Streptokinase and Deep Vein Thrombosis

Five patients with deep vein thrombosis were given streptokinase. Five others with similar phlebograms were given anticoagulants, and the results assessed by examining changes in the iliac, femoral, and calf segments of the phlebograms when repeated 7-10 days later. Those of the anticoagulant group were unchanged. Four of the five given streptokinase had a reduction in the size and extent of their thrombosis. Fresh thrombus surrounded by flowing blood was lysed. Thrombus completely blocking a vein was not lysed.The indications for the use of streptokinase in deep vein thrombosis are reviewed.     

Deep Vein Thrombosis in a Queensland Hospital

Investigation in the postoperative period of 75 patients by means of the radioiodinated fibrinogen uptake method, by the use of the Doppler ultrasonic flow detector, and by clinical assessment revealed an incidence of deep vein thrombosis of only 12%. This is distinctly lower than has been reported by other investigators using the same techniques both in Australia and elsewhere. It appears from this study and associated work that the Doppler ultrasonic technique is sufficiently accurate to be of value in the clinical diagnosis of significant deep vein thrombosis.     

Postoperative Deep Vein Thrombosis in Sudanese Patients

The incidence of postoperative deep vein thrombosis diagnosed by radioisotope scanning in 100 Sudanese patients aged 40 or over was 12%. This compares with an incidence of nearly 30% in 542 patients reported from British hospitals using the same diagnostic technique. The reason for the difference is obscure and needs further investigation.     

Optimal Electrical Stimulus for Prevention of Deep Vein Thrombosis

The most effective electrical stimulus to the calf muscles which prevents stasis in the soleal veins during operation was determined. This was subsequently used in a clinical trial and was shown to produce a 92% relative reduction in the incidence of deep vein thrombosis as determined by the ¹²⁵I-fibrinogen test.     

Influence of Smoking on Deep Vein Thrombosis after Myocardial Infarction

As part of a study of the factors affecting the risk of deep vein thrombosis after myocardial infarction a surprising and unexplained finding was that non-smokers had a significantly higher incidence of thrombosis than cigarette smokers.     

Prevention of Deep Vein Thrombosis by Intermittent Pneumatic Compression of Calf

A consecutive, randomly allocated, controlled clinical trial of the prophylactic effect of intermittent pneumatic compression of the calf on the incidence of postoperative deep vein thrombosis showed that in patients without malignant disease there was a highly significant reduction in the incidence of thrombosis. In patients with malignant disease the incidence of thrombosis was higher than in those without, and there was no reduction in incidence by the application of intermittent compression. In the absence of malignant disease, severity of operation and the age of the patient were the most significant aetiological factors. We found no relation between the incidence of deep venous thrombosis and obesity, length of preoperative stay, location of hospital, or duration of anaesthesia. We suggest that intermittent pneumatic compression as used in this trial is a safe, effective, and extremely practical method of preventing postoperative deep vein thrombosis in patients not suffering from malignant disease.     

Increased Incidence of Deep Vein Thrombosis after Myocardial Infarction in Non-smokers

Out of 102 patients with cardiac infarction admitted to the coronary care unit at this hospital and not treated with anticoagulants 30 (29%) developed isotopic evidence of deep vein thrombosis. Of the 65 smokers only 7 (11%) developed a deep vein thrombosis, whereas of the 37 non-smokers 23 (62%) developed a deep vein thrombosis. This difference is highly significant (P < 0·00001).     

Prevention of Postoperative Deep Vein Thrombosis in Patients with Malignant Disease

We have used the ¹²⁵I-fibrinogen test to asses the value of an improved method of peroperative intermittent calf compression as a prophylactic measure against postoperative thrombosis. In a group of 99 patients over the age of 40 undergoing operations lasting more than 30 minutes the technique reduced the incidence of postoperative thrombosis by over 75%. In patients suffering from malignant disease, who are generally considered to be in the very high risk category, the reduction achieved was almost 90%.     

Useful Measures in the Prevention of Deep Vein Thrombosis in the Legs

The three probable factors involved in deep venous thrombosis are: (1) stasis, (2) alteration in the endothelium of the veins, and (3) alteration in the clotting mechanism of the blood.Control of stasis is assisted by elevation of the foot of the bed and by the use of washable elastic stockings and early ambulation, together with foot exercises. To prevent damage to the endothelium of the veins during operation, the heels should be elevated off the operating table by means of a small rolled towel in order to take weight off the calf muscles. The use of elastic stockings demonstrated in diagrams and some of the fallacies in connection with their use are outlined.     

Bed Rest versus Early Ambulation with Standard Anticoagulation in The Management of Deep Vein Thrombosis: A Meta-Analysis

Introduction

Bed rest has been considered as the cornerstone of management of deep vein thrombosis (DVT) for a long time, though it is not evidence-base, and there is growing evidence favoring early ambulation.

Methods

Electronic databases including Medline, PubMed, Cochrane Library and three Chinese databases were searched with key words of “deep vein thrombosis”, “pulmonary embolism”, “venous thrombosis”, “bed rest”, “immobilization”, “mobilization” and “ambulation”. We considered randomized controlled trials, prospective or retrospective cohort studies that compared the outcomes of acute DVT patients managed with early ambulation versus bed rest, in addition to standard anticoagulation. Meta-analysis pertaining to the incidence of new pulmonary embolism (PE), progression of DVT, and DVT related deaths were conducted, as well as the extent of remission of pain and edema.

Results

13 studies were included with a total of 3269 patients. Compared to bed rest, early ambulation was not associated with a higher incidence of new PE, progression of DVT, or DVT related deaths (RD −0.03, 95% CI −0.05∼ −0.02; Z = 1.24, p = 0.22; random effect model, Tau² = 0.01). Moreover, if the patients suffered moderate or severe pain initially, early ambulation was related to a better outcome, with respect to remission of acute pain in the affected limb (SMD 0.42, 95%CI 0.09∼0.74; Z = 2.52, p = 0.01; random effect model, Tau² = 0.04). Meta-analysis of alleviation of edema cannot elicit a solid conclusion because of significant heterogeneity among the few studies.

Conclusions

Compared to bed rest, early ambulation of acute DVT patients with anticoagulation was not associated with a higher incidence of new PE, progression of DVT, and DVT related deaths. Furthermore, for the patients suffered moderate or severe pain initially, a better outcome can be seen in early ambulation group, regarding to the remission of acute pain in the affected limb.     

患肢加压溶栓治疗下肢深静脉血栓形成的临床疗效及护理效应

目的:探讨止血带结扎患肢,从足背浅静脉推注尿激酶治疗下肢深静脉血栓形成的临床疗效及护理效应。方法:对62例下肢深静脉血栓患者经患肢足背静脉穿刺,踝关节上用止血带阻断浅静脉后,推注中等剂量尿激酶.通过测量腿围和彩超结果来评价是否有效。并采用多种护理辅助手段辅助治疗。结果:临床症状迅速改善,有效率22.5%,显效率77.5%。结论:此方法操作简单,所用材料价格便宜,临床效果明显,值得推广应用。     

Diagnosis of Established Deep Vein Thrombosis with the 125I Fibrinogen Uptake Test

One hundred and two patients with clinical signs indicating a possible diagnosis of deep vein thrombosis were studied with the fibrinogen uptake test and phlebography to assess the reliability of the test as a means of diagnosing established venous thrombosis. The test gave a correct diagnosis in 78% of the 85 legs shown to contain thrombus by phlebography and only 19 (10%) false-negative results in the 195 legs examined. The duration of the symptoms, the administration of anticoagulants, and mild leg swelling did not affect the accuracy of the test. Very old thrombus, phlebographically more than 11 days old, was associated with an increased false-negative rate.The fibrinogen uptake test is accurate enough to make it a valuable method of clinical investigation.     

Treatment of Deep Vein Thrombosis. A Trial of Heparin,Streptokinase, and Arvin

Thirty patients with deep vein thrombosis of the legs of less than four days'' duration were allocated at random to treatment with heparin, streptokinase, or Arvin under laboratory control. When the fate of the thrombi was assessed by objective techniques—phlebography and the ¹²⁵I-labelled fibrinogen test—the incidence of complete thrombolysis was greatest in the streptokinase group. Complications arose during treatment in each group but were least with Arvin. The natural history of the disease favours clinical but not always anatomical recovery.     

Occlusive Impedance Plethysmography: A Noninvasive Method of Diagnosis of Proximal Deep Vein Thrombosis

The purpose of this study was to assess and confirm the accuracy of impedance plethysmography (IPG) by the occlusive cuff method, in detecting proximal (popliteal, femoral and iliac) deep vein thrombosis in patients with symptomatic limbs. In 27 patients 30 consecutive limbs were studied with concurrent venography and IPG. The IPG result was normal in 9 of 9 limbs which were normal on venography, and abnormal in 15 of 16 limbs which showed venographic evidence of proximal deep vein thrombosis (DVT). An abnormal IPG strongly suggests proximal DVT (predictive value 0.88). A normal IPG virtually rules out proximal DVT (predictive value 1.0).