http://xoomer.virgilio.it/lusebra/NuoviFile/PrevenzioneTVP.pdf

Prevention of venous thromboembolism

https://www.srcv.ro/en/ghiduri/Preventia%20trombembolismului%20la%20pacientii%20nonortopedici%20-%20Ghidurile%20ACCP%202012.pdf

Prevention of VTE in Nonorthopedic Surgical Patients : Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

After almost two decades of intensive research, low-molecular-weight heparins have established their niche as an important class of antithrombotic compounds. The demonstration that these compounds are safe and effective for the prevention and treatment of venous thromboembolism has led to the licensing of several of them in Europe and North America. In addition, danaparoid sodium, which is a mixture of dermatan sulfate, heparan sulfate, and chondroitin sulfate, is often used for the treatment of heparin-induced thrombocytopenia.1 Low-molecular-weight heparins have replaced unfractionated heparin in many parts of Europe but are only now finding their place in North America. Their use is . . .

Low-molecular-weight heparins.

Venous thromboembolism

Objective: To review the published clinical data on prophylaxis for thromboembolism in order to develop general guidelines to encourage the establishment of local protocols for management. Data sources: Published papers on thromboembolism over the period 1991-1997 were identified by Medline search and/or from the authors' personal literature collections and reviewed. Study selection: A total of 981 studies were identified. Only those papers reporting randomized studies with clearly defined diagnostic methods and clear end-points were included in this review. Data extraction: The available evidence for each specialty was summarized and reviewed by the authors responsible for each specialty, prior to presentation and discussion of their findings within the group. Where a consensus opinion was achieved in a speciality, general guidelines for thromboprophylaxis were summarized. Where a consensus could not be agreed, recommendations for further work were made. Data synthesis: There is evidence to support the preferred use of low-molecular-weight heparins (LMWHs) over unfractionated heparin (UFH) in orthopaedic surgery, major trauma and general surgery. However, the ideal duration of thromboprophylaxis has yet to be defined. The use of once daily subcutaneous administration of LMWH offers major practical advantages and may have significant cost saving implications. Further work is required to investigate the use of thromboprophylaxis in minimal access surgery, trauma, elective lower limb surgery, hip fracture and pregnancy; to compare the efficacy of LMWH and mechanical prophylaxis; and to investigate extended prophylaxis after discharge. Conclusions: There is overwhelming evidence that thromboembolic prophylaxis reduces the incidence of postoperative deep vein thrombosis and pulmonary embolism. Recommendations concerning the management of these patients when stratified into low, moderate and high risk are made with the suggestion that hospitals develop their own guidelines for the treatment of these patients.

Risk of and prophylaxis for venous thromboembolism in hospital patients

Deep venous thrombosis in acute spinal cord injury: a comparison of 125 I fibrinogen leg scanning, impedance plethysmography and venography

/pdf/deep-venous-thrombosis-in-acute-spinal-cord-injury-a-5eq8tupicc.pdf

Deep venous thrombosis in acute spinal cord injury: a comparison of 125I fibrinogen leg scanning, impedance plethysmography and venography.

Acute spinal cord injury patients were assigned alternately to a control and a heparin prophylaxis group to determine the effect of 5,000 μ sodium heparin subcutane-ously every 12 hours on the incidence of venous thrombosis as detected by impedance plethysmography of the lower extremities. Venous thrombosis was unexpectedly uncommon in both the control (1 of 17) and the heparinised (1 of 15) group, suggesting an unidentified, overriding prophylactic factor.

/pdf/low-dose-heparin-prophylaxis-for-deep-venous-thrombosis-in-13ziyn69zo.pdf

Low dose heparin prophylaxis for deep venous thrombosis in acute spinal cord injury patients: a controlled study.

An animal model. To test the natural sequence of venous thrombosis and pulmonary thromboembolism experimentally. Veterans Administration Hospital, USA. In dogs, a venous thrombosis was induced in a isolated segment of the internal jugular vein by a 5 min exposure to sodium morrhuate and then re-establishing venous patency. A tracer, 125I human fibrinogen, was administered through another vein 1 h prior to the end of each experiment when a blood sample, the venous thrombus, and the lungs were removed. Thrombi were described by age, weight, histology, and fibrin uptake (thrombus to blood radioactivity ratio, g/g). Pulmonary emboli (PE) were identified by autoradiography of lung slices or by microscopic examination of lung sections. Venous thrombosis developed in all experiments, duration 1–64, median 5 h (n=12). Histologically, younger thrombi were characterized by platelet aggregates surrounded by polymorphonuclear leukocytes (PMN), and uniform fibrin deposit; the older thrombi by platelet ghost cells, fewer PMN leukocytes, and broken fibrin strands and loops (n=6). Pulmonary thromboemboli were imaged as ‘hot spots’ in six of six experiments in which lung slices were autoradiographed and were identified microscopically in six of six experiments in which lung sections were taken. The number of PE diagnosed microscopically did not correlate with the age of the corresponding thrombus but was directly related to fibrin uptake (n=5, r=0.99, P<0.01). An animal model for venous thrombosis that generates pulmonary thromboembolism has been described.

/pdf/an-animal-model-for-venous-thrombosis-and-spontaneous-3c0sghtq36.pdf

An animal model for venous thrombosis and spontaneous pulmonary embolism.

Patients with spinal cord injury or multiple sclerosis were surveyed for the presence of extreme foot deformities and spasticity. Pes cavus and claw toes were found in eight of 80 spastic spinal cord injury and two of 20 multiple sclerosis patients. Pes cavus and claw toes were not found in 29 flaccid spinal cord injury patients. Pes cavus and claw toes were associated with flexor reflexes which could be elicited by pin prick proximal to the knee, suggesting extreme spasticity--and by low excitatory thresholds for the anterior tibialis as indicated electromyographically. Complications of severe spasticity associated with spinal cord injury and multiple sclerosis include pes cavus and claw toes, mediated in part by spasms of the anterior tibialis.

/pdf/pes-cavus-and-claw-toes-deformity-in-patients-with-spinal-ajqqk0nvkl.pdf

Pes cavus and claw toes deformity in patients with spinal cord injury and multiple sclerosis.

Study design: Case control Objectives: To describe the effect of spinal cord injury on microvascular stability Setting: Veterans Administration Medical Center, West Roxbury, MA, USA Methods: A total of 19 tetraplegic patients, aged 63±12 years, were surveyed for microvascular instability Photoelectric pulse sensors were applied to the skin surface of the neck on both sides and to the distal pads of the left and right fourth fingers of subjects in the sitting position All pulses during the survey periods were recorded by a polygraph system The unstable fraction of pulsatile cutaneous blood flow (UFCF) was calculated by the sum of the periods during which pulses at any site were either half or twice the baseline amplitude divided by the survey time Simultaneous UFCF, which was pulsatile flow change in the same direction at the same time in two leads, was also measured Flow changes in patients with motor and sensory complete lesions were compared with incomplete lesions Results: Survey times were 7017±670 s Tetraplegic complete UFCF and simultaneous UFCF were 025±012 and 007±007, respectively Tetraplegic incomplete UFCF and simultaneous UFCF were 0013±09 and 002±004, respectively The differences between the groups were significant for UFCF (P=004), but not for simultaneous UFCF (P=014) Conclusions: Tetraplegic subjects demonstrate an instability of cutaneous microvascular blood flow that is related to the severity of paralysis

/pdf/microvascular-instability-in-tetraplegic-patients-3xafzgvp4o.pdf

J H Frisbie

Papers

Deep venous thrombosis in acute spinal cord injury: a comparison of 125I fibrinogen leg scanning, impedance plethysmography and venography.

Low dose heparin prophylaxis for deep venous thrombosis in acute spinal cord injury patients: a controlled study.

An animal model for venous thrombosis and spontaneous pulmonary embolism.

Pes cavus and claw toes deformity in patients with spinal cord injury and multiple sclerosis.

Microvascular instability in tetraplegic patients: preliminary observations