The authors present a case of refractory multiple myeloma in an elderly patient with heterozygosity for the G20210A mutation of factor II and for the C677T mutation of methylenetetrahydrofolate reductase. This patient developed acute, multiple cerebral infarctions 5 months into the treatment with thalidomide. The patient improved on oral anticoagulation. ...

OBJECTIVE: To describe the successful use of bivalirudin as the primary procedural anticoagulant in a patient with suspected heparin-induced thrombocytopenia (HIT) undergoing carotid endarterectomy (CEA). CASE SUMMARY: A 73-year-old white man presented for an elective CEA 3 weeks after emergent, on-pump coronary artery bypass grafting. Bivalirudin was used for procedural ...

BACKGROUND: Out-of-hospital treatment of patients with deep-vein thrombosis (DVT) is routine in many countries regardless of frequent concomitant asymptomatic pulmonary embolism (PE) in this group. However, patients with symptoms and verified PE are still regularly treated in hospital. The objectives were to test a model for outpatient tinzaparin therapy and ...

BACKGROUND: CT pulmonary angiography (CTPA), D-dimer testing, and pre-test probability scoring have greatly improved the ability to manage patients with suspected pulmonary embolism. International guidelines suggest combining these investigations for the best yield. We have been investigating the use of CTPA in patients with suspected pulmonary embolism (PE) admitted to ...

OBJECTIVE: The purpose of our study was to develop and validate a clinical score (the Hamilton score) for the assessment of lower limb deep venous thrombosis (DVT) and to determine the usefulness of this score and a D-dimer assay before a complete lower limb sonographic examination. SUBJECTS AND METHODS: Five ...

STUDY OBJECTIVES: Much attention has been paid in recent years to optimizing the diagnosis of acute pulmonary embolism (PE). However, little is known about the changes in clot burden that occur at the level of the pulmonary arteries after documented PE. It is often problematic to distinguish between a new ...

INTRODUCTION: We conducted a prospective study to determine the prevalence and the prognosis of antiphospholipid syndrome (APS) in patients with retinal venous occlusion (RVO). PATIENTS: Consecutive patients presenting with retinal vein occlusion were screened for vascular risk factors (diabetes mellitus, hypertension, hyperlipidemia) and for antiphospholipid antibodies (aPL): anticardiolipin (aCL), anti-beta2-glycoprotein ...

OBJECTIVE: Behçet's disease (BD) is a multisystemic inflammatory disorder classified among the vasculitides, which can affect all types and sizes of blood vessels. Vascular involvement may be seen in 25-50% of BD patients. In this study, we examined the characteristics of vascular involvement in patients with BD. METHODS: One hundred ...

BACKGROUND: Management of patients with multiple trauma requires prophylaxis for venous thromboembolism (VTE). This involves recognition of the physiologic factors that are associated with VTE risk. Currently, there is no effective strategy for risk assessment. The purpose of this study is to investigate the relationship of serum P-selectin and interleuken-10 ...

BACKGROUND: There are sparse data on the frequency of venous thromboembolism in patients with various types of cancer. We sought to determine the incidence and relative risk of venous thromboembolism, pulmonary embolism, and deep venous thrombosis in patients with malignancies. SUBJECTS AND METHODS: The number of patients discharged with a ...

Extracts from the seed of the horse chestnut (Aesculus hippocastanum L.) have traditionally been used to treat patients with chronic venous insufficiency and to alleviate its associated symptoms, including lower leg swelling. The efficacy of preparations that contain horse chestnut seed extract (HCSE) is believed to be due largely to ...

BACKGROUND: Substantial variations have been reported in the advice given by competing guidelines addressing the same clinical problem. OBJECTIVE: This study aimed to assess the usefulness of classification tree analysis in comparing competing guidelines. METHOD: The authors implemented a classification tree-growing algorithm on cross-sectional data from 818 patients to determine ...

Venous duplex scan (VDS) has been used for interim bedside diagnosis of pulmonary embolism (PE) in severely injured patients deemed to be at risk if transported out of the intensive care unit. In combination with the level of clinical suspicion for PE, VDS helps select patients for temporary treatment until ...

We review the pathogenesis of atherosclerosis and the issues that must be taken into consideration when performing microsurgery in atherosclerotic patients. Atherosclerosis is a systemic disease, and may affect the success of microsurgery. Atherosclerotic patients have a tendency toward thrombosis, because the nature of the arteries is changed. Such patients ...

Antiphospholipid syndrome (APS) is associated with arterial and venous thrombosis, pregnancy morbidity, and thrombocytopenia. Some APS patients develop rapid and disseminated microthrombosis and are known as having catastrophic APS or CAPS. We document here a case of CAPS in a patient who presented with various clinical symptoms and serious abnormalities ...

BACKGROUND: The incidence of postsurgical venous thromboembolism is thought to be low in Asian ethnic populations. OBJECTIVE: We studied the incidence of deep-vein thrombosis (DVT) in Asian patients undergoing major orthopedic surgery of the lower limbs. PATIENTS/METHODS: We performed a prospective epidemiological study in 19 centers across Asia (China, Indonesia, ...

We retrospectively assessed whether heritable thrombophilia-hypofibrinolysis was more common in patients developing venous thromboembolism after total hip replacement than among control patients who did not develop venous thromboembolism, as an approach to better identify causes of venous thromboembolism after total hip arthroplasty. Twenty patients with proximal deep venous thrombosis after ...

BACKGROUND: In the treatment of pulmonary embolism (PE), the presence of residual emboli is known to seriously affect the recurrence and prognosis. We attempted to depict the residual emboli in the subacute stage of PE using indium-111-oxine labeled platelet scintigraphy (In-plt). METHODS: In-plt was performed on 22 patients with PE ...

In this prospective study, we assessed the incidence of central venous catheter (CVC)-related thrombosis in haematopoietic stem cell transplant (HSCT) recipients. We determined the contribution of inherited prothrombotic abnormalities in blood coagulation to CVC-related thrombosis in these patients. The study was conducted between May 2002 and September 2004. CVCs were ...

INTRODUCTION: The diagnostic value of clinical presentation of pulmonary embolism (PE) is uncertain in the elderly, who often have concomitant cardiopulmonary diseases that may mimic PE. The aim of our study was to assess the differential value of risk factors, symptoms and clinical signs of venous thromboembolism, results of electrocardiogram ...

This retrospective study aimed to analyze laboratory findings in Thai patients with venous thrombosis in Phramongkutklao Hospital from August 1997 to October 2004. Blood samples obtained from 166 patients with ages ranging from 10 months to 87 years were tested for protein S (PS), protein C (PC), antithrombin (AT), factor ...

INTRODUCTION: In the monitoring of anticoagulant therapy, prothrombin time (PT) is used to measure the effect of warfarin, whereas the partial thromboplastin time (PTT) measures the therapeutic effect of unfractionated heparin. Low molecular weight heparin (LMWH) does not require routine monitoring. OBJECTIVE: We collected data on the frequency of simultaneous ...

BACKGROUND: To determine the sequelae of patients after deep venous thrombosis inpatients with azygos continuation defined as agenesis of the inferior vena cava with collateral flow. PATIENTS AND METHODS: Five patients post deep venous thrombosis in the context of azygos continuation were followed up clinically and with colour duplex ultrasonography. ...

Antiphospholipid antibody syndrome (APS) is a complex autoimmune thrombotic disorder with defined clinical phenotypes. Although not all patients with elevated antiphospholipid antibody (aPLA) levels develop complications, the severity of these potential events mandates aggressive and extended lifelong anti-thrombotic therapy. One hundred twenty-nine patients (57 patients with APS and venous thromboembolism ...

PURPOSE: Deep vein thrombosis (DVT) is a well-known complication of stroke and frequently develops in acute stroke patients. Immobility in stroke patients increases the risk of DVT and pulmonary embolism (PE). The incidence of DVT in non-ambulatory stroke patients is more frequent than the incidence in ambulatory stroke patients. We ...

BACKGROUND: Venous thromboembolism (VTE), manifest as deep venous thrombosis (DVT) or pulmonary embolus, remains an important complication in bariatric operation patients. Our purpose was to determine the incidence of VTE in a consecutive series of patients undergoing Roux-en-Y gastric bypass (RYGB) to guide appropriate therapy. METHODS: We prospectively examined a ...

BACKGROUND/AIMS: The aim of this study was to elucidate the incidence and clinical manifestations of portal vein thrombosis (PVT) in patients with idiopathic portal hypertension (IPH) in Japan during long-term follow-up. PATIENTS AND METHODS: Twenty-two patients with IPH were examined for PVT by sonography during a follow-up of 12+/-6 years. ...

Deep venous thromboembolism (DVT) is common and leads to disability, economic loss and even death. The aims of this paper are to start from the basic knowledge that we have about DVT and to tailor our knowledge to the treatment and diagnosis of thromboembolism in obese patients and trauma patients, ...

BACKGROUND: Several studies have focused on the safety of withholding anticoagulant therapy in patients with negative results on helical computed tomography (CT). However, these studies were either retrospective or had a selection bias, since spiral CT was performed only in selected patients. Moreover, no special attention has been directed towards ...

Behçet's disease (BD) is a multisystemic disease of unknown aetiology characterized by chronic relapsing oral aphthous lesions, genital ulcers, uveitis, and vasculopathy of both arteries and veins of all sizes. We present the case of a female patient, with BD on oral contraceptive pills, who sustained deep venous thrombosis of ...

BACKGROUND: Clinical signs and symptoms such as swelling, pain, and redness are unreliable markers of deep vein thrombosis (DVT). Because of this venous duplex scanning (VDS) has been heavily used in DVT detection. The purpose of this study was to determine if a combination of D-dimer testing and pretest clinical ...

BACKGROUND: While the number of patients with suspected venous thromboembolism (VTE) referred to hospital emergency units increases, the proportion in whom the diagnosis can be confirmed is decreasing. A more efficient but safe diagnostic strategy is needed. OBJECTIVE: To evaluate the safety of withholding anticoagulant therapy in patients suspected of ...

AIM: To describe the characteristics, outcomes and treatment complications of patients with pulmonary embolism (PE) who were treated at home and as outpatients in an ambulatory care program. METHODS: Retrospective descriptive study of patients with PE who were treated in the ambulatory care unit during 2003. Ambulatory care unit data ...

The presence of anomalies of the systemic and pulmonary venous connection associated with single ventricle anomalies has been considered a contraindication for the Fontan operation (FO). The aim of this study is to outline the technical considerations associated with the presence of anomalies of systemic and/or pulmonary venous connections and ...

BACKGROUND: Pulmonary embolism (PE) continues to be a major challenge in terms of diagnosis, as evidenced by the fact that many patients die undiagnosed and/or untreated. The aim of this multicenter study was to determine the accuracy of thorax ultrasound (TUS) in the diagnosis of PE (TUSPE). METHODS: From January ...

BACKGROUND: Inflammatory bowel diseases (IBD) are characterized by an increased risk for venous and arterial thrombosis. Although the pathogenetic mechanisms of this predisposition are unclear, a possible role of inherited risk factors for thrombosis in determining this predisposition has been suggested. AIM: To evaluate the role of factor V Leiden ...

OBJECTIVES: A prospective outcome study designed to evaluate a simple strategy for the management of outpatients with suspected pulmonary embolism (PE), based on clinical probability, D-dimer, and multi-slice computed tomography (MSCT). METHODS: A cohort of 432 consecutive patients admitted to the emergency department with suspected PE was managed by sequential ...

PURPOSE: To establish the safety of withholding anticoagulation therapy after negative findings at a complete lower limb ultrasonographic (US) examination of the symptomatic leg for suspected deep venous thrombosis (DVT). MATERIALS AND METHODS: Regional ethics committee approval and patient consent were obtained. A total of 542 consecutive ambulatory patients presented ...

BACKGROUND: Routine thrombophilia testing is controversial because of the low yield of positive tests, costs involved, and debate about the clinical usefulness of the data obtained from testing. Laboratory investigations are rarely done for those with superficial venous thrombosis (SVT) or isolated calf vein thrombosis (CVT) which are often not ...

BACKGROUND: In this study, we used an endogenous thrombin potential (ETP)-based assay to examine the response to activated protein C (APC) during early puerperium of 6 Japanese patients of deep vein thrombosis (DVT) and pulmonary embolism (PE) without a history of familial thrombophilia or antiphospholipid syndrome. METHODS: The patient group ...

BACKGROUND: The safety of laparoscopic cholecystectomy (LC) has been proven in patients with several pre-existing clinical conditions. This study was conducted to evaluate the applicability and safety of elective LC in patients with pre-existing cardiovascular conditions who were receiving anticoagulant treatment. PATIENTS AND METHODS: Between January 1998 and December 2002, ...

OBJECTIVE: Thrombophlebitis occurs in a third of patients with Behçet's syndrome (BS). The thrombotic tendency in BS has been studied with inconclusive results perhaps due to the inadequate numbers of patients studied during the acute phase of the thrombosis as well as the lack of appropriate diseased controls. We have ...

BACKGROUND: Venous thromboembolism (VTE) occurs due to a number of hereditary and acquired disorders of hemostasis. A recently identified polymorphism in factor V gene (A4070G; named HR2) has been reported to be a possible risk factor for the development of VTE, with a high prevalence of 9.5%-15.2% in patients of ...

OBJECTIVE: Livedo reticularis (LR) is a skin vasculopathy that has been frequently described in patients with anti-phospholipid syndrome (APS) and reported to be present in association with valvular heart pathology and strokes (i.e. Sneddon's syndrome). METHODS: In a cohort of APS patients we investigated the possible association of LR with ...

Retinal vein occlusion (RVO) is a multifactorial disease involving vessel damage, stasis, viscosity and thrombosis. Conflicting findings on hereditary thrombophilic risk factors have been reported and their impact on RVO features remains to be defined. The aim of the present study was to evaluate the prevalence of hereditary thrombophilic risk ...

Inflammatory bowel disease (IBD) is associated with an increased risk of vascular complications. The most important of these complications are arterial and venous thromboembolism, which represent a significant cause of morbidity and mortality in IBD patients. Recent data suggest that thromboembolism is a disease-specific extraintestinal manifestation of IBD. The most ...

We present an observational case report describing the clinical history and pathologic findings of a patient with an in situ porta-cath for acute intermittent porphyria who developed an inferior vena caval (IVC) thrombosis. CT contrast studies showed a possibly infected IVC thrombosis below the level of the renal vessels, extending ...

C-Mpl and PRV-1 expression was measured in a cohort of 48 patients with essential thrombocythemia (ET). A retrospective analysis was conducted to asses whether the presence of one or both markers correlates with a higher risk of developing thromboembolic complications. In this cohort, PRV-1 overexpression was associated with a significantly ...

OBJECTIVE: In Belgium oral anticoagulation therapy is mainly supervised by general practitioners (GPs). This study aims to evaluate the quality of management of oral anticoagulation by Belgian GPs and to verify the relation between time in range and a set of potentially influencing co-variables. METHODS: In a retrospective cross-sectional study, ...

BACKGROUND: Venous thromboembolic (VTE) disease remains a significant cause of morbidity for trauma patients because many patients have injuries that may preclude effective VTE prevention and treatment. Retrievable vena cava filters may prove beneficial in this subset of trauma patients. METHODS: Trauma patients at risk for VTE were identified and ...