1/49. Multicentric warfarin-induced skin necrosis complicating heparin-induced thrombocytopenia.Two patients developed catastrophic multicentric skin necrosis while receiving warfarin to treat venous thromboembolism complicated by immune-mediated heparin-induced thrombocytopenia (HIT). Patient 1 developed skin necrosis involving the breasts, thighs, and face, as well as venous limb gangrene and bilateral hemorrhagic necrosis of the adrenal glands, resulting in death. The second patient developed bilateral mammary necrosis necessitating mastectomies, as well as skin necrosis involving the thigh. Neither patient had an identifiable hypercoagulable syndrome, other than HIT. HIT may represent a risk factor for the development of multicentric warfarin-induced skin necrosis (WISN).- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
2/49. venous thromboembolism and renal cell carcinoma.There is a vast amount of literature documenting the relationship between cancer and venous thromboembolism. Nevertheless, many aspects of this association remain obscure and the best approach to be taken towards a patient with apparently idiopathic venous thromboembolism has yet to be defined. We present a case of a patient with venous thromboembolism in whom abdominal ultrasonography, prescribed as a cautionary measure to rule out the presence of a tumour, revealed liver metastases, while the subsequent CAT scan showed hepatic angiomatosis and two small bilateral renal carcinomas. Although there are as yet no indications in the literature on screening patients with idiopathic venous thromboembolism for occult tumours, our case shows how the clinical decision to perform abdominal ultrasonography saved the patient's life.- - - - - - - - - - ranking = 8keywords = thromboembolism (Clic here for more details about this article) |
3/49. Recurrent thromboembolism in a patient with beta-thalassemia major associated with double heterozygosity for factor v R506Q and prothrombin G20210A mutations.Double heterozygosity for factor v R506Q and prothrombin G20210A mutations was identified in a 24-year-old man with beta-thalassemia major. The patient experienced a first thrombotic event at the age of 19 years and three recurrent thromboses in a short time interval, the third occurring while the patient was receiving long-term anticoagulant treatment. This case suggests that patients with major thalassemia and congenital thrombophilic mutations need intensive and long-lasting anticoagulant treatment. Thus, even if thrombotic events could be explained by a hypercoagulable state observed in patients with major thalassemia, after a first thrombotic event has occurred these patients should be screened for acquired and congenital thrombophilia.- - - - - - - - - - ranking = 4keywords = thromboembolism (Clic here for more details about this article) |
4/49. Laparoscopic procedures as a risk factor of deep venous thrombosis, superficial ascending thrombophlebitis and pulmonary embolism--case report and review of the literature.Since its introduction laparoscopic surgery has been used for many indications, e.g., cholecystolithiasis, hernia, appendicitis, fundoplication, benign large bowel disease and gynaecological disorders. It has been considered as safe and efficient procedure for most patients with only few contraindications, mostly heart-lung disease. When the initial enthusiasm has been replaced by a more critical observation, more complications of laparoscopy or laparoscopic surgery were not only discovered but also reported. In laparoscopic hernia repair there is a tendency for severe complications when compared to open surgery. There is a controversy on possible side-effects of laparoscopic surgery, e.g., thrombosis, and the increased necessity of prophylaxis for thromboembolic events. Recently a growing number of reports on thromboembolic complications in association with laparoscopic surgery were published. Thrombosis may be caused by detrimental effects of pneumoperitoneum on venous flow (increased abdominal pressure and negative Trendelenburg position) and activation of the haemostatic system. Further risk factors may contribute to the risk to develop venous thrombosis. It is well accepted that varicose veins are associated with an increased risk for the thrombosis. However, the association of varicose veins with complications of laparoscopic surgery is unclear. The possible impact of thrombotic complications makes an analysis of the association of varicose veins or a history of deep vein thrombosis on the development of thrombosis after laparoscopic surgery mandatory. Although this is the first report on ascending thrombophlebitis and thrombosis of the sapheno-femoral junction after laparoscopic surgery, the incidence of deep vein thrombosis or superficial thrombophlebitis after laparoscopic surgery or laparoscopy may be much higher according to the pathophysiological changes during and after these procedures. In many patients venous thrombosis may not be recognized or it appears when the patient is already discharged. CONCLUSION: laparoscopy and laparoscopic procedures may have an increased risk for the development of thrombosis due to increased abdominal pressure and negative Trendelenburg position. patients with varicose veins and a history of thromboembolism may aggravate laparoscopy associated risks for the development of thromboembolic complications. Superficial thrombophlebitis in the thigh is not a benign disease entity and may lead to deep vein thrombosis (DVT) and pulmonary embolism (PE). Urgent surgical treatment (high ligation) may be warranted together with low-molecular weight heparin (LMWH) and compressions therapy. patients with varicose veins and a history of venous thrombosis may not be suitable candidates for laparoscopic surgery. family practitioners may be confronted with this complication more often since patients are discharged earlier from hospital after laparoscopic interventions due to legislative regulations.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
5/49. Acute pulmonary embolectomy with cardiopulmonary bypass support.Deep venous thrombosis and pulmonary thromboembolism remain major sources of patient morbidity and mortality. The authors present the case of a 55-year-old man with a massive pulmonary embolism and subsequent hemodynamic decompensation who was successfully treated by open pulmonary embolectomy supported with cardiopulmonary bypass. Indications for embolectomy and patient selection as well as technical considerations are discussed.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
6/49. venous thromboembolism and travel: is there an association?This paper reviews the literature on the association between venous thromboembolism and travel. There are plausible physiological reasons why sitting still for long periods (particularly in the cramped conditions of most aircraft) might predispose to venous thromboembolism. This may have been the explanation for the apparent excess of deaths from pulmonary embolism seen during the first months of the london blitz. No published controlled studies of thromboembolism and travel were identified, but eight case reports were analysed. They covered 25 people aged from 19 to 84 years with deep vein thrombosis or pulmonary embolism following travel. The reports suggest that long journeys are a particular risk and that there are often no symptoms until many hours after leaving the plane (so conventional methods of assessing the hazards of air travel may underestimate the problem). It is concluded that the literature tends to support the hypothesis that venous thromboembolism is associated with travel, but that carefully controlled studies are needed to test this properly.- - - - - - - - - - ranking = 8keywords = thromboembolism (Clic here for more details about this article) |
7/49. Thromboembolic complications in beta thalassemia major.Thromboembolic complications in beta-thalassemia major have seldom been reported and their association with risk factors such as left ventricular failure and postsplenectomy thrombocytosis has remained speculative. In this report we describe 4 patients with unusual thromboembolic manifestations: recurrent arterial occlusion, recurrent pulmonary thromboembolism, venous thrombosis and a fatal cerebrovascular event. Although in all patients both risk factors were present, the precise causes for their thromboembolic complications were not identified. In 1 patient, however, a marked increase in hematocrit following blood transfusion resulted, in all likelihood, in a fatal cerebrovascular infarction. We suspect that these patients (constituting 4% of our beta-thalassemic group) represent a subset of those with high susceptibility to both arterial and venous thromboembolic complications.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
8/49. Temporary placement of the cava filter to the suprarenal segment of the inferior vena cava.This paper describes successful results of temporary placement of the Russian removable cava filter "Zontik" to the suprarenal segment of the inferior vena cava for the time of performing cesarean section and for the short-term postoperative period in a patient with late pregnancy, venous thrombosis of the lower limbs and pulmonary thromboembolism.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
9/49. Case report: venous thromboembolism in AIDS.Recently, the authors managed three patients with AIDS and venous thromboembolism. All three were active, ambulatory, and without known risk factors for pulmonary embolism or deep venous thrombosis. One patient had a low titer for IgG anticardiolipin antibody (1:13). Two had low normal values for free protein s, and the third patient had a very low value (5%). Clinicians caring for AIDS patients should be alert to the possibility that venous thromboembolism may complicate hiv infection.- - - - - - - - - - ranking = 6keywords = thromboembolism (Clic here for more details about this article) |
10/49. Two cases of chronic pulmonary thromboembolism saved by postoperative use of a percutaneous cardiopulmonary support device.We performed pulmonary thromboendarterectomy under deep hypothermic intermittent circulatory arrest in 18 patients with chronic pulmonary thromboembolism from August 2001 to January 2004. In some of these cases, reperfusion pulmonary edema prevented a satisfactory improvement in hemodynamic data soon after the surgery. Here we report two cases of chronic pulmonary thromboembolism in which we successfully prevented postoperative persistent pulmonary hypertension and hypoxia caused by severe reperfusion pulmonary edema by the use of a percutaneous cardiopulmonary support device.- - - - - - - - - - ranking = 6keywords = thromboembolism (Clic here for more details about this article) |
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