The Experts below are selected from a list of 261 Experts worldwide ranked by ideXlab platform
A N Nicolaides - One of the best experts on this subject based on the ideXlab platform.
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graduated compression stockings in the prevention of postoperative Deep Vein thrombosis
British Journal of Surgery, 1990Co-Authors: P Jeffery, A N NicolaidesAbstract:This review examines the role of graduated elastic compression stockings in the prevention of postoperative Deep Vein thrombosis. Used alone compression stockings reduce the incidence of postoperative Deep Vein thrombosis by approximately 60 per cent and when used in combination with other preventive methods, such as low dose heparin or intermittent calf compression, they further reduce the incidence by up to 85 per cent.
P Jeffery - One of the best experts on this subject based on the ideXlab platform.
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graduated compression stockings in the prevention of postoperative Deep Vein thrombosis
British Journal of Surgery, 1990Co-Authors: P Jeffery, A N NicolaidesAbstract:This review examines the role of graduated elastic compression stockings in the prevention of postoperative Deep Vein thrombosis. Used alone compression stockings reduce the incidence of postoperative Deep Vein thrombosis by approximately 60 per cent and when used in combination with other preventive methods, such as low dose heparin or intermittent calf compression, they further reduce the incidence by up to 85 per cent.
Samuel Z Goldhaber - One of the best experts on this subject based on the ideXlab platform.
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pharmacomechanical catheter directed thrombolysis for Deep Vein thrombosis
The New England Journal of Medicine, 2017Co-Authors: Suresh Vedantham, Samuel Z Goldhaber, Jim A Julian, Susan R Kahn, Michael R Jaff, David J Cohen, Elizabeth A Magnuson, Mahmood K Razavi, Anthony J Comerota, Heather L GornikAbstract:BackgroundThe post-thrombotic syndrome frequently develops in patients with proximal Deep-Vein thrombosis despite treatment with anticoagulant therapy. Pharmacomechanical catheter-directed thrombolysis (hereafter “pharmacomechanical thrombolysis”) rapidly removes thrombus and is hypothesized to reduce the risk of the post-thrombotic syndrome. MethodsWe randomly assigned 692 patients with acute proximal Deep-Vein thrombosis to receive either anticoagulation alone (control group) or anticoagulation plus pharmacomechanical thrombolysis (catheter-mediated or device-mediated intrathrombus delivery of recombinant tissue plasminogen activator and thrombus aspiration or maceration, with or without stenting). The primary outcome was development of the post-thrombotic syndrome between 6 and 24 months of follow-up. ResultsBetween 6 and 24 months, there was no significant between-group difference in the percentage of patients with the post-thrombotic syndrome (47% in the pharmacomechanical-thrombolysis group and 48% ...
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Deep Vein Thrombosis in Orthopedic Surgery
Clinical and Applied Thrombosis-Hemostasis, 2009Co-Authors: Marcella Calfon, Ali Seddighzadeh, Gregory Piazza, Samuel Z GoldhaberAbstract:We compared 315 patients with Deep Vein thrombosis who underwent major orthopedic surgery with 618 who underwent general surgery in a prospective registry of consecutive ultrasound-confirmed Deep Vein thrombosis patients. Orthopedic patients had fewer indwelling central venous catheters (14.0% vs. 46.4%, P < .0001) as well as lower rates of congestive heart failure (7.0% vs. 13.4%, P = .002), cancer (5.1% vs. 28.6%, P < .0001), and diabetes (7.0% vs. 12.6%, P = .004). Extremity discomfort (43.5% vs. 30.3%, P < .0001) and erythema (10.1% vs. 4.8%, P = .001) were more common in orthopedic patients, but dyspnea was less common (11.4% vs. 18.0%, P = .005). There was an increased use of graduated compression stockings (19.4% vs. 15.0%, P = .04), low-molecular-weight heparin (18.7% vs. 12.1%, P = .003), and warfarin (31.7% vs. 11.0%, P < .0001) for Deep Vein thrombosis prophylaxis in the orthopedic surgery group. Orthopedic surgical patients had a higher frequency of calf Deep Vein thrombosis than patients who ...
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Deep-Vein Thrombosis in the Elderly:
Clinical and Applied Thrombosis-Hemostasis, 2008Co-Authors: Gregory Piazza, Ali Seddighzadeh, Samuel Z GoldhaberAbstract:Venous thromboembolism, including Deep-Vein thrombosis and pulmonary embolism, is a major source of morbidity and mortality among elderly patients. To improve our understanding of elderly patients with Deep-Vein thrombosis, we compared 1932 patients with Deep-Vein thrombosis aged 70 years or older with 2554 nonelderly patients in a prospective registry of consecutive ultrasound-confirmed Deep-Vein thrombosis patients. The mean age of elderly patients was 78.9 ± 6.1 years compared with 51.8 ± 12.9 years in nonelderly (P < .0001). Elderly patients were more likely to have prior recent hospitalization (49.2% vs 44.7%, P = .03), congestive heart failure (20.5% vs 9.9%, P < .0001), chronic obstructive pulmonary disease (18.2% vs 11.7%, P < .0001), and recent immobilization (50.5% vs 39.6%, P < .0001) than the nonelderly patients. Elderly patients were less likely to present with typical Deep-Vein thrombosis symptoms of extremity discomfort (44.4% vs 60.6%, P < .0001) and difficulty ambulating (8.4% vs 11.2%, P...
Paolo Prandoni - One of the best experts on this subject based on the ideXlab platform.
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Upper extremity Deep Vein thrombosis.
Current Opinion in Pulmonary Medicine, 1999Co-Authors: Paolo Prandoni, Enrico BernardiAbstract:: Upper extremity Deep-Vein thrombosis has recently been recognized as being a more common and less benign disease than previously reported. It arises generally in the presence of recognizable risk factors, such as central venous catheters and cancer. However, as many as 20% of patients present with apparently spontaneous episodes. The prevalence of inherited coagulation defects in patients with this disease ranges from 10% to 26%. The clinical picture of upper extremity DVT is characterized by pain, edema, and functional impairment, although it may be completely asymptomatic. Because the prevalence of this thrombotic disease is less than 50% among symptomatic subjects, objective diagnosis is mandatory prior to instituting an anticoagulant treatment. When available, compression ultrasonography (alone or associated with Doppler or color Doppler facilities) should be the preferred initial diagnostic test. However, contrast venography may be necessary before anticoagulants are withheld because of negative findings on compression ultrasonography. Pulmonary embolism complicates upper extremity Deep-Vein thrombosis in up to 36% of patients and may even be the presenting manifestation of this disorder. Its long-term clinical course is complicated by recurrent thromboembolism and post-thrombotic sequelae. Among the therapeutic options advocated for the therapy of upper extremity Deep-Vein thrombosis, unfractionated or low molecular weight heparin followed by at least 3 months of oral anticoagulants should be regarded as the treatment of choice. Thrombolysis and surgical procedures may be indicated in selected cases. The prevention of this disease requires the institution of appropriate pharmacologic measures (i.e., low-dose unfractionated or low molecular weight heparin or low-dose warfarin) whenever an indwelling central venous catheter is indicated. This review suggests that upper extremity Deep-Vein thrombosis is at least as serious a disease entity as Deep-Vein thrombosis of the lower extremities.
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Deep Vein thrombosis
The Lancet, 1999Co-Authors: Anthonie W A Lensing, Paolo Prandoni, Martin H Prins, Harry R. BüllerAbstract:Summary Deep-Vein thrombosis is an important complication of several inherited and acquired disorders, but may also occur spontaneously. Prevention of recurrent venous thrombosis and pulmonary embolism is the main reason for accurate diagnosis and adequate treatment. This seminar discusses only symptomatic Deep-Vein thrombosis. The diagnosis can be confirmed by objective tests in only about 30% of patients with symptoms. Venous thromboembolic complications happen in less than 1% of untreated patients in whom the presence of venous thrombosis is rejected on the basis of serial ultrasonography or ultrasonography plus either D-dimer or clinical score. Initial anticoagulant treatment (intravenous or subcutaneous heparin) should continue until oral anticoagulant treatment, started concurrently, increases the international normalised ratio above 2·0 for more than 24 h. The optimum duration of oral anticoagulant treatment is unresolved, but may be guided by the presence of temporary or persistent risk factors or presentation with recurrent venous thromboembolism.
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accuracy of clinical assessment of Deep Vein thrombosis
The Lancet, 1995Co-Authors: Philip S Wells, Anthonie W A Lensing, D R Anderson, Gary Foster, Robert Dovidio, Clive Kearon, Annalisa Cogo, Jeffrey I Weitz, Jack Hirsh, Paolo PrandoniAbstract:Abstract The clinical diagnosis of Deep-Vein thrombosis is generally thought to be unreliable. From experience, we hypothesised that this widely held view might be incorrect. We developed a clinical model and prospectively tested its ability in three tertiary care centres to stratify symptomatic outpatients with suspected Deep-Vein thrombosis into groups with high, moderate, or low probability groups of Deep-Vein thrombosis. We evaluated our clinical model in combination with venous ultrasonography to determine the potential for an improved and simplified diagnostic approach in patients with suspected Deep-Vein thrombosis. All patients were clinically assessed to determine the probability for Deep-Vein thrombosis before they had ultrasonography and venography. All tests were performed and interpreted by independent observers. In 529 patients, the clinical model predicted prevalence of Deep-Vein thrombosis in the three categories: 85% in the high pretest probability category, 33% in the moderate, and 5% in the low category. There was no statistical difference in the performance of the model in the three centres. The model demonstrated excellent interobserver reliability (Kappa=0.85). There were important differences with ultrasonography between the high and low pretest probability groups for both positive predictive values (100% (95% Cl, 94-100%) vs (63% [35-85%], respectively). Thus, use of the clinical model combined with ultrasonography would decrease the number of false positive and negative diagnosis if venography were done when the ultrasound result and pretest probability were discordant. The diagnostic process could be simplified by excluding those patients with low pretest probability and normal ultrasound results from serial testing.
Jeffrey S. Ginsberg - One of the best experts on this subject based on the ideXlab platform.
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Anatomic distribution of Deep Vein thrombosis in pregnancy
Canadian Medical Association Journal, 2010Co-Authors: Wee-shian Chan, Frederick A Spencer, Jeffrey S. GinsbergAbstract:BACKGROUND: Prospective studies of nonpregnant patients have demonstrated that most Deep Vein thromboses of the lower extremity originate in the calf Veins and progress proximally, but the anatomic distribution of thromboses in pregnant patients is unclear. An understanding of the anatomic distribution of Deep Vein thrombosis in pregnancy has important implications for optimizing diagnostic imaging protocols. We undertook this study to determine the anatomic distribution of Deep Vein thrombosis of the lower extremity in symptomatic pregnant patients. METHODS: We systematically searched MEDLINE (1966 to January 2009), Embase (1980 to January 2009) and the Cochrane Library using prespecified criteria to identify articles providing objective diagnostic and anatomic information for unselected or consecutive symptomatic pregnant patients with Deep Vein thrombosis. RESULTS: Six articles from an initial list of 1098 titles met the inclusion criteria. These articles provided information for 124 pregnant women with a diagnosis of Deep Vein thrombosis. Overall, involvement of the left leg was reported in 84 (88%) of the 96 patients for which the side affected was known, and 87 (71%) of 122 thromboses were restricted to the proximal Veins without involvement of the calf Veins. Among these cases of proximal Deep Vein thrombosis, 64% (56/87) were restricted to the iliac and/or femoral Vein. CONCLUSION: Despite a paucity of studies in this area, the results of our review suggest that the anatomic distribution of Deep Vein thrombosis in pregnant women differs from that for nonpregnant patients. In addition to what was previously known--that left-sided Deep Vein thrombosis is more common in pregnancy--we also found that proximal Deep Vein thrombosis restricted to the femoral or iliac Veins is also more common (> 60% of cases). If confirmed by larger studies, these findings could affect our understanding of the pathophysiology and derivation of diagnostic algorithms for examination of pregnant women with suspected Deep Vein thrombosis.
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treatment of Deep Vein thrombosis
The New England Journal of Medicine, 2004Co-Authors: Shannon M Bates, Jeffrey S. GinsbergAbstract:A 52-year-old woman with no history of venous thromboembolism presents with a four-day history of discomfort in her left calf. Proximal Deep-Vein thrombosis is diagnosed by compression ultrasonography. How should her case be managed?
