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Warwick, David John. "Deep vein thrombosis after total hip replacement." Thesis, University of Bristol, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.283969.
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Howard, Adam Quentin. "The prevention of post-operative deep vein thrombosis." Thesis, Imperial College London, 2007. http://hdl.handle.net/10044/1/8187.
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Background: In a university hospital, disparate and unsatisfactory thromboprophylaxis in surgical patients was found. No hospital consensus was in place for the prevention of postoperative deep vein thrombosis (DVT). Literature review suggested low molecular weight heparin (LMWH) and anti-embolic stockings were the best prophylaxis, however the optimal length of stocking was unknown. Method: Audit of thromboprophylaxis in surgical patients and surgical doctors was performed. A randomised controlled trial investigated the efficacy and safety of a new single protocol of LMWH and the best length of stocking, for every patient requiring surgery under general anaesthesia. Of 426 patients interviewed, 376 were randomised into three stocking groups, Medi Thrombexin® Climax™ thigh-length, Thrombexin® Climax™ knee-length and Kendall TEDTM thigh-length. All patients received LMWH. DVT incidence was assessed by duplex ultrasonography. Complications of thromboprophylaxis were recorded. Compliance and health outcome measures were developed to assess patient stocking acceptability. Results: Audit revealed inadequate surgical thromboprophylaxis. A simple 'single protocol' improved doctors' thromboprophylaxis compliance on replicate audit. The randomised trial assessing the 'single protocol' showed no postoperative DVT occurred in the low or moderate-risk patients (n=85). Twenty-one DVT occurred in nineteen patients, all were high-risk patients (n=291): two with Thrombexin® Climax™ thigh-length stockings and eleven with Thrombexin® Climax™ kneelength (p
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Baarslag, Hendrik Jan. "Diagnosis and management of upper extremity deep vein thrombosis." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2003. http://dare.uva.nl/document/86567.
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Cate-Hoek, Arina Janna ten. "New developments in diagnosis and treatment of deep vein thrombosis." [Maastricht] : Maastricht : [Maastricht University] ; University Library, Universiteit Maastricht [host], 2008. http://arno.unimaas.nl/show.cgi?fid=13095.
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Kahn, Susan Rebecca. "Clinical predictors of-deep vein thrombosis in patients with leg symptoms." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq29730.pdf.
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Lindmarker, Per. "Treatment of deep vein thrombosis and risk of recurrent venous thromboembolism /." Stockholm, 1998. http://diss.kib.ki.se/1998/91-628-3211-5/.
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Kahn, Susan Rebecca. "Clinical predictors of deep vein thrombosis in patients with leg symptoms." Thesis, McGill University, 1996. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=27355.
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Background. Deep vein thrombosis (DVT) is a common condition with significant mortality and morbidity. Proximal DVT is more often associated with pulmonary embolism and the post-phlebitic syndrome than calf DVT. Identifying which clinical variables predict DVT and proximal DVT could be useful for the effective targeting of diagnostic tests for DVT.Purpose. To determine, in patients presenting with leg symptoms, which clinical variables best predict (1) DVT and (2) proximal DVT. To estimate the probability of DVT in an individual presenting with a particular grouping of these variables.
Results. Male sex, orthopedic surgery, and warmth and superficial venous dilation on exam were independent predictors of DVT (adjusted odds ratios and 95% confidence intervals 2.8 (1.5, 5.1), 5.4 (2.2, 13.6), 2.1 (1.2, 3.9) and 2.9 (1.4, 5.7), respectively) and proximal DVT (adjusted odds ratios 2.4 (1.2, 4.8), 4.1 (1.4, 12.3), 2.3 (1.2, 4.7) and 3.4 (1.6, 7.0), respectively). A clinical prediction index that categorized patients into different levels of DVT risk was created, and its ROC curve showed moderate predictive ability. No single cutoff point was ideal in terms of desired sensitivity and specificity, however the index was useful in a strategy aimed to limit the need for contrast venography in patients with suspected DVT. Using this strategy, 78% of study patients could have avoided contrast venography. (Abstract shortened by UMI.)
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Balendra, Padma Rani. "Deep vein thrombosis of the leg : natural history and haemostatic variables." Thesis, Queen's University Belfast, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.334477.
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Brock, Sheila Anne. "Compression and Doppler ultrasound of deep vein thrombosis in patients on tuberculosis treatment." Thesis, Cape Peninsula University of Technology, 2013. http://hdl.handle.net/20.500.11838/1570.
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Thesis submitted in fulfilment of the requirements for the degree of
Doctor of Technology: Radiography in the Faculty of Health and Wellness Sciences at the Cape Peninsula University of Technology
2013Background. Ultrasound has until recently been regarded as a sophisticated examination reserved for tertiary health care. In reality it is well suited to the district or primary health-care situation. A DVT (deep vein thrombosis) is an important complication of the treatment of TB and this can lead to more devastating sequelae such as a pulmonary embolus. Many DVTs are clinically silent, making the diagnosis difficult. Method. This study was a prospective, longitudinal observational study. The study documented the incidence of DVTs and their onset, assessed certain aspects in an attempt to identify some risk factors, and noted the most common position of the DVT in a TB population. The feasibility of a sonographer-led ultrasound clinic for the diagnosis of DVTs was also assessed. This was achieved by screening the in-patient population at a district TB hospital. The participants received up to four routine duplex Doppler compression ultrasound examinations of the venous system of the lower extremities on week 0, week 4, week 8 and week 14. In addition a single abdominal ultrasound was performed at week 0. Results The incidence of DVTs in this TB population was 15.3%. A median of day 10 from commencing TB treatment was identified as the most common day to develop a DVT. The popliteal vein was the most frequent position for a DVT. Several statistically significant factors were identified, including a decreased ambulatory status, TB regimen and the use of anticoagulants. Only 52% of the DVTs were clinically symptomatic. The clinical evaluation for a DVT diagnosis in this study population had a sensitivity of 52.4% and a specificity of 65.3%. The positive predictive value (PPV) was 21.7%. Of the abdominal ultrasound reports there were 75.5% (281) abnormal reports, 22.5% (n = 90) normal reports and 4.5% (n = 18) with no report. Conclusion This body of work has shown how an effective ultrasound service can be provided at a district level TB hospital successfully administered by a trained ultrasonographer. This also facilitated a screening service to diagnose both symptomatic and asymptomatic deep vein thromboses in newly diagnosed tuberculosis patients. This study confirmed a higher rate of DVT in newly diagnosed TB patients than has been previously seen. It also provided detail on additional risk factors. The study illustrates the poor performance of clinical signs and symptoms as a trigger for further investigation for the confirmation of a DVT. Given the frequency and impact of the embolic complications of DVT, this study provides a strong justification for further research into routine serial ultrasonic screening and/or prophylactic antithrombolytics in newly diagnosed TB patients. As well as the DVT ultrasound scans there was the ancillary service offered by the research sonographers. This included an abdominal scan that detected abdominal pathology in 75% of the scans performed. An ultrasound scan is not pathognomonic but it does provide significant insight into the extent of some of the abdominal pathologies seen in TB patients. The information provided from this study gives a good indication of the problem that DVTs present in this population and the complexities of the disease TB. It is hoped that the results from this study will better equip the medical team in the non-tertiary situation to be vigilant for the presence of a DVT and educate them on the usefulness of the ultrasound scan.
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Alshehri, Mohammed Faiez. "Risk factors for deep vein thrombosis in a South African public hospital." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/2879.
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Includes bibliographical referencesIncludes abstract.
The evidence suggests an association between HIV, TB and DVT. There are no studies of this link in the Southern African setting, where the incidence of both of these conditions (HIV and TB) is high. We therefore undertook a study to define the incidence of HIV and TB in patients with confirmed DVT in this setting. The aim of this study is to describe the incidence of HIV, TB and the more commonly accepted risk factors in patients with confirmed DVT in a South African public hospital.
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Brandão, Gustavo Muçouçah Sampaio [UNESP]. "Pentasaccharides para o tratamento da trombose venosa profunda." Universidade Estadual Paulista (UNESP), 2016. http://hdl.handle.net/11449/141498.
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Pentasaccharides para o tratamento da trombose venosa profunda Questão da revisão: Os novos anticoagulantes da classe dos pentasaccharides podem ser uma alternativa eficaz e segura aos anticoagulantes convencionais utilizados na terapia padrão do tratamento da trombose venosa profunda? Visão geral: Trombose venosa profunda (TVP) é uma doença grave e potencialmente fatal que se caracteriza pela formação aguda de um coágulo de sangue nas veias profundas. Sua incidência aumenta exponencialmente com a idade e estima-se que na população geral, sua incidência seja de 5 casos em 10,000 habitantes. O tratamento padrão se faz por meio de medicamentos anticoagulantes, inicialmente pela administração de medicamentos injetáveis, as heparinas, por 5 a 7 dias e em seguida pelo uso prolongado de medicamentos de uso oral, os antagonistas da vitamina K. Entretanto, o alto risco de sangramento e a necessidade de um rigoroso controle laboratorial, permanecem como importantes limitações à terapia padrão. Os pentasaccharides são anticoagulantes sintéticos que podem apresentar vantagens em relação ao tratamento convencional como um efeito mais previsível, um regime de dosagem mais conveniente, a ausência da necessidade de controle laboratorial, ausência de interações com medicamentos e/ou alimentos, ausência da temida diminuição das plaquetas induzida pela heparina e em muitos casos melhor custo-benefício. Características chaves e resultados: Nossas buscas, realizadas até julho de 2015, identificaram 20 entre 730 registros que representavam 5 estudos elegíveis, compreendendo um total de 6981 pacientes. Os estudos compararam os pentasaccharides fondaparinux, idraparinux e idrabiotaparinux com a terapia padrão (heparina seguida por antagonista da vitamina K). O principal resultado de eficácia foi feito pela avaliação da incidência de qualquer episódio tromboembolismo venoso (novo episódio de TVP ou embolia pulmonar) durante o tratamento. E o principal resultado de danos foi incidência de sangramento. Esta revisão mostrou que os pentasaccharides (fondaparinux, e a dose de 2.5 mg de idraparinux e a dose equivalente de 3.0 mg de idrabiotaparinux) podem ser uma alternativa eficaz e segura a anticoagulação convencional para o tratamento da TVP. Qualidade da evidência: A qualidade da evidência foi considerada moderada a alta. Um único estudo incluído (Persist) poderia ser julgado potencialmente falho devido ao relevante número de pacientes que foram perdidos ou descontinuaram prematuramente o tratamento após a randomização. De forma geral, os estudos incluídos responderam diretamente as perguntas e foram considerados de boa qualidade. Os resultados dos estudos foram consistentes e os efeitos estimados foram precisos. Nós acreditamos que seja improvável que a maioria dos nossos principais resultados de eficácia e danos possam ser modificados por estudos adicionais. Entretanto, estudos futuros com os pentasaccharides de meia vida prolongada (idraparinux e idrabiotaparinux) em baixas doses podem confirmar nossas estimativas com relação a sua não inferioridade em comparação à terapia padrão.
Background: Deep vein thrombosis (DVT) is a severe disorder caused by acute formation of a clot or thrombus in the deep vein system. The incidence of DVT increases with age: from 2 to 3/10,000 in adults aged 30 to 49 years to 20/10,000 in adults aged 70 to 79 years. If left untreated, the clot can travel up to the lungs and cause a potentially life-threatening pulmonary embolism (PE). Standard treatment is based on antithrombotic therapy, initially with parenteral administration of unfractionated heparin or low molecular weight heparins (LMWH) for five to seven days, then subsequent long-term oral vitamin K antagonists (e.g. warfarin) therapy. However, hemorrhagic complications are a major concern associated with warfarin treatment. Indeed, the hemorrhagic risk of warfarin and the required laboratory control remain the Achilles’ heel of vitamin K antagonist management. The pentasaccharides have characteristics that may be favourable over conventional treatment, including a predictable effect, lack of frequent monitoring or re-dosing and few known drug interactions and absence of heparin-induced thrombocytopenia. To date, no systematic review has measured the effectiveness and safety of these drugs in the treatment of DVT. Objectives: To assess the efficacy and harms of pentasaccharides for the treatment of deep venous thrombosis. Search strategy: 1 The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched July 2015) and the Cochrane Register of Studies (last searched July 2015). We searched clinical trials databases for details of ongoing or unpublished studies and the reference lists of relevant articles retrieved by electronic searches for additional citations. Selection criteria: We included randomised controlled trials in which people with a DVTconfirmed by standard imaging techniques, were allocated to receive a pentasaccharide (fondaparinux, idraparinux or idrabiotaparinux) for the treatment of DVT. Data collection and analysis: Three review authors (GB, DJ and MS) independently extracted the data and assessed the risk of bias in the trials. Any disagreements were resolved by discussion. We performed meta-analyses when we considered heterogeneity low. The two primary outcomes were recurrent VTE and major (and clinically non-major) bleeding. Other outcomes included all-cause mortality, recurrent DVT, PE, thrombocytopenia, heparin-induced thrombocytopenia syndrome and all other adverse effects induced by the treatments . We calculated all outcomes using a relative risk (RR) with a 95% confidence interval (CI). Main results: We included 5 randomised controlled trials of 6981 participants. Two studies tested fondaparinux, while three tested idraparinux (being one tested idrabiotaparinux). We deemed all included studies to be of high methodological quality and generally low risk of bias. The quality of the evidence was generally graded as high as the outcomes were direct and effect estimates were consistent and precise, as reflected in the narrow CIs around the RRs. Meta-analysis of two studies (2658 participants) comparing fondaparinux with standard anticoagulation groups showed no difference in the risk of recurrent VTE (RR 0.88, 95% CI 0.60 to 1.29). The RR of bleeding in the initial period of treatment (RR 0.94, 95% CI 0.73 to 1.22) and three months of follow up (RR 0.61, 95% CI 0.36 to 1.01) were similar comparing both interventions. Two studies comparing idraparinux with standard therapy showed no difference in the risk of recurrent VTE during three months (RR 1.51; 95% CI 0.26, 8.90) and (RR 0.79; 95% CI 0.21; 2.91). The treatment with idraparinux clearly showed a bleeding risk with a pattern dose-response. However, at a dose of 2.5 mg idraparinux, there was no significant difference in the risk of bleeding in patients receiving idrapaparinux in comparison to standard therapy during six months of follow up (RR 0.92, 95% CI 0.69 to 1.22). One study contributed with data for the analysis (n=741 participants) that there was no significant difference in the risk of recurrent VTE during six months follow-up between idrabiotaparinux compared with idraparinux (RR 0.71, 95% CI 0.30 to 1.66). The risk of bleeding was also similar comparing the two interventions (RR 0.71, 95% CI 0.49 to 1.04). Authors' conclusions: The pentasaccharides (fondaparinux, the dose of 2.5 mg idraparinux and equimolar dose of 3.0 mg idrabiotaparinux) may be an effective and safe alternative to conventional anticoagulation treatment for acute DVT.
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Daniel, Öberg. "Clinical Assessment for Deep Vein Thrombosis using Support Vector Machines : A description of a clinical assessment and compression ultrasonography journaling system for deep vein thrombosis using support vector machines." Thesis, KTH, Skolan för datavetenskap och kommunikation (CSC), 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-178419.
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This master thesis describes a journaling system for compression ultrasonography and a clinical assessment system for deep vein thrombosis (DVT). We evaluate Support Vector Machines (SVM) models with linear- and radial basis function-kernels for predicting deep vein thrombosis, and for facilitating creation of new clinical DVT assessment. Data from 159 patients where analysed, with our dataset, Wells Score with a high clinical probability have an accuracy of 58%, sensitivity 60% and specificity of 57% these figured should be compared to those of our base models accuracy of 81%, sensitivity 66% and specificity 84%. A 23 percentage point increase in accuracy.The diagnostic odds ratio went from 2.12 to 11.26. However a larger dataset is required to report anything conclusive. As our system is both a journaling and prediction system, every patient examined helps the accuracy of the assessment.I denna rapport beskrivs ett journalsystem samt ett system för klinisk bedömning av djupvenstromboser.Vår modell baserar sig på en stödvektormaskin (eng. Support Vector Machine) med linjär och radial basfunktion för att fastställa förekomsten av djupa ventromboser samt att hjälpa till i skapandet av nya modeller för bedömning. 159 patientjournaler användes för att fastställa att Wells Score har en klinisk precision på 58%, 60% sensitivitet och specificitet på 57% somkan jämföras med våran modell som har en precision på 81%, 66% sensitivitet och specificitet på 84%. En 23 procentenheters ökning i precision.Den diagnostiska oddskvoten gick från 2.12 till 11.26. Det behövs dock en större datamängd för att rapportera något avgörande. Då vårt system både är för journalskapande och klinisk bedömning så kommer varje undersökt patient att bidra till högre precision i modellen.
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Dalton, Edward J. "A Novel Manually Operated Compression Device for the Prevention of Deep Vein Thrombosis." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/503693.
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BioengineeringM.S.
Deep Vein Thrombosis, a potentially fatal event, occurs when a blood clot forms within the deep veins of the body. This most frequently manifests in the lower extremities. The goal of this research was to build an inexpensive device that could apply therapeutic compressive pressure to the lower leg to aid in the prevention of deep vein thrombosis using only mechanical input from the user. Several different prototypes were designed and built with varying degrees of success. Characterization of the final prototype required calibration of pressure and force measurement sensors. Additionally, a mathematical model was developed in order to predict how changes in the design of the device, as well as differing sizes and shapes of lower legs, would impact the amount of applied pressure. The predictions of this mathematical model were found to be substantially larger when compared against empirical data. However, there is evidence to indicate that the final prototype could be minimally altered to apply ample therapeutic pressure.
Temple University--Theses
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Olakareem, Halima. "Prognostic factors associated with the development of post-thrombotic syndrome after a deep vein thrombosis of the lower limb." Thesis, University of Birmingham, 2016. http://etheses.bham.ac.uk//id/eprint/7002/.
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Within 10 years of experiencing a deep vein thrombosis of the lower limb, up to 60% of people will be classed as suffering from post-thrombotic syndrome (PTS). The cause and risk factors for PTS are not well understood and there are no universally agreed diagnostic criteria. This thesis aimed to identify prognostic factors associated with developing PTS, the method(s) of diagnosing PTS and their relative reliability in identifying PTS. A systematic review of systematic reviews and a systematic review of primary studies was conducted to identify prognostic factors. Methods used to diagnose PTS were noted from these reviews. Prognostic factors from best evidence and methods of diagnosing PTS noted were presented to clinical experts for prioritisation via an e-Delphi study. Consensus was defined as ≥75% agreement. Fifty one potential prognostic factors and seventeen methods of diagnosing PTS were identified from the reviews and initial exploration of experts’ views. Experts reached consensus on eight prognostic factors and one method of diagnosing PTS. The prognostic factors identified can be considered for the development of a prognostic model, while the method of diagnosing PTS found to be most reliable from experts’ opinion should be considered when developing a reference standard for PTS diagnosis.
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Guerrero, Julian. "System for vessel characterization : development and evaluation with application to deep vein thrombosis diagnosis." Thesis, University of British Columbia, 2008. http://hdl.handle.net/2429/1558.
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A system for vessel characterization aimed at detecting deep vein thrombosis (DVT) in the lower limbs has been developed and evaluated using ultrasound image processing, location and force sensors measurements, blood flow information and a protocol based on the current clinical standard, compression ultrasound. The goal is to provide an objective and repeatable system to measure DVT in a rapid and standardized manner, as this has been suggested in the literature as an approach to improve overall detection of the disease.
The system uses a spatial Kalman filter-based algorithm with an elliptical model in the measurement equation to detect vessel contours in transverse ultrasound images and estimate ellipse parameters, and temporal constant velocity Kalman filters for tracking vessel location in real-time. The vessel characterization also comprises building a 3-D vessel model and performing compression and blood flow assessments to calculate measures that indicate the possibility of DVT in a vessel. A user interface designed for assessing a vessel for DVT was also developed.
The system and components were implemented and tested in simulations, laboratory settings, and clinical settings. Contour detection results are good, with mean and rms errors ranging from 1.47-3.64 and 3.69-9.67 pixels, respectively, in simulated and patient images, and parameter estimation errors of 5%. Experiments showed errors of 3-5 pixels for the tracking approaches. The measures for DVT were evaluated, independently and integrated in the system. The complete system was evaluated, with sensitivity of 67-100% and specificity of 50-89.5%. System learnability and memorability were evaluated in a separate user study, with good results.
Contributions include a segmentation approach using a full parameter ellipse model in an extended Kalman filter, incorporating multiple measurements, an alternate sampling method for faster parameter convergence and application-specific initialization, and a tracking approach that includes a sub-sampled sum of absolutes similarity calculation and a method to detect vessel bifurcations using flow data. Further contributions include an integrated system for DVT detection that can combine ultrasound B-mode, colour flow and elastography images for vessel characterization, a system interface design focusing on usability that was evaluated with medical professionals, and system evaluations through multiple patient studies.
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麥寶晶 and Po-ching Mak. "Evidence-based guidelines for deep vein thrombosis prophylaxis in a surgical intensive care unit." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193031.
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Deep vein thrombosis (DVT) and pulmonary embolism (PE) are together known as venous thrombo-embolism (VTE), one of the most common complications after surgery and trauma injury. In the case of critically ill patients, it is also a significant medical and financial burden, associated with high mortality and morbidity. In recent years, much evidence has come to light showing that DVT prophylaxis can effectively reduce DVT, and it has been incorporated into various evidenced-based guidelines (Geerts et al., 2008; Nicolaides et al., 2006).
The objectives of this study are to examine, through a comprehensive literature review of published studies, the effectiveness of various means of DVT prophylaxis aimed at reducing DVT, and to develop an evidence-based guideline for the use of DVT prophylaxis in surgical intensive care unit (ICU) settings.
Keywords related to DVT prophylaxis were used in conducting the search in electronic bibliographic databases like MEDLlNE, CINAHL, PubMed and the Cochrane Library. A total of 110 articles were identified, and seven studies fulfilled the inclusion criteria of the study. Data from the seven studies have been extracted to form tables of evidence; the qualities of the studies were then rated, and the levels of evidence assigned according to SIGN 50: A guideline developer’s handbook (Network, Harbour & Forsyth, 2011). Three studies attained a higher level of evidence with strong methodological design and demonstrated a statistically significant reduction in the incidence of DVT.
The implementation potential of DVT prophylaxis was examined in terms of target setting, target audience, transferability of findings, feasibility and cost-benefit ratio. And it was found that the development of evidence-based guidelines for DVT prophylaxis was feasible, cost-beneficial and transferable in current settings. The findings of the seven reviewed studies have been translated into an evidence-based DVT prophylaxis guideline.
The main focuses of the guideline are the choice of prophylaxis used with surgical ICU patients and the strategies for improving adherence and prophylaxis monitoring. Combined pharmacological and mechanical DVT prophylaxis is recommended for ICU patients who are at high risk of DVT. For patients with active bleeding or high risk of bleeding, mechanical prophylaxis like intermittent pneumatic compressor (IPC) or gradual compression stocking (GCS) should be used first, followed by a review for pharmacological prophylaxis when the risk of bleeding has decreased. In addition, routine assessment of thrombosis and bleeding risk for high-risk ICU patients and regular checking of fitting and functioning of the DVT prophylaxis are recommended.
An implementation plan consisting of communication, pilot and evaluation plan was developed. A 12-month programme including communication with stakeholders, marketing of the innovation, training of frontline staff, a five-week pilot study and implementation of the guideline followed by evaluation will be carried out. In the evaluation, programme effectiveness was assessed in terms of patient outcome (e.g. incidence of DVT), process outcomes (e.g. level of knowledge related to DVT, compliance with the guideline and level of staff satisfaction) and system outcome (e.g. financial cost reduction).published_or_final_version
Nursing Studies
Master
Master of Nursing
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Horner, Daniel. "Isolated distal deep vein thrombosis in symptomatic ambulatory patients : a prospective data analysis and therapeutic feasibility study." Thesis, University of Manchester, 2013. https://www.research.manchester.ac.uk/portal/en/theses/isolated-distal-deep-vein-thrombosis-in-symptomatic-ambulatory-patients-a-prospective-data-analysis-and-therapeutic-feasibility-study(02979c49-ec26-4099-b0f8-3da2acbf0672).html.
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Isolated distal deep vein thrombosis (IDDVT) is a condition recently suggested to be a different entity to that of proximal disease. There is currently little evidence defining the clinical importance of detection and treatment. International guidelines vary regarding management advice.An observational cohort study, prospective service evaluation and pilot randomised controlled trial were performed within a United Kingdom ambulatory thrombosis service. This project aimed to describe the burden of disease and explore three poorly researched aspects of IDDVT assessment and management: whole-leg compression ultrasound (CUS) performed by non-physicians within an ambulatory framework as a principal diagnostic modality; clinical presentation data and risk profile in comparison to that of proximal disease; the feasibility of further interventional randomised research and the risk/benefit profile of therapeutic anticoagulation.Within this ambulatory cohort, IDDVT accounted for 49.7% of acute thrombosis and differed significantly to proximal disease regarding provocation and symptomatology at clinical presentation. A negative whole-leg CUS excluded deep vein thrombosis with an adverse event rate (diagnosis of symptomatic venous thromboembolism during the 3 month follow up period) of 0.47% (95% CI 0.08 to 2.62). Future interventional research was proved feasible within an ambulatory setting.The randomised controlled trial conducted within this project is the largest to date comparing therapeutic anticoagulation against conservative strategy for the management of acute IDDVT. Patients allocated to therapeutic anticoagulation had significantly less overall propagation of thrombus (Absolute risk reduction [ARR] 25.7%, 95% Confidence interval 5.9 to 44.3 p<0.01), less short-term symptomatic progression (ARR 16.7%, 95% CI 2.6 to 32.1 p=0.05) and a result trending towards significance for reduction in serious thromboembolic complications (ARR 11.4%, 95% CI -1.5 to 26.7 p=0.11).IDDVT is a condition of equal prevalence to proximal venous thrombosis, which varies significantly regarding risk profile and clinical presentation. Using a single whole leg CUS reported by a non-physician within an emergency department pathway is associated with a low adverse event rate. This contemporary data also suggests that therapeutic anticoagulation is beneficial for reduction of short-term complications in IDDVT. The risk of false positive diagnosis and excess anticoagulation remains.This data can inform and direct future design of adequately powered randomised studies, in order to attempt external validation of these findings.
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Forgie, Melissa Anne. "Duration of oral anticoagulation in first-episode idiopathic deep vein thrombosis: A Markov decision analysis." Thesis, University of Ottawa (Canada), 2001. http://hdl.handle.net/10393/9288.
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Deep venous thrombosis (DVT) of the lower extremity is a serious illness with an estimated incidence of 1 per 1000 persons per year. Objectives. To compare the lifetime risks and benefits of three months, six months, twelve months, two years, and lifelong anticoagulation for first episode idiopathic DVT. Secondary objectives were to assess quality of life for patients on warfarin therapy for DVT and for patients with post-thrombosic syndrome. A third objective was to determine if quality of life for these two health states differed between patients and healthy volunteers. Methods. Decision analysis with a Markov model was used to simulate patients with first episode idiopathic DVT who would be treated with durations of therapy ranging from three months to lifelong. The probabilities of clinical events were extracted from a systematic review of the literature on duration of therapy for DVT as well as rates of bleeding secondary to anticoagulant therapy and rates of developing post-thrombotic syndrome. Utilities for each of the associated health outcomes were elicited from patients and healthy volunteers using a computerized interview. (Abstract shortened by UMI.)
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Jackson, Brandon Spencer. "Hypercoagulability using biophysical parameters in HIV positive versus HIV negative patients with deep vein thrombosis." Thesis, University of Pretoria, 2018. http://hdl.handle.net/2263/65529.
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Introduction: Patients infected with the Human immunodeficiency virus (HIV) are more prone to developing a hypercoagulable state. This may be due an upregulated inflammatory system resulting in a different coagulation profile.
Aim(s): To compare the coagulation profile of HIV positive patients to HIV negative patients.
Methods: A descriptive comparative prospective study recruiting symptomatic confirmed deep vein thrombosis (DVT) adult patients with HIV status. Patients blood samples were analysed using inflammatory markers, thromboelastogram, light microscopy smears and the scanning electron microscope.
Results: DVT patients have a raised inflammatory profile and a hypercoagulable viscoelastic profile but no significant difference between HIV+ and HIV- groups. Ultrastructural changes of red blood cells, platelets and fibrin network are demonstrated in DVT patients. These changes were more extreme in the HIV positive patients.
Conclusion: Patients with deep vein thrombosis are in a state of inflammation. HIV infection is linked to inflammation and inflammation is linked with a hypercoagulable state. HIV positive patients do have a different coagulation profile compared to HIV negative patients which can result in hypercoagulability and deep vein thrombosis.Thesis (PhD)--University of Pretoria, 2018.
Surgery
PhD
Unrestricted
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Galanaud, Jean-Philippe. "Les thromboses veineuses méconnues des membres inferieurs : thromboses veineuses profondes distales et thromboses veineuses superficielles." Thesis, Montpellier 1, 2011. http://www.theses.fr/2011MON1T027.
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Rationnel: Bien qu'elles constituent la majorité des thromboses veineuses des membres inférieurs, les thromboses veineuses profondes (TVP) distale et les thromboses veineuses superficielles (TVS) ont été peu étudiées et leur significativité clinique et leur prise en charge sont débattues.Méthodes: Cette thèse collige les résultats des travaux effectués par J.P. Galanaud sur les TVP distales et les TVS à partir des études épidémiologiques OPTIMEV, POST et RIETE.Résultats commentés: TVP distale: La TVP distale n'a pas le même profil de facteur de risque que la TVP proximale. Sa mortalité associée à court terme est plus faible que celle des TVP proximales mais supérieure à celle de témoins confirmant qu'il s'agit d'une entité cliniquement significative. Les différences de profil de population et de complications entre ces deux types de TVP suggèrent que le rapport bénéfice/risque du traitement anticoagulant est différent. Il n'est donc pas légitime d'extrapoler les résultats des essais des TVP proximales aux TVP distales. Des essais spécifiques sont donc nécessaires.TVS: En cas de TVS le risque de TVP concomitante est élevé. Un examen écho-doppler doit être réalisé et devra au moins explorer l'ensemble du réseau profond du membre inférieur affecté. Sexe masculin et antécédents de TVP/Embolie pulmonaire constituent des facteurs prédictifs indépendants de récidive. Si certaines TVS peuvent être traitées avec succès sans traitement anticoagulant, celles associées à un cancer ou à une atteinte saphéno-fémorale sont à haut risque de récidive y compris après un traitement anticoagulant curatifBackground: Though they represent the majority of all lower limbs thromboses, isolated distal deep-vein thrombosis (DVT) (without symptomatic pulmonary embolism (PE)) and isolated superficial vein thrombosis (SVT) (without DVT or PE) have been poorly studied. Their clinical significance and management are under debate.Methods: Data from epidemiological multicenter prospective studies OPTIMEV, POST, RIETEResults and comments: Isolated distal DVT: Distal and proximal DVTs exhibit a different risk factor profile, the latter being more associated with chronic risk factors. Three-month mortality of distal DVT patient is lower than that of proximal DVT ones but is higher than that of controls. This evidences that distal DVT is a clinically significant finding. Differences in population profile and outcomes suggests that the benefit/risk ratio of anticoagulant treatment is not similar. Data from proximal DVT clinical trials should no longer be extrapolated to distal DVT.Isolated SVT: In case of SVT the risk of concomitant DVT is high. A compression ultrasonographic exam should be performed and at least explore the whole deep venous system of the affected limb. Male gender and history of DVT/Pulmonary embolism are independent predicators of recurrence. Some SVT can be safely treated without anticoagulants. On contrary, in patients with cancer or a sapheno-femoral junction involvement, the risk of deep venous recurrence is high even upon full therapeutic dose of anticoagulants
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Ikesaka, Rick. "The Risk of Upper Extremity Deep Vein Thrombosis and Primary Thromboprophylaxis with Low Dose Rivaroxaban in Oncology Patients with Central Venous Catheters." Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/41954.
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Venous thromboembolism (VTE) is a common disorder which causes significant morbidity and mortality. Upper extremity deep vein thrombosis(UEDVT) is a relatively understudied subtype of VTE which is commonly associated with central venous catheters, cancer, and thrombophilia.
The goal of this project was to better characterize the risk of UEDVT and to design and execute a pilot study that will demonstrate the efficacy of a strategy preventing the occurrence of VTE in a high-risk population for UEDVT.
This M.Sc project, was conducted in three parts.
Chapter 1 of the thesis outlines a systematic review of the literature which assessed the risk of VTE in UEDVT patients by search for and including data from studies with patients with prospectively enrolled symptomatic UEDVT.
Chapter 2 describes the development and final protocol of the TRIM-Line pilot study, a randomized open-label study comparing 90 days of rivaroxaban 10mg po daily against the current standard of care (observation) in patients with active cancer and central venous catheters, two known risk factors for VTE.
Finally in Chapter 3 the TRIM-Line study was executed as a pilot trial involving The Ottawa Hospital and the Juravinski Cancer Centre located in Hamilton. The study was conducted from March 2019 until February 2020. 105 patients underwent randomization at the two Canadian centres. The study met its prespecified feasibility endpoint average enrolment rate of 7.5 per month (95% CI:4.56, 10.44) at the coordinating Ottawa Hospital site and 2.0 per month (95% CI:0.87, 3.13) for the Juravinski Cancer Centre site. The randomized controlled trial met its enrollment targets and demonstrated that a full scale randomized controlled trial on the topic of prevention of cancer associated venous thromboembolism is feasible.
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Sobieraj, Diana M., Craig I. Coleman, Vinay Pasupuleti, Abhishek Deshpande, Roop Kaw, and Adrian V. Hernández. "Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysis." Elsevier B.V, 2015. http://hdl.handle.net/10757/346496.
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Diana.sobieraj@hhchealth.orgObjective To systematically review the literature and to quantitatively evaluate the efficacy and safety of extended pharmacologic treatment of venous thromboembolism (VTE) through network meta-analysis (NMA). Methods A systematic literature search (MEDLINE, Embase, Cochrane CENTRAL, through September 2014) and searching of reference lists of included studies and relevant reviews was conducted to identify randomized controlled trials of patients who completed initial anticoagulant treatment for VTE and then randomized for the extension study; compared extension of anticoagulant treatment to placebo or active control; and reported at least one outcome of interest (VTE or a composite of major bleeding or clinically relevant non-major bleeding). A random-effects Frequentist approach to NMA was used to calculate relative risks with 95% confidence intervals. Results Ten trials (n=11,079) were included. Risk of bias (assessed with the Cochrane tool) was low in most domains assessed across the included trials. Apixaban (2.5mg and 5mg), dabigatran, rivaroxaban, idraparinux and vitamin K antagonists (VKA) each significantly reduced the risk of VTE recurrence compared to placebo, ranging from a 73% reduction with idraparinux to 86% with VKAs. With exception of idraparinux, all active therapies significantly reduced VTE recurrence risk versus aspirin, ranging from a 73% reduction with either apixaban 2.5mg or rivaroxaban to 80% with VKAs. Apixaban and aspirin were the only therapies that did not increase composite bleeding risk significantly compared to placebo. All active therapies except aspirin increased risk of composite bleeding by 2 to 4-fold compared to apixaban 2.5mg, with no difference found between the two apixaban doses. Conclusion Extended treatment of VTE is a reasonable approach to provide continued protection from VTE recurrence although bleeding risk is variable across therapeutic options. Our results indicate that apixaban, dabigatran, rivaroxaban, idraparinux and VKAs all reduced VTE recurrence when compared to placebo. Apixaban appears to have a more favorable safety profile compared to other therapies.
Revisión por pares
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Prado, Lucas Bessa 1986. "Avaliação da atividade anticoagulante e antitrombótica de enoxaparina encapsulada em nanopartículas em modelo de trombose venosa profunda em ratos." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310153.
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Orientador: Joyce Maria Annichino-BizzacchiDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: A Trombose Venosa Profunda (TVP) é definida como uma oclusão parcial ou total da circulação venosa profunda. A heparina é um fármaco com ação anticoagulante e antitrombótica utilizado desde 1930. O custo, a via de administração (endovenosa ou subcutânea) e as doses repetidas são algumas das limitações do seu uso. Assim, o desenvolvimento de um produto que possa ser administrado por via subcutânea ou oral em um menor número de aplicações, torna-se um importante desafio e de grande aplicabilidade clínica. Sistemas de liberação sustentada permitem que o fármaco seja encapsulado e liberado gradativamente. Este estudo constituiu na preparação, caracterização e avaliação in vivo de nanopartículas de poli (?-caprolactona) (PCL) e quitosana como carreadores de heparina de baixo peso molecular (enoxaparina). As nanopartículas foram preparadas pelo método de dupla emulsão água/óleo/água e evaporação do solvente. A caracterização das nanopartículas foi realizada por microscopia eletrônica de varredura (MEV), onde foram observadas partículas esféricas e homogêneas. O diâmetro médio das nanopartículas foi de 512,8 ± 13,8 nm e o potencial zeta foi de +30,9 ± 1,3 mV. A eficiência de encapsulamento, analisada pelo método Azure II foi de 99,04 ± 0,001 %. A atividade anticoagulante in vivo da enoxaparina encapsulada foi avaliada pela atividade anti-Xa plasmática, através de método colorimétrico. Quando a enoxaparina livre foi administrada por via subcutânea observou-se um pico de atividade (0,5 UI/mL) em 1 hora, com um decréscimo gradual até 6 horas. A atividade anticoagulante da enoxaparina encapsulada em nanopartículas manteve-se por até 14 horas, quando foi administrada por via subcutânea, sugerindo que as nanopartículas podem permitir que a enoxaparina seja liberada de forma gradual, podendo ser uma vantagem na prática clínica. Após a administração das nanopartículas por via oral não se observou nenhuma atividade em até 14 horas, sugerindo que as nanopartículas não tenham sido absorvidas ou a enoxaparina tenha sido degradada no trato gastrointestinal. Para avaliação do efeito antitrombótico foi padronizado o modelo de TVP por estase e hipercoagulabilidade em ratos. Após administração subcutânea, houve uma significativa diminuição do tamanho do trombo formado tanto com o emprego de enoxaparina livre (p= 0,002) como após encapsulamento em nanopartículas (p= 0,0411) em comparação ao grupo controle. Quando foram administradas nanopartículas por via oral, os resultados mostraram que não houve diferença estatística em comparação ao grupo controle (p= 0,9476) e a um grupo de nanopartículas vazias (p= 0,9372). Em resumo, o método de dupla emulsão a/o/a mostrou-se eficiente para o encapsulamento de enoxaparina, proporcionando a obtenção de nanopartículas esféricas e com alta eficiência de encapsulamento. Pelos estudos in vivo, a enoxaparina encapsulada mostrou uma atividade anticoagulante com liberação sustentada, por um período superior ao obtido com a enoxaparina livre, com excelente efeito antitrombótico quando administrada por via subcutânea. Contudo, não se observou nenhum efeito anticoagulante ou antitrombótico quando as nanopartículas foram administradas por via oral. Novos experimentos com quitosanas de diferentes massas molares serão necessários na tentativa de possibilitar a absorção oral dessas nanopartículas
Abstract: Deep vein thrombosis (DVT) is defined as partial or total occlusion of the deep venous circulation. Heparin is a drug with anticoagulant and antithrombotic action used since 1930. The costs, administration vias (intravenous or subcutaneous) and the repeated doses are some limitations of its use. Thus, the development of a product that could be administered subcutaneous or orally in a smaller number of applications becomes a major challenge with huge clinical applicability. Sustained release systems allow the medication to be gradually encapsulated and released. This study was based on the preparation, characterization and in vivo evaluation of nanoparticles of poly (?-caprolactone) (PCL) and chitosan as carriers of low molecular weight heparin (enoxaparin). The nanoparticles were prepared by the double emulsion water/oil/water method and solvent evaporation. The nanoparticles characterization was performed by scanning electron microscopy (SEM), in which were observed spherical and homogeneous particles. The average diameter of the nanoparticles was 512.8 ± 13.8 nm and the zeta potential was +30.9 ± 1.3 mV. The encapsulation efficiency, analyzed by Azure II method, was 99.04 ± 0.001%. The in vivo anticoagulant activity of the encapsulated enoxaparin was evaluated by plasmatic anti-Xa activity performed by colorimetric method. When the free enoxaparin was subcutaneously administered a peak of activity was observed (0.5 IU/mL) in 1 hour with a gradual decrease until 6 hours. The anticoagulant activity of the nanoparticles encapsulated enoxaparin was kept until 14 hours when it was administered subcutaneously, suggesting that nanoparticles may allow the enoxaparin release by a gradual way, what could be an advantage on clinical practice. After the oral administration of the nanoparticles, any activity could be observed in until 14 hours, suggesting that or the nanoparticles might be not absorbed or the enoxaparin might be degraded on the gastrointestinal tract. In order to evaluate its antithrombotic effect, it was standardized a model of DVT by stasis and hypercoagulability in rats. After subcutaneous administration, there was a significative reduction on the thrombus size both with free enoxaparin (p= 0.002) and after encapsulation (p= 0.0411) in comparison with control group. When nanoparticles were administered orally, the results showed no statistical difference compared to the control group (p = 0.9476) and to a group of empty nanoparticles (p = 0.9372). In summary, the double emulsion method w/o/w was efficient for the enoxaparin encapsulation, providing the obtainment of spherical nanoparticles with high encapsulation efficiency. For in vivo studies, the encapsulated enoxaparin showed a sustained release anticoagulant activity for a higher period than that obtained with free enoxaparin, with an excellent antithrombotic effect when administered subcutaneously. However, there was no anticoagulant or antithrombotic effect when the nanoparticles were administered orally. Further experiments with chitosans of different molecular weights will be needed on the attempt to allow the oral absorption of these nanoparticles
Mestrado
Medicina Experimental
Mestre em Fisiopatologia Médica
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Midha, Prem Anand. "Long-term patency of a polymer vein valve." Thesis, Atlanta, Ga. : Georgia Institute of Technology, 2009. http://hdl.handle.net/1853/29721.
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Thesis (M. S.)--Bioengineering, Georgia Institute of Technology, 2010.Committee Chair: Ku, David; Committee Member: Gleason, Rudolph; Committee Member: Milner, Ross. Part of the SMARTech Electronic Thesis and Dissertation Collection.
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Smith, Sarah Faith. "Influences on the incidence of clinical deep vein thrombosis and pulmonary embolism in a prospectively collated population of 21,000 neurosurgical inpatients." University of Sydney. Public Health and Community Medicine, 2001. http://hdl.handle.net/2123/818.
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Records of all neurosurgical inpatients admitted to Royal North Shore Hospital since 1976 have been prospectively kept in a relational database. Demographic details, diagnoses, operations and complications have been entered continuously since 1982 by the author of this study. Complications are monitored at monthly review meetings attended by medical staff. The recurrence of deep vein thrombosis (DVT) and pulmonary embolism (PE) at these meetings, despite continual improvements in patient care, prompted this study. It aims to use the database to study changes in the incidence of DVT and PE over the previous twenty years; to find what database variables predict these complications; and whether use of mechanical and pharmacological agents has had an impact on DVT and PE rate. Univariate analysis of the incidence of DVT and PE by age, sex, length of stay (LOS), admission month, diagnosis, operation and surgeon over time was run. Any significant variables were then analysed by multivariate logistic regression. The DVT rate was low by world standards, but rose from 0.6% in 1979-83 to 1.2% in 1984-88, then rose exponentially to 3.60% in 1994-98 with a significantly increasing trend over the twenty years (c2 MH =114.20, with IDF, P<0.001). PE rate doubled significantly over the twenty years from 0.6% to 1.2% (c2 MH =17.94 with 1DF, P<0.001). Age, LOS, diagnosis, operation and surgeon were significant predictors of DVT and PE. After adjustment for LOS, time period and age, vascular surgery was found to be the strongest predictor of DVT (OR=2.82, 95% CI: 2.08-3.82, c2 =43.91, P<0.01). Vascular diagnosis was the strongest diagnosis predictor. No effect of sex or month of admission was shown. After adjustment for LOS, time period and age, spinal fusion was the strongest predictor of PE (OR=4.04, 95% CI: 1.81-9.03). Anterior communicating artery aneurysm was the diagnosis most highly associated with PE. The rise in DVT rate may be due to increased complexity of surgical and nursing management, and some screening of patients with the introduction of duplex scanning. The doubling of PE rate is unexplained. The risk of brain or spinal cord haemorrhage makes prophylactic anticoagulation a difficult choice. This study reveals groupings which can be used to determine appropriate prophylaxis. Use of mechanical and pharmaceutical agents is not recorded consistently in the database, but it is known approximately when they were introduced. No impact on the rate of DVT and PE can be demonstrated by these agents. More vigilant and widespread use of mechanical prophylaxis might be just as effective in controlling DVT and PE.
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Cheung, William Ka Wai. "Development and initial evaluation of wireless self-monitoring pneumatic compression sleeves for preventing deep vein thrombosis in surgical patients." Thesis, University of British Columbia, 2007. http://hdl.handle.net/2429/402.
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This thesis describes the successful development and initial evaluation of a proof-of-concept wireless monitoring system for improving the effectiveness and safety of pneumatic compression therapy to help prevent deep vein thrombosis (DVT). In the development, an important objective was to make feasible the practical and commercial deployment of such improved therapy systems in future, by focusing on a cost-effective design and implementation.
Over the years, pneumatic compression has been shown to be an effective solution for the prevention of DVT. However, different problems and complications related to the use of commercial pneumatic compression de-vices that typically include automatic pressure controllers and pneumatic compression sleeves have been reported. For example, one study reported a high percentage of improperly applied or nonfunctional pneumatic compression devices in routine usage. Technical problems, non-compliance, and human error were identified as the causes behind the failed therapies. Also, it was reported that dedicated in-service instruction did not improve the proper use of the pneumatic compression controllers and sleeves. In another study, significant unanticipated variations between expected and delivered pneumatic compression therapy were reported: expected therapy delivered only an average of 77.8% of the time during the therapy, and much of the time key values related to the outcome of the therapy were found to have variations great than 10%. Specific hazards have also been reported. For example, one patient developed acute compartment syndrome after wearing a pair of pneumatic compression sleeves with faulty pressure release valves. In another case, epidural analgesia masked a malfunction resulting from a reversed connection between four-way plastic tubing of the sleeves and the controller, exposing a patient to a hazardous pressure of around 300mmHg,blocking all blood flow for a prolonged period of time.
Newer models of pneumatic compression sleeves and controllers from various manufacturers claim to improve therapy by, for example, increasing the peak blood flow velocity. However, there is no evidence in the published literature to support such claims. A published review of the literature from1970-2002 reached the conclusion that the most important factors in im-proving therapy with pneumatic compression devices, particularly during and after surgery, were the degree of conformance of delivered therapy to the prescribed therapy, patient compliance, and the appropriateness of the site of compression. The inability to monitor delivered therapy and patient compliance remains a problem in efforts to improve pneumatic compression therapy.
The above-described problems were addressed in the successful development of the innovative prototype described in this thesis. This wireless monitoring system should improve the effectiveness and safety of pneumatic compression therapy. Also, innovative aspects of the system design allow for cost-effective integration into existing commercial controllers and sleeves. For example, an innovative and potentially patentable usage and reprocess indicator was developed for pneumatic compression sleeves to significantly improve their safety and to reduce their cost of use per patient.
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Matida, Caroline Kazue [UNESP]. "Trombose venosa profunda dos membros inferiores em crianças e adolescentes tratados em um único centro no Brasil: epidemiologia e evolução." Universidade Estadual Paulista (UNESP), 2010. http://hdl.handle.net/11449/103480.
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matida_ck_dr_botfm.pdf: 889840 bytes, checksum: e2fb39fd0a8e59a674752ea187a4c74b (MD5)A importância do estudo da trombose venosa profunda (TVP) em crianças e adolescentes reside no impacto desta doença sobre a qualidade de vida desta população, tendo em vista sua longa expectativa de vida e a morbidade associada ao tromboembolismo venoso. Com o passar dos anos, a síndrome pós-trombótica e a recorrência podem deixar sequelas que vão desde dor crônica nos membros, edema e até úlceras de difícil cicatrização. A TVP em crianças está sendo melhor estudada nos últimos anos. Até então, seu diagnóstico e tratamento eram baseados em experiências individuais, pequenas séries de casos ou extrapolados das recomendações para adultos. Realizamos a presente revisão para melhor compreensão da epidemiologia, fisiopatologia, etiologia, diagnóstico, tratamento desta doença
The study of deep vein thrombosis (DVT) in children and adolescents assesses the important impact of this disease on the quality of life of this population considering its long life expectancy and morbidity associated to venous thromboembolism. Within the years, the pos-thrombotic syndrome and recurrence can cause sequelae including chronic lower limb pain, edema and even hard cicatrization ulcer. Recently, DVT in children has been studied more appropriately. Previously, its diagnosis and treatment were based on individual experience, some serial cases or comparisons with recommendations to the adult treatments. This present study has been presented to better comprehend the epidemiology, physiopathology, etiology, diagnosis, treatment and prophylaxis of the deep vein thrombosis
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Tinkler, Kerry. "Setting up, piloting, implementing and reviewing a GP direct access service for the diagnosis of lower limb deep vein thrombosis." Thesis, University of Portsmouth, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.407268.
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Frappé, Paul. "Epidémiologie en soins primaires de la thrombose veineuse superficielle des membres inférieurs." Thesis, Saint-Etienne, 2015. http://www.theses.fr/2015STET004T/document.
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La sévérité potentielle de la thrombose veineuse superficielle (TVS) des membres inférieurs a récemment été documentée par des études réalisées en soins secondaires et tertiaires. Son épidémiologie reste cependant inconnue en soins primaires. Le premier objectif de ce travail était de mesurer la prévalence de la TVS en soins primaires, ainsi que le taux d'évènements thromboemboliques concomitants au moment du diagnostic. Pour y répondre, un réseau de recherche collaborative entre médecins généralistes et médecins vasculaires de la région stéphanoise a été mis en place. Une étude transversale descriptive a été réalisée au sein de ce réseau pendant un an. La prévalence annuelle de la TVS a été mesurée à 0,64 pour mille habitants. Au moment du diagnostic, 24,6% des TVS étaient associées à une thrombose veineuse profonde symptomatique et 4,7% à une embolie pulmonaire symptomatique. Une seconde étude a recherché une variation saisonnière de la fréquence de la TVS en analysant les données individuelles de trois études aux designs différents ; l'étude STENOX, l'étude POST et l'étude STEPH. Une variation significative n'a été retrouvée que dans l'étude POST, et les peak-to-low ratios étaient inférieurs à 1,2 dans les trois études. Ainsi, si une variation existe, celle-ci parait être de faible envergure, sans conséquence sur la pratique et la rechercheThe potential severity of superficial vein thrombosis (SVT) of the lower limbs has recently been shown by studies perfomed in secondary and tertiary care. The epidemiology of SVT remains unknown in primary care. The first objective of this study was to measure the prevalence of SVT in primary care, and the rate of concomitant thromboembolic events at diagnosis. A collaborative research network between general practitioners and vascular physicians from Saint-Etienne has been set up. A cross-sectional study has been conducted within this network during one year. The annual prevalence of SVT was measured to 0.64 per thousand inhabitants. At diagnosis, 24.6% of SVT were associated with symptomatic deep vein thrombosis and 4.7% with symptomatic pulmonary embolism. A second study was looking for a seasonal variation of SVT frequency by analyzing individual data from three studies with different designs; the STENOX study, the POST study and the STEPH study. A significant variation was found only in the POST study, and peak-to-low ratios were below 1.2 in the three studies. Thus, if other more powerful and exhaustive studies could find a seasonal variation, that variation would probably be of low magnitude and without clinical significance
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Blecher, Gabriel E. "Diagnosing DVT in the Emergency Department: Combining Clinical Predictors, D-dimer and Bedside Ultrasound." Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/24003.
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I assessed the accuracy of two clinical prediction rules, the d-dimer blood test and point of care ultrasound for diagnosing lower limb deep vein thrombosis.
Emergency physicians were trained in ultrasound and prospectively scanned emergency department patients with suspected deep vein thrombosis. Accuracy of the Wells and AMUSE rules and the ultrasound result was compared to radiology-performed ultrasound and a 90-day clinical outcome. Univariate and multivariate analyses were performed assessing which factors were associated with the outcome.
The sensitivity and specificity of the Wells score for the clinical outcome was 85.7% and 68.5%; the AMUSE score 85.7% and 54.4%. Ultrasound had a sensitivity of 91.7% and specificity of 91.7% for radiology-diagnosed thrombus and 78.6% and 95.0% for clinical outcome. The odds ratio of a positive outcome with a positive ultrasound was 65.1.
After receiving the ultrasound training program, emergency physicians were unable to demonstrate sufficient accuracy to replace current diagnostic strategies.
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Matida, Caroline Kazue. "Trombose venosa profunda dos membros inferiores em crianças e adolescentes tratados em um único centro no Brasil : epidemiologia e evolução /." Botucatu : [s.n.], 2010. http://hdl.handle.net/11449/103480.
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Orientador: Francisco Humberto de Abreu MaffeiBanca: Hamilton de Almeida Rollo
Banca: José Roberto Fioretto
Banca: Fausto Miranda Junior
Banca: Jorge David Aivazoglou Carneiro
Resumo: A importância do estudo da trombose venosa profunda (TVP) em crianças e adolescentes reside no impacto desta doença sobre a qualidade de vida desta população, tendo em vista sua longa expectativa de vida e a morbidade associada ao tromboembolismo venoso. Com o passar dos anos, a síndrome pós-trombótica e a recorrência podem deixar sequelas que vão desde dor crônica nos membros, edema e até úlceras de difícil cicatrização. A TVP em crianças está sendo melhor estudada nos últimos anos. Até então, seu diagnóstico e tratamento eram baseados em experiências individuais, pequenas séries de casos ou extrapolados das recomendações para adultos. Realizamos a presente revisão para melhor compreensão da epidemiologia, fisiopatologia, etiologia, diagnóstico, tratamento desta doença
Abstract: The study of deep vein thrombosis (DVT) in children and adolescents assesses the important impact of this disease on the quality of life of this population considering its long life expectancy and morbidity associated to venous thromboembolism. Within the years, the pos-thrombotic syndrome and recurrence can cause sequelae including chronic lower limb pain, edema and even hard cicatrization ulcer. Recently, DVT in children has been studied more appropriately. Previously, its diagnosis and treatment were based on individual experience, some serial cases or comparisons with recommendations to the adult treatments. This present study has been presented to better comprehend the epidemiology, physiopathology, etiology, diagnosis, treatment and prophylaxis of the deep vein thrombosis
Doutor
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Farrell, Laura-Lee Amelia Catherine. "Prosthetic Vein Valve: Delivery and In Vitro Evaluation." Thesis, Available online, Georgia Institute of Technology, 2007, 2007. http://etd.gatech.edu/theses/available/etd-04042007-180135/.
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Tófano, Viviane Alessandra Capelluppi [UNESP]. "Avaliação clínica e ultrassonografia tardia de pacientes com trombose venosa profunda, portadores de trombofilia." Universidade Estadual Paulista (UNESP), 2008. http://hdl.handle.net/11449/103481.
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A trombose venosa profunda (TVP) caracteriza-se pela formação aguda de um trombo no interior das veias profundas. É uma doença de alta incidência e de grande importância clínica e epidemiológica devido à sua morbimortalidade, sendo atualmente, considerada multifatorial. São vários os fatores de risco genéticos e/ou adquiridos relacionados à TVP e a compreensão da interação destes, permite melhor entender esta doença, não só devido aos seus sintomas de fase aguda mas, principalmente, por sua complicação mais temida, a embolia pulmonar e, a longo prazo, a síndrome pós-trombótica (SPT), que apresenta importante morbidade, inclusive com repercussões sócio-econômicas. A avaliação a longo prazo, clínica e ultrassonográfica, de pacientes com diagnóstico de TVP, visando verificar a incidência e gravidade da SPT é necessária para a compreensão da evolução destes pacientes. Desconhecemos a existência de trabalhos em nosso meio, que avaliem a evolução tardia da TVP. Objetivo: Determinar a evolução a longo prazo de pacientes com TVP de membros, portadores de trombofilia e verificar se existem diferenças na evolução de pacientes trombofílicos e não trombofílicos. Método: Num estudo coorte retrospectivo foram avaliados os prontuários de 275 pacientes atendidos no Hospital das Clínicas da Faculdade de Medicina de Botucatu-Unesp, dos quais foram identificados 60 pacientes trombofílicos, sendo possível contactar 40 deles para consulta, dos quais 39 pacientes aceitaram participar do estudo. Foram selecionados 25 pacientes com diagnóstico de TVP, não trombofílicos, pareados para sexo e idade, para comparação com o grupo trombofílico. Durante a consulta foi preenchido um protocolo que continha as seguintes variáveis: dados demográficos, profissão, antecedentes pessoais e antecedentes obstétricos (se mulher), antecedentes familiares com relação...
Deep vein thrombosis (DVT) is characterized by the acute formation of a thrombus in the interior of the deep veins. It is a disease of high incidence and great clinical and epidemiological importance due to its morbimortality, being presently considered multifactorial. The genetic and/or acquired risk factors related to DVT are various and understanding their interaction allows a better comprehension of this illness, due to both symptoms of the acute stage and, mainly, its most feared complication, the pulmonary embolism and, in long term, the post-thrombotic syndrome (PTS), which presents important morbidity, inclusively with social and economical repercussions. The long-term clinical and ultrasound evaluation of patients with DVT diagnosis, aiming to verify the incidence and seriousness of PTS, is necessary to understand the evolution of these patients. We are not aware of the existence of works in our area which evaluate the late evolution of DVT. Objective: To determine the long-term evolution of patients with DVT of limbs, carriers of thrombophilia, and verify the existence of differences in the evolution of thrombophilic and non-thrombophilic patients. Method: In a retrospective cohort study, the medical registers of 275 patients attended at the Clinics Hospital of the School of Medicine of the Paulista State University, in Botucatu, São Paulo, Brazil, were evaluated, from which 60 thrombophilic patients were identified. It was possible to contact 40 of them for appointment, from which 39 patients accepted to participate in the study. 25 non-thrombophilic patients, paired for sex and age, were selected with DVT diagnosis, for comparison with the thrombophilic group. During the appointment, a protocol was filled in, containing the following variables: demographic data, occupation, personal antecedents and obstetric antecedents (if woman), familiar antecedents concerning thrombosis... (Complete abstract click electronic access below)
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Sathe, Rahul D. "Design and Development of a Novel Implantable Prosthetic Vein Valve." Thesis, Georgia Institute of Technology, 2006. http://hdl.handle.net/1853/14495.
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Over seven million Americans suffer from Chronic Venous Insufficiency (CVI), a painful and debilitating disease that affects the superficial and deep veins of the legs. Problems associated with CVI include varicose veins, bleeding, ulcerations, severe swelling, deep vein thrombosis, and pulmonary embolism, which may lead to death. The presence of CVI results from damaged (incompetent) one-way vein valves in leg veins. These valves normally allow forward flow of blood to the heart, and prevent blood from pooling at the feet. However, incompetent valves allow reflux of blood, causing clinical problems.
There are few effective clinical therapies for treating CVI. Vein valve transplantation is a surgical option for treatment. However, it is often difficult to find suitable donor valves. Very few prosthetic valves developed in the past have demonstrated sufficient clinical or mechanical functionality. Persistent problems include thrombus formation, leaking valves, and valves that do not open at physiologic pressure gradient. The primary objective of this research was to develop a clinically relevant functional prosthetic vein valve.
The novel prosthetic valve is flexible, biocompatible, has low thrombogenecity, and is easy to manufacture. It was designed to address well-defined consumer needs and functional design requirements. The valve was required to 1) withstand 300 mmHg of backpressure with leakage less than 1.0 mL/min, 2) open with a pressure gradient less than 5 mmHg, and 3) meet criteria 1 and 2 after 500,000 cycles of operation. The valve met these design requirements in bench testing. The valve can open with a pressure gradient of 2.6 0.7 mmHg, and can withstand 300 mmHg with leakage less than 0.5 mL/min. The valve remained functional after opening and closing over 500,000 times. The valve presented in this research is operationally functional, and is a potential solution for treating venous incompetence in CVI patients.
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Autar, A. Ricky. "Advancing clinical practice in the management of deep vein thrombosis (DVT) : development, application and evaluation of the Autar DVT risk assessment scale." Thesis, De Montfort University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.250780.
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Domberg, Asplund Jenny, and Stina Isaxon. "Prevention mot djup ventrombos : vad säger evidensen och hur arbetar sjuksköterskan kliniskt?" Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-294573.
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Bakgrund: Djup ventrombos (DVT) är en allvarlig komplikation efter kirurgiska och ortopediska ingrepp. Detta leder till ökat lidande för patienten, längre vårdtider och därav ökade kostnader för samhället. För att förebygga DVT krävs kunskap om vilka preventiva omvårdnadsåtgärder som har effekt och hur de ska användas. Syfte: Syftet med studien var att genom en systematisk litteraturstudie se vad kunskapsläget säger om preventiva omvårdnadsåtgärder mot DVT samt vad som ser mest effektivt ut. Syftet var också att genom en enkät ta reda på hur sjuksköterskor arbetar kliniskt för att förebygga DVT. Metod: Litteraturstudie som baserades på tio orginalartiklar. Som komplement till litteraturstudien gjordes även en enkätstudie som inkluderade tio sjuksköterskor. Resultat: Tidig mobilisering tillsammans med mekanisk profylax ses som effektivt för att förebygga DVT. I många av studierna som granskats gavs patienterna lågmolekylärt heparin (LMH). Det var dock ingen lägre frekvens av DVT hos dessa patienter jämfört med de som ej fick LMH. Det var vid införandet av profylaktiska omvårdnadsåtgärder som tidig mobilisering, kompressionsstrumpor och kompressionspumpar som frekvensen av DVT sjönk. Sjuksköterskorna arbetar aktivt med förebyggande omvårdnadsåtgärder men det finns dock inga specifika riktlinjer för dessa omvårdnadsåtgärder i den kliniska verksamheten. Slutsats: Studien visar att ett behov finns för utvecklandet av att arbeta med individanpassad profylax då patienterna utifrån olika riskgrupper har olika behov av profylaxtyper. Stor vikt bör läggas på att utveckla och implementera riktlinjer för tidig mobilisering då detta utifrån denna studies resultat har god effekt för att förebygga uppkomsten av DVT.Background: Deep vein thrombosis is a serious complication during surgical and orthopaedic procedures. This leads to increased patient suffering, longer hospital stays and thereby also higher cost for society. To prevent DVT requires knowledge about preventive care measures that are effective, and how they will be used. Aim: The aim of this study was to examine the current state of knowledge about preventive care measures against DVT and how effective they are. The aim was also, by conducting a survey, to find out how nurses work clinically for the prevention of DVT. Study design: A literature study was conducted. The study was based on ten original articles. As a complement to the literature study a questionnaire was created and handed out to ten surgical and orthopaedic nurses. Results: Early mobilization in combination with mechanical prophylactics is seen as effective for preventing DVT. In many of the included studies patients were given low molecular weight heparin (LMH). However the frequency of DVT in these patients was not lower compared to those who did not get LMH. Instead it was at the introduction of prophylactic care measures such as early mobilization, compression stockings and compression pumps as the frequency of DVT fell. The questionnaires showed that clinical nurses worked actively with care measures. However, there were no specific guidelines for the measures in the organisation. Conclusion: The study shows that there is a need for developing methods for individual prophylactic care as patients from different risk groups have different needs. There should also be focus on developing and implementing guidelines for early mobilization as this study has shown it is effective in preventing DVT.
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Bichsel, Leila Tièche Raphaël. "D-dimers, localization of first deep vein thrombosis and awareness of risk factors as independent predictors of the risk of recurrent thromboembolic events /." Bern : [s.n.], 2006. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.
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Hebeshy, Mona Ibrahim. "ATTITUDE, SUBJECTIVE NORMS, PERCEIVED BEHAVIORAL CONTROL, AND INTENTION OF EGYPTIAN NURSES TOWARDS PREVENTION OF DEEP VEIN THROMBOSIS AMONG CRITICALLY ILL PATIENTS IN INTENSIVE CARE UNITS." Kent State University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=kent1524226281287546.
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Rowland, Denise Phi-Phoung. "Evaluation of soluble fibrin as an early marker of thrombosis." Thesis, Queensland University of Technology, 1997.
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Tófano, Viviane Alessandra Capelluppi. "Avaliação clínica e ultrassonografia tardia de pacientes com trombose venosa profunda, portadores de trombofilia /." Botucatu : [s.n.], 2008. http://hdl.handle.net/11449/103481.
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Orientador: Francisco Humberto de Abreu MaffeiBanca: Hamilton Almeida Rollo
Banca: Adilson F. Paschôa
Banca: Newton Key Hokama
Banca: Cyrillo C. Filho
Resumo: A trombose venosa profunda (TVP) caracteriza-se pela formação aguda de um trombo no interior das veias profundas. É uma doença de alta incidência e de grande importância clínica e epidemiológica devido à sua morbimortalidade, sendo atualmente, considerada multifatorial. São vários os fatores de risco genéticos e/ou adquiridos relacionados à TVP e a compreensão da interação destes, permite melhor entender esta doença, não só devido aos seus sintomas de fase aguda mas, principalmente, por sua complicação mais temida, a embolia pulmonar e, a longo prazo, a síndrome pós-trombótica (SPT), que apresenta importante morbidade, inclusive com repercussões sócio-econômicas. A avaliação a longo prazo, clínica e ultrassonográfica, de pacientes com diagnóstico de TVP, visando verificar a incidência e gravidade da SPT é necessária para a compreensão da evolução destes pacientes. Desconhecemos a existência de trabalhos em nosso meio, que avaliem a evolução tardia da TVP. Objetivo: Determinar a evolução a longo prazo de pacientes com TVP de membros, portadores de trombofilia e verificar se existem diferenças na evolução de pacientes trombofílicos e não trombofílicos. Método: Num estudo coorte retrospectivo foram avaliados os prontuários de 275 pacientes atendidos no Hospital das Clínicas da Faculdade de Medicina de Botucatu-Unesp, dos quais foram identificados 60 pacientes trombofílicos, sendo possível contactar 40 deles para consulta, dos quais 39 pacientes aceitaram participar do estudo. Foram selecionados 25 pacientes com diagnóstico de TVP, não trombofílicos, pareados para sexo e idade, para comparação com o grupo trombofílico. Durante a consulta foi preenchido um protocolo que continha as seguintes variáveis: dados demográficos, profissão, antecedentes pessoais e antecedentes obstétricos (se mulher), antecedentes familiares com relação... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Deep vein thrombosis (DVT) is characterized by the acute formation of a thrombus in the interior of the deep veins. It is a disease of high incidence and great clinical and epidemiological importance due to its morbimortality, being presently considered multifactorial. The genetic and/or acquired risk factors related to DVT are various and understanding their interaction allows a better comprehension of this illness, due to both symptoms of the acute stage and, mainly, its most feared complication, the pulmonary embolism and, in long term, the post-thrombotic syndrome (PTS), which presents important morbidity, inclusively with social and economical repercussions. The long-term clinical and ultrasound evaluation of patients with DVT diagnosis, aiming to verify the incidence and seriousness of PTS, is necessary to understand the evolution of these patients. We are not aware of the existence of works in our area which evaluate the late evolution of DVT. Objective: To determine the long-term evolution of patients with DVT of limbs, carriers of thrombophilia, and verify the existence of differences in the evolution of thrombophilic and non-thrombophilic patients. Method: In a retrospective cohort study, the medical registers of 275 patients attended at the Clinics Hospital of the School of Medicine of the Paulista State University, in Botucatu, São Paulo, Brazil, were evaluated, from which 60 thrombophilic patients were identified. It was possible to contact 40 of them for appointment, from which 39 patients accepted to participate in the study. 25 non-thrombophilic patients, paired for sex and age, were selected with DVT diagnosis, for comparison with the thrombophilic group. During the appointment, a protocol was filled in, containing the following variables: demographic data, occupation, personal antecedents and obstetric antecedents (if woman), familiar antecedents concerning thrombosis... (Complete abstract click electronic access below)
Doutor
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Crawford, Yupin. "The cost-effectiveness of current practice of venous thromboembolism prophylaxis as compared to no prophylaxis or pharmaceuticals only prophylaxis." Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/120279/1/Yupin_Crawford_Thesis.pdf.
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This research uses economic evaluation methods to model the current practice of VTE prevention at the Gold Coast Hospital and Health Services compared to historical controls. Additionally the research tested the hypothesis that improved prescribing compliance would achieve better clinical outcomes and would be cost effective. This research revealed that current VTE prophylaxis practice were cost effective as compared to either no or suboptimal prevention. Economic modeling revealed that increasing prescribing compliance to 95% to achieve a lower incidence of DVT and PE was cost effective for General Surgical and Orthopaedic patients. For Medical Patients a blanket prescribing approach was not cost effective.
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Gandara, Esteban. "Is an Intermediate Dose of LMWH Effective for Secondary Prevention of Recurrent Venous Thromboembolism in Pregnant Patients Diagnosed with Deep Vein Thrombosis or Pulmonary Embolism? Design of a Pilot Study." Thèse, Université d'Ottawa / University of Ottawa, 2012. http://hdl.handle.net/10393/23388.
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Statement of the problem The primary objective of this thesis was to determine the best study design to evaluate the safety and effectiveness of an intermediate dose of low molecular weight heparin for secondary prevention of pregnancy associated VTE (PAVTE). An RCT was deemed unfeasible,so the use of a single arm study with prior evaluation of feasibility with a pilot study is proposed. // Methods - A systematic review was conducted to evaluate the efficacy of current strategies used for secondary prevention of PAVTE.A survey was used to elicit the non-inferiority margin. // Results - The pooled proportion of recurrent VTE in patients treated with full dose LMWH was 0.012(95% CI 0.006 to 0.02) and the rate of major bleeding was 0.025(95% CI=0.01 to 0.041). The non-inferiority margin was elicited at 2.5%. // Conclusions - Although a randomized controlled trial should be conducted whenever possible, in certain scenarios they are unfeasible. Therefore, an alternative study design should perhaps be used to evaluate the safety and efficacy of therapeutic strategies.
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Nilsson, Elin, and Linnéa Oskarsson. "Graderade kompressionsstrumpors preventiva effekt för djup ventrombos och posttrombotiskt syndrom." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-408302.
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Bakgrund: Djup ventrombos (DVT) är en allvarlig komplikation postoperativt och kan leda till ett livshotande tillstånd för patienten. Graderade kompressionsstrumpor (GCS) används på många postoperativa avdelningar tillsammans med andra profylaktiska åtgärder för att förebygga utvecklingen av DVT. Kompressionsstrumpor används även till att förebygga posttrombotiskt syndrom (PTS) efter en DVT. PTS kan utvecklas på grund av att de venösa klaffarna skadas vid en DVT, till följd stockar sig blodet och ödem bildas vilket leder till försämrad näring- och syretillförsel till vävnaderna. Syfte: Syftet var att genom en litteraturstudie undersöka om kompressionsstrumpor hade någon effekt för att förebygga DVT postoperativt samt om kompressionsstrumpor hade någon effekt att förebygga PTS efter en DVT. Metod: Litteraturstudie som baserads på 11 RCT studier. Resultat: GCS utan andra profylaktiska åtgärder visade sig ha en god effekt för att undvika utvecklingen av DVT på patienter som genomgått en operation. Däremot visade sig användandet av GCS i kombination med andra beprövade profylax inte ha någon större effekt för att reducera uppkomsten av DVT ytterligare. Resultatet angående GCS effekt för att undvika utvecklingen av PTS visade ingen entydighet. Slutsats: GCS har en förebyggande effekt för att undvika uppkomsten av DVT. Användningen av GCS i kombination med andra profylax potentierar däremot inte effekten av preventionen för DVT. GCS verkan för att förebygga uppkomsten av PTS är inte entydigt och flera studier behövs för att se evidens kring detta.ABSTRACT Background: Deep vein thrombosis (DVT) is a serious complication postoperatively and can lead to a life threatening condition for the patient. Graded compression stockings (GCS) are used in many post-operative departments along with other prophylactic measures to prevent the development of DVT. Compression stockings are also used to prevent postthrombotic syndrome (PTS) after a DVT. PTS can develop because the venous valves are damaged by a DVT, as a result, the blood is stored and edema is formed, which leads to poor nutritional and oxygen supply to the tissues. Aim: The aim of the literature study was to investigate whether compression stockings had any effect in preventing DVT postoperatively, and also whether the compression stockings had any effect in preventing PTS after a DVT. Method: Literature study based on 11 RCT studies. Results: GCS without other prophylactic measures was found to have a good effect in avoiding the development of DVT in patients who underwent surgery. However, the use of GCS in combination with other proven prophylaxis was found to have no significant effect in further reducing the onset of DVT. The results regarding the GCS effect to avoid the development of PTS showed no unambiguity. Conclusion: GCS has a preventive effect to avoid the onset of DVT. However, the use of GCS in combination with other prophylaxis does not potentiate the effect of prevention for DVT. The effect of GCS in preventing the onset of PTS is not unambiguous and several studies are needed to see evidence of this.
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Harrison, Jeffrey. "Deep vein thrombosis after total hip and knee replacement : a review of the incidence, prophylaxis, diagnosis and economic impact of thromboembolic disease in lower limb joint replacement. A comparison of low molecular weight heparin and pneumatic plantar." Thesis, University of Bristol, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.311366.
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Huang, Wei. "A Population-Based Perspective on Clinically Recognized Venous Thromboembolism: Contemporary Trends in Clinical Epidemiology and Risk Assessment of Recurrent Events: A Dissertation." eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsbs_diss/730.
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Background: Venous thromboembolism (VTE), comprising the conditions of deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common acute cardiovascular event associated with increased long-term morbidity, functional disability, all-cause mortality, and high rates of recurrence. Major advances in identification, prophylaxis, and treatment over the past 3-decades have likely changed its clinical epidemiology. However, there are little published data describing contemporary, population-based, trends in VTE prevention and management.
Objectives: To examine recent trends in the epidemiology of clinically recognized VTE and assess the risk of recurrence after a first acute episode of VTE.
Methods: We used population-based surveillance to monitor trends in acute VTE among residents of the Worcester, Massachusetts, metropolitan statistical area (WMSA) from 1985 through 2009, including in-hospital and ambulatory settings.
Results: Among 5,025 WMSA residents diagnosed with acute PE and/or lower-extremity DVT between 1985 and 2009 (mean age = 65 years), 46% were men and 95% were white. Age- and sex-adjusted annual event rates (per 100, 000) of clinically recognized acute first-time and recurrent VTE was 142 overall, increasing from 112 in 1985/86 to 168 in 2009, due primarily to increases in PE occurrence. During this period, non-invasive diagnostic VTE testing increased, vi while treatment shifted from the in-hospital (chiefly with warfarin and unfractionated heparin) to out-patient setting (chiefly with low-molecular-weight heparins and newer anticoagulants). Among those with community-presenting first-time VTE, subsequent 3-year cumulative event rates of key outcomes decreased from 1999 to 2009, including all-cause mortality (41% to 26%), major bleeding episodes (12% to 6%), and recurrent VTE (17% to 9%). Active-cancer (with or without chemotherapy), a hypercoagulable state, varicose vein stripping, and Inferior vena cava filter placement were independent predictors of recurrence during short- (3-month) and long-term (3-year) follow-up after a first acute episode of VTE. We developed risk score calculators for VTE recurrence based on a 3-month prognostic model for all patients and separately for patients without active cancer.
Conclusions: Despite advances in identification, prophylaxis, and treatment between 1985 and 2009, the disease burden from VTE in residents of central Massachusetts remains high, with increasing annual events. Declines in the frequency of major adverse outcomes between 1999 and 2009 were reassuring. Still, mortality, major bleeding, and recurrence rates remained high, suggesting opportunities for improved prevention and treatment. Clinicians may be able to use the identified predictors of recurrence and risk score calculators to estimate the risk of VTE recurrence and tailor outpatient treatments to individual patients.
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Huang, Wei. "A Population-Based Perspective on Clinically Recognized Venous Thromboembolism: Contemporary Trends in Clinical Epidemiology and Risk Assessment of Recurrent Events: A Dissertation." eScholarship@UMMS, 2011. http://escholarship.umassmed.edu/gsbs_diss/730.
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Background: Venous thromboembolism (VTE), comprising the conditions of deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common acute cardiovascular event associated with increased long-term morbidity, functional disability, all-cause mortality, and high rates of recurrence. Major advances in identification, prophylaxis, and treatment over the past 3-decades have likely changed its clinical epidemiology. However, there are little published data describing contemporary, population-based, trends in VTE prevention and management.
Objectives: To examine recent trends in the epidemiology of clinically recognized VTE and assess the risk of recurrence after a first acute episode of VTE.
Methods: We used population-based surveillance to monitor trends in acute VTE among residents of the Worcester, Massachusetts, metropolitan statistical area (WMSA) from 1985 through 2009, including in-hospital and ambulatory settings.
Results: Among 5,025 WMSA residents diagnosed with acute PE and/or lower-extremity DVT between 1985 and 2009 (mean age = 65 years), 46% were men and 95% were white. Age- and sex-adjusted annual event rates (per 100, 000) of clinically recognized acute first-time and recurrent VTE was 142 overall, increasing from 112 in 1985/86 to 168 in 2009, due primarily to increases in PE occurrence. During this period, non-invasive diagnostic VTE testing increased, vi while treatment shifted from the in-hospital (chiefly with warfarin and unfractionated heparin) to out-patient setting (chiefly with low-molecular-weight heparins and newer anticoagulants). Among those with community-presenting first-time VTE, subsequent 3-year cumulative event rates of key outcomes decreased from 1999 to 2009, including all-cause mortality (41% to 26%), major bleeding episodes (12% to 6%), and recurrent VTE (17% to 9%). Active-cancer (with or without chemotherapy), a hypercoagulable state, varicose vein stripping, and Inferior vena cava filter placement were independent predictors of recurrence during short- (3-month) and long-term (3-year) follow-up after a first acute episode of VTE. We developed risk score calculators for VTE recurrence based on a 3-month prognostic model for all patients and separately for patients without active cancer.
Conclusions: Despite advances in identification, prophylaxis, and treatment between 1985 and 2009, the disease burden from VTE in residents of central Massachusetts remains high, with increasing annual events. Declines in the frequency of major adverse outcomes between 1999 and 2009 were reassuring. Still, mortality, major bleeding, and recurrence rates remained high, suggesting opportunities for improved prevention and treatment. Clinicians may be able to use the identified predictors of recurrence and risk score calculators to estimate the risk of VTE recurrence and tailor outpatient treatments to individual patients.
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Brown, John Gordon. "A study of deep venous thrombosis." Thesis, Queen's University Belfast, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.303015.
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Goudot, Guillaume. "Applications innovantes des ultrasons en pathologie vasculaire : utilisation de l'imagerie ultrarapide dans l'analyse de la rigidité artérielle et des ultrasons pulsés en thérapie Arterial stiffening assessed by ultrafast ultrasound imaging gives new insight into arterial phenotype of vascular Ehlers–Danlos mouse models Aortic wall elastic properties in case of bicuspid aortic valve Segmental aortic stiffness in bicuspid aortic valve patients compared to first-degree relatives Wall shear stress measurement by ultrafast vector flow imaging for atherosclerotic carotid stenosis Pulsed cavitational therapy using high-frequency ultrasound for the treatment of deep vein thrombosis in an in vitro model of human blood clot." Thesis, Sorbonne Paris Cité, 2018. https://wo.app.u-paris.fr/cgi-bin/WebObjects/TheseWeb.woa/wa/show?t=2215&f=13951.
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Meng-Shan, Li, and 李孟珊. "Deep Vein Thrombosis in Acute Stroke Patients." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/07555884155882226575.
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碩士大葉大學
生物資源學系碩士班
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DVT (Deep Vein Thrombosis, DVT) referring to the leg vein thrombosis, is a common complication of acute stroke patients. Usually non-routine prophylaxis is associated with a high mortality rate of pulmonary embolism (Pulmonary embolism, PE). Both the D-dimer blood test and ultrasonography of the lower extremities were applied for the clinical diagnosis. In Asia there is no enough research and regular preventive approach for DVT, this research explored the ischemic and hemorrhagic acute stroke patients with deep vein thrombosis incidence from Changhua Christian Hospital. 19 of 136 acute stroke patients with deep vein thrombosis (14.0%), one-way anova analysis with and without deep vein thrombosis in two groups of patients, D-dimer (P = 0.025), age> 80 years (P = 0.041), anticoagulants (P = 0.041), showed significant statistical difference. The binary regression analysis showed that independent predictors of deep vein thrombosis are: age> 80 years (odds ratio = 4.23, P = 0.017) and D-dimer (odds ratio = 1.03 per 100 ng / mL, P = 0.041). The results showed that acute stroke patients had a significant risk of deep vein thrombosis rate, and age> 80 years and D-dimer can be considered as the independent predictors of deep vein thrombosis diagnosis.
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"Arterial resistance changes in lower limb deep vein thrombosis." 1998. http://library.cuhk.edu.hk/record=b5889782.
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by Liu Kin Hung.Thesis submitted in: Dec, 1997.
Thesis (M.Phil.)--Chinese University of Hong Kong, 1998.
Includes bibliographical references (leaves 87-95).
Abstract also in Chinese.
Chapter 1 --- Introduction --- p.1
Chapter 2 --- Literature Review --- p.3
Chapter 2.1 --- Venous anatomy --- p.3
Chapter 2.2 --- Arterial anatomy --- p.6
Chapter 2.3 --- Deep vein thrombosis --- p.8
Chapter 2.3.1 --- Clinical Examination --- p.11
Chapter 2.3.2 --- Contrast Venogram --- p.12
Chapter 2.3.3 --- Color duplex ultrasound --- p.13
Chapter 2.4 --- Arterial resistance --- p.24
Chapter 2.5 --- Basis for study --- p.28
Chapter 3 --- Method --- p.30
Chapter 3.1 --- Subjects --- p.30
Chapter 3.2 --- Equipments --- p.30
Chapter 3.3 --- Procedure --- p.31
Chapter 3.4 --- Data analysis --- p.38
Chapter 4 --- Results --- p.40
Chapter 4.1 --- Arterial resistance changes in different groups --- p.40
Chapter 4.1.1 --- Symptomatic with no DVT versus asymtomatic with no DVT --- p.40
Chapter 4.1.2 --- Symptomatic with DVT versus symptomatic with no DVT --- p.43
Chapter 4.1.3 --- Symptomatic acute DVT versus symptomatic chronic DVT --- p.46
Chapter 4.1.4 --- Symptomatic proximal-DVT versus symptomatic calf-DVT --- p.49
Chapter 4.1.5 --- symptomatic occlusive DVT versus symptomatic non- occlusive DVT --- p.52
Chapter 4.2 --- Diagnosis of DVT by arterial resistance changes --- p.57
Chapter 4.2.1 --- Detection of presence of symptomatic DVT --- p.57
Chapter 4.2.2 --- Differentiation of characteristics of symptomatic DVT --- p.60
Chapter 5 --- Discussion --- p.64
Chapter 5.1 --- Investigation of arterial resistance changes --- p.64
Chapter 5.1.1 --- Symptomatic with no DVT versus asymtomatic with no DVT --- p.66
Chapter 5.1.2 --- Symptomatic with DVT versus symptomatic with no DVT --- p.69
Chapter 5.1.3 --- Symptomatic acute DVT versus symptomatic chronic DVT --- p.72
Chapter 5.1.4 --- Symptomatic proximal-DVT versus symptomatic calf-DVT --- p.74
Chapter 5.1.5 --- symptomatic occlusive DVT versus symptomatic non- occlusive DVT --- p.76
Chapter 5.2 --- Detection and differentiation of DVT by arterial resistance --- p.80
Chapter 5.2.1 --- Detection of symptomatic DVT --- p.80
Chapter 5.2.2 --- Differentiation of occlusive DVT from non-occlusive DVT --- p.82
Chapter 6 --- Conclusion --- p.85
Chapter 7 --- References --- p.87