Deep vein thrombosis management

This guidance will assist employers and workers to understand the risks of Deep Vein Thrombosis (DVT).US Dept of Health, Education, and Welfare Publication NIH 76-866.Other prospective studies with higher (therapeutic) doses of heparin have reported a similar incidence of thrombocytopenia. 314 315 316 317 318 319 320 321 322 323 324.Leyvraz PF, Richard J, Bachmann F, Van Melle G, Treyvaud JM, Livio JJ, Candardjis G.

Sharath MD, Metzger WJ, Richerson HB, Scupham RK, Meng RL, Ginsberg BH, Weiler JM.Deep vein thrombosis (DVT) or blood clot in the leg symptoms include swelling, warmth, redness, and pain in the leg with the blood clot.Cumulative incidence of recurrent venous thromboembolism after the first episode of symptomatic deep vein thrombosis.Treatment of patients who develop complications during anticoagulant therapy involves management of the actual complication and subsequent management of the thromboembolic event for which the patient is being treated.The objectives of treating venous thrombosis and PE are to prevent local extension of the thrombus, prevent the thrombus from embolizing, and, in certain clinical circumstances, accelerate fibrinolysis.

Interaction of heparin with platelets, including heparin-induced thrombocytopenia.It is contraindicated in the postoperative period and in other situations in which there is a high risk of bleeding.Hull RD, Raskob GE, Rosenbloom D, Panju AA, Brill-Edwads P, Ginsberg JS, Hirsh J, Martin GJ, Green D.Assays for protein C and protein S can be performed while the patient is on high-dose subcutaneous heparin.

Testing for APC resistance with coagulation-based assays during anticoagulant therapy has been difficult in the past.Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials.Risks to the fetus of anticoagulant therapy during pregnancy.A novel and rapid whole-blood assay for D-dimer in patients with clinically suspected deep vein thrombosis.Changes in venous filling are produced by inflating the thigh cuff to obstruct venous return and then reestablishing blood flow by deflating the cuff and assessing the time taken for venous volume in the calf to return to baseline.Stein PD, Athanasoulis C, Alavi A, Greenspan RH, Hales CA, Salzman HA, Vreim CE, Terrin ML, Weg JG.However, because of the potential for minor bleeding, it should not be used in patients undergoing cerebral, ocular, or spinal surgery.

However, patients can have subacute symptoms of leg pain and swelling, which may mimic acute recurrence of DVT.Shorter courses of oral anticoagulant therapy have been investigated in randomized trials, but the results have been inconclusive. 177 178 179 It is now clear that risk of recurrence varies in different subgroups.

Pulmonary angiography, ventilation lung scanning, and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan.The most common indication for venous interruption in patients with DVT or PE is anticoagulant-induced bleeding or anticipation of hemorrhagic complications in a patient with a predisposing lesion, such as a bleeding peptic ulcer, gastrointestinal malignancy, recent intracranial operation, or an underlying hemorrhagic state (eg, liver failure or thrombocytopenia).In patients with an inadequate response to heparin therapy by both the aPTT and heparin assay, the dosage of heparin is increased, and an assay for AT-III is obtained.

Thrombolytic therapy has lifesaving potential for patients with massive PE 184 185 and should be considered in patients with major PE who have syncope, hypotension, severe hypoxemia, or heart failure. 184 185 186 Thrombolytic therapy should also be considered for patients with a submassive embolism and underlying cardiac or respiratory disease.Heparin therapy should be used for a longer period for massive PE or iliofemoral thrombosis.

There is good evidence that patients with PE have a high mortality and a high rate of recurrence if untreated. 142 There is also good evidence that patients with symptomatic proximal 143 144 or calf vein thrombosis 145 have a high recurrence rate without treatment.Fatal pulmonary emboli in hospitalized patients: an autopsy study.Comerota AJ, Katz ML, Greenwald LL, Leefmans E, Czeredarczuk M, White JV.Before labeling the patient as having a deficiency, it is important to repeat the test on several occasions, exclude an underlying acquired abnormality that could produce a falsely low test result, and, if possible, perform studies in family members to confirm the inherited nature of the deficiency.The risk of recurrent VTE was increased by the presence of malignancy and coagulation abnormalities and reduced in patients who had a reversible risk factor (eg, surgery and trauma or fracture).Rose SC, Zwiebel WJ, Nelson BD, Priest DL, Knighton RA, Brown JW, Lawrence PF, Stults BM, Reading JC, Miller FJ.

Mintz G, Acevedo-Vazquez E, Gutierrez-Espinosa G, Avelar-Garnica F.New diagnostic modalities and therapeutic agents have been developed that are more effective, less expensive, and more convenient.There is evidence that reductions of factor II and, possibly, factor X are more important than reduction of factors VII and IX for the antithrombotic effect of warfarin.If bleeding occurs in a patient with calf vein thrombosis who has received an adequate course of heparin therapy, then oral anticoagulant therapy can be stopped and replaced with low-dose heparin 5000 U twice daily SC.