Deficiencies of coagulation-inhibiting and fibrinolytic proteins in outpatients with deep-vein thrombosis

Article Abstract:

Although deep-vein thrombosis (clot formation) is common, occurring in 1 of 1,000 people each year, the cause of most cases remains a mystery. Thrombosis is often a complication of surgery, prolonged immobilization, or malignant disease. Progress has been made toward the understanding of how blood coagulates, but the exact cause of thrombosis is elusive. Recently, researchers have proposed that deficiencies of proteins and other agents involved in the clotting process prevent the anticlotting mechanism from working properly. These agents are antithrombin III, protein C, protein S, and plasminogen. There have been several reports of these deficiencies among patients with deep-vein thrombosis, but all the studies had flaws in research design. However, it has been proposed that routine screening of all patients with deep-vein thrombosis be undertaken. A total of 277 patients who had deep-vein thrombosis and 138 controls who did not were examined to determine whether these deficiencies or other variables, such as patient or family history, would predict the likelihood of thrombosis. Deficiencies of fibrinolytic (anticlotting) agents occurred in just over eight percent of the patients with thrombosis, and just over two percent without. Patients who had recurrent, familial, and juvenile histories of thrombosis had a 30 percent probability of having a protein deficiency, but there were only three such cases. Although the difference between patients and controls was significant, screening all deep-vein thrombosis patients would be neither useful nor cost-effective. This does not mean that there is no relation between these deficiencies and blood clots in the deep veins. A problem arises if clinicians consider identifying all patients with protein disorders a prerequisite for long-term anticoagulant therapy, which would require screening all patients with deep-vein thrombosis. At this time, there is no convincing clinical evidence that all such patients should receive long-term treatment. Only patients with a combination of recurrent, familial and juvenile history of the condition should be screened; among the remaining 90 percent of patients the predictive value of screening is not cost-effective. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Physiological aspects, Blood clotting disorders, Blood coagulation disorders, Fibrinolytic agents, Thrombolytic drugs

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Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home

Article Abstract:

Low-molecular-weight heparin appears to offer safe and effective home treatment for deep leg vein clots. Researchers randomly assigned 400 patients with proximal deep-vein clots and no other complications to either the traditional in-hospital intravenous treatment with standard heparin or twice-daily injections of low-molecular-weight heparin administered by the patient or a family member at home. Questionnaires assessed quality of life. During the 24-week follow-up period, 9% of the hospital group versus 7% of the home treatment group experienced a recurrent, symptom-causing clot. Two percent of patients in the hospital group had a hemorrhage versus 0.5% of the home treatment group. Fifteen patients in the hospital group versus 27 patients in the home treatment group had minor bleeding. The hospital group averaged 8 days in the hospital versus 3 days for the home treatment group. The home treatment group scored higher in physical activity and social functioning.

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Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal-vein thrombosis

Article Abstract:

The anticoagulant heparin combined with acenocoumarol (a vitamin K antagonist) may be a safe and effective treatment for patients with deep vein thrombosis. Deep vein thrombosis is the formation or presence of a blood clot in a major vein. Among 120 patients with deep vein thrombosis, 60 were treated with heparin combined with acenocoumarol and 60 were treated with acenocoumarol alone. Four patients (6.7%) in the heparin plus acenocoumarol group developed symptoms of deep vein thrombosis compared with 12 patients (20%) in the acenocoumarol group. Eight percent of the patients treated with heparin plus acenocoumarol continued to suffer from deep vein thrombosis without any symptoms, compared to 40% of those treated with acenocoumarol alone. The study was terminated early because of the large number of symptoms of deep vein thrombosis in patients taking acenocoumarol only.

Thrombophlebitis

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