxis can include graduated compression stockings and external pneumatic sleeves for neurosurgical patients, inferior vena cava filter placement for multiple trauma patients and anticoagulant therapy for hip replacement candidates.

Introduction: Pneumatic compression stocking (PCS) devices have been introduced to decrease the incidence of postoperative deep venous thrombosis (DVT). However, their role in the prophylaxis against pulmonary embolism (PE) remains [...]

Surgery, chronic illness and prolonged immobility increase patients' risks of developing deep vein thrombosis (DVT) and its life-threatening consequence, pulmonary embolism. The cause of DVT, its main symptom, method of treatment and ways of protecting patients with high DVT risk are presented., Shorter hospital stays haven't eliminated the threat of deep vein thrombosis. You need to assess for it, and teach patients what to look for when they get home. Today patients [...]

The embolus trap (ET) is a new device that interrupts the inferior vena cava (IVC) for the prevention of pulmonary embolism. It has a central column from which six wires extend in two tiers. The adjacent wires are formed into loops with hooks at the distal ends that grip the vein wall. Each tier contains three wire loops, and the loops are staggered circumferentially between the tiers. The ET was implanted into the IVC in 26 dogs via a femoral or jugular venotomy. IVC patency was evaluated by venacavagrams. Autologous clots were embolized via the femoral vein to test the efficacy of the ET. The animals were followed for 1 to 4 months prior to postmortem examination. The ET remained patent in all animals and consistently trapped the thromboemboli while preserving blood flow. Lysis of the trapped emboli was observed in 4 to 6 weeks. There was no evidence of malpositioning, penetration through the vein wall, or migration of the ET.

* Background. - Preventing pulmonary embolization by interrupting vena caval flow has been attempted since 1893. Inferior vena cava (IVC) filters have been available for 20 years, and currently there are five filters commercially available in the United States (Greenfield filter, Titanium Greenfield filter, Simon-Nitinol filter, Bird's Nest filter, and LGM or Vena Tech filter) and two other filters under development (Amplatz filter and Gunther filter). Although these devices are widely used, their clinical utility and safety have not been completely evaluated. Controlled clinical trials to determine the clinical role for IVC filters have not been attempted, but numerous case series describing the outcomes of the seven current filters have been published. We have systematically reviewed these studies to clarify what is known about the indications, safety, and effectiveness of IVC filters. Methods. - Using the MEDLINE database, all English-language publications since 1970 that included follow-up clinical information after filter insertion were reviewed and eight methodologic guidelines were employed to assess the scientific quality of the clinical information. Results. - Twenty-four case series were reviewed: 16 concerned the Greenfield filter (1632 patients), and eight dealt with newer designs (925 patients). Commonly noted methodologic problems included failure to report the initial extent of thromboembolic disease, incomplete description of the patient assembly process, and incomplete and potentially biased outcome assessment. Recurrent clinical pulmonary embolism was rare after filter placement, and only eight deaths from pulmonary embolism were reported. Filter complications were common but rarely life threatening; four (0.16%) deaths from filter complications were noted among the reviewed studies. Thrombotic complications following filter placement included insertion-site deep vein thrombosis and IVC obstruction. These events were rare, but they occurred with all filter types. Conclusions. - Inferior vena cava filters appear to be effective in preventing recurrent pulmonary embolism. Despite the large published experience with IVC filters, many questions remain about their indications, safety, and effectiveness. Anticoagulant therapy, if not contraindicated, should be used in conjunction with filters. While there is no ideal filter, some situations call for specific filters. Filter selection and insertion require experience, modern angiographic technique, and collaboration between clinicians caring for patients and the interventional radiologists or surgeons inserting the device.

Lower extremity deep venous thrombosis is an abnormal condition in which clotting elements and cell debris accumulate and attach to a point on the interior wall of the vessel; the condition can result in clot formation within a vessel. These clots can be carried by the blood stream into vessels with smaller diameters, and become lodged within them. Within the circulation, the fragments of clotted tissue are known as emboli. Pulmonary embolism (obstruction of the pulmonary artery) and embolism within the heart often develop from a thrombosis in the lower extremities. To prevent these complications, patients at risk for thromboembolism are frequently given low-dose anticoagulation medication such as heparin. If this medical treatment can not be carried out or is unsuccessful, a Greenfield filter may be placed within the vena cava (the large vein that returns blood from the peripheral circulation to the heart) to prevent emboli from obstructing the pulmonary artery or heart. Placement of these filters has a low complication rate, and is effective in 95 percent of patients. A recognized complication of filter insertion is inadvertent placement or migration of the filter into the heart, or even further migration into the pulmonary artery. The best method of treatment when this occurs has not been determined; patients are often too sick to undergo surgical removal of the filter from the heart or pulmonary artery. A review was undertaken of 156 patients who underwent Greenfield filter placement; the average patient age was 72 years. In six patients (4 percent) the filter was inappropriately placed. Three cases are presented in which the filter was inadvertently placed in the right atrium of the heart. In two cases, attempts were made to remove the filter; these were unsuccessful and one attempt caused the filter to migrate further into the pulmonary artery. These patients have been followed for 2, 45 and 60 months with no evidence of complications. It is concluded that when migration or inadvertent placement of the filter occurs, the patient may be treated conservatively. (Consumer Summary produced by Reliance Medical Information, Inc.)

Venous thromboembolism is the formation of blood clots in the circulation, often of the legs. The blood clots in the legs have a tendency to break away and travel throughout the bloodstream until they reach a vessel too small to pass through; they lodge in this vessel, obstructing blood flow and causing damage. Clots from the legs most often lodge in the lungs as pulmonary emboli, which can be fatal. The incidence of pulmonary embolism is greatly underestimated by physicians, and some studies suggest that as many as two-thirds of them are undiagnosed. Certain people are at higher risk for the development of venous thromboemboli than others. These include the elderly, those who have had major surgery, those who are bedridden for longer than five days, people with cancer or heart disease, and people who are obese or pregnant. Recent studies have suggested that the use of blood-thinning medications and devices to promote good circulation are very useful in reducing the incidence of thromboembolism in people at risk. A study was performed in 16 hospitals to determine the rate at which such prophylactic measures against thromboembolism are used. A randomly selected group of over 2,000 patients deemed to be at high risk for thromboemboli were assessed. Of these, 563 received acceptable thromboembolism prophylaxis. Teaching hospitals had a 44 percent prophylaxis rate, while community hospitals had only a 19 percent prophylaxis rate. Surgeons were more likely to order prophylaxis than nonsurgeons. Patients with a history of previous pulmonary embolism were likely to receive prophylaxis, while those with a history of only venous thrombosis were less likely to receive prophylactic measures, despite the known risk of recurrent venous thrombosis. Of note, this study was completed before the more recent studies showing the value of prophylaxis were published, so some possibility exists that the practice of treating a patient for a risk of thromboembolism has increased. However, several studies have suggested that changes in practice do not follow the publication of new data very rapidly. To reduce the mortality associated with thromboembolic disease, patients with high risk should be evaluated for their need for prophylactic therapies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pulmonary embolism strikes suddenly and--all too often--fatally. Yet despite the fact that PE is a relatively common complication among hospitalized patients, it's often misdiagnosed--or not diagnosed at all. A small [...]

Deep vein thrombosis (DVT) leads to hospitalization for up to 600,000 persons each year in the United States. Venous thrombosis in itself may be benign, but the condition can lead to dangerous complications and has a high recurrence rate. Strategies to prevent DVT involve prevention of stasis and reversal of changes in blood coagulability that allow thrombi to form. Pharmacologic agents have been effective in reducing the incidence of DVT and pulmonary embolism. Low-dose subcutaneous heparin is considered a nearly ideal DVT preventative for surgically treated patients. The risk of hemorrhage is the main limitation to routine use of subcutaneous anticoagulants for DVT, but careful patient selection can minimize that risk. After anticoagulant therapy with heparin, generally for 7 to 10 days, oral warfarin is the drug of choice for maintenance anticoagulation to prevent DVT recurrence. Therapy for pulmonary embolism is the same as for DVT-immediate anticoagulation with heparin followed by maintenance with warfarin. (Am J Cardiol 1990;6S:50C-S4C), Deep venous thrombosis, the formation of a clot within a deep thigh or leg vein, accounts for the hospitalization of 600,000 people each year. Although the condition is generally not serious in its own right, the complications may be. Chief among the complications of venous thrombosis is pulmonary embolism, obstruction of the pulmonary artery or one of its branches by a clot, which has usually travelled within the circulation from a leg thrombosis. Fatalities due to pulmonary embolism usually occur within 30 minutes, underscoring the need for thrombosis and embolism prevention as well as rapid management of patients with pulmonary embolism. Prevention involves prophylactic treatment, which can attack on three fronts. First, patients at relatively low risk may be treated with approaches that focus on the prevention of static blood flow. These include rhythmic compression of the calves, wearing elastic stockings, and performing leg exercises. Although reports of efficacy have been mixed, these treatments are inexpensive and generally beneficial. Secondly, for higher risk patients, antithrombotic therapy should provide prophylaxis for deep vein thrombosis. Drugs such as aspirin inhibit platelet aggregation by irreversibly inhibiting the enzyme cyclooxygenase in platelets. The platelet remains inhibited for its life-span. Studies have tried combinations of dipyridamole and aspirin to inhibit platelet aggregation, but results are inconclusive. Thirdly, the coagulation mechanism itself may be interfered with; this is usually accomplished with an oral agent like warfarin (coumadin) or subcutaneous heparin. Although the risk of hemorrhage is not negligible in patients treated with warfarin, the superior anticoagulant activity justifies its use in patients at high risk of deep venous thrombosis. (Consumer Summary produced by Reliance Medical Information, Inc.)